Developing Clinical Hypnotherapy Educational Guidelines Through Consensus
Leon W. Cowen
Doctor of Philosophy
University of Western Sydney School of Medicine
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Dedication Page This degree may have my name on it but it would not have been possible without the support of many others whose fingerprints are all over this PhD. There are so many people to thank for their help, support and belief that have resulted of the publication of this thesis. Obviously the first are my amazing supervisors Prof Ian Wilson and Dr David Saltmarsh both brilliant educators and people. To my previous supervisors Dr Brenda Dobia, Dr Maggie Clark, Dr Ray Hayek and all those who participated in the survey, I thank you for your contribution to my work. Apart from my supervisors there are others without whom this thesis would not exist. Their names are in alphabetical order because I simply cannot find a way to decide whose name should come first; Dr Robyn Beirman, Ms Francesca Graham and Prof Jim McKnight. The caring, support and belief these colleagues have shown in me and my vision is nothing short of incredible.
I would also like to thank my whole profession. Those who have given their time, energy and support to cultivate our profession, to help it grow during some very turbulent times and provide not only the vision but the means for us to follow. The practitioners for supporting our profession and the ‘nay sayers’ for providing everyone else with the motivation to prove them wrong.
To all of you I dedicate this and hope it and I will of benefit in the future.
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Statement of Authentication Page The work presented in this thesis is, to the best of my knowledge and belief, original except as acknowledged in the text. I hereby declare that I have not submitted this material, either in full or in part, for a degree at this or any other institution.
Leon W. Cowen
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Table of Contents
1
Abstract
16
1.1
Background to the profession
16
1.2
Research Aim
17
1.3
Methodology: Brief outline
18
1.4
Synopsis of results
19
1.5
Synopsis of conclusions
20
2
Introduction: Overview
21
3
About Delphi Methodology
26
4
3.1
Summary: Delphi Methodology
26
3.2
History: Delphi Methodology
27
3.3
Description: Delphi Methodology
28
3.4
Selecting Delphi methodology
32
3.5
Strengths: Delphi Methodology
33
3.6
Limitations: Delphi Methodology
35
3.7
Other research undertaken by Delphi Methodology
37
Background to the research question
39
4.1
Clinical hypnotherapy: A health profession?
41
4.2
Clinical hypnotherapist: A health professional?
42
4.3
Profession and professionalism: Who decides?
42
4.4
The literature: Transition to a profession?
42
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4.5
Professionalism: Concepts
43
4.6
Professionalisation: Process
45
4.7
Clinical hypnotherapy: The profession and professionalisation
46
4.8
Clinical hypnotherapy: Current educational models
47
4.9
Clinical hypnotherapy: Professional competencies
50
4.10
Clinical hypnotherapy: Determining foundational practitioner competencies
51
4.11
Clinical hypnotherapy: Pedagogy
52
4.12
Using Delphi Methodology: Clinical hypnotherapy education
55
4.13
Clinical hypnotherapy: Educational framework
56
4.14
Curriculum
57
4.15
Curriculum: Development process
58
5
Research Methodology 5.1 a.
60
Introduction
60
Filtering Process
5.2
62
Identifying Stakeholders
63
5.2.1
Peak bodies
66
5.2.2
Professional associations
66
5.2.3
Australian Teaching Institutions
68
5.2.4
Additional Stakeholders
68
5.3
Setting up the survey
71
5.4
Applying the Delphi Methodology
72
5.5
Delphi methodology: Number of survey rounds
72
5.6
Survey questions: Round one
72
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6
7
5.7
Round one questions: Distilling and grouping
73
5.8
Round one: Process
78
5.9
Stakeholder: Email
80
5.10
Email: Participation
80
Results
82
6.1
Introduction
82
6.2
Results details
83
6.3
Consensus and high agreement
109
6.4
Summary of the results
109
6.5
Description of the cohort
111
6.6
Details of Round 1
113
6.6.1
Responses to invitation emails
113
6.6.2
Survey: Round 1 details
114
6.6.3
Survey: Round 1 results
116
6.7
Survey: Round 2 details
117
6.8
Survey: Round 2 results
117
6.9
High Agreement (near consensus)
118
Survey questions and responses
122
7.1
Ethics (summary)
126
7.2
Governance (summary)
126
7.3
Concepts (summary)
127
7.4
Techniques (summary)
127
7.5
Practical (summary)
127
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7.6 8
Education (summary)
127
Survey: Category Summary and Discussion
129
8.1
Ethics
129
8.2
Governance
130
9
8.2.1
Governance: Quality assurance and best practice
131
8.2.2
Governance: Professional recognition
136
8.2.3
Governance: VET sector accredited
138
Concepts
142
9.1
Concepts: Counselling and psychotherapy
142
9.2
Concepts: Clinical hypnotherapy adjunct techniques
145
9.3
Concepts: Suggestion
146
9.4
Concepts: Business and marketing
147
9.5
Concepts: Practical work in general
151
9.6
Concepts: Scripts
153
9.7
Concepts: ‘Hypnosis’ and ‘hypnotherapy’
153
9.8
Concepts: Research
155
10
Clinical hypnotherapy education: Discussion
10.1
Clinical hypnotherapy: Introduction to categories
158 163
10.1.1
Clinical hypnotherapy category: Fundamental (AQF level 4 – Certificate IV)164
10.1.2
Clinical hypnotherapy category: Intermediate (AQF level 5 – Diploma)
10.1.3
Clinical hypnotherapy category: Advanced (AQF level 6 – Advanced
Diploma) 10.2
179
192
Concepts: Past life work
203
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11
Practical: Demonstration of skills
206
12
Clinical hypnotherapy: Professional attributes
210
13
Clinical hypnotherapy education
215
14
Final comments
220
15
Results summary
221
15.1 16
Assessment of results
221
Conclusion
223
16.1
Why is the study important?
224
16.2
Areas of Consensus
226
16.2.1
Ethics
226
16.2.2
Governance (summary and questions)
226
16.2.3
Concepts (summary and questions)
227
16.2.4
Techniques (summary and questions)
231
16.2.5
Practical (summary and questions)
233
16.2.6
Education (summary and questions)
234
16.3
Areas of High Agreement
235
16.3.1
Ethics (summary and questions)
235
16.3.2
Governance (summary and questions)
235
16.3.3
Concepts (summary and questions)
236
16.3.4
Techniques (summary and questions)
236
16.3.5
Practical (summary and questions)
236
16.3.6
Education (summary and questions)
236
16.4
Areas of No Consensus
237
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16.4.1
Ethics
237
16.4.2
Governance (summary and questions)
237
16.4.3
Concepts (summary and questions)
238
16.4.4
Techniques (summary and questions)
239
16.4.5
Practical (summary and questions)
239
16.4.6
Education (summary and questions)
240
16.5
Educational standards: Depth and level of training
16.5.1
Entry level into the profession
240 240
16.6
Qualifications and the related nomenclature
242
16.7
The ‘hypnosis’ and ‘hypnotherapy’ debate - or lack of it!
243
16.8
Quality assurance within the profession
245
16.9
Clinical hypnotherapists: Primary health professional
248
16.10
Clinical hypnotherapy as a therapy or hypnosis as an adjunct therapy
253
17
Ethics: Business and marketing
257
18
Clinical hypnotherapy pedagogy: Lack of research
260
19
Limitations of the research data
262
20
Summary
265
21
Concluding comments
266
22
References
269
23
Appendices
316
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List of Tables Table 1: Benefits of the Delphi methodology
35
Table 2: Limitations of Delphi methodology
36
Table 3: Clinical hypnotherapy training institutions
76
Table 4: Themes: Clinical hypnotherapy training courses
76
Table 5: Techniques within clinical hypnotherapy training courses.
77
Table 6: Results Details Table
109
Table 7: Primary working role of cohort
111
Table 8: Secondary work role
112
Table 9: Invitations to participate
113
Table 10: Round 1 Results
116
Table 11: Round 2 results
118
Table 12: Governance Questions
119
Table 13: Concepts Questions
120
Table 14: Techniques Questions
120
Table 15: Practical Questions
120
Table 16: Education Questions
121
Table 17: Cohort qualifications
123
Table 18: Length of initial training
124
Table 19: Years in practice
124
Table 20: Primary work role
125
Table 21: Secondary work role(s)
126
Table 22: Who Guidelines (WHO, 2005, p. 29)
135
Table 23: AQF pedagogical terms
161
Table 24 : AQF level 4 criteria
165
Table 25: Fundamental Skills
174
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Table 26: AQF level 5 criteria
179
Table 27: Intermediate Skills
184
Table 28: Questions not relevant to day-to-day practice
186
Table 29: Question with high consensus - not relevant to day-to-day practice
187
Table 30: Questions relevant to day-to-day- practice
188
Table 31: Questions with indirect relevance
189
Table 32: AQF level 6 criteria
192
Table 33: Advanced Skills
195
Table 34: Questions related to Induction
197
Table 35: Hypnotic phenomenon questions
197
Table 36: Question on Metaphor
198
Table 37: Question on pain management
198
Table 38: Questions on Hypnoanalysis and Hypnoanalytical Techniques
200
Table 39: Question - Past Life hypnotherapy
204
Table 40: Questions related to 'practical' aspects
208
Table 41: Professional attribute questions
213
Table 42: Clinical hypnotherapy educations questions
217
Table 43: Consensus – Ethics
226
Table 44: Consensus – Governance
227
Table 45: Consensus - Concepts
230
Table 46: Consensus - Techniques
232
Table 47: Consensus - Practical
233
Table 48: Consensus - Education
234
Table 49: High Agreement - Governance
235
Table 50: High Agreement - Concepts
236
Table 51: High Agreement - Techniques
236
Table 52: High Agreement – Education
236
Table 53: No Consensus – Governance
238
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Table 54: No Consensus – Concepts
239
Table 55: No Consensus – Techniques
239
Table 56: No Consensus – Education
240
Table 57: Entry level into the profession
241
Table 58: Terms ‘hypnosis’ or ‘hypnotherapy’
243
Table 59: Clinical hypnotherapy is a subset of other professions.
253
Table 60: Primary methodology
256
Table 61: Business and marketing - Consensus
257
Table 62: Business and marketing - High Agreement
257
Table 63: Business and marketing - No Consensus
258
Table 64: Question too precise
263
Table 65: Question with inherent qualities
264
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List of Figures and Illustrations Page Figure 1 Miller's pyramid of competence
44
Figure 2: Australian Qualifications Framework
58
Figure 3: Two Step Delphi process
110
Figure 4: Example consensus achieved
115
Figure 5: Example consensus not achieved
116
Figure 6: Example consensus almost achieved
118
Figure 7: Number of questions included in the survey
122
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Abbreviations Page AACHP: Australian Association of Clinical Hypnotherapy & Psychotherapy AAH: Academy of Applied Hypnosis AAPHAN: Australian Assoc of Professional Hypnotherapists & NLP Practitioners Inc ACA: Australian Counselling Association ACCH: Australian and Pacific College of Clinical Hypnotherapy ACER: Australian Council for Educational Research ACH: Australian College of Hypnotherapy AHS: Academy of Hypnotic Sciences AQF: Australian Qualifications Framework ASCH (USA): American Society of Clinical Hynosis ASH: Australian Society of Hypnosis ASTA: Australasian Subconscious-mind Therapists’ Association ATMS: Australian-Traditional Medicine Society CA: Career Accelerators CCH: Council of Clinical Hypnotherapists CPD: Continuing Professional Development DOHA: Department of Health and Ageing EICH: Essex Institute of Clinical Hypnosis EMDR: Eye Movement Desensitisation Reprocessing HCA: Hypnotherapy Council of Australia MM: Mind Motivations & The Australian Academy of Hypnosis NCNLC: National College of Neuro Linguistic Communication NCTM: National College of Traditional Medicine NSW CSH-ITAB: Community Services and Health Industry Training Advisory Board NTRAC: Natural Therapies Review Advisory Committee
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PACFA: Psychotherapists and Counsellors Federation of Australia PCHA: Professional Clinical Hypnotherapists of Australia PHA: Professional Hypnotherapists of Australia PHWA: Professional Hypnotists of Western Australia RPL: Recognition of Prior Learning RTO: Registered Training Organisation SPSS: Statistical Package for the Social Sciences TA: Transactional Analysis TATP: The Academy of Transformational Psychotherapy VET: Vocational Education Training
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1 Abstract 1.1
Background to the profession
Clinical hypnotherapy has been practiced for many years. The first professional association was founded in 1949 (AHA, 2013b) and since then other associations have emerged as the profession has developed (AACHP, 2012; ASCH, 2014c; PHA, 2014). South Australia commissioned two reports on hypnosis (PoSA, 2008, 2009a) which were a prelude to the deregulation of hypnosis in South Australia, followed by similar legislation in Western Australia (SASH, 2010; WAG, 2005). As the profession has developed there have been simultaneous concerns for other unregistered health practitioners that has generated discussion and subsequent legislation related to all unregistered practitioners (AHMAC, 2011; Department of Health, 2013; HCCC (NSW), 2012; Swan, 2014).
Although practitioners are unregistered some clinical hypnotherapy training has chosen to become accredited under the Australian Skills Quality Authority (ASQA) that is the national regulator for Australia’s vocational education and training (VET) sector. Courses with those accreditations provide qualifications ranging from Certificate IVs to Advanced Diplomas in clinical hypnotherapy (AAH, 2013b; ACH, 2013; AHS, 2013; CA, 2013a; Phoenix, 2013) and other training provides professionally accepted qualifications.
At the heart of the difficulty within clinical hypnotherapy education is the lack of agreed standards or even a core of skills that all would agree are its essential competencies and proficiencies. Various attempts have been made to arrive at a set of core competencies but this has proven fraught given the various interest groups and constituencies that claim to represent the profession (PoSA, 2009a). The literature surrounding clinical hypnotherapy pedagogy is at best sparse providing little and out of date commentary (Hammond & Elkins, 1994).
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For hypnosis to take its place alongside other accredited complementary therapies it needs to generate a set of standards that reflect the required competencies a practitioner needs to acquire to become competent. With the paucity of literature available a Delphi methodology was chosen to provide the data which would serve as a basis from which guidance can be drawn and future research could be undertaken.
1.2
Research Aim
The objective of this research is to identify competencies and skills required by clinical hypnotherapists. The research will seek to identify both the underpinning theoretical constructs as well as the application of the identified skills and proficiencies for clinical hypnotherapy. The broad aims of this research were to identify the current educational subjects required to enter the profession of clinical hypnotherapy and, once analysed, to propose a foundational set of professional competencies. To address the primary research question “What are the key skills or competencies required by commencing clinical hypnotherapists?” the research engaged with multiple experts and other stakeholders in the profession. The term ‘expert’ in this thesis refers to an individual from any background with experience, qualifications and/or expertise on which to base an informed decision (Hsu & Sandford, 2007a; Linstone & Turoff, 2002; Low-Beer, Lupton, & Higham, 2010; Okoli & Pawlowski, 2004)
Currently clinical hypnotherapy pedagogy is determined within the domain of the training institution. Identified diversity within the profession (HCA, 2012e) provides graduates with broad variation of competencies and skills via varied volumes and levels of training.
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1.3
Methodology: Brief outline
The research was undertaken using Delphi methodology as the lack of available research in clinical hypnotherapy pedagogy nullified other research methodologies. Delphi uses group communication to achieve a convergence of expert opinion.
All sections of the profession (including external stakeholders were identified by their activities within the profession and invited to by email to participate. The self-selected participants completed a registration process to capture vocational data before commencing the surveys.
A two round electronic survey was conducted with questions devised from association membership criteria and teaching institutions curricula. The first questionnaire presented 157 questions in the areas of governance, ethics, concepts, techniques, practical and education. The data were analysed to ascertain which questions had achieved consensus. The participant’s responses were compiled into the questions that achieved consensus, those that achieve high agreement, and those that did not achieve consensus.
The questions that achieved consensus were returned to the cohort for reference but no response was required. The questions that did not achieve consensus were returned to the cohort for their response. The second round responses were analysed to determine which additional questions had achieved consensus and analyse the stability of the remaining questions.
Cohort responses were grouped into questions that achieved: consensus, high agreement and no consensus and via their categories of governance, ethics, concepts, techniques, practical and education; then the interactions between the categories.
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1.4
Synopsis of results
Consensus identified topics that the cohort determined should be included/not included within clinical hypnotherapy training. High agreement identified topics that should be considered and no consensus indicated uncertainty.
The areas of consensus, high agreement and no consensus give clear indications of topics that are considered essential, required and optional with clinical hypnotherapy training. However, the research did not identify the volume or teaching level for each topic. Areas such as ethics, psychology and psychotherapy achieved consensus in the first round which indicates the prominence of these topics in the profession. High agreement was achieved in various areas such as medical sciences, pharmacology and standardised clinical hypnotherapy training. No questions in the categories of ethics or practical returned a ‘no consensus’ result with limited governance, concepts, techniques and education questions returning a ‘no consensus’ response. The data show consensus in areas such as ethics, quality assurance and recognition of prior learning but although there was negative high agreement (80.8%) that standardised clinical hypnotherapy training is not required in Australia there was no consensus on educational pathways or articulation into government accredited qualifications.
The analysis of the interaction between categories provided additional data. Key elements such as educational standards for clinical hypnotherapy; defining ‘hypnosis’ and ‘hypnotherapy’ as discrete terms; quality assurance within the profession; hypnosis as an adjunct to other therapies as distinct from clinical hypnotherapy as a therapy in its own right; the ethics in business and marketing within the profession; and the lack of targeted research into clinical hypnotherapy pedagogy. All these points emerged as potential issues for further investigation. These key issues can be perceived as both individual and integrated areas.
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1.5
Synopsis of conclusions
Viewing the key elements viewed in concert with the full research data identifies areas attitudes toward these capstone elements. The range of responses indicated the diversity of perspective within the profession.
The diversity of the profession demonstrated a variance of opinion in some areas. Identified differences within beliefs surrounding e.g. educational levels, indicate an improbable agreement on educational standards but quality assurance with each sector is achievable. This professional range provides some sectors with a greater capacity to deal with specified key elements more than others. Practitioners with university degrees would be unlikely to have the capacity to design and conduct pedagogical research than practitioners with professional or accredited vocational qualifications. Diversity within a profession is a double-edged sword. It may be perceived that a strength resides in the range, breadth and depth provided by the diversity yet when an accord may be necessary, the cohesion to achieve that accord (e.g. educational standards) may not be there.
The data demonstrate that the profession of clinical hypnotherapy is developing and evolving. The evolution may be due to continuing research, legislative impact or other as yet identified factors. This thesis is part of that evolution. The areas identified in this research may be perceived as discrete when in fact they are, in most cases, part of the profession as a whole. The number of practitioners is growing and the efficacy of the art/science is being further researched. However the lack of clinical hypnotherapy pedagogy available indicates more research is required in this fundamental area.
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2 Introduction: Overview Within Australia the profession of clinical hypnotherapy is undergoing changes in the area of governance (HCA, 2011a), education, professional standards (AACHP, 2013; AAH, 2013a; ACH, 2013; AHA, 2011c; AHS, 2014; CA, 2013a; Phoenix, 2013) and recognition (Bupa, 2009; CCH, 2011; HCA-WP, 2010; t.g.au, 2014). Previously, various State governments have tried unsuccessfully to impose quality controls via blanket complementary therapy legislation with little success and now state legislation restricting the practice of hypnosis has been removed (PoSA, 2009a; WAG, 2005). However with the advent of ASQA accreditation the educational sector of the profession has seen an enhancement of quality assurance procedures not previously experienced (ASQA, 2013a). Clinical hypnotherapy is currently unregulated in Australia and the one constant in the profession has been change.
At the heart of the difficulty of regulating clinical hypnotherapy is the lack of agreed standards or core skills that all would agree are its essential competencies, proficiencies and skills. Limited research in clinical hypnotherapy education (Elkins & Hammond, 1998; Hammond & Elkins, 1994), commercial in confidence courses and various interest groups (ASH, 2013d; HCA, 2014b) hamper the development of a unified curricula. An accepted set of competencies would assist in positioning clinical hypnotherapy alongside other accepted therapies.
For hypnosis to take its place alongside other proven complementary therapies it needs to generate a set of standards that reflect the required competencies a practitioner needs to acquire to become competent. This research will investigate the professional competencies required to practice clinical hypnotherapy by seeking expert consensus on the proficiencies and skills required to be a clinical hypnotherapist. With no nationally
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endorsed training package a diverse range of training is apparent. Some training is Australian Skills Quality Authority (ASQA) accredited (AAH, 2013a; ACH, 2013; AHS, 2013; CA, 2013a; Phoenix, 2013; t.g.au, 2014), other training has professional association accreditation (AHA, 2013c; ASCH, 2014b) and other training does not display accreditation information (ASA, 2013). With this diverse range of training the question of what constitutes professionally acknowledged skill sets becomes complex and diverse.
The broad aims of this research are to identify the current educational subjects required to enter the profession of clinical hypnotherapy and, once analysed, to propose a foundational set of professional competencies and the professional requirements to enter the profession. The primary research question is: What are the key skills or competencies required by commencing clinical hypnotherapists?
The objective is to use expert opinion as the initiating component of a methodology which will get experts to determine the topics by achieving consensus. The Delphi technique is a widely used methodology and is acknowledged as a credible method for gathering expert opinion (Cuhls; Gunaydin; Hasson, Keeney, & McKenna, 2000; Hsu & Sandford, 2007a; Jorm, Hart, & Kanowski, 2008; Neutens & Rubinson, 2010). Anticipated benefits of the research to the clinical hypnotherapy profession, government, and the public would be multiple and include standardised training requirements, common professional terminology, validated research from a new sector within the profession of clinical hypnotherapy, and quality assurance of practitioners and organisations in the sector leading to greater public assurance of the profession.
The research related to clinical hypnotherapy pedagogy is very limited. The literature talks about training issues but few document pedagogy (APA, 1961; Dane & Kessler, 1998; Daniels, 1985; Elkins & Hammond, 1998; Fellows, 1985, 1996; Hammond, 1996; Hammond & Elkins, 1994; Oster, 1998; Stanley, Rose, & Burrows, 1998; Taub-Bynum &
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House, 1983; Walling & Baker, 1996; Walling, Baker, & Dott, 1996, 1998; D. Wark & Kohen, 1998; D. M. Wark & Bloom, 2010; D. M. Wark & Kohen, 2002; Watkins, 1998).
There is an abundance of research pertaining to vocational competencies but the application of that research to clinical hypnotherapy is yet to be determined. One paper (Elkins & Hammond, 1998) acknowledges the lack of research into a standard curriculum and does undertake research to determine the theoretical orientation and training topics. A methodology to determine clinical hypnotherapy pedagogy is the Delphi Method (Campbell, Shield, Rogers, & Gask, 2004; Cuhls; T.J. Gordon, 1994; Hsu & Sandford, 2007a). Delphi uses a methodology which allows a group of expert individuals to function as a single entity in dealing with a complex issue (S. Wilson & Moffat, 2010). The intended outcome of the Delphi structured group communication is a consensus of ideas based on informed judgement (Yousuf, 2007). The Delphi technique selects panellists with relevant experience (experts) who independently and anonymously respond to several rounds of questionnaires.
Evaluating the methodologies for the research model to be used has demonstrated that the Delphi Technique fulfils the criteria required for this research. The Delphi demonstrates a conceptual style already accepted by the profession, it is able to gather information when there is a paucity of information from the literature and it provides current data which will be scrutinised by a cohort of key professional stakeholders. Taking these factors into consideration the Delphi Methodology is the chosen research methodology.
Clinical hypnotherapy stakeholders/panellists were identified by past activities such as active participation in clinical hypnotherapy education (e.g. training institutions), professional acknowledgement of hypnotherapists (e.g. associations, health funds and professional indemnity insurance companies), previous governmental/institutional
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submission processes (SADH, 2008), (e.g. individuals or groups presenting submissions as well as the organisation requesting the submissions) or involvement in professional activities (e.g. establishment of a clinical hypnotherapy peak body). These stakeholders were contacted by email, association newsletters, letters and direct contact. Each stakeholder was informed the scope of the research was to identify educational components and attitudes then invited to be a participant.
The identification of educational components and attitudes to clinical hypnotherapy training using a consensus methodology is the primary aim of this research. Currently there are many different stakeholders with diverse and sometimes divergent views of what clinical hypnotherapy is and the required skills and competencies to achieve standing as a health professional. The cohort of industry experts would anonymously and independently rate and assess the questions using the Delphi methodology. The experts’ opinions form a consensus, high agreement or no consensus which provides greater clarity and potentially strategies to resolve the issues.
The chapters in this thesis are: 1
Abstract
2
Introduction: Overview
3
About Delphi Methodology
4
Background to the research question
5
Research Methodology
6
Results
7
Survey questions and responses
8
Survey: Category Summary and Discussion
9
Concepts
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10
Clinical hypnotherapy education: Discussion
11
Practical: Demonstration of skills
12
Clinical hypnotherapy: Professional attributes
13
Clinical hypnotherapy education
14
Final comments
15
Results summary
16
Conclusion
17
Ethics: Business and marketing
18
Clinical hypnotherapy pedagogy: Lack of research
19
Limitations of the research data
20
Summary
21
Concluding comments
22
Appendices
23
References
The chapter dealing with results has been combined with the discussion chapter. The reason is that during the discussion chapter would necessitate reviewing the results concurrently. The combining of the results and discussion chapters provides a clearer, more detailed and easier to read document.
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3 About Delphi Methodology 3.1
Summary: Delphi Methodology
The Delphi Methodology uses expert opinion in a consensus development process (Armon et al., 2001).and requires an expert panel to be selected from key stakeholders in the topic under investigation. (T.J. Gordon, 1994; S. Wilson & Moffat, 2010) It offers an opportunity for those stakeholders engaged in a particular discipline to evaluate, explore or discover what is known or not known about a specific subject (Hsu & Sandford, 2007a). This methodology is ideal where there is unknown or incomplete knowledge about a specific issue (Skulmoski, Hartman, & Krahn, 2007). These experts are requested to answer questions and their responses are rated by the level of consensus or importance of the nominated topic identified by the expert’s opinions (Jorm et al., 2008). The aim is to achieve a reliable consensus from that group of experts (Linstone & Turoff, 2002). The name Delphi was originally chosen as it referred to a way of predicting future events.
Delphi methodology is used in a variety of scholarly disciplines, including health and medicine, over many years. Examples of the use of this methodology for research in medicine include Ferri et al. (2005), Loughlin and Moore (1979),Low-Beer et al. (2010), Zevin et al. (2013). In nursing see Grant, Hanson, Johnson, Idell, and Rutledge (2012), McKenna (1994), Neville et al. (2011), and Persoon, Bakker, van der Wal-Huisman, and Rikkert (2015). For use of Delphi methodology in complementary medicine see (Lachance et al., 2009) or Schnyer et al. (2005). Delphi methodology has been employed for these studies because of its potential to demonstrate practitioner use and preferences. The methodology provided viable, trustworthy findings that have led to changes in medical curricula, policymaking, planning, allocation of resources and have also formed the basis future research (Austin, Henderson, Power, Jirwe, & Ålander, 2013).
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3.2
History: Delphi Methodology
The Delphi Method name was derived from the site of the Greek oracle at Delphi where necromancers told of or prophesised the future. Delphi research methodology was a concept developed by the United States Air Force and sponsored by the Rand Corporation (T.J. Gordon, 1994; Linstone & Turoff, 2002, p. 10). Starting in the 1950’s, the original objective was to achieve a reliable consensus of opinion by a group of experts using questionnaires and controlled feedback of opinion. Although the Delphi method is often attributed to the Rand Researchers Dalkey and Hemler, its conceptual origins can be found in earlier times (Baker, Lovell, & Harris, 2006). The Rand researchers reasoned that when experts agree, they are more likely than non-experts to be correct about questions relating to their field of expertise (T.J. Gordon, 1994). It was postulated (T.J. Gordon, 1994) that the gathering of experts in a conference room did not enhance the process, as the most dominant personality or strident voice may win the debate rather than the most reasonable argument; or an expert may be reluctant to speak in front of their peers, so all perspectives may not be heard. Development of the Delphi Method was undertaken to consider the then new epistemological approach to inexact sciences which could explain past events and predict future events (Helmer & Rescher, 1959).
The United States Air Force commissioned ‘Project Delphi’ in the 1950s to estimate the number of A-bombs required to reduce the output of munitions by a predetermined amount (Dalkey & Helmer, 1963). The project identified a panel of experts who considered the query from the viewpoint of a Soviet strategic planner and then provided an expert opinion. The paper ‘An Experimental Application of The Delphi Method to the use of Experts’ was withheld from publication until 1963 for security reasons (Dalkey & Helmer, 1963). Since then the Delphi Method has continued to be developed, gained popularity (Hsu & Sandford, 2007b; Skulmoski et al., 2007) and is now being used extensively in health and social research (Hart, Jorm, Kanowski, Kelly, & Langlands, 2009).
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The development of the Delphi model removed the need for experts to assemble in one location, which provided significant cost savings (Yousuf, 2007). Time and travel savings allowed geographically diverse experts to be involved (Hsu & Sandford, 2007a; S. Wilson & Moffat, 2010) and removed the constraints of personality and volume of voice (T.J. Gordon, 1994). The first significant research was the Report on a Long-Range Forecasting Study. The research described a trend predicting model which could cover a period extending over 50 years (Theodore J Gordon & Helmer, 1964). Delphi Method gained popularity and grew from the number of studies being ‘counted in three digits’ in 1969 to potentially having reached ‘four digits’ in 1974 (Linstone & Turoff, 2002, p. 3). The technique evolved and is now used as a model which allows experts to present their opinion, independently and anonymously (Hsu & Sandford, 2007a) whilst setting goals or predicting future trends.
3.3
Description: Delphi Methodology
The Delphi Method is a structured multi-stage group communication process (Campbell et al., 2004; Linstone & Turoff, 2002, p. 5; Sumsion, 1998) and is based upon the assumption of safety in numbers i.e. several experts are less likely to arrive at a wrong decision than a single individual (Hasson et al., 2000). Criteria which can identify the suitability of the Delphi methodology include: the issue is best considered by collective subjective judgements rather than analytical techniques, more experts are required than is feasible in a face-to-face exchange, time and cost constraints preclude group meetings, or the issues to be considered are sufficiently unpalatable so that they interfere with group communication (Stitt-Gohdes & Crews, 2005). Evaluation of the Delphi methodology as an appropriate research strategy includes the identification of the objective, identification of the resources required to achieve the objective, a re-evaluation to ensure the Delphi methodology is appropriate and establishment the survey questions (Cuhls). Once all
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aspects of the evaluation are completed and the Delphi methodology is validated the research phase may be commenced.
The typical structure is a series of questions based on a Likert-type response i.e., Strongly Agree, through to Strongly Disagree (Langlands, Jorm, Kelly, & Kitchener, 2008) and is comprised of two or more ‘rounds’ (Cuhls, 2003; Skulmoski et al., 2007; Thomson et al., 2009). The classic Delphi technique comprises four rounds (Miles-Tapping, Dyck, Brunham, Simpson, & Barber, 1990), however, as its methodology evolved it became ‘up to four rounds’ (Hsu & Sandford, 2007a). The questions which do not achieve consensus in Round 1 are returned to the panel of experts for review in each successive round until consensus (Hsu & Sandford, 2007a) or stability of results is achieved (Linstone & Turoff, 2002). It is postulated that after two or three rounds consensus or stability of results should have been achieved and respondents become fatigued (Sumsion, 1998).
A outline of the Delphi Methodology stages (Stitt-Gohdes & Crews, 2005) are: 1. Selection of expert panel. 2. Development and distribution of Round One questionnaire. 3. Completion and return of Round One questionnaire. 4. Collation and analysis of Round One questionnaire and development of Round Two questionnaire with Round One group scores included. 5. Distribution of Round Two questionnaire. 6. Completion and return of Round Two questionnaire. 7. Collation and analysis of Round Two questionnaire and development of Round Three questionnaire (if required). 8. Possible further rounds of voting and possible request for rationale and comments for more extreme scores. 9. Achievement of group consensus with calculation of summary statistics: maximum, minimum, and range of scores for each suggestion.
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10. Distribution and use of findings. The multi-staged communication allows the experts to review their responses in relation to the group response.
Once consensus or stability of agreement is achieved, the final analysis of the data is undertaken and documents are published. Often, the expert panel is provided with a summary of the results as an additional means of disseminating the research results.
The expert panel is derived from informed individuals with specialised knowledge of the research questions (McKenna, 1994; Randic, Carley, Mackway-Jones, & Dunn, 2002). The Likert rating they provide for each question collates to a group response. Each round gives each individual expert the opportunity to review their own responses in relation to the group response (McKenna, 1994; Okoli & Pawlowski, 2004). There are no universally agreed criteria which an expert should possess (Keeney, Hasson, & McKenna, 2006), however some expected requirements of an expert are knowledge and experience in the field of the research topic, capacity, availability, capability and agreement to participate (Skulmoski et al., 2007).
The application of each stage of the Delphi model enhances effective decision making (Hasson et al., 2000) by gathering data (expert opinion) (Linstone & Turoff, 2002, p. 10; Yousuf, 2007), developing ideas (Wright, 2004), and identifying key priorities and opportunities (S. Wilson & Moffat, 2010) by which they can deal with a complex problem. This methodology has gained favour with researchers, as demonstrated by the abundance of studies in the literature. For the determinations to have validity, the methodology requires a high degree of precision (Hasson et al., 2000) such as in the selection of the panel (Campbell et al., 2004). The selection criteria will ensure that the sampling will include various stakeholders. In this study, the stakeholders are organisations (professional associations and teaching institutions), expert individuals who
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have a unique knowledge of the profession, and practitioners with a range of training and experience. This ensures all stakeholder positions are proportionately sampled (Yousuf, 2007). The literature supports that when the Delphi Method process is applied, clarification of multifaceted issues is achieved and potential solutions can be revealed (Hasson et al., 2000). Enhanced decision-making is a keynote of the Delphi Method.
The enhanced decision making inherent within the Delphi methodology incorporates the examination of the topic under review, produces a group perspective, explores disagreements within the group structure and develops the final evaluation when all previous information has been reviewed by the group (Linstone & Turoff, 2002, p. 6). Delphi Method’s group facilitation multistage process is designed to develop a range of opinions into group consensus. This flexible approach is finding favour in the health and social sciences sector (Hasson et al., 2000).
Delphi Expert Panel and Consensus The selection of the panel requires consideration of who is an expert (Balaraman & Venkatakrishnan, 1980). The literature does not define ‘expert’ within the Delphi methodology, although in healthcare, the term expert is widely used (Baker et al., 2006). A characteristic of an expert is specialist knowledge (Baker et al., 2006; Hsu & Sandford, 2007a; Keeney, Hasson, & McKenna, 2001; McKenna, 1994). The specialist knowledge also has a shadow side which means opinions have been formed and could potentially lead to bias (Cuhls, 2003; Keeney et al., 2001), however having specialist knowledge allows informed opinion and informed consensus should it occur.
The aim of the Delphi methodology is to achieve consensus (Benton, González-Jurado, & Beneit-Montesinos, 2013; Keeney et al., 2006; Linstone & Turoff, 2002). Since consensus is a foundation of Delphi method, more research is required to establish a process on how it is determined (Keeney et al., 2006). However, it should be noted that
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consensus does not ensure the correct answer has been determined, only that there is agreement with the answer (Keeney et al., 2001).
3.4
Selecting Delphi methodology
Evaluating the methodologies for the research model to be used has demonstrated that the Delphi Technique fulfils the criteria required for this research. The Delphi Method demonstrates a conceptual style already accepted by the clinical hypnotherapy profession (Elkins & Hammond, 1998), it is able to gather information when there is a paucity of information from the literature and it provides current data which will be scrutinised by a cohort of professional stakeholders. The Delphi method is particularly valid in this aspect of research due to the many opinions even in regard to a definition of hypnosis. The many definitions of hypnosis which exist (Araoz, 2005; Joseph P Green, Barabasz, Barrett, & Montgomery, 2005; Heap, 2005; Spiegel & Greenleaf, 2005), demonstrate a lack of agreement about this fundamental core issue.
With no universally agreed definition of hypnosis, a methodology of assembling an authoritative accord is required. According to Hsu and Sandford (2007), the Delphi technique is a widely used methodology and is acknowledged as a credible method for gathering expert opinion. This is supported by Jorm, Hart, and Kanowksi (2008), who state the Delphi method is an accepted means of assessing expert opinion to achieve consensus. Other papers (Cuhls; Gunaydin; Hasson et al., 2000; Hsu & Sandford, 2007a) confirm the validity of Delphi model as a method of gathering data from experts in their domain of expertise.
Starting with broad categories allows the Delphi panel to search for depth within the questions and produce responses from multiple viewpoints. This search for meaning allows them to explore issues using their own interpretation and hence give the broadest responses (Linstone & Turoff, 2002, p. 56). As consensus is achieved in each round, the
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questions become more specific, and as such, direct the panellists into focused responses. The panellists were drawn from the broadest range of stakeholders being ‘a panel of informed individuals’ (Hasson et al., 2000) to ensure a broad base of informed opinion. The broad topics were identified from association membership criteria and teaching school curricula. This ensured the topics were based on current values and appropriate for Australian stakeholders.
3.5
Strengths: Delphi Methodology
The strengths of the Delphi methodology include (Hsu & Sandford, 2007a; Linstone & Turoff, 2002, p. 18; Stitt-Gohdes & Crews, 2005) providing anonymity of the panellists, inclusivity, controlled feedback, convenience of location (being the panellists can be at any location), avoidance of dominant personalities controlling the process and cost savings to both the researchers and panellists.
The Delphi methodology has various strengths and weaknesses. An important fundamental strength of Delphi Method is its capacity to allow the exploration of complex issues which require measured objectivity to achieve informed assessment (T.J. Gordon, 1994). As the participants are experts with experience in the field, the methodology can address the realities of that field (Yan & Tsang, 2005). Other strengths include flexibility (T.J. Gordon, 1994; Hasson et al., 2000; Yousuf, 2007) and a process to allow the panel of experts to revise their decisions (T.J. Gordon, 1994; Hsu & Sandford, 2007a; Linstone & Turoff, 2002, p. 3; Yousuf, 2007). The flexibility relates to gathering responses (questionnaires or one-to one), using web based survey instruments, reducing time constraints so participants can complete the tasks/questionnaire in their own time or at any location and the analysis of responses using computer based programs (T.J. Gordon, 1994; Hasson et al., 2000; Linstone & Turoff, 2002, p. 4; Yousuf, 2007).
A variety of publications outline the benefits of the Delphi methodology. These include:
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Reporting on each individual round allows a clear indication of the consensus for each topic (Hasson et al., 2000). The application of the Delphi Method process may build relationships between different stakeholder groups (S. Wilson & Moffat, 2010). The Delphi Method techniques can be applied when other methods are inadequate or inappropriate (Yousuf, 2007). The issue requires a collective appraisal and subjective judgements (Linstone & Turoff, 2002; Yousuf, 2007, p. 4). The experts required to examine the issue have not communicated previously or are from diverse locations (Yousuf, 2007). Too many individuals would be required so a face to face interaction would be ineffective (Yousuf, 2007). Time and cost considerations make group meetings unworkable (Stitt-Gohdes & Crews, 2005). The effectiveness of face to face meetings can be supplemented by group communication (Yousuf, 2007) If participants occupied the same space it could affect the validity of responses because of strength of personalities, viewpoints (e.g. political or religious), domination due to hierarchy or education (Yousuf, 2007) Consensus provides one representative opinion from the cohort of experts. (Helmer, Linstone and Turoff and Dalkey as cited inYousuf, 2007) The technique is simple to use. Advanced mathematical skills are not necessary for design, implementation, and analysis of a Delphi Method project (Barnes as cited inYousuf, 2007). As it provides confidentiality, many barriers to communication are overcome (Barnes, 1987). (Barnes as cited in Yousuf, 2007) It avoids producing ‘group think’ dominated by the strong personalities in the group (Yousuf, 2007) “…it gives the broadest possible modelling [sic] of any inquirer on any problem.” (Linstone & Turoff, 2002, p. 33) The strength of the stakeholder panel can be shown (Campbell et al., 2004) Integration of management and staff ideas can be incorporated (Beech, 1999)
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It facilitates improved communication networks e.g. between management and staff (Beech, 1999) It allows the development of resources within a best practice model (Hart et al., 2009) The use of experts allows opinion in areas where research is lacking (Armon et al., 2001) Table 1: Benefits of the Delphi methodology
3.6
Limitations: Delphi Methodology
With previous research into educational requirements for clinical hypnotherapy sparse, and the only real avenue available being that of expert opinion, it is necessary to be mindful of the limitations of consensus research. Delphi Method requires consideration to allow for possible problematic issues that can occur (Hsu & Sandford, 2007a; Linstone & Turoff, 2002, p. 7). These issues include restrictions on the panel which restricts freedom of thought, inadequately summarising the panel’s views, leading the panel, not exploring dissenting views and causing the panel to tire because of too many requirements in responding, possible low response to questionnaires and variation in the depth of knowledge of the panellists.
Various publications acknowledge the limitations of the Delphi methodology. These include: Questions may be asked for which a better research techniques exist (T.J. Gordon, 1994); Delphi Method takes time. A single round could take three or four weeks and three rounds, including preparation and analysis could require three or four months (T.J. Gordon, 1994; Hsu & Sandford, 2007a; Yousuf, 2007citing Barnes); There may be confusion in the meaning of questions; Questions may impose the researcher’s preconceptions on the panel (Linstone & Turoff, 2002); The assumption that Delphi Method can replace all forms of communications (Linstone & Turoff, 2002); Poor techniques of summarizing and presenting the group response (Linstone & Turoff, 2002); Not exploring disagreements which may mean an artificial consensus is generated (Linstone &
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Turoff, 2002); Under estimating the demands of the Delphi Method on participants (Linstone & Turoff, 2002); The appropriateness of the panel (Linstone & Turoff, 2002); Correctness of the design of the individual Delphi Method survey design (Linstone & Turoff, 2002); Honesty of the research monitor (Linstone & Turoff, 2002); Honesty of the panellists (Linstone & Turoff, 2002); Identifying General Statements instead of the specific topics (Hsu & Sandford, 2007a); Low response rates (Hsu & Sandford, 2007a); Appropriateness of the technique for the research topic (Linstone & Turoff, 2002); Panel members may not be able to see the vision or the big picture in which they are involved. (Fortune as cited in Yousuf, 2007); The panel’s judgments may be those of a select group and not be representative the majority of stakeholders (Barnes as cited inYousuf, 2007); Delphi Method may eliminate extreme positions and present a middle-of-the-road consensus (Barnes as cited inYousuf, 2007); Panel fatigue (Balaraman & Venkatakrishnan, 1980); Collective error (Armon et al., 2001). Table 2: Limitations of Delphi methodology
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3.7
Other research undertaken by Delphi Methodology
Delphi methodology is used in a variety of research areas which in some cases Delphi Methodology is guided by a systematic review (Ferri et al., 2005). In 1994 (McKenna) stated that since the 1940s, Delphi methodology has been used as the research methodology in over 1000 publications. Obviously that number has increased since that time. Delphi methodology has been applied in a variety of fields (Hsu & Sandford, 2007a). Table 1 gives a brief overview of research using Delphi methodology.
There are a range of studies which has used Delphi Methodology. The diversity of research includes complementary and alternative medicine (defined as “diagnosis, treatment and/or prevention which complements mainstream medicine by contributing to a common whole, by satisfying a demand not met by orthodoxy or by diversifying the conceptual frameworks of medicine.” (Ernst, 2000, p. 1133), education, environmental policy, graduate research, group decision, industry, health, in-service programs, information systems, nursing, social planning, social work, research, self-help, standards of practice (Balaraman & Venkatakrishnan, 1980; Bond & Bond, 1982; Broom & Adams, 2007; Brown, 2004; Ferri et al., 2005; Hart et al., 2009; Hasson et al., 2000; Lachance et al., 2009; Lindeman, 1975; Macdonald, Ritchie, Murray, & Gilmour, 2000; A. J. Morgan & Jorm, 2009; J. I. Morgan, Darby, & Heath, 1992; Moscovice, Armstrong, Shortell, & Bennett, 1977; Neville et al., 2011; Okoli & Pawlowski, 2004; Randic et al., 2002; Schmidt, 1997; Schnyer et al., 2005; Skulmoski et al., 2007; Stitt-Gohdes & Crews, 2005; Sudre, Breman, & Koplan, 1990; Thomson et al., 2009; Van Tulder, Van Der Vegt, & Veenman, 1993; Van Tulder & Veenman, 1991; Ven & Delbecq, 1974; Werneke et al., 2005; West & Cannon, 1988; Wright, 2004; Yan & Tsang, 2005)
Delphi methodology facilitates exploration and disclose of underpinning assumptions, potential alternatives and information which may lead to different assessments and a
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correlation of well-informed judgements in broad areas (Delbecq, Van de Ven, and Gustafson as cited in Hsu & Sandford, 2007a). This demonstrates that the Delphi Technique is a useful tool that can provide research data which would be challenging to obtain by other research methodologies (Beech, 1999).
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4 Background to the research question Clinical hypnosis is currently unregulated in Australia. In Australia, various State governments have tried unsuccessfully to impose quality controls via blanket complementary therapy legislation. The State governments have repealed or removed these restrictions in subsequent legislation.
At the heart of the difficulty of regulating clinical hypnotherapy is the lack of agreed standards, or even a core of skills that all would agree are its essential competencies, proficiencies and skills. Various attempts have been made to arrive at a set of core competencies, but this has proven fraught given the various interest groups and constituencies that claim to represent the profession. For hypnosis to take its place alongside other evidence-based complementary therapies, it needs to generate a set of standards that reflect the required competencies a practitioner needs to acquire in order to become competent.
This research investigated the professional competencies required to practice clinical hypnotherapy. It sought to gain expert consensus on the proficiencies and skills required to be a clinical hypnotherapist. With no nationally endorsed training package, a diverse range of training is available. With this diversity, the question of what constitutes professionally acknowledged skill sets became a complex issue.
Whilst there is a range of literature regarding hypnosis, rather than addressing educational matters such as competencies and skills it is directed towards the training of clients in various techniques such as self-hypnosis (Baumann, 2002; Der & Lewington, 1990; Elkins, Jensen, & Patterson, 2007), curricula (Daniels, 1985; Dorcus, 1958; Hoencamp, 2004; Rodolfa, Kraft, Reilley, & Blackmore, 1983; Wald & Kline, 1955), hypnosis
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standards (Elkins & Hammond, 1998; Hammond & Elkins, 1994; Rodolfa et al., 1983), application of techniques in a clinical setting (de Klerk, Plessis, Steyn, & Botha, 2004; Gonsalkorale, Houghton, & Whorwell, 2002; Patterson & Jensen, 2003) and some data relating to public attitudes on hypnosis (Joseph P. Green, 2003; McConkey, 1986). There is little relating to practitioner proficiencies.
There are limited publications relating to competencies and proficiencies in clinical hypnotherapy training from 1955 through to the current literature (APA, 1961; Bloom, 1993, 2001; Bourgeois, 1997; Dane & Kessler, 1998; Daniels, 1985; Dorcus, 1958; Elkins & Hammond, 1998; Fellows, 1996; Gardner, 1976; Gravitz, 2006; Hammond & Elkins, 1994; Hoencamp, 2004; Levitt & Hershman, 1963; Rodolfa et al., 1983; Stanley et al., 1998; Taub-Bynum & House, 1983; Valett, 1962; Voit & Molly, 2004; Wald & Kline, 1955; Walling & Baker, 1996; Walling et al., 1996, 1998; D. M. Wark & Kohen, 2002; Watkins, 1998; R. H. Woody, Houck, & Thompson, 1969; Yapko, Barretta, & Barretta, 1998; Zeig, 1985). The references which discuss standards and curricula topics (Elkins & Hammond, 1998; Hammond & Elkins, 1994) assume an underpinning knowledge commensurate of a medical practitioner, psychologist or dentist. Some books (Heap, Aravind, & Hartland, 2002; Temes, 1999) outline clinical hypnotherapy topics but do not form these topics into a cohesive course.
The paucity of literature on professional competencies for clinical hypnotherapy has been acknowledged, “Very little research has been conducted regarding the opinions of professionals regarding the content of a standard curriculum” (Elkins & Hammond, 1998, p. 55). The scarcity of previous research in this area makes a literature review less viable. Hence the most valid research approach is that that of ‘expert opinion’ as indicated by a 1998 article (Elkins & Hammond, 1998). Elkins et al sought opinion from clinicians, teachers
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and scientists to rate the relevance of 57 predetermined topics within the scope of clinical hypnotherapy training.
4.1
Clinical hypnotherapy: A health profession?
The term ‘profession’ is descriptive of the identifying characteristics which differentiate a ‘profession’ from an ‘occupation’ (Weiss-Gal & Welbourne, 2008). Surrounding the concept of a profession remains a definition of identity, foundational professional competencies and skills which confer the access to practice (Jacob & Boisvert, 2010). It is generally accepted that the qualities of a profession include specialised knowledge through education, a distinctive code of conduct, autonomy and altruism (Katz, 2000; Sim & Radloff, 2009; Watts, 2000). Over time, scholarly publications have outlined additional professional characteristics including extended training periods in higher education, management of those accepted to enter clinically recognised training, practitioner status, commitment to service, fiduciary responsibilities and financial gain (Weiss-Gal & Welbourne, 2008). Funder (2010), quoting a 1951 definition by Judge Peter Wright, comments that this definition is still valid by today’s values. “A profession is a selfdisciplined group of individuals who hold themselves out as possessing special skills derived from education and training which they are prepared to exercise primarily in the interests of others.” (Funder, 2010, p. 246)
Derived from the definition of a medical professional (Lynch, Surdyk, & Eiser, 2004), another definition describes health professionalism as the ability to meet relationshipcentred expectations, in order to practice a health profession competently. The issue at hand is that there are no universally accepted criteria or theoretical frameworks which can serve as a foundation. Governmental changes necessitate adaptations within Australian clinical hypnotherapy (HCA, 2011b) and these changes are creating a set of circumstances where an agreed definition is unlikely (I. Wilson, 2013).
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4.2
Clinical hypnotherapist: A health professional?
It then follows that a health professional would demonstrate the qualities required by a profession. These qualities (as outlined earlier) have been given a further perspective using language such as autonomy, credentials, ethics, evaluation, expertise, knowledge, professionalism (Picciotto, 2011) and extension of their clinical role by voluntarily participating in continuing professional development (Sim & Radloff, 2009). Supplementary to these concepts are the development of new perspectives of professional work and extending the boundaries of existing work (Bourgeault, Benoit, & Hirschkorn, 2009) which form the foundation for occupational change (Evetts, 2006b). The application of these principles assist the exploration of professional boundaries (Bourgeault et al., 2009) and lead to new dimensions in the profession.
4.3
Profession and professionalism: Who decides?
The question remains: what criteria are required of a health discipline in order to be acknowledged as a profession, and who determines those criteria? The questions surrounding the factors determining a profession (and the consequential professionalism) are numerous and encompass such areas as; the development of clinical standards (Cornett, 2006), accreditation and compliance requirements (Cornett, 2006), curriculum taught to practitioners (Wear & Castellani, 2000), rationalist thinking and science (Wear & Castellani, 2000) and the employment of evidence based models (Cornett, 2006)?
4.4
The literature: Transition to a profession?
The literature does not give a definitive answer as to the moment when a health discipline transforms into a profession. There is no clear delineation of what or how any evaluation is undertaken for a vocation to be deemed as a profession, or to have the quality of professionalism. When dealing with a health discipline, the inference is that it occurs when compliance is achieved in accordance with some government regulatory authority
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(Clauser, Margolis, Holtman, Katsufrakis, & Hawkins, 2012; Cornett, 2006). Professionalism at a practitioner level is achieved when the profession (of which they are a member) accepts that they have achieved specified criteria (Bennett, Roman, Arnold, Kay, & Goldenhar, 2005; Clauser et al., 2012; Cornett, 2006; Holtman, 2008; Jackson et al., 2007; Konkin & Suddards, 2012). Using the literature as a foundation, it can be argued that clinical hypnotherapy is satisfying the requirements of a profession but it depends on who is setting the criteria (Katz, 2000). The development of specialist knowledge, propositional, personal and process knowledge can be argued. The argument’s validity is only as strong as its weakest link (Clauser et al., 2012) and that link could be the recognition of the specialist knowledge as having universal acceptance. The pedagogy may differ with each training organisation, but professionalism necessitates that the knowledge and competencies have strong concordance (Lesser et al., 2010), as would be required for the specialist knowledge required to be a clinical hypnotherapist.
4.5
Professionalism: Concepts
Inherent within the modern profession are the concepts of trust, discretion, and competence (Evetts, 2006a), with ‘professionalism’ being considered as having benefits in a commercial sense (Fournier, 1999) rather than simply an occupational title (Evetts, 2011). However, professionalism within the health care sector is more than a title as it inherently includes other attributes and beliefs such as altruism (ABIM, ACP-ASIM, & EFIM, 2002). This encompasses all concepts of the health profession, in addition to the expectation of consistency as demonstrated by best practice and high quality practice (Driever, 2002). The term ‘best practice’ has a variety of definitions and uses dependent on its context. Clinical hypnotherapy as with many other fields has no accepted usage of the term. Generally it is regraded to be a methodology, based on evidence and for the purposes of this thesis it means (from a practitioner perspective) what is effective for most people most of the time.
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With professional conduct being challenged within an increasingly litigious society, the move from knowledge to clinical effectiveness is more difficult (Clauser et al., 2012) and is increasingly relevant where increased accountability is an emerging theme (Cornett, 2006; Evetts, 2006a), with competence (Veloski, Fields, Boex, & Blank, 2005) being a keynote.
Clinical competence is more than the acquisition of knowledge (Pond, 1979). Assessing a client’s suitability for treatment requires an integrated competence-based approach (Parent et al., 2011). Miller’s conceptual structure of clinical competence is represented (Wass, Van der Vleuten, Shatzer, & Jones, 2001) by a structure whose base represents the focus on the broad foundation labelled ‘Knows’ – this being the recall of facts and knowledge. The next level in the pyramid is ‘Knows how’, which represents the theoretical application of that knowledge, ‘Shows how’ is the demonstration of a specified skill set and ‘Does’ represents the competencies that are used in the work place. The ultimate test that each domain of conceptual knowledge (Know, Knows how, Shows how and Does) has been translated into the clinical setting is the application in the workplace.
Figure 1 Miller's pyramid of competence (Wass et al., 2001, p. 946)
Regulators and consumers expect that professionals in the workplace have competencies across all domains of competence. Some competencies may provide in-depth knowledge of a specialisation or be sufficient to provide competent referral to those with the required specialist competencies. In total, these competencies form the core of minimum
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educational standards, proficiencies, and together with ethical conduct, form the basis on which many professional policies are based (Evetts, 2011). These policies and methodologies have benefits for many sectors; however professionalism tightens definitions and often restricts ideological alternatives, modes of conduct and other behaviours which may appear to be outside regulatory guidelines (Hansen, 2010).
4.6
Professionalisation: Process
The professionalisation of an ‘occupation’ occurs as it develops the attributes of a profession including expansion of professional knowledge, increased responsibility, role expansion (Sim & Radloff, 2009) and the movement away from theory or script based treatments to research and evidence based on randomised controlled trials (Alladin, Sabatini, & Amundson, 2007) and the subsequent systematic reviews and meta-analyses. This process causes a tightening of definitions, education, ethics and practices to adhere to the ideological models often external to the profession, but related to being a profession (Hansen, 2010). The approach to professionalisation has been outlined as two possible methodologies: the attribute approach or the control approach (Weiss-Gal & Welbourne, 2008) The attributes approach emphasises the functionality of the profession and includes attributes of knowledge, professional authority, community sanction, regulatory code of ethics, and all sustained by professional governance. The control approach claims a dominant position in respect to the area of practice and therefore control over the content of their work. These processes may be undertaken at a practitioner, organisational or institutional levels (Jacob & Boisvert, 2010), and as the knowledge base develops the profession can be classed as ‘emerging’ (Weiss-Gal & Welbourne, 2008).
The process of professionalisation requires a definition of the profession, specified professional behaviours, and essential competencies to achieve the identified behaviours (Jacob & Boisvert, 2010). In combination with the procedural aspects, it is also mooted that the profession requires an evidence based body of knowledge, professional authority
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recognised by its patrons, an enforceable code of ethics and a culture supported by professional associations (Weiss-Gal & Welbourne, 2008). With increasing regulations surrounding professionals it is suggested that licensure and formalised accreditations are also required (Neukrug, 2011). The requirement for empirically supported treatments (DOHA, 2012) and an evidence base are becoming the norm for professions (Hansen, 2010). This matter needs to be considered within the professionalisation process and has become more evident as ‘emerging’ professions - which do not train practitioners at a university level - have restricted capacities in research methodologies. Consideration needs to be given to these emerging professions that train in the VET sector, as they have less capacity to develop the required research based criteria essential for the demonstration of empirical support for clinical treatments which is necessary to enter the assembly of health professions.
4.7
Clinical hypnotherapy: The profession and professionalisation
The role of the peak body - as distinct from that of an association - is to govern the profession rather than its members. A fundamental component of a profession lies in its professional associations, and in some cases the licensing bodies (Cruess, Johnston, & Cruess, 2002). If no legislative restrictions exist and voluntary self-regulation is the chosen path (Kelly, 2012) there is an obligation to provide governance and support for lower level professional associations in the areas of ethical conduct, professional standards, and disciplining of infractions which must be rigorous, transparent and fair (Cruess et al., 2002). The inclusion of governance within all associations (Evetts, 2011) and the communication with all sectors including the public and government, infuses a higher level managerial component into the peak body. There is a responsibility for the executive of all associations and especially the peak body to understand and fulfil their legal and professional obligations (ASIC, 2013; Evetts, 2011; NHMRC, ARC, & AVCC, 2007).
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The establishment of the HCA in 2011 signified the commencement of a representative Australian clinical hypnotherapy peak body which was to engage with professional obligations. It is suggested that most professional activity occurs in organisational settings (Muzio & Kirkpatrick, 2011) but this is not the case in clinical hypnotherapy. Membership of the HCA is restricted to clinical hypnotherapy ‘entities’. The membership criteria states “‘entity’ means an association or educational organisation as relevant under these rules, or any other organisation deemed as relevant under these rules to the working of the HCA” (HCA, 2012d, p. 2). The HCA publishes policy documents in regard to various aspects of the profession e.g. ethical conduct (HCA - EP, 2012) and minimum educational standards (HCA, 2012c).
4.8
Clinical hypnotherapy: Current educational models
The current pedagogical methodologies surrounding clinical hypnotherapy are based primarily in the vocational sector and the availability of continuing education programs for existing health professionals (PoSA, 2009a, p. 9). Previous master/apprentice models have proven to be financially unsustainable with the advent of commercial courses. The current primary teaching methodology is didactic learning which uses classroom teaching, demonstration of the required practitioner techniques, practice and some online learning (Hammond, 1996; Taub-Bynum & House, 1983; D. M. Wark & Kohen, 2002). The scientist-practitioner model has only one reference in the literature (Dyer & Hawkins, 1997) and relates more to the training of psychologists than clinical hypnotherapists. Few practitioner internships occur within clinical hypnotherapy and this lack maintains the modified master/apprentice model (AAH, 2013a). Irrespective of the educational model, the training emphasis is now on workplace competencies (Carmichael, 1993). A report published by the South Australian Government states that they “…strongly support the introduction of a new regulatory framework to ensure that only those who are properly trained and have met appropriate standards of education” (PoSA, 2009a, p. 3) and there is a need to “ ..ensure that, as part of the new regulatory framework, proper standards of
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education and training for the practice of hypnosis are established” (PoSA, 2009a, p. 15). This suggests that the educational rigor required of the VET sector or higher education is missing from clinical hypnotherapy training. The training is acknowledged by various clinical hypnotherapy associations as fulfilling requirements for professional memberships (AHA, 2012; ASCH, 2010c; HCA, 2012g; PHWA, 2010) and continuing professional development (CAPA, 2013a, 2013b).
The vocational identity of the clinical hypnotherapist is yet to be determined. Scholarly articles and texts have posited hypnotherapy training within continuing professional development for qualified physicians, psychologists, osteopathic physicians, podiatrists, dentists, doctoral level social workers and nurses, and Masters degree level social workers, nurses, marriage and family therapists, and mental health counsellors (Hammond & Elkins, 1994), psychologists, medical practitioners and dentists (Pelling, 2007), psychiatric resident training (Walling et al., 1998) and doctoral candidature (Parrish, 1975; Pelling, 2007; Walling et al., 1998). Clinical hypnotherapists who do not fall within the aforementioned professional categories are usually not university graduates. This being the case, they are usually not skilled in writing peer reviewed articles and are not proportionately represented in the literature. Their training is generally from within the vocational sector and often using a master/apprentice learning style.
The main teaching methodologies are reading, practical handouts, lectures, demonstrations for (modeling) and small group work (Hammond, 1996). Practitioners are excellent at doing, however they may or may not achieve the same level of excellence at teaching how they do, what they do. Educationalists are excellent at interpreting what practitioners do and designing learning objectives, course content and material, delivery methods and assessment criteria. It is the fusion of the practitioner’s and educationalist’s abilities which will allow hypnosis educational methodologies to be encapsulated into hypnotherapy training methodologies. Using past and present data, course designers can
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discern curriculum, training methodologies and assessment criteria. From this, a targeted set of learning objectives can be derived. It seems that hypnosis training may have evolved from the tacit learning of master – apprentice, but has not progressed to the educational style of academic learning. Tacit learning or academic learning both require outcome driven goals and an ability to assess when the proponent has achieved the required standards. Research into past and existing courses will provide data of learning objectives and associated assessment criteria. This will allow course customisation to be derived for the various stakeholder groups.
The pedagogies used in hypnotherapy training for any stakeholder cohort in Australia have largely not been described. Australia wide, only five hypnotherapy training institutions from approximately 40 have achieved a tertiary accreditation from the Australian Skills Quality Assurance (ASQA) within the Vocational Education Training (VET) sector. None of the hypnotherapy educators publish their respective curricula; so there are limited opportunities to achieve educational cohesion within hypnotherapy education. Statements regarding the vocational independence of clinical hypnotherapy are rare. It is evident that the assumption that clinical hypnotherapy is an independent vocation is accepted unless otherwise stated. Statements on this have been made by the Australian Society of Clinical Hypnotherapists (ASCH) on their website (ASCH, 2011c) which was revised (ASCH, 2011d) shortly afterwards. The Australian Society of Hypnosis (ASH) integrates their belief that hypnosis is not an independent vocation into their ethical considerations (ASH, 2013d). This principle is in line with their membership and training restrictions.
Concrete evidence of pedagogical changes from master/apprentice scenarios within teaching methodologies with the advent of VET sector accredited courses (t.g.au, 2012) cannot be determined. Details of teaching approaches can only be gleaned from materials published by the respective teaching organisations. However, the master/apprentice (Day,
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2010) style currently seems to underpin the methodological approach used in hypnotherapy training, although the literature does not reference any pedagogical methodology.
4.9
Clinical hypnotherapy: Professional competencies
It is postulated that a profession has central features that are the nature of professionalism (Watts, 2000). The crucial components are a specialist knowledge base, autonomy, and service. Currently, clinical hypnotherapy could validate autonomy and service. With legislative restrictions for the practice of clinical hypnotherapy removed across Australia (Kelly, 2012) and voluntary self-regulation occurring with the establishment of the Hypnotherapy Council of Australia (HCA) (2012g), the concept of professional autonomy could be argued. The concept of service to the client is inherent in codes of ethical conduct (AHA, 2013f; HCA - EP, 2012), henceforth validation of service to the client can also be argued. The specialist knowledge, however, cannot be argued with the same validity. Whilst the features of autonomy and service can be substantiated by relevant data which is cohesive across the profession, the aspect of specialist knowledge fails to be coherent. Across the profession it is postulated that there are similarities in the specialist knowledge as evidenced by association membership requirements and training institution curricula. The HCA has developed minimum standards for the profession (HCA, 2012c) which fulfil the profession’s requirements, yet are non-specific, thus enabling the encapsulation of all dimensions of the profession. Further illustration of this point is demonstrated by the HCA’s Mission Statement (HCA, 2012e) which acknowledges the diversity within the profession.
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4.10
Clinical hypnotherapy: Determining foundational practitioner competencies
The determination of the constituent competencies for practitioners of a profession must encompass the diversity of the profession and adequately define the uniqueness of the profession. A competency is often described as the knowledge, attitudes and skills that facilitate the performance of the practitioner and conform to the standards of the profession (Jackson et al., 2007). Eraut comments (Katz, 2000) that the development of specialist knowledge within a profession requires propositional, personal and process knowledge. Propositional knowledge is discipline and practice based. Personal knowledge is learned and intuitive; and is used for critical evaluation while process knowledge describes how the professional builds their expertise through task orientated functions. Other publications vary the constituents of professionalism (Bennett et al., 2005; Clauser et al., 2012; Cornett, 2006; Holtman, 2008; Jackson et al., 2007; Konkin & Suddards, 2012; Lesser et al., 2010; Wear & Castellani, 2000; Whitcomb, 2000) but acknowledge their importance.
If professionalism is established by the demonstration of constituent practitioner behaviours (Cornett, 2006), then the presence of propositional, personal and process knowledge would demonstrate specialist knowledge and hence professional behaviours. There are many reasons that professional behaviours are absent in many discussions about health (Lesser et al., 2010). One such reason could be that with no clear delineation of the specialist knowledge required to be a clinical hypnotherapist, the acknowledgement of ‘professionalism’ is unlikely. The assessment of professional conduct (Holtman, 2008), professional behaviours (Whitcomb, 2000) and accountability (Bennett et al., 2005; Wear & Castellani, 2000) become indeterminable.
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With a clinical hypnotherapy peak body being established (HCA, 2012g) and voluntary self-regulation being undertaken (HCA-H, 2013), the constituents of professional behaviours (Holtman, 2008) are being addressed. Where more information is required on a particular aspect of a profession and no universally accepted standard exists, some researchers have compiled data by surveying expert opinion (Benton et al., 2013; Hart et al., 2009; Low-Beer et al., 2010). Similar methodologies are apposite to determine competencies within a health discipline where no universal standards exist. Key issues in determining the validity of such a survey are the identification of desired outcomes (Wass et al., 2001). The current literature relating to practitioner education in clinical hypnotherapy is sparse, so surveying expert opinion to determine clinical hypnotherapy standards/curriculum as previously mooted (Elkins & Hammond, 1998; Rodolfa, Kraft, & Reilley, 1985) is considered a valid methodology.
4.11
Clinical hypnotherapy: Pedagogy
Current literature on clinical hypnotherapy pedagogy is sparse. The paucity of literature on professional competencies for clinical hypnotherapy has been acknowledged; “Very little research has been conducted regarding the opinions of professionals regarding the content of a standard curriculum.” (Elkins & Hammond, 1998, p. 55). Many teaching institutions publish marketing documentation pertaining to the content of their clinical hypnotherapy training (AAH, 2013a; ACH, 2013; AHS, 2007; MM, 2010b) without outlining the associated pedagogy. Associations require specified membership criteria (ACA, 2013; AHA, 2010b; ASH, 2013d) but it is not the association’s purview to stipulate the methodologies required to achieve those competencies.
The clinical hypnotherapy competencies achieved and the methodologies designed to achieve those competencies have not been the focus of many professional articles. In relation to clinical hypnosis training “Very little research has been conducted regarding the opinions of professionals regarding the content of a standard curriculum” (Elkins &
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Hammond, 1998, p. 55). Publications make reference to some methodologies such as experiential workshops and seminars (Dane & Kessler, 1998; Hammond, 1996; Yapko et al., 1998), individual instruction (Dorcus, 1958), demonstrations (Hammond, 1996), supervised practicum (Fellows, 1996; Stanley et al., 1998; Watkins, 1998), didactic training (Stanley et al., 1998), stepwise approach (Hoencamp, 2004) and facilitation (D. Wark & Kohen, 1998). However, they do not outline the educational components used to achieve competency. A survey (Elkins & Hammond, 1998) was undertaken to determine a standard curriculum. The survey requested 242 clinicians, educators and scientists to rate the relevance of 57 predetermined topics within the scope of clinical hypnotherapy training. The survey identified topics of study but no questions regarding pedagogy were asked. The results of the survey were adopted as the American Society of Clinical Hypnosis (ASCH (USA)) Certification in Clinical Hypnosis program. Only one article describes a number of skill-building exercises used in training programs (Yapko et al., 1998) and one book (Hammond & Elkins, 1994) provides pedagogical information.
The article presents exercises to enhance practitioner skills. Specific skills are identified as developing sensory acuity, using naturalistic methods, cultivate flexibility in forming, reframing, delivering and embedding suggestions (Yapko et al., 1998, p. 19). A rationale and goal for each exercise are also presented in order to help create an appropriate context for its use (Yapko et al., 1998, p. 18). The skills are taught sequentially to ensure each exercise builds on previous learning and creating a pyramid effect.
The book by Hammond & Elkins (1994b) provides recommended learning objectives, duration for each topic and recommended content (which also contains some methodology) for each of the 15 Beginning Workshop Curriculum topics and the 11 Intermediate Workshop Curriculum topics.
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Assessment criteria linked to the learning objectives are not included in this outline. However, there is an outline entitled Requirements for Certification in Clinical Hypnosis (Hammond & Elkins, 1994, p. 19) which related to pre-existing qualifications and post degree American Society of Clinical Hypnosis education, rather than specified competencies assessed during the training.
Two articles (Elkins & Hammond, 1998; Hammond & Elkins, 1994) relate to the training undertaken by the American Society of Clinical Hypnosis. The 1994 article contains some pedagogy and the 1998 article includes the Delphi style methodology used to compile the curriculum. No assessment strategies were identified. Assessment issues were identified within South Australian legislation pertaining to clinical hypnotherapy. Legislation restricted the practice of hypnosis to specified professions irrespective of whether they are appropriately trained (PoSA, 2009d).
With published research pedagogy in clinical hypnotherapy so sparse it seems that the following comment is still relevant “Although hypnosis has been used for centuries, there are few reports of systematic, professional training.” (D. M. Wark & Kohen, 2002, p. 119). Therefore the identification of key skills and competencies must either be gleaned from articles which outline therapeutic interventions, or a methodology designed to utilise expert opinion employed. Using expert opinion as the initiating component, a methodology which sought to get experts to determine the topics and then achieve consensus may be of higher research validity. According to Hsu and Sandford (2007), the Delphi technique is a widely used methodology and is acknowledged as a credible method for gathering expert opinion. Using consensus, expert opinion can identify essential skills and competencies. The literature shows a similar methodology has been employed (Elkins & Hammond, 1998) and the results were adopted as the American Society of Hypnosis (ASH(USA)) Certification in Clinical Hypnosis program.
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4.12
Using Delphi Methodology: Clinical hypnotherapy education
The Delphi Methodology uses consensus to evaluate expert opinion. The Elkins (1998) research did not adhere to the Delphi methodology as it did not take a cross section of stakeholders nor use anonymous panellists, neither did it use the previous round questionnaire to structure the next round questionnaire although it did canvass expert opinion.
Evaluating the methodologies for the research model to be used has demonstrated that the Delphi Technique fulfils the criteria required for this research. The Delphi demonstrates a conceptual style already accepted by the profession, it is able to gather information when there is a paucity of information from the literature and it provides current data which will be scrutinised by a cohort of key professional stakeholders. Taking these factors into consideration the Delphi Methodology is the chosen research methodology.
The Delphi Technique requires a panel to be selected (T.J. Gordon, 1994; S. Wilson & Moffat, 2010) from key stakeholders in the profession. The selection criteria will ensure that the sampling will include various organisations (professional associations and teaching institutions), expert individuals who have a unique knowledge of the profession, as well as practitioners with a range of training and experience within the profession, thus ensuring that all stakeholder positions are proportionately sampled (Yousuf, 2007). These experts will be presented with data pertaining to topics currently being taught by educational institutions as part of clinical hypnotherapy training. The experts will be requested to rate topics which will identify their opinion of the importance of the nominated topic (Jorm et al., 2008) within clinical hypnotherapy training. A more detailed summary of the Delphi methodology is included in the Research Methodology chapter of this thesis.
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The aim is to achieve consensus on topics which and use this as a basis to determine the essential competencies for a clinical hypnotherapist.
The research will seek to identify both the underpinning theoretical constructs as well as the application of the identified skills and proficiencies for clinical hypnotherapy. It will engage with multiple stakeholders as experts in the profession and secondly as stakeholders within the profession. Currently there are many different stakeholders with diverse and sometimes divergent views of what clinical hypnotherapy is, and the nature of the skills and competencies required to achieve standing as a health professional.
The research outcomes seek to provide clarity of clinical hypnotherapy pedagogy and its associated competencies and proficiencies, by developing consensus around professional requirements. Anticipated benefits of the research to the clinical hypnotherapy profession, government, and the public would be multiple. This could include standardised training requirements, common professional terminology, validated research from a new sector within the profession of clinical hypnotherapy, and quality assurance of practitioners and organisations in the sector leading to greater public assurance of the profession.
4.13
Clinical hypnotherapy: Educational framework
Clinical hypnotherapy education is supplied by private providers. Some have achieved VET sector accreditation for their courses as no training package has been developed. Training packages (AQFC, 2013) under the Australian Qualifications Framework (AQF) have become the desired framework for Australian vocational sector (Wheelahan, Arkoudis, Moodie, Fredman, & Bexley, 2012). Some of the inherent aspects of the AQF such as Recognition of Prior Learning (RPL) have transitioned into clinical hypnotherapy training through the VET sector accredited courses. Australian clinical hypnotherapy qualifications are accepted by professional associations and health fund providers. RPL is accepted as satisfying membership criteria as professional associations acknowledge
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clinical hypnotherapy courses meet their requirements for membership (AHA, 2013c; ASCH, 2013d). No association has a website which outlines the criteria by which the course recognition is based.
Thirty nine providers offer training that ranges from the Australian Hypnosis Certification in one weekend (ASA, 2013) to an Advanced Diploma of Clinical Hypnotherapy accredited by the Australian Skills Quality Authority (AAH, 2013a) comprising of a nominal 1800 hours of training. Educational standards for membership of professional associations ranges from no published criteria (PCHA, 2013) to membership criteria stating a requirement of 500 hours of classroom training (AHA, 2013d). Requirements for health fund rebates are changing (AU, 2013; Bupa, 2009) and these changes relate to educational requirements to government accredited qualifications being required to achieve health fund rebates. The result of the private health insurance funds’ changes in educational requirements, have brought comment from the profession (AACHP, 2013) which may ultimately bring changes to meet the new requirements and henceforth a new curriculum.
4.14
Curriculum
In Australian all government accredited curricula are structured in line with the national Australian Qualifications Framework (AQF) (AQFC, 2013). The structure of the AQF includes school, vocational education and university education.
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Figure 2: Australian Qualifications Framework (Go8, 2012)
The AQF provides the structure for the course curriculum, training package or other learning pathway that leads to the issuing of the qualification.
4.15
Curriculum: Development process
Curriculum changes occur in vocational and professional education as knowledge and methods evolve. In established vocations and professions, curriculum development follows educational guidelines (Collins, 1993; LSIS, 2013; Sade, 2009). In line with current attitudes, vocational and/or professional stakeholders have input into educational initiatives (Low-Beer et al., 2010; Ntshoe, 2012; Sade, 2009; Smith, 2002; Wheelahan & Carter, 2001). These initiatives are reviewed and often reformed as government and/or educational attitudes change (Canning, 2007; LSIS, 2013; Smith, 2002; Wheelahan & Carter, 2001). Drivers which initiate change can include funding variations (LSIS, 2013), equity and social justice issues (LSIS, 2013; Ntshoe, 2012), recognition of weaknesses in the current system (Wheelahan & Carter, 2001) and changes in professional standards (LSIS, 2013).
Factors which influence curricula are varied. These factors can include financial (Devos, 2005), regulatory (ALTC, 2011; Wiggins & McTighe, 2001), workplace requirements (LowBeer et al., 2010), assessment (Canning, 2007) and accountability (McTighe & Thomas, 2003). The ‘knowledge economy’ (Devos, 2005) is demanding trained workers who are
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capable of creating, applying and manipulating new knowledge in the workplace (Devos, 2005). The concept of backward design suits workplace requirements because it focuses on desired outcomes (Wiggins & McTighe, 2001). Backward design inherently incorporates the workplace as a location for knowledge productions and learning (Devos, 2005; Wiggins & McTighe, 2001). An example of Backward Design process, is the development of a curriculum topics based on student feedback. The innovative methodology (Delphi Technique) was used to design a curriculum which fulfilled workplace and regulatory requirements and provided medical practitioner qualifications (Low-Beer et al., 2010).
In today’s climate, existing curricula need to be actively updated (Canning, 2007). Current curriculum design processes encourage data be gathered from multiple sources (LowBeer et al., 2010; McTighe & Thomas, 2003) including feedback from students (Ahluwalia, Das, & Verity, 2005). Creative approaches provide the opportunity to identify specific priorities (McTighe & Thomas, 2003) and use the design process as an opportunity to address issues with innovative methodologies (Sade, 2009).
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5 Research Methodology 5.1
Introduction
A literature review demonstrated a lack of research into clinical hypnotherapy pedagogy. This paucity restricted viable research methodologies. The Delphi methodological structures had been previously used within clinical hypnotherapy (Elkins & Hammond, 1998) as well as more recently (Low-Beer et al., 2010).
A systematic literature review was undertaken using specialised hypnosis/hypnotherapy journals and electronic databases. Relevant publications which were unavailable electronically were retrieved manually. The searches were limited to Australian publications less than ten years old and international publications less than five years old. This differentiation is based on the quantity of publications produced in within Australia in comparison to the rest of the world. Controlled vocabulary, Medical Subject Headings (MeSH) descriptors and free text terms were identified and included in the search strategy. Only articles in the English language were included in the results (McCormack, 2010). An example of the search strategy is included as Appendix 1.
Relevant literature was identified by searching specialist hypnosis journals - American Journal of Clinical Hypnosis, Australia Journal of Clinical and Experimental Hypnosis, Australian Journal of Clinical Hypnotherapy and Hypnosis, Contemporary Hypnosis: the Journal of the British Society of Experimental and Clinical Hypnosis, European Journal of Clinical Hypnosis, International Journal of Clinical and Experimental Hypnosis and Sleep and Hypnosis. The Australian Journal of Hypnosis was rejected as it was not peer reviewed. An outline of the search strategy appears in Appendix 2: Search Strategies.
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Additionally, Cinahl, Cochrane, Health Source Nursing/Academic, Medline, PsycARTICLES, PsycINFO, and Scopus were searched to include other relevant sources that may provide peer reviewed articles which matched the selection criteria. Google Books, Google Scholar, Library of Congress, Lista, Pubmed, and Web of Science were used to support data retrieved if any additional information was required. The articles in English were searched using controlled vocabulary, Medical Subject Headings (MeSH) descriptors being Hypnosis, Treatment Outcome, Evaluation Studies, Hypnotic and Sedatives and free text terms.
The data returned then were subjected to a two tier filtering process. The first round was to determine if the article was generally relevant to hypnosis research. The second tier determined the article’s relevance and appropriateness to provide the data required for the literature review. The selected articles were then reviewed for relevance and veracity of the research.
The search strategy returned 1994 articles of which 211 were duplicates. The search criteria returned numerous medical articles referring to the term ‘hypnotic’ in accordance with medical conditions involving sleep. These articles were filtered from the results at the first level. These articles were assessed using levels of evidence and evidence hierarchy (NHMRC, 2009).
The articles were reviewed and categorised according to the type of research undertaken. There were a considerable number of anecdotal accounts which outline the benefits of clinical hypnotherapy yet these reviews lacked the research rigor required and did not provide sufficient empirical evidence to substantiate a claim of efficacy. The filtering process is outlined and concluded with 74 articles remaining.
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a.
Filtering Process
Database Search: 1994 Articles Reviewed articles by abstract Cinahl, Cochrane, Health Source removed non relevant 1756
`
Nursing/Academic, Medline,
Second filter process
Reviewed full articles
238 articles remained
removed 164 articles
Articles remaining 74 articles remained
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Although some may consider the Delphi methodology a lower level of evidence (CCNET, 2011), the scarcity of previous research in clinical hypnotherapy education makes a systematic review of all relevant literature less reliable. Hence the only suitable research approach is that that of ‘expert opinion’ The research methodology adopted was to canvas expert opinion as a means to 1. Understand the maturation of the profession over time; 2. Develop uniform professional training as an adjunct to existing skills; 3. Clearly identify of the qualifications, education and knowledge; 4. Provide differentiation within the profession; 5. Provide a common core of knowledge; 6. Encourage research and scientific inquiry; and prepare clinical hypnotherapy professionals for the 21st century.
The aim is to achieve consensus on topics which could be used this as a basis to determine the essential competencies for a clinical hypnotherapist.
5.2
Identifying Stakeholders
The stakeholders in clinical hypnotherapy were identified by previous involvement in the profession. Past activities were identified, such as: active participation in clinical hypnotherapy education (e.g. training institutions), professional acknowledgement of hypnotherapists (e.g. associations, health funds and professional indemnity insurance companies), previous governmental/institutional submission processes (SADH, 2008) (e.g. individuals or groups presenting submissions as well as the organisation requesting the submissions) or by involvement in professional activities (e.g. establishment of a clinical hypnotherapy peak body), reviewing professional journals, professional publications, advertising material and online content.
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Additional stakeholders were identified by searching the internet and reviewing relevant publications (PoSA, 2009a). This provided data indicating 12 profession specific clinical hypnotherapy associations and 37 teaching institutions in Australia. Many associations were established by teaching institutions (SADH, 2008) so there may be a situation where the representative of an association is also the owner of a teaching institution. Each association has their own membership requirements e.g. educational standards, code of ethics, mission statement to which their members are required to comply. Determining the exact number of stakeholders within this cohort is difficult, as is illustrated in the comment in the South Australian report (PoSA, 2009a, p. 33) “There are possibly 17 or more colleges………….”. Some institutions have VET sector accreditation but most do not. The educational requirements to complete each qualification are determined by each individual institution. The manner by which each institution establishes the requirements for each qualification may be determined by teachers who are also practitioners.
A good stakeholder panel is one which encompasses different perspectives and includes those who will be or are directly affected, those with specialist knowledge or experience, and those with alternative views (Linstone & Turoff, 2002). A wide range of stakeholders was invited to ensure that the significant difference between stakeholders (Campbell et al., 2004) was addressed. The selected stakeholder cohorts were: 1. Peak bodies (clinical hypnotherapy); 2. Peak bodies (with clinical hypnotherapy membership criteria); 3. Professional clinical hypnotherapy associations; 4. Professional associations with clinical hypnotherapy membership criteria ; 5. Clinical hypnotherapy teaching institutions (government Accredited); 6. Clinical hypnotherapy teaching institutions (not government Accredited); 7. Professional Indemnity Insurance Underwriters (who provide clinical hypnotherapy cover); 8. Health Funds (who provide clinical hypnotherapy cover);
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9. Government departments (who provide recognition of clinical hypnotherapy); 10. Clinical hypnotherapy practitioners; 11. Clinical hypnotherapy students; 12. Health professionals (who use clinical hypnotherapy as an adjunct to existing skills); and 13. Interested parties.
There are approximately 12 profession specific clinical hypnotherapy associations. Many associations were established by teaching institutions (SADH, 2008) so there may be a situation where the representative of an association is also the owner of a teaching institution. Each association has their own membership requirements e.g. educational standards, code of ethics, mission statement to which their members are required to comply.
Of the 39 institutions which teach hypnosis and/or clinical hypnotherapy, some have VET sector accreditation but most do not. The educational requirements to complete each qualification are determined by each individual institution. The manner by which each institution establishes the requirements for each qualification may be determined by teachers who are also practitioners.
The stakeholder categories were then researched using the internet, websites, journals and newsletters. Where the correct contact person was undefined the default contact person was the perceived head of the organisation or department.
Since the creation of a clinical hypnotherapy peak body some associations have relinquished their claim of peak body status on their websites. However some internal documents (AHA, 2010b) still promote their status as a peak body.
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The inclusion of these cohorts identifies a wide range of perspectives (S. Wilson & Moffat, 2010) on a wide range of topics and provides data which will be evaluated for a convergence of opinion (Hsu & Sandford, 2007a) and allow conclusions to be determined. With little or no existing research, the wide range of stakeholders provides responses on topics where there is a reliance on informed judgement (Yousuf, 2007).
5.2.1
Peak bodies
The clinical hypnotherapy profession established a peak body in June 2011 (HCA, 2012g). Other modality peak bodies in counselling and psychotherapy (ACA, 2010; PACFA, 2004) acknowledge clinical hypnotherapy and accept clinical hypnotherapists and members. The three bodies are
1. Hypnotherapy Council of Australia (HCA), 2. Australian Counselling Association (ACA), and 3. Psychotherapists and Counsellors Federation of Australia (PACFA).
5.2.2
Professional associations
The perspective of an association will differ markedly from that of other stakeholders. Associations have ongoing responsibilities to their members and the profession. These associations have entry criteria requirements for clinical hypnotherapy. Some are specialist clinical hypnotherapy organisations and others are allied in some way to clinical hypnotherapy. 1. Australasian Subconscious-mind Therapists’ Association (ASTA) 2. Australian Association of Clinical Hypnotherapy & Psychotherapy (AACHP) 3. Australian Association of Professional Hypnotherapists & NLP Practitioners Inc (AAPHAN) 4. Australian Hypnotherapists’ Association (AHA) 5. Australian Society of Clinical Hypnotherapists (ASCH)
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6. Australian-Traditional Medicine Society (ATMS) 7. Council of Clinical Hypnotherapists (CCH) – this organisation is now being incorporated in the HCA 8. Professional Clinical Hypnotherapists of Australia (PCHA) 9. Professional Hypnotists of Western Australia (PHWA) recently changed its name to Professional Hypnotherapists of Australia (PHA) Inc.
Some associations are specialist clinical hypnotherapy practitioner based (AHA, 2010a; ASCH, 2010c; PHWA, 2010) whilst others represent a number of therapeutic modalities which include clinical hypnotherapy (ATMS, 2013; CAPA., 2012). Others represent hypnotherapy organisations (HAQ, 2010; HCA, 2012g) and one organisation represents a combination of both (they administer a practitioner register and represent organisations) (CCH, 2013).
The roles of each association would differ in regard to those who they represent but their functions include: Ongoing professional development(AHJ, 2013a; ASCH, 2013a) 1. Workshops 2. Conferences 3. Supervision
Governance (AHA, 2013f; HCA - EP, 2012; HCA, 2012a) 1. Code of Ethics 2. Constitution 3. Minimum Standards of Education and Training
Profession’s communications (AHJ, 2013a; HCA, 2011b) 1. Updates
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2. Newsletter
Professional register (ASCH, 2013b; CCH, 2010; NHRA, 2010) 1. Membership Status 2. Levels of membership
Increasing standards (ACA, 2009; AHJ, 2013a) 1. Upgrading of Qualifications 2. Recognition of Prior Learning (RPL)
Submissions to government (AHA, 2013g; HCA, 2013b)
The role of the association would influence their perspective of the profession. The association’s role involves the ongoing management of the profession. They achieve this by using governance, ongoing professional development and monitoring professional educational standards. Hence their standpoint is unique.
5.2.3
Australian Teaching Institutions
These teaching institutions are comprised of those who have VET sector accreditation, those who have association accreditation and those who have both or neither. In (2008) a South Australian Department of Health report listed 19 institutions teaching clinical hypnotherapy in Australia. In 2013 the number has risen to over 35 but the number of teaching institutions can vary as previously noted (PoSA, 2009a, p. 33).
5.2.4
Additional Stakeholders
The stakeholders can be further dissected into categories and some into subcategories. The largest group of stakeholders are practitioners. Recent graduates who become clinical hypnotherapists hold a unique position by being able to assess the effectiveness
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of their training as they implement their techniques in the clinical setting. They can comment on whether they believe that their training should have included additional/different topics and if they are equipped to meet the requirements of the profession. They are the subject of the profession’s governance as they make their way in their new career. Clinical hypnotherapists who have been in practice over five years (or longer) have a long term view of the profession at the grass roots level. They are the recipients of all changes in the profession, required to undertake ongoing professional development and have a deeper understanding of the necessities of day to day practice. They provide a longer term view on what is required by the profession from a practitioner viewpoint and whether their training was appropriate to meet the needs of day to day practice.
The role of the educational institutions involves training the student to enter the profession and provide the foundation for continuing practise. The minimum training provides entry level qualifications for the profession. Because there is much diversity and no universally recognised educational standards for clinical hypnotherapy training in Australia (HCA, 2012e; PoSA, 2009e) and no Vocational Education Training (VET) sector training package, the choice of curricula is entirely the choice of the training institution. Therefore each school will have a distinctive view of the profession which would be reflected in their answers to the survey questions. The students who undertake courses provide the future view of the profession. They are the ones who will make the future changes, and what they learn now will affect the ongoing opportunities. Their expectations will fuel changes in clinical hypnotherapy education. They will be the future leaders of the profession and it will be their decision regarding issues such as recognition and accreditation which will shape the profession.
Various organisations accredit/recognise clinical hypnotherapy training and practitioners. Some do full accreditation audits such as the Australian Skills Quality Authority (ASQA)
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and others such as the New South Wales Community Services and Health Industry Training Advisory Board (NSWCSH-ITAB) in the capacity of a non-profit organisation advises government regarding education and training in the vocational sector (CSH-ITAB, 2013). The most directly involved is the Australian Skills Quality Authority (ASQA), as VET sector accreditation is achieved through that department (ASQA, 2013a). CSH-ITAB provides advice on ASQA educational requirements while other organisations undertake a less rigorous style of audit. These organisations are comprised of clinical hypnotherapy associations (AHA, 2013c; ASCH, 2010a; HCA, 2014b), associations affiliated with clinical hypnotherapy such as counselling (ACA, 2010; CAPA., 2012), psychotherapy (PACFA, 2004) and other health associations (ATMS, 2013). These accreditations/recognitions may impact on the view of other providers to the profession. These entities may provide services such as professional indemnity insurance, potentially use clinical hypnotherapy such as private health fund providers or WorkCover, or be a government department who has influence over the profession such as the Department of Health and Ageing (DOHA, 2012). The influence these entities exert over the profession (direct or indirect) gives them a distinct perspective. Two stakeholder groups indirectly influence the profession significantly. These groups are Private Health Fund providers (AHA, 2012; HCA, 2012g) and Professional Indemnity Insurance providers (AHA, 2012; HCA, 2012g). The associations seek health fund rebates as a mechanism for achieving more client consultations. Professional Indemnity Insurance is a requirement for membership of some associations (AHA, 2010b) and keeping the premiums low is an association aim.
A final group of stakeholders can be described as interested parties. They are other individuals who have a special interest in clinical hypnotherapy. These may be retired clinical hypnotherapists, clinical hypnotherapists who never belonged to a professional association, other health professionals use clinical hypnotherapy as an adjunct to their own professional skills but remain stakeholders because of their continued interest. Other health professionals such as counsellors and psychologists may have undertaken ongoing
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training in order to enhance their existing skills. Some modalities have sections of their professions devoted to clinical hypnotherapy (ACA, 2009; ASH, 2013a). These parties may be government departments, researchers, other referring health professionals and associates of clinical hypnotherapists who can provide an adjunctive view of the profession. An example is when reference is made to a change in policy or legislation which may impact clinical hypnotherapy as part of a larger cohort. An example of this is the Department of Health and Ageing (DOHA, 2012) when they called for submissions regarding the ‘Review of the Australian Government Rebate on Private Health Insurance for Natural Therapies’. These stakeholders are required because previous research in clinical hypnotherapy is sparse on which to base empirical evidence and almost nonexistent in clinical hypnotherapy education. Therefore the only valid methodology is to use an approach which examines existing professional and stakeholder opinion to determine a common core of knowledge though consensus. This can be achieved by surveying existing stakeholders within the profession of clinical hypnotherapy. The survey would invite all stakeholders to ensure the widest variety of opinions available (S. Wilson & Moffat, 2010) and thus increase the quantity of responses. With a greater volume of responses the validity of the consensus achieved will also increase (Hasson et al., 2000; Linstone & Turoff, 2002, p. 56).
5.3
Setting up the survey
The survey was designed to be delivered over the internet using Survey Monkey (SM, 2012b). Survey Monkey (SM) is an internet based survey development tool which provides delivery and analytical facilities for researchers undertaking web based surveys (SM, 2012a). Application of the Delphi methodology using an internet based survey instrument is enhanced because of the ease in administering the questionnaires.
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5.4
Applying the Delphi Methodology
The validity of Delphi methodology depends on the selection of ‘experts’. In this scenario ‘expert’ may relate to different levels of skill, knowledge and experience. To determine a baseline structure for clinical hypnotherapy education it is valid to extend the invitation to participate to all stakeholders. The research intention was to generate data (Yan & Tsang, 2005) which may be used to develop competencies, proficiencies and professional structures which will satisfy professional, governmental, commercial and social expectations of clinical hypnotherapists. Therefore, the invitation was extended to all stakeholders who satisfy these selection criteria. The fact that the panel consists of experts and non-experts in clinical hypnotherapy adds to the validity of the findings (Baker et al., 2006).This supports the validity and reliability of the Delphi methodology (Yousuf, 2007) and generates opinions from the broadest perspectives (Yousuf, 2007).
5.5
Delphi methodology: Number of survey rounds
Direction in the application of the Delphi Technique was taken from the literature (Bond & Bond, 1982; Campbell et al., 2004; Cuhls; T.J. Gordon, 1994; Gunaydin; Hasson et al., 2000; Hsu & Sandford, 2007a; Lindeman, 1975; Linstone & Turoff, 2002; McKenna, 1994; Randic et al., 2002; Thomson et al., 2009; Van Tulder et al., 1993; Van Tulder & Veenman, 1991; Ven & Delbecq, 1974; Werneke et al., 2005; West & Cannon, 1988; S. Wilson & Moffat, 2010; Wright, 2004; Yan & Tsang, 2005; Yousuf, 2007). The literature provided a framework for the style of survey questions and the number of survey rounds. As the Delphi method depends on consensus the number of rounds would be determined by the reaching of consensus (Yousuf, 2007). The initial round forms the basis for all other rounds.
5.6
Survey questions: Round one
Data to compile the round one survey questions were sourced from training institutions’ course curricula (accredited and non-accredited) which reflected associations’
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membership criteria. The data gathered was sorted into categories. The categories were determined by the number of occasions the theme appeared as an identified topic. Those categories were further distilled to general groupings based on whether the topic related to concepts, techniques, education, standards for practice, ethics or governance. The data were compiled to develop the round one questionnaire topics is foundational for all other rounds.
5.7
Round one questions: Distilling and grouping
The round one selection of topics was based on the frequency the topic appeared in the associations’ membership criteria and the topics included in the curricula from training institutions’. It was considered that existing accreditations could indicate aspects of quality assurance. Hence the selection criteria for topics on which the first Delphi round questionnaire would be based was from accredited teaching institutions and recognised associations. It was postulated that the hierarchy of training accreditations would be: 1. VET sector accreditation 2. Representative Professional Alliances accreditation 3. Professional association accreditation. The criterion for each organisation’s initial accreditation has not been determined. The current VET sector requirements are available (VETAB, 2010) but whether these were the prevailing requirements at the time of each VET sector accreditation has not been determined as VET sector requirements change and each accreditation occurred at different times.
Clinical hypnotherapy VET Sector Accreditations at that time existed for four Australian training institutions. Subsequently, more institutions have achieved vet sector accreditation. The selected training institutions with VET sector accreditations were 1. AAH
Academy of Applied Hypnosis – New South Wales Based government
accredited training
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2. ACH
Australian College of Hypnotherapy – New South Wales Based –
government accredited training 3. AHS
Academy of Hypnotic Sciences – Victorian based – government
accredited training 4. CA
Career Accelerators – Queensland Based – government accredited
training Since this data was collected, another course (Phoenix, 2013) was developed and achieved VET sector accreditation. This course has not been included in this original data. The course co-ordinator was invited to take participate in the surveys.
A category of ‘Representative Professional Alliances’ (HCA-WP, 2010) was established with the primary intention of acting as a representative body for a number of associations and/or educational organisations in Australia. The two Representative Professional Alliances that were active at the time were the Council of Clinical Hypnotherapists (which wound up on the 30 June 2011) (CCH, 2011) and the Hypnosis Association of Queensland.
As the Hypnosis Association of Queensland is a member of the Council of Clinical Hypnotherapists it was reasoned to use accreditations from the more senior representative alliance. The following are the Council of Clinical Hypnotherapists Member Training Associations: 1. AAH: Academy of Applied Hypnosis (previously included) 2. ACCH: Australian College of Clinical Hypnotherapy (name changed to Australian and Pacific College of Clinical Hypnotherapy) 3. EICH: Essex Institute of Clinical Hypnosis - Australia 4. MM: Mind Motivations & The Australian Academy of Hypnosis 5. NCNLC: National College of Neuro Linguistic Communication (no documents available)
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6. NCTM: National College of Traditional Medicine 7. TATP: The Academy of Transformational Psychotherapy One training institution was previously surveyed due an existing VET sector accreditation. The National College of Neuro Linguistic Communication at the time of compiling the round one questionnaire topics (3 January 2011) had no website available. Therefore no data from this institution were accessible.
Professional associations are organisations which have membership requirements for the profession; provide assessment of the practitioner in terms of the appropriate level of training and education required for professional practice; require relevant continuing professional development as a condition of practising membership, maintaining a code of ethics which all members must uphold in order to continue to be a member; and maintain a formal disciplinary procedure, which includes a process to suspend or expel members, inclusive of an appropriate complaints resolution procedure (HCA-WP, 2010). Professional associations are now embracing the more rigorous accreditations (ASCH, 2010e).
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Clinical hypnotherapy training institutions and themes The tables outline the number of times that each topic was mentioned on the nominated training institutions website course outline. Each table’s contents have been ranked to demonstrate a hierarchy of importance. The contents of each table will form the basis for the first Delphi questionnaire. The abbreviated training institutions institution names are: AAH Academy of Applied Hypnosis – NSW Based government accredited training EICH Essex Institute of Clinical Hypnosis - Australia ACCP Australian College of Clinical Hypnotherapy MM Mind Motivations & The Australian Academy of Hypnosis ACH Australian College of Hypnotherapy – NSW Based – government accredited training NCNLC National College of Neuro Linguistic Communication (no data available) AHS Academy of Hypnotic Sciences – Vic based – government accredited training NCTM National College of Traditional Medicine CA Career Accelerators – Qld Based – government accredited training TATP The Academy of Transformational Psychotherapy
Table 3: Clinical hypnotherapy training institutions Themes within clinical hypnotherapy training courses 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29.
Topic Eye movement desensitization and reprocessing (EMDR) Subconscious Mind Healing Personal Empowerment Semantics Rapport False Memory Syndrome Business Ego State Therapy Transactional Analysis Marketing Psychodynamics Pharmacology Human Sexuality Gestalt Hypnotherapy Theory Medical Sciences Ericksonian Hypnosis Legal requirements Metaphor Past Life Hypnotherapy Psychotherapy Ethics History of Hypnosis Practice Management Hypnotic Theory Hypnotic Phenomenon Psychology Counselling Treatment management Total
AAH
ACH 1 1
AHS
CA
ACCP
EICH
MM
NCNLC
NCTM
TATP
1 1 1
1 1
1
1
1 1
1 1 1
1 1 2
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 21
1
1 1 1
1 1 1
2 1 1 1 1
1 1
1
1 2
1 4
2 1 6 4 1 5 10 40
1
2
1 1 2 11
1 3 3 19
1 1 1 1 1 1
9 16
Table 4: Themes: Clinical hypnotherapy training courses
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1 1 1
2 1 1 1
1 4
1 1 8 1 6 23
7 6 4
1
1
6 26 51
1 1
0
8
2 3 8 24
Total 1 1 1 1 2 2 2 2 2 2 2 3 3 3 4 4 4 5 5 5 6 8 9 10 11 12 18 20 65
Techniques within clinical hypnotherapy training courses. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. 56. 57. 58. 59. 60. 61.
Topic Fertility Rapid Inductions Automatic Writing Hypnotapping Six Step Reframe Psychonutrition Emotional Freedom Tech (EFT) Scripts Luscher Test Fundamentals of Hypnosis Hypnoanalysis Dream Therapy Hypno-kinesiology Predicates Hypnoanalytical Techniques Ideomotor Questioning Waking Hypnosis Future Pacing Meta model Milton Model Anchors Susceptibility Progression Regression Reframing Practical Application Self-hypnosis Suggestion Post Hypnotic Suggestion Deepening NLP Induction Total
AAH
ACH
AHS
CA
ACCP
EICH
MM
NCNLC
NCTM
TATP
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 24
1 1 1 1 1 1 1
1 1 1
1 2 2 2 2
1
1 1 1 3 2 2 2 1 3 5 2 36
1
1 1 1
1 1
1 6
1 1
1 1
1 1 1 2
4
1 5
7
2 3 5 1 15 28
Table 5: Techniques within clinical hypnotherapy training courses.
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0
0
1 1 1 2 10
Total 0 1 1 1 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 3 3 4 4 4 4 5 5 6 7 10 11 21
The topics for the first round of the Delphi questionnaire were based on association membership criteria and topics included in the curricula from training institutions.
The Delphi round one questionnaire was therefore based on topics that the clinical hypnotherapy profession concluded to be the requirements to join the profession. These requirements were grouped into general categories (e.g. various types of induction were grouped as were various scripts) and these categories formed the basis for the first round questionnaire.
5.8
Round one: Process
The first round was to establish the categories which the cohort considered appropriate material and underpinned the narrowing focus of the subsequent rounds (Linstone & Turoff, 2002). The subsequent questionnaires would be somewhat self-determined by the consensus from the previous rounds. Using consensus as the self-selection criteria each subsequent round would include expanded categories which achieved consensus in the previous round (Linstone & Turoff, 2002).
The profession itself has provided the model for consensus. In the 25th July 2010 Hypnotherapy Council of Australia Working Party meeting it was agreed that the vote to pass any resolution should be 85% (HCA-WP, 2010). The meeting reasoned that 85% would constitute the majority of the profession so matters with this majority would be supported by the major part of the profession. As the profession has defined consensus in this manner it would be appropriate to use this as the accepted definition of consensus for this research.
The number of rounds required is dependent on when consensus or stability of results is achieved. Guidelines for up to four rounds (Hsu & Sandford, 2007a) were assessed as a
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potential model for the collection of data even though potentially more/less than four rounds may be needed to achieve consensus as the panellists are stakeholders with different perspectives of the profession.
At each round the responses would be analysed and would be assessed by the researcher to determine if consensus of 85% had been achieved. Those responses which achieve consensus would be returned in the next round stating that consensus had been achieved and no further response was required. The responses which did not achieve consensus would be returned in the next round showing the number and percentage each category on the Likert Scale achieved and the panellist were asked to respond again. This analysis of responses would continue for each round of the survey until consensus or stability of results was achieved.
Typically Delphi Surveys are comprised of two to four rounds (Benton et al., 2013). In round 1, questions of a general nature gain responses that provide the impetus for the more specific questions which follow in the later rounds. The topics which achieved consensus were noted as achieving consensus and no response was required in the next round. The round 2 questionnaire was a summary and extension of the topics which achieved consensus in the first round. This gave the panel the opportunity to further rate the topics. In that round, areas of agreement and disagreement formed. These then formed outcomes or served as the basis for round 3 questions. In round 3, the panel often summarised the consensus and non-consensus previously determined. That gave the panellists a further opportunity for clarification of their decisions and previous determinations. It is expected that there will be a ratification of the existing consensus. The fourth round is often the final round when remaining items are distributed to the panellists. This is the round when they reconfirm previous decisions. It is at this point that the panellists (stakeholders with different perspectives) will have achieved consensus.
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The number of rounds required to achieve consensus and/or stability of responses cannot be determined until the research is undertaken.
5.9
Stakeholder: Email
The identified stakeholders (100) were invited to participate by an email. Professional associations were requested to extend the invitation to their members and teaching institutions were requested to extend the invitation to their students and graduates. Government Departments and larger organisations were requested to forward the email to the appropriate person within that domain.
Three invitation emails were sent to potential participants and three invitations were sent through associations. After the cohort was identified and had registered, three emails (one invitation and two reminders) were sent for the round 1 survey. The round two survey incorporated three emails (one invitation and two reminders) to elicit responses from the cohort.
5.10
Email: Participation
The invitation email was sent to each stakeholder Appendix 1: Office of Research Services: Ethics Approval in October 2012 and contained a link to Survey Monkey (SM). The SM page gave complete information regarding the research and invited them to complete a consent form (Appendix 2) which registered them to participate in the survey. The first invitation yielded 19 responses that consented to participate in the survey. The second email was sent between November 9, 2012 and November 14, 2012, and yielded 27 responses.. The final invitation was emailed on December 10, 2012 and 40 responses were received. Some late responses were received and in total 87 stakeholders consented to participate in the four rounds of research.
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The data were analysed at the end of each round. The first round compiled the responses into consensus and no consensus. The questions which achieved consensus were returned to the cohort in the second round but no response was required. The questions which did not achieve consensus were returned to the cohort in the second round with the responses from round one. The cohort was asked to review the questions in round two with consideration to the responses from round one. The round two responses were then exported into Statistical Package for the Social Sciences (SPSS) (version 21 IBM New York) for further analysis. The relevant data were extracted and presented as results.
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6 Results 6.1
Introduction
The issues presented in this thesis address clinical hypnotherapy training. While hypnosis has been used as a therapeutic modality for centuries, reports on any systematic professional training are rare (D. M. Wark & Kohen, 2002). With little information or research available on clinical hypnotherapy training, alternative valid sources of clinical hypnotherapy pedagogy are scarce. To address this lack of information, research has been undertaken to seek expert opinion leading to expert consensus on aspects of professional education. This approach has been used in similar professional situations and has been productive, and this methodology is germane for research within clinical hypnotherapy (Elkins & Hammond, 1998; Low-Beer et al., 2010).
Broadly, the issues associated with training include competency (Jackson et al., 2007), quality assurance (COAG, 2009; Grove, 2012) and best practice considerations (Hansen, 2006). When the perspective is narrowed, the issues become more precise and involve training deliberation in areas of ethics (AHA, 2013f; Kelly, 2012), governance (COAG, 2008b, 2009; HCA, 2012b, 2012e), clinical hypnotherapy concepts, techniques, practical application and education (Elkins & Hammond, 1998; Oster, 1998). Within each category there are multidimensional aspects which encapsulate intrinsic issues such as professionalism (Muzio & Kirkpatrick, 2011; Surdyk, Lynch, & Leach, 2003), best practice (Hansen, 2006) and regulation (Khoury, 2009; MM, 2009). Drawing on the model used to form the first standard curriculum of the American Society of Clinical Hypnosis standard curriculum (Elkins & Hammond, 1998; Hammond & Elkins, 1994) will provide an outline for further investigation of these results. As each category has multidimensional aspects which intersect, the data will thus be reported in a unified format.
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6.2
Results details
The questions are outlined and colour coded for ease of identification. The colour legend for tables is as follows: Consensus - 1st Round (C1) Consensus – 2nd Round (C2) High Agreement (HA) 77%-84.99% No Consensus (NC).
The abbreviations indicate ‘C1’ consensus in the 1st Round, ‘C2’ consensus in the 2nd Round, ‘HA’ high agreement, ‘NC’ no consensus, ‘SA’ indicates Strongly Agree, ‘A’ indicates Agree, ‘D’ indicates Disagree and ‘SD’ indicates Strongly Disagree.
The percentage of agreement was calculated by adding Strongly Agree and Agree together or adding Disagree and Strongly Disagree to establish the agreement or consensus.
Indented questions with the letter ‘s’, indicate questions that were added for the second round. The identifying numbers of each question changed in the second round because of the additional questions and the removal of questions that achieved consensus in the first round. Questions dealing with administrative issues such as name, address, etc. have been excluded from the list.
A summary of the results is outlined, then divided by topics with a synthesis of related questions from all sections of the survey. The survey questions will be presented with the responses, percentages obtained and whether that question achieved consensus in round 1 (C1), consensus in round 2 (C2), high agreement (HA) or no consensus (NC). The survey will then be divided into topics. Each topic will then be associated to the relevant
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survey questions and analysed. The topics will be presented and a discussion with a brief conclusion as a final summary. The categories of concepts, techniques and practical will be presented as sections of curricula being fundamental, intermediate and advanced to illustrate the progression of skills through training (Hammond & Elkins, 1994).
Some percentages may not equal 100% due to rounding to one decimal point.
#
Question
SA
A
D
SD
Result
3
Ethics needs to be taught
39
15
1
1
C1
(69.6%)
(26.8%)
(1.8%)
(1.8%)
Ethical safeguards should
37
18
1
0
be included in the training
(66.1%)
(32.1%)
(1.8%)
(0%)
40
16
0
0
(71.4%)
(28.6%)
(0%)
(0%)
35
21
0
0
(62.5%)
(37.5%)
(0%)
(0%)
44
12
0
0
(78.6%)
(21.4%)
(0%)
(0%)
7
14
12
2
(20.0%)
(40.0%)
(34.3%)
(5.7%)
within clinical hypnotherapy training. 4
C1
of clinical hypnotherapists. 5
Ethical considerations are required within a
C1
hypnotherapy training course. 6
A Code of Practice is required by the profession
C1
of clinical hypnotherapy. 7
Ethical practice is required within the profession of
C1
clinical hypnotherapy. 8s
Clinical hypnotherapy requires one self governing peak body
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NC
9.
Clinical hypnotherapy
1
21
22
8
(1.9%)
(40.4%)
(42.3%)
(15.4%)
7
18
10
1
(19.4%)
(50.0%)
(27.8%)
(2.8%)
Clinical hypnotherapy
0
6
21
8
requires several peak
(0.0%)
(17.1%)
(60.0%)
(22.9%)
17
26
7
2
(32.7%)
(50%)
(13.5%)
(3.8%)
1
6
20
9
(2.8%)
(16.7%)
(55.6%)
(25.0%)
11
13
21
7
(21.2%)
(25.0%)
(40.4%)
(13.5%)
15
36
0
0
(29.4%)
(70.6%)
(0%)
(0%)
19
28
4
1
(36.5%)
(53.8%)
(7.7%)
(1.9%)
requires several self
NC
governing peak bodies 9s
Clinical hypnotherapy requires one peak
NC
body 10s
HA
bodies 10.
Clinical hypnotherapy qualifications should be
HA
standardised across Australia 11s
Clinical hypnotherapy requires several self
HA
governing peak bodies 11.
Clinical hypnotherapy should be registered by
NC
government 12.
Governance involves quality assurance
C1
guidelines 13.
Governance involves best practice guidelines
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C1
14.
Quality assurance is
22
24
5
1
necessary within the
(42.3%)
(46.2%)
(9.6%)
(1.9%)
1
4
19
10
(2.9%)
(11.8%)
(55.9%)
(29.4%)
2
4
20
9
(5.7%)
(11.4%)
(57.1%)
(25.7%)
21
22
6
0
(42.9%)
(44.9%)
(12.2%)
(0%)
Quality Assurance is not
0
6
31
14
required for associations
(0%)
(11.8%)
(60.8%)
(27.5%)
C1
profession of clinical hypnotherapy 14s.
Quality Assurance is not necessary for
C2
practitioners to receive health fund rebates 15s.
Best Practice is not necessary for
HA
practitioners to receive health fund rebates 16.
Best Practice is necessary within the profession of
C1
clinical hypnotherapy 17.
giving recognition to teaching institution
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C!
18s
Accredited
11
21
4
0
(30.6%)
(58.3%)
(11.4%)
(0%)
9
22
4
0
(25.7%)
(62.9%)
(11.4%)
(0%)
5
18
9
4
(13.9%)
(50.0%)
(25.0%)
(11.1%)
Professional credibility is
9
18
9
1
based upon qualifications
(24.3%)
(48.6%)
(24.3%)
(2.7%)
7
23
4
1
(20.0%)
(65.7%)
(11.4%)
(2.9%)
2
9
17
8
(5.2%)
(25.0%)
(47.2%)
(22.2%)
qualifications will be
C2
the future standard for the clinical hypnotherapy profession 19.
Good governance will effect whether clinical
C2
hypnotherapy receives professional acknowledgement 20.
VET sector accredited qualifications will be the
NC
future standard for the clinical hypnotherapy profession 21.
22.
Entry level into clinical hypnotherapy should be at
NC
C2
an industry defined training standard 23.
Entry level into clinical hypnotherapy should be a government accredited Cert IV standard
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NC
24.
Entry level into clinical hypnotherapy requires a
1
10
15
9
(2.9%)
(28.6%)
(42.9%)
(25.7%)
0
5
23
8
(0.0%)
(13.9%)
(63.9%)
(22.2%)
3
4
21
8
(8.3%)
(11.1%)
(58.3%)
(22.2%)
1
13
16
6
(2.8%)
(36.1%)
(44.4%)
(16.7%)
3
8
22
2
(8.3%)
(22.2%)
(61.1%)
(8.3%)
2
16
13
6
(5.4%)
(43.2%)
(35.1%)
(16.2%)
NC
government accredited Diploma standard 25.
Entry level into clinical hypnotherapy requires a
C2
government accredited Advanced Diploma standard 26.
Entry level into clinical hypnotherapy requires a
HA
government accredited Degree standard 27.
Training in clinical hypnotherapy should be at
NC
the Vocational Education Training level (TAFE level education based on occupation or employment called vocational education) 28.
Training in clinical hypnotherapy should be at
NC
the Higher Education level (University level) 29.
Clinical hypnotherapy is a subset of other professional modalities
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NC
30.
31.
Self regulation of clinical
14
32
4
1
hypnotherapy is required
(27.5%)
(62.7%)
(7.8%)
(2.0%)
Self regulation of clinical
6
26
4
0
(16.7%)
(72.2%)
(11.1%)
(0.0%)
External recognition of
10
28
10
2
clinical hypnotherapy is
(20.0%)
(56.0%)
(20.0%)
(4.0%)
External recognition of
3
20
14
0
clinical hypnotherapy is
(8.1%)
(54.1%)
(37.8%)
(0.0%)
External recognition of
0
8
22
6
clinical hypnotherapy is
(0.0%)
(22.2%)
(61.1%)
(16.7%)
External recognition of
0
21
11
4
clinical hypnotherapy is
(0.0%)
(58.3%)
(30.6%)
(11.4%)
9
19
8
2
(23.7%)
(50.0%)
(21.1%)
(5.3%)
hypnotherapy ‘qualification
C1
C2
names’ is required 32.
NC
based upon qualifications 33.
NC
based upon peer reviewed research 34.
HA
based upon commercial considerations 35.
NC
based upon public demand 36.
Use of ‘Diploma’ and ‘Advanced Diploma’ titles by non VET sector organisations is creating confusion.
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NC
37s
Suggestion is the
4
25
12
1
(9.5%)
(59.5%)
(28.6%)
(2.4%)
39
14
3
0
(69.6%)
(25.0%)
(5.4%)
(0.0%)
Direct suggestion is the
0
4
32
7
primary methodology for
(0.0%)
(9.3%)
(74.4%)
(16.3%)
7
30
4
0
(17.1%)
(73.2%)
(9.8%)
(0.0%)
Marketing skills are
6
29
8
0
required by clinical
(14.0%)
(67.4%)
(18.6%)
(0.0%)
42
13
1
0
(75.0%)
(23.2%)
(1.8%)
(0.0%)
30
24
0
1
(54.5%)
(43.6%)
(0.0%)
(1.8%)
primary methodology
NC
for clinical hypnotherapists 38.
Clinical hypnotherapy requires counselling skills
39.
C2
C2
clinical hypnotherapists 40.
Business management skills are required by clinical
C1
hypnotherapists 41.
HA
hypnotherapists 42.
Practical work should be included in clinical
C1
hypnotherapy training 43.
Preparing the client prior to the first induction is required within a hypnotherapy training course
page 90 of 346
C1
44.
History of hypnosis is
40
40
6
0
(17.9%)
(71.4%)
(10.7%
(0.0%)
23
31
2
0
(41.1%)
(55.4%)
(3.6%)
(0.0%)
6
17
18
0
(14.3%)
(41.5%)
(43.9%)
(0.0%)
29
24
2
0
(52.7%)
(43.6%)
(3.6%)
(0.0%)
The terms ‘hypnosis’ and
0
3
34
16
‘hypnotherapy’ mean the
(0.0%)
(5.7%)
(64.2%)
(30.2%)
22
30
3
0
(40.0%)
(54.5%)
(5.5%)
(0.0%)
required within a
C1
hypnotherapy training course 45.
Self hypnosis: how & what to teach patients is required
C1
within a hypnotherapy training course 46.
‘Hypnosis is viewed not as an independent science,
NC
but as an adjunct to the range of treatment modalities for a wide range of medical, psychological, dental and therapeutic applications’ 47.
Inductions are essential for clinical hypnotherapy
C1
training 48.
C1
same thing 49.
Psychotherapeutic concepts are required in clinical hypnotherapy training
page 91 of 346
C1
50.
Clinical hypnotherapists require knowledge of
22
25
8
0
(40.0%)
(45.5%)
(14.5%)
(0.00%)
18
31
6
0
(32.7%)
(56.4%)
(10.9%)
(0.0%)
5
28
7
0
(12.5%)
(70.0%)
(17.5%)
(0.0%)
3
31
7
0
(7.3%)
(75.6%)
(17.1%)
(0.0%)
6
28
8
0
(14.3%)
(66.7%)
(19.0%)
(0.0%)
20
36
0
0
(35.7%)
(64.3%)
(0.0%)
(0.0%)
13
37
5
1
(23.2%)
(66.1%)
(8.9%)
(1.8%)
11
36
6
2
(20.0%)
(65.5%)
(10.9%)
(3.6%)
C1
psychology 51.
Clinical hypnotherapists require knowledge of
C1
psychotherapy 52.
Clinical hypnotherapists require knowledge of
HA
medical sciences 53.
Clinical hypnotherapists require knowledge of
HA
pharmacology 54.
Clinical hypnotherapists require knowledge of
HA
human sexuality 55.
Clinical hypnotherapists require knowledge of legal
C1
requirements in a health practice 56.
Clinical hypnotherapists require knowledge of
C1
susceptibility techniques 57.
Clinical hypnotherapists require knowledge of hypnoanalysis
page 92 of 346
C1
58.
Clinical hypnotherapy should include training in
2
19
15
8
(4.5%)
(43.2%)
(34.1%)
(18.2%)
2
2
30
22
(3.6%)
(3.6%)
(53.6%)
(39.3%)
5
24
11
2
(11.9%)
(57.1%)
(26.2%)
(4.8%)
20
33
2
0
(36.4%)
(60.0%)
(3.6%)
(0.0%)
1
5
25
12
(2.3%)
(11.6%)
(58.1%)
(27.9%)
12
27
2
1
(28.6%)
(63.4%)
(4.8%)
(2.4%)
15
35
3
2
(27.3%)
(63.6%)
(5.5%)
(3.6%)
NC
past life work 59.
Clinical safeguards should not be included in the
C1
training of clinical hypnotherapists 60.
Scripts are an integral part of clinical hypnotherapy
NC
training 61.
Hypnotic phenomenon is a required part of clinical
C1
hypnotherapy training 62.
Clinical hypnotherapy training does not require
C2
national standards 62s.
Training a client in self hypnosis should be
C2
part of clinical hypnotherapist training 63.
A definition of hypnosis is required in training programs
page 93 of 346
C1
64.
Myths and misconceptions
24
32
0
0
need to be discussed within
(42.9%)
(57.1%)
(0.0%)
(0.0%)
21
31
1
0
(39.6%)
(58.5%)
(1.9%)
(0.0%)
20
34
1
0
(36.4%)
(61.8%)
(1.8%)
(0.0%)
25
30
0
0
(45.5%)
(54.5%)
(0.0%)
(0.0%)
Rapid inductions
8
27
5
2
should be part of
(19.0%)
(64.3%)
(11.9%)
(4.8%)
18
36
2
0
(32.1%)
(64.3))
(3.6%)
(0.0%)
C1
a hypnotherapy training course 65.
Hypnotic phenomena & their potential usefulness is
C1
required within a hypnotherapy training course 66.
Working with hypnotic phenomenon is required
C1
within a hypnotherapy training course 67.
Principles of induction are required within a
C1
hypnotherapy training course 67s
HA
clinical hypnotherapy training 68.
Theories of hypnosis are required within a hypnotherapy training course
page 94 of 346
C1
69.
Awakening procedures from
23
30
1
0
(42.6%)
(55.6%)
(1.9%)
(0.0%)
53
33
2
1
(94.6%)
(58.9%)
(3.6%)
(1.8%)
29
26
0
1
(51.8%)
(46.4%)
(0.0%)
(1.8%)
Principles in formulating
27
29
0
0
hypnotic suggestions are
(49.20%)
(51.8%)
(0.0%)
(0.0%)
24
30
1
0
(43.6%)
(54.5%)
(1.8%)
(0.0%)
the hypnotic state is
C1
required within a hypnotherapy training course 70.
Understanding the stages (levels) of hypnosis is
C1
required within a hypnotherapy training course 71.
Deepening techniques are required within a
C1
hypnotherapy training course 72.
C1
required within a hypnotherapy training course 73.
Decision making strategies in selecting techniques is required within a hypnotherapy training course
page 95 of 346
C1
74.
Hypnosis for treating
6
11
18
7
(14.3%)
(26.2%)
(42.9%)
(16.7%)
Forensic & investigative
3
16
22
3
hypnosis techniques are
(6.8%)
(36.4%)
(50.0%)
(6.3%)
4
28
12
0
(9.1%)
(63.6%)
(27.3%)
(0.0%)
2
17
22
3
(4.5%)
(38.6%)
(50.0%)
(6.8%)
5
29
9
1
(11.4%)
(65.9%)
(20.5%)
(2.3%)
12
28
4
0
(27.3%)
(63.6%)
(9.1%)
(0.0%)
1
28
12
3
(2.3%)
(63.6%)
(27.3%)
(6.8%)
severely mentally disturbed
NC
patients is required within hypnotherapy training 75.
NC
required within a hypnotherapy training course 76.
Working with group hypnosis is required within
NC
a hypnotherapy training course 77.
Designing and conducting clinical research is required
NC
within a hypnotherapy training course 78.
Working within a heath care team is required in clinical
HA
hypnotherapy training 79.
Observation of actual client cases is required within a
C2
hypnotherapy training course 80.
The word trance is confusing for clients
page 96 of 346
NC
81.
Self hypnosis for personal
8
30
3
2
(18.6%)
(69.8%)
(7.0%)
(4.7%)
13
26
5
0
(29.5%)
(59.1%)
(11.4%)
(0.0%)
5
34
4
1
(11.4%)
(77.3%)
(9.1%)
(2.3%)
Health issues client intake
19
32
1
2
sheet and treatment plan is
(35.2%)
(59.3%)
(1.9%)
(3.7%)
25
28
3
0
(44.6%)
(50.0%)
(5.4%)
(0.0%)
33
23
0
0
(58.9%)
(41.1%)
(0.0%)
(0.0%)
use is required within a
C2
hypnotherapy training course 82.
Training to teach self hypnosis is required within
C2
a hypnotherapy training course 83.
Ericksonian hypnosis is required within a
C2
hypnotherapy training course 84.
C1
required within a hypnotherapy training course 85.
Working within a therapeutic framework is
C1
required within a hypnotherapy training course 86.
Rapport building (Therapeutic Alliance) with the client is required within hypnotherapy training
page 97 of 346
C1
86.
Rapport building
33
23
0
0
(58.9%)
(41.1%)
(0.0%)
(0.0%)
29
26
0
0
(52.7%)
(47.3%)
(0.0%)
(0.0%)
Deepening the hypnotic
54
30
0
1
state is required within a
(98.1%)
(54.5%)
(0.0%)
(1.8%)
20
32
2
1
(36.4%)
(58.2%)
(3.6%)
(1.8%)
17
32
4
2
(30.9%)
(58.2%)
(7.3%)
(3.6%)
33
23
0
0
(58.9%)
(41.1%)
(0.0%)
(0.0%)
(Therapeutic Alliance) with
C1
the client is required within hypnotherapy training 87.
Dealing with abreactions is required within a
C1
hypnotherapy training course 88.
C1
hypnotherapy training course 89.
Practice management forms (e.g. Client intake
C1
sheet) are required within hypnotherapy training 90.
Treatment plans are required within a
C1
hypnotherapy training course 91.
Ethical issues are a required topic within a hypnotherapy training course
page 98 of 346
C1
92.
Ego strengthening is required within a
20
30
3
1
(37%)
(55.6%)
(5.6%)
(1.9%)
3
21
12
5
(7.3%)
(51.2%)
(29.3%)
(12.2%)
18
31
6
1
(32.1%)
(55.4%)
(10.7%)
(1.8%)
24
32
0
0
(42.9%)
(57.1%)
(0.0%)
(0.0%)
4
2
31
19
(7.4%)
(3.7%)
(57.4%)
(35.2%)
C1
hypnotherapy training course 93.
Neuro LinguisticProgramming is required
NC
within a hypnotherapy training course 94.
Occupational health and safety policies are required
C1
within a hypnotherapy training course 95.
Work within a legal and ethical framework is
C1
required within a hypnotherapy training course 96.
A variety or hypnotherapeutic concepts is not required within a hypnotherapy training course
page 99 of 346
C1
97.
Working within a structured
7
30
4
1
(16.7%)
(71.4%)
(9.5%)
(2.4%)
The depth of training in
19
34
2
0
clinical hypnotherapy is
(34.5%)
(61.8%)
(3.6%)
(0.0%)
26
28
0
0
(41.8%)
(51.9%)
(0.0%)
(0.0%)
32
22
0
0
(59.3%)
(40.7%)
(0.0%)
(0.0%)
22
29
2
1
(40.7%)
(53.7%)
(3.7%)
(1.9%)
23
9
1
(56.1%)
(22.0%)
(2.4%)
counselling process is
C2
required within a hypnotherapy training course 98.
C1
important (e.g. reasons to use particular techniques) 100.
Fundamental techniques should be included in
C1
clinical hypnotherapy training 101.
Practical application of techniques is required in
C1
clinical hypnotherapy training 102.
Hypnoanalytical techniques should be included in
C1
clinical hypnotherapy training 103.
Training a client in self hypnosis is an essential
(19.5%)
part of clinical hypnotherapist training
page 100 of 346
NC
104.
Demonstrating hypnotic
29
26
0
0
(52.7%)
(47.3%)
(0.0%)
(0.0%)
19
29
3
1
(36.5%)
(55.8%)
(5.8%)
(1.9%)
Hypnotic techniques with
20
32
1
0
pain are required within a
(27.7%)
(60.4%)
(1.9%)
(0.0%)
15
33
4
1
(28.3%)
(62.3%)
(7.5%)
(1.9%)
Formulating therapeutic
29
26
0
0
suggestions is required
(52.7%)
(47.3%)
(0.0%)
(0.0%)
4
25
14
1
(9.1%)
(56.8%)
(31.8%)
(2.3%)
inductions is required within
C1
a hypnotherapy training course 105.
Methods of egostrengthening are required
C1
within a hypnotherapy training course 106.
C1
hypnotherapy training course 107.
Hypnotic susceptibility techniques are required
C1
within a hypnotherapy training course 108.
C1
within a hypnotherapy training course 109.
Rehearsing scripts is beneficial for the practice of clinical hypnotherapy
page 101 of 346
NC
110.
Using hypnotherapy
4
35
4
2
(8.9%)
(77.8%)
(8.9%)
(4.4%)
17
28
6
1
(32.7%)
(53.6%)
(11.5%)
(1.9%)
12
37
3
2
(22.2%)
(68.5%)
(5.6%)
(3.7%)
Induction and deepening
27
26
0
1
techniques are required
(50.0%)
(48.1%)
(0.0%)
(1.9%)
27
26
0
0
(50.9%)
(49.1%)
(0.0%)
(0.0%)
2
23
15
0
(5.0%)
(57.5%)
(37.5%)
(0.0%)
terminology to
C2
communicate with others is required within a hypnotherapy training course 111.
Self hypnosis is required topic within a hypnotherapy
C1
training course 112.
Susceptibility techniques are required within a
C1
hypnotherapy training course 113.
C1
within a hypnotherapy training course 114.
Creating basic suggestions is required within a
C
hypnotherapy training course 115.
Rehearsing practice management skills are required within a hypnotherapy training course
page 102 of 346
NC
116.
Inductions are required
25
28
1
0
within a hypnotherapy
(46.3%)
(51.9%)
(1.9%)
(0.0%)
4
21
15
4
(9.1%)
(47.7%)
(34.1%)
(9.1%)
20
30
1
0
(39.2%)
(58.8%)
(2.0%)
(0.0%)
20
29
3
1
(37.7%)
(54.7%)
(5.7%)
(1.9%)
23
29
1
0
(43.4%
(54.7%)
(1.9%)
(0.0%)
13
32
6
1
(25.0%)
(61.5%)
(11.5%)
(1.9%)
16
32
4
0
(30.8%)
(61.5%)
(7.4%)
(0.0%)
C1
training course 117.
Rapid inductions are essential competencies for
NC
clinical hypnotherapy training 118.
Post hypnotic suggestion is required within a
C1
hypnotherapy training course 119.
Therapeutic metaphors are required within a
C1
hypnotherapy training course 120.
Creating suggestions is required within a
C1
hypnotherapy training course 121.
Waking hypnosis is required within a
C1
hypnotherapy training course 122.
Sensory language is required within a hypnotherapy training course
page 103 of 346
C1
123.
Psychotherapy (e.g. NLP,
1
7
29
17
(1.9%)
13.0%)
(53.7%)
(31.5%)
2
3
25
23
(3.8%)
(5.7%)
(47.2%)
(43.4%)
Composing patter for each
16
27
2
0
individual client is required
(35.6%)
(60.0%)
(4.4%)
(0.0%)
31
24
0
0
(56.4%)
(43.6%)
(0.0%)
(0.0%)
Demonstrations of deep
12
26
4
1
trance phenomenon are
(27.9%)
(60.5%)
(9.3%)
(2.3%)
Practical work is not
1
3
19
32
required in a clinical
(1.8%)
(5.5%)
(34.5%)
(58.2%)
Ego State Therapy or
C1
Gestalt) techniques should not be practised in clinical hypnotherapy training 124.
Counselling techniques should not be practised in
C1
clinical hypnotherapy training 125.
C2
in clinical hypnotherapy training 127.
Formulating hypnotic suggestions is required
C1
activity within a hypnotherapy training course 128.
C2
required within a hypnotherapy training course 129.
hypnotherapy training course
page 104 of 346
C1
130.
Demonstrations and
37
18
0
0
(67.3%)
(32.7%)
(0.0%)
(0.0%)
Preparing a treatment plan
18
33
3
1
for case studies is required
(32.7%)
(60.0%)
(5.5%)
(1.8%)
17
35
3
0
(30.9%)
(63.6%)
(5.5%)
(0.0%)
7
29
7
1
(15.9%)
(65.9%)
(15.9%)
(2.3%)
6
30
9
1
(13.0%)
(65.2%)
(19.6%)
(2.2%)
33
21
0
0
(61.1%)
(38.9%)
(0.0%)
(0.0%)
practical exercises are
C1
required within a hypnotherapy training course 131.
C1
within a hypnotherapy training course 132.
Make referrals to health care professionals is
C1
required within a hypnotherapy training course 133.
Business planning is required within a
HA
hypnotherapy training course 134.
Marketing is required within a hypnotherapy training
HA
course 135.
Demonstration of practical skills is required within a hypnotherapy training course
page 105 of 346
C1
136.
Assessment of practical
28
25
1
0
skills is required within a
(51.9%)
(46.3%)
(1.9%)
(0.0%)
7
37
2
0
(15.2%)
(80.4%)
(4.3%)
(0.0%)
1
7
23
24
(1.8%)
(12.7%)
(41.8%)
(43.6%)
A clinical hypnotherapist
30
25
0
1
requires specific skills to
(53.6%)
(44.6%)
(0.0%)
(1.8%)
0
8
28
10
(0.0%)
(17.4%)
(60.9%)
(21.7%)
0
9
26
12
(0.0%)
(19.1%)
(55.3%)
(25.5%)
1
6
32
16
(1.8%)
(10.9%)
(58.2%)
(29.1%)
C1
hypnotherapy training course 137.
Case consultation conferences within a
C2
workshop or class format is required in hypnotherapy training 138.
Supervision is not required in a clinical hypnotherapy
C1
training program 140.
C1
enter the profession 141.
Current educational standards are not impacting
HA
on the profession. 142.
Standardised clinical hypnotherapy training is not
HA
required in Australia 143.
Clinical hypnotherapy educators do not require their skills and competencies to be assessed
page 106 of 346
C1
144.
Developing a clinical
2
10
25
9
(4.3%)
(21.7%)
(54.3%)
(19.6%)
1
12
27
7
(2.1%)
(25.5%)
(57.4%)
(14.9%)
1
2
39
15
(1.8%)
(3.5%)
(68.4%)
(26.3%)
22
33
2
0
(38.6%)
(57.9%)
(3.5%)
(0.0%)
Quality Assurance of
17
33
5
1
training institutions is
(30.4%)
(58.9%)
(8.9%)
(1.8%)
19
36
1
1
(33.3%)
(63.2%)
(1.8%)
(1.8%)
hypnotherapy educational
NC
pathway is not required in Australia (e.g. From non VET training to VET training to Higher Education) 145.
Articulation from non government accredited
NC
training into government accredited training is not required in Australia 146.
Recognition of Prior Learning (RPL) is not
C1
necessary within the profession of clinical hypnotherapy 147.
Assessment of competencies is required at
C1
all levels of training 148.
C1
required in the profession of clinical hypnotherapy 149.
Assessment is a method of ensuring competency in clinical hypnotherapy training
page 107 of 346
C1
150.
Clinical hypnotherapists
20
22
4
1
(42.6%)
(46.8%)
(8.5%)
(2.1%)
18
34
3
1
(32.1%)
(60.7%)
(5.4%)
(1.8%)
10
41
2
3
(17.9%)
(73.2%)
(3.6%)
(5.4%)
19
35
3
0
(33.3%)
(61.4%)
(5.3%)
(0.0%)
Clinical hypnotherapy
21
33
2
0
trainers require more
(37.5%)
(58.9%)
(3.6%)
(0.0%)
20
35
2
0
(35.1%)
(61.4%)
(3.5%)
(0.0%)
require ongoing supervision 151.
Clinical hypnotherapy supervisors require
C2
C1
specialised training 152.
Clinical hypnotherapy needs to consider external
C1
stakeholders (Health Funds/Professional Indemnity Insurance) when considering professional standards 153.
Clinical hypnotherapy trainers require higher level
C1
skills than those they are training. 154.
C1
practical experience than those they are training 155.
Clinical hypnotherapy supervisors require higher level skills than those they are supervising
page 108 of 346
C1
156.
Clinical hypnotherapy
24
32
1
0
(42.1%)
(56.1%)
(1.8%)
(0.0%)
Vocational competency
2
20
27
8
combined with relevant
(3.5%)
(35.1%)
(47.4)
(14.0%)
supervisors require more
C1
practical experience than those they are supervising 157.
NC
industry experience is all that is required to become a clinical hypnotherapist Table 6: Results Details Table
6.3
Consensus and high agreement
As outlined in the methodology, the level of agreement required to achieve consensus has been provided by the clinical hypnotherapy profession. The Hypnotherapy Council of Australia (HCA) agreed that the vote to pass any resolution should be 85% (HCA, 2012b). High agreement would then be a significant figure which is close to consensus. The chosen figure was approximately 10% less than consensus which was rounded to be 77%. These figures were adopted as the definition of consensus and high agreement for this research.
6.4
Summary of the results
The results were broken down into a round by round description as well as the full questionnaire (including the round were consensus or near consensus was achieved). The survey questions reflected topics on ethics, governance, concepts, techniques, practical aspects and education derived from stakeholder’s websites and communications. The questions represent appropriate and important aspects (Van Tulder & Veenman, 1991) of clinical hypnotherapy education.
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There has been little research into clinical education (D. M. Wark & Kohen, 2002) which is reflected in the training variations (SADH, 2008, p. 34). The question of who is an expert (Balaraman & Venkatakrishnan, 1980) is relevant as the ‘expert’ opinion are the data on which the research findings are based. People or organisations that have real experience in a specialist sector are experts or stakeholders (Hsu & Sandford, 2007a). The aim is to relate the ‘experts’ real experience to the research objectives (Campbell et al., 2004) and give validity to the data. The expert panel members self-selected from an invitation communicated to key stakeholders who then disseminated it to the profession as a whole. The panel was requested to rate statements in six categories being ethics, governance, concepts, techniques, practical aspects and education using a four point Likert style scale (Langlands et al., 2008). Additional space was provided for additional comments at the end of each category.
Results from the Round 1 thematic analysis provided data for additional questions to be added to the survey. The additional questions and questions which did not achieve consensus were returned in Round 2 (Thomson et al., 2009). This is a brief diagram of the process undertaken (Skulmoski et al., 2007)
Literature Review
Delphi R1 Analysis
Develop Questions
Research Design
Delphi Round 1
Delphi Round 2
Delphi R2 Analysis
Publish Research
Figure 3: Two Step Delphi process
The full questionnaires are in Tables 5 (Survey Round 1 Questions) and 6 (Survey Round 2 Questions). The data are summarised in Table 7: Full Questionnaire and Consensus achieved.
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6.5
Description of the cohort
The cohort was requested to identify their primary working role. Fifty three participants responded. Three groups of stakeholders - Government Departments, Organisations that influence clinical hypnotherapy and Interested Parties - were invited to participate in the research, but none undertook the survey. The total exceeds 100% as respondents were able to select more than one primary role.
The results were: Primary Working Role
Actual values
Percentage of Cohort
Clinical hypnotherapist
30
56.6%
Counsellor
6
11.3%
Educator (not specifically clinical hypnotherapy)
4
7.5%
Organisation administrator
0
0.0%
Organisation executive
3
5.7%
Psychologist
4
7.5%
Psychotherapist
2
3.8%
School owner
1
1.9%
Trainer Clinical hypnotherapy
3
5.7%
Student
3
5.7%
Clinical social worker
1
1.9%
Integrative therapist
1
1.9%
Natural therapist many modalities
1
1.9%
Table 7: Primary working role of cohort
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The cohort was requested to identify any other working role(s). Forty four of the 53 participants responded to this question. Some participants identified more than one other working role, thus the totals exceed 100%. The results were: Actual
Percentage of
values
Cohort
Clinical hypnotherapist
24
54.5%
Counsellor
22
50.0%
Educator (not specifically clinical hypnotherapy)
16
36.4%
Organisation administrator
5
11.4%
Organisation executive
6
13.6%
Psychologist
2
4.5%
Psychotherapist
7
15.9%
School owner
5
11.4%
Trainer Clinical hypnotherapy
8
18.2%
Student
2
0.05%
Other
9
2.07%
Other Working Role
Table 8: Secondary work role
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6.6 6.6.1
Details of Round 1 Responses to invitation emails
The following data show the response rate to the invitation emails: Date
Details
Response Rate
15-11-12
Email Invitation to participate (Figure 5)
19
14-12-12
Reminder - Invitation Email (Figure 6)
27
10-12 12
Reminder – Invitation Email (Figure 7)
40
16-10-12
Invitation - Professional Newsletter AHA Discussion Group
Unknown
(Figure 8) 19-10-12
Invitation - Professional Newsletter ASCH Forum (Figure 9)
Unknown
19-10-12
Invitation - Professional Newsletter ASCH Forum continued
Unknown
(Figure 10) 23-1-13
Information for Participants Round 1 Email (Figure 11)
Not Applicable
6-2-13
Information for Participants Round 1 Reminder Email
Not Applicable
(Figure 12) 22-2-13
Information for Participants Round 1 Final Reminder Email
Not Applicable
(Figure 13) 28-4-13
Information for Participants Round 2 Email (Figure 14)
Not Applicable
10-5-13
Information for Participants Round 2 Reminder Email(Figure
Not Applicable
15) 24-5-13
Information for Participants Round 2 Final Reminder Email
Not Applicable
(Figure 16) Table 9: Invitations to participate
Only the responses to identified emails were tracked to their source. The responses from the professional newsletters were not identified. A cohort of 87 agreed to participate in the survey.
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The potential participant first registered their interest and was then emailed a further link, giving full disclosure prior to consent being given and the survey undertaken.
The cohort was comprised of all stakeholder groups, comprising: 1. Professional Associations which acknowledge clinical hypnotherapy 2. Clinical hypnotherapy training institutions 3. Organisations which may impact the profession 4. Practitioners of varying experience. 5. Significant people in the profession 6. Interested parties
At the commencement of each category all participants were required to acknowledge that their knowledge and skills were within the identified domain prior to opening the survey category (Okoli & Pawlowski, 2004).
6.6.2
Survey: Round 1 details
The first round of the survey consisted of 157 questions broken into survey administration (7), ethics (5), governance (28), concepts (61), techniques (26), practical (12), and education (18).
The electronic link to the first round of the survey was emailed to the cohort on January 2013. A reminder email was sent two weeks later and the third reminder in a further two weeks. A total of 61 participants responded to the first round of the survey.
All questions were returned to the participants so they could relate all responses in relation to the whole survey. Instructions at the beginning of the survey asked the participants to reassess their answers in reference to the responses from the rest of the
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stakeholder group. This allowed for any ambiguity within any question to be reviewed and reassessed. The questions that achieved the requisite 85% consensus were returned to the participants and with the following instruction “Consensus was achieved on this question so no further response is required”.
Figure 4: Example consensus achieved
Questions which did not achieve consensus were returned to the participants with a request to reconsider the question before answering it again.
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Figure 5: Example consensus not achieved
A text box to allow for any comments was added at the end of each category.
The following results were achieved in the first round of the survey. 6.6.3
Survey: Round 1 results
Category
Number of questions
Consensus achieved
Ethics
5
5
100%
Governance
28
6
21.42%
Concepts
61
40
65.57%
Techniques
26
19
70.08%
Practical
12
8
66.67%
Education
18
11
61.11%
Total
150
89
59.33%
Table 10: Round 1 Results
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6.7
Survey: Round 2 details
The second round presented the opportunity to identify the primary and secondary vocation of the participants. The electronic link for the second round of the survey was emailed to the 61 participants on 28 April 2013. The first reminder email was sent in May 2013, the second reminder email was sent two weeks later and a third reminder another two weeks later. Responses were received from 53 participants (86.88%).
The second round of the survey consisted of 84 questions broken into survey administration (16), governance (27), concepts (23), techniques (8), practical (4), and education (6). There were no questions relating to Ethics as consensus had been achieved for all in this category. Ten questions were added form the round one survey (Cuhls, 2003). Two questions were to capture supplementary participant information and eight questions to improve clarity and remove possible ambiguity. The data were analysed to determine the percentage of questions that had achieved consensus.
6.8
Survey: Round 2 results
The questions which achieved consensus in Round 1 were identified and the method by which consensus was established was outlined and included in Round 2 (Langlands et al., 2008).No further response was required from the participants on the questions which achieved consensus. This ensured participants were only answering questions in Round 2 that had not previously achieved consensus (Langlands et al., 2008).
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The Round 2 results are outlined in Table 11: Round 2 results. Category
Number of
Consensus achieved
questions Ethics
0
0
Not applicable
Governance
27
6
22.22%
Concepts
23
8
34.78%
Techniques
8
3
37.50%
Practical
4
2
50.00%
Education
6
1
16.67%
Total
68
20
29.41%
Table 11: Round 2 results
6.9
High Agreement (near consensus)
Of the questions that did not achieve consensus, 15 questions when reviewed by the cohort achieved a score of above 77%. An example of an almost consensus is:
Figure 6: Example consensus almost achieved
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A compilation of the questions (and their categories) which achieved high agreement i.e. above 77% were: Governance Questions #
Question
%
Round
Agreement
Achieved
10 Clinical hypnotherapy requires several peak bodies
82.9%
2
11 Clinical hypnotherapy requires several self governing
80.6%
2
80.6%
1
82.8%
2
80.5%
1
77.8%
1
peak bodies 10 Clinical hypnotherapy qualifications should be standardised across Australia 15 Best Practice is not necessary for practitioners to receive health fund rebates 26 Entry level into clinical hypnotherapy requires a government accredited Degree standard 34 External recognition of clinical hypnotherapy is based upon commercial considerations Table 12: Governance Questions
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Concepts Questions #
Question
52 Clinical hypnotherapists require knowledge of medical
Consensus
Round
%
Achieved
82.50%
1
82.90%
1
81.00%
1
77.30%
1
sciences 53 Clinical hypnotherapists require knowledge of pharmacology 54 Clinical hypnotherapists require knowledge of human sexuality 78 Working within a heath care team is required in clinical hypnotherapy training Table 13: Concepts Questions
Techniques Questions #
Question
67 Rapid inductions should be part of clinical hypnotherapy
Consensus
Round
%
Achieved
83.30%
2
Consensus
Round
%
Achieved
81.80%
1
78.20%
1
training Table 14: Techniques Questions
Practical Questions #
Question
133 Business planning is required within a hypnotherapy training course 134 Marketing is required within a hypnotherapy training course Table 15: Practical Questions
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Education Questions #
Question
141 Current educational standards are not impacting on the
Consensus
Round
%
Achieved
82.60%
1
80.80%
1
profession. 142 Standardised clinical hypnotherapy training is not required in Australia Table 16: Education Questions
One question reduced in the level of agreement (Clinical hypnotherapy qualifications should be standardised across Australia) from 82.7% to 80.6%.
The data were analysed and evaluated. The data achieved consensus or were stable. It was concluded that a third round would not provide any statistically significant variations to the data already gathered.
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7 Survey questions and responses Figure 7: Number of questions included in the survey includes seven additional demographic questions in round one.
Round 1
Number of questions (N=150)
Questions achieving consensus (N=89)
Questions achieving High Agreement (N=11)
Questions not achieving consensus (N=50)
Questions achieving High Agreement (N=15)
Questions not achieving consensus or high agreement
Round 2
Number of questions (N=68)
Questions achieving consensus (N=20)
Figure 7: Number of questions included in the survey
As part of the registration process, the participants were asked to identify the duration of their training. The question stated “4. If you are a clinical hypnotherapist please answer the following questions otherwise please continue to the next question.” The several subsections of this question were: 1. Qualification(s) 2. Length of initial training 3. Years in practice 4. Name of school from which you graduated 5. Year of graduation
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Respondents reported qualifications that included university degrees (bachelor, master and PhD), Vocational Education Training (VET) sector qualifications, professional sector qualification and unidentified awards. Table 17: Cohort qualifications, shows the cohorts responses. The table has divided the qualifications into sections. All effort has been made to identify and categorise Australian Skills Quality Assurance (ASQA) qualifications from non ASQA qualifications however with the no protection on qualification nomenclature the data are unverifiable. This highlights the question of qualification nomenclature which is addressed later in this thesis. Some respondents have multiple qualifications so the total exceeds the number of respondents. The raw data is available within the appendices. Qualification
Frequency
Percent
Clinical hypnotherapy – Certificate ASQA
7
0.06
Clinical hypnotherapy – Certificate
10
0.09
Clinical hypnotherapy – Diploma ASQA
4
0.04
Clinical hypnotherapy – Diploma
21
0.19
Clinical hypnotherapy – Advanced Diploma ASQA
0
0.00
Clinical hypnotherapy – Advanced Diploma
2
0.02
Clinical hypnotherapy - other
18
0.16
Degrees – Psychology
4
0.04
Degrees – Psychology (Mast)
4
0.04
Degrees – Counselling
1
0.01
Degrees - other
9
0.08
Other - Psychology
5
0.05
Other - Counselling
5
0.05
Other
20
0.18
PhD
1
0.01
Total
111 Table 17: Cohort qualifications
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This table denotes the responses to the ‘length of initial training’. Thirty six participants (41.1%) did not respond to the question.
Length of initial training
Valid
Frequency
Percent
< 3 months
9
10.3
3 mths - 6 mths
1
1.1
6mths - 12 mths
3
3.4
12 mths - 2 yrs
16
18.4
> 2 yrs
22
25.3
No response
36
41.4
Total
87
100.0
Table 18: Length of initial training
This table denotes the responses to the ‘years of practice’ of the cohort Years in practice Frequency Percent 10
13
14.9
35
1
1.1
Total
37
42.5
Missing System
50
57.5
Total
87
100.0
Valid
Table 19: Years in practice
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Questions 2 and 3 related to working roles and allowed multiple responses so responses exceeded 100%. Question 2: Please select your primary working role. Response Percent Clinical Hypnotherapist
30
56.6%
Counsellor
6
11.3%
Educator (not specifically clinical hypnotherapy)
4
7.5%
Organisation Administrator
0
0.0%
Organisation executive
3
5.7%
Psychologist
4
7.5%
Psychotherapist
2
3.8%
School owner
1
1.9%
Trainer Clinical hypnotherapy
3
5.7%
Other
6
11.4%
Total
59 Table 20: Primary work role
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Question 3: Please select any other working
Response
Percent
Clinical Hypnotherapist
24
54.5%
Counsellor
22
50.0%
Educator (not specifically clinical hypnotherapy)
16
36.4%
Organisation Administrator
5
11.4%
Organisation executive
6
13.6%
Psychologist
2
4.5%
Psychotherapist
7
15.9%
School owner
5
11.4%
Trainer Clinical hypnotherapy
8
18.2%
Other
8
18.2%
Total
103
role(s). You can select multiple categories
Table 21: Secondary work role(s)
It is not possible to compare this data to the population of clinical hypnotherapists as this data are not available. Although the data does not exist, in my extensive experience of the clinical hypnotherapy profession, this cohort provided a reasonable representation of the profession.
7.1
Ethics (summary)
The ethics section received 61 responses and achieved above 98% consensus on all five questions in the first round. See Table 6: Results Details Table for detailed results.
7.2
Governance (summary)
The governance section received 61 responses in the first round and 52 in the second round. The questions (33) (number of questions is in brackets) encompassed areas of
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voluntary self-regulation (9), qualifications (13), quality assurance (4), best practice (3) and professional recognition (4). Consensus was achieved in some overarching questions but not in overall topic areas. See Table 6: Results Details Table for detailed results.
7.3
Concepts (summary)
With the additional questions in Round 2, the concepts category contained 63 questions. All but 15 questions achieved consensus with four returning agreement above 77%. See Table 6: Results Details Table for detailed results.
7.4
Techniques (summary)
The techniques category contained 28 questions (not including administrative). Twenty three achieved consensus, one achieved very high agreement and five did not achieve consensus. See Table 6: Results Details Table for detailed results.
7.5
Practical (summary)
All questions in the practical category achieved consensus or high agreement. The questions which returned high agreement pertained to business and marketing functions within a clinical hypnotherapy practice. See Table 6: Results Details Table for detailed results.
7.6
Education (summary)
Of the 18 questions in this category, those which did not achieve consensus or high agreement related to standardised training, articulation and educational pathways. See Table 6: Results Details Table for detailed results.
Elkins and Hammond (1998) examined the constructs of clinical hypnotherapy education directly related to the developing uniform educational standards for clinical hypnotherapy.
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This research follows on and identifies topics related to clinical hypnotherapy as a standalone profession. The results demonstrate there is consensus and agreement, in principle, across broad areas in clinical hypnotherapy. This agreement was achieved with panellists from diverse vocations (Langlands et al., 2008) with a common claim of being a stakeholder in the profession of clinical hypnotherapy. The survey presented broad questions on ethics, governance, concepts, practical aspects, techniques and education. The responses provided by the expert panel provide the groundwork from which future research can develop a foundation for future educational research in clinical hypnotherapy.
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8 Survey: Category Summary and Discussion The survey questions are based on the knowledge, skills and attitudes required by clinical hypnotherapists. The survey questions were divided into six categories being ethics, governance, concepts, techniques, practical and education. The category divisions were selected to enable the questions to form a cohesive matrix of knowledge, skills and competencies which associations (see AHA, 2013d; ASCH, 2013f) and training institutions require to enter the vocation (AAH, 2013b; ACH, 2013; AHS, 2013; CA, 2013a; Phoenix, 2013). Vocational competency has been described as a broad industry with experience often associated with industry qualifications (NSSC, 2011). Vocational education provides learners with specific knowledge, skills and competencies to enter the workforce within a specified labour market (Agbola & Lambert, 2010; AQFC, 2013). Clinical hypnotherapy training is within the vocational sector (DEEWR., 2012) and training courses hold accreditation within that sector (AAH, 2013b; ACH, 2013; AHS, 2013; CA, 2013a; Phoenix, 2013). The summary and discussion section presents the data as a unified whole combining all categories as would be required in a practitioner setting.
8.1
Ethics
Questions on ethics were spread across two categories being ethics and concepts. The clinical hypnotherapy profession considers ethics to be important. Associations all require ethical conduct from their members and produce a code of ethics (AHA, 2013f; ASCH, 2014d; HCA - EP, 2012).
Discussion: The ethics section received 61 responses in the first round. Consensus was achieved on all five questions in the first round. All five achieved consensus with above 98%
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consensus in the first round. The two questions from the concepts section also achieved consensus in the first round. See Table 6: Results Details Table for detailed results.
8.2
Governance
The data demonstrate that there is consensus on issues of self-regulation. However, no consensus was achieved in the area regarding the type self-regulation. Several options were postulated; one peak body, several peak bodies and government regulation. The cohort achieved high agreement in support of the proposal that clinical hypnotherapy does not require several peak bodies. Expert opinion was divided (agree – (24) 46.2% and disagree – (28) 53.9%) on government registration. Consensus was not achieved in response to the regulation of clinical hypnotherapy by government. See Table 6: Results Details Table for detailed results.
Discussion: No definition of a ‘Peak Body’ was provided to the cohort in the preamble to this category so it is not certain if a peak body is understood as an overarching body to regulate clinical hypnotherapy. The matter of governance is further complicated by the establishment in 2011 of a clinical hypnotherapy peak body (HCA, 2012g) that does not function at the practitioner level. HCA membership is for teaching institutions and associations so students and clinical hypnotherapists have only a cursory arm’s length relationship through their teaching institution or association respectively.
The data raise questions regarding the connection between the HCA and the practitioner level of the profession and any decisions being made regarding curricula, assessment, competency and standards (HCA, 2012c) implemented by the peak body. As the data demonstrate an inconsistency around the question of a peak body, the role of the peak body, as distinct from that of professional associations, would require clarification. A survey
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of clinical hypnotherapy practitioners relating to the functions of a peak body would resolve these issues.
8.2.1
Governance: Quality assurance and best practice
A brief description of quality assurance and best practice was provided in the survey preamble for governance. Both quality assurance and best practice achieved consensus as being required by the profession. The data show these concepts were extended to the activities of teaching institutions and further extended with practitioners being required to have both quality assurance and best practice to receive rebates from health funds. See Table 6: Results Details Table for detailed results.
Discussion: The cohort has achieved consensus and acknowledge quality assurance and best practice concepts are required within clinical hypnotherapy. High agreement rather than consensus was achieved in relation best practice being required for practitioner rebates from health funds. No data were available to identify the reason for the high agreement rather than consensus. The difference between high agreement and consensus within this question was 2.2% which was one participant. In this case, it appears that the result is not statistically significant and could be considered in a similar capacity as the other questions which achieved consensus.
The questions for governance (quality assurance and best practice) were adapted from APEC (2005), and refer to the process through which an authority enacts policies and decisions regarding the constituent performance of a profession or its members, which then relate to quality assurance and best practice. The peak body achieves its legitimacy by its representativeness, accountability and efficiency bestowed upon it by the profession. In this scenario the description outlines a supportive relationship between the elements of the stakeholders of the profession.
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Quality assurance ensures the integrity of the processes to which it is applied and within the parameters of this thesis, relates to governance and training (Finnegan-John, Molassiotis, Richardson, & Ream, 2013). Within the clinical hypnotherapy profession the direct quality assurance arbiters are the professional associations. These fall into three categories: the peak body being the HCA, the associations that represent other associations (an association of associations), and the associations whose membership is comprised of clinical hypnotherapy practitioners. This paper deals with specialist clinical hypnotherapy associations. There are associations that stand on the periphery of the profession and have an indirect impact rather than direct input. These are the Australian Counselling Association (ACA) (2010), Australian-Traditional Medicine Society (ATMS) (2013) and Psychotherapists and Counsellors Federation of Australia (PACFA) (2013). These larger associations have different quality assurance procedures in place that have little direct impact on clinical hypnotherapy.
In the clinical hypnotherapy training sector some organisations related to complementary and alternative medicine, and counselling and psychotherapy associations have accreditation procedures; but they have little direct impact on the clinical hypnotherapy profession. The only direct quality assurance of training is ASQA, that administers government sanctioned standards (ASQA, 2013a) on those teaching institutions which choose to develop training under their umbrella. ASQA’s enabling legislation passed in March 2011 and ASQA began exercising its regulatory functions on 1 July 2011 (ASQA, 2011). Since that time ASQA (the nationally based accrediting authority) has been responsible for the assessment of Registered Training Organisations (RTO) that transitioned to ASQA from state and territories based accreditation authorities. The quality assurance required under ASQA may serve as a guide if clinical hypnotherapy is to adopt the consensus demonstrated by the survey results.
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However the auditing of those standards is called into question when the initial audit results of RTOs seeking re-registration 2012/2013 show 64% failed to meet SNR 25 Transition from superseded courses (ASQA, 2013b). Does this indicate that the previous state and territory accreditation authorities were inadequate in the application of the standards, or that the new authority is applying the standards in a way causing RTOs to become non-compliant? Whichever the case, clinical hypnotherapy education standards and policies (AHA, 2013c; ASCH, 2013e; HCA, 2012c) have no self-regulatory process to determine training quality, and therefore remains dependent on ASQA for that function.
On the issue of quality assurance, the cohort has achieved consensus making the statement that quality assurance is not necessary within the profession of clinical hypnotherapy. The data show that the cohort does not believe quality assurance is required for the internal process of association recognition of training institutions or the external recognition by health funds to provide practitioner rebates. No questions were asked regarding any alternative auditing methodologies for quality assurance processes.
The quality assurance of clinical hypnotherapy training, when there is no universally accepted definition of hypnosis or hypnotherapy and no universally accepted standards for clinical hypnotherapy education, places any clinical hypnotherapy peak body at a disadvantage. Governments are moving to training packages (AQFC, 2013) yet with no clinical hypnotherapy training package ASQA accreditations remain as training courses (DEEWR., 2012). With the diversity that is clinical hypnotherapy training there is no agreed curriculum that reflects the profession’s requirements. Training courses are privately owned unlike government developed and endorsed training packages (NSSC, 2014).
VET training is comprised of two structures being training packages and courses. Clinical hypnotherapy training is comprised of training courses. These courses are constructed by the owners of the course. The curricula are comprised of topics that, in the opinion or the
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course owner, will provide the required professional competencies. A training package is a nationally endorsed basis from which training programs can be customised. These packages include nationally recognised competencies, assessment guidelines and qualifications relevant to the industry (SA DETFE, 1997). To develop a training package the industry would be required to reach consensus on many aspects of clinical hypnotherapy training that are currently acknowledged as being diverse.
The diversity of the profession is encompassed within the HCA Mission Statement; “The HCA provides a cohesive identity for the diversity of hypnotherapy methodologies and promotes their professional an ethical practice for the benefit of the community.” (HCA, 2012e) which suggests the application of quality assurance policies are more challenging.
By publishing Minimum Standards of Education and Training for Hypnotherapy Practitioners (HCA, 2012c), the HCA has acknowledged that it has a responsibility for setting training standards. With membership restricted to associations and training institutions, the HCA has access to key stakeholders who could develop professional standards containing quality assurance procedures. The question of whether the educational and quality assurance tools should be open source or copyrighted (Productivity Commission, 2011) is a matter for the HCA national executive.
The development of educational competencies and quality assurance processes usually conform to specified guidelines. Basic standards are expressed by ‘must’ and quality development standards are expressed by ‘should (WHO, 2005). Guidelines for the development of quality assurance procedures are available, as other professions in complementary therapies have engaged in the same process for their own specific modalities. Using these guidelines (WHO, 2005), it is postulated that credible quality assurance has the following attributes. It should:
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include all major stakeholders; be open to external public scrutiny; be conducted in a consultative and consensus-building fashion; be collegial but not collusive; balance academic priorities with those of regulating authorities; should identify both strengths and weaknesses; encourage innovation and re-orientation toward changing health needs; have the means and authority to implement its conclusions; monitor progress on an ongoing cycle of review; focus on the achievement of self-specified objectives; encourage a variety of methods of teaching and learning; ensure the choice of credible student assessment methods appropriate for the teaching and learning methods chosen; ensure there are adequate resources to deliver the curriculum; be concerned with good outcomes and not detailed specifications of curriculum contents. Table 22: Who Guidelines (WHO, 2005, p. 29)
Once the mechanisms for quality assurance are in place or planned, the supporting procedures would be developed (APEC, 2005) to enable the quality assurance assessors to decide whether organisations, trainers and assessors meet the appropriate standards. A commitment to continuous review and improvement would be required by the peak body and those being reviewed, in order to ensure the ongoing development of the profession (COAG, 2008a). The development of quality assurance procedures may become an integral conversation within the discussion. One association acknowledges quality assurance (AHJ, 2014) and the peak body uses the terminology ‘safety and quality’ (HCA, 2013b, p. 4) rather than quality assurance. If the peak body, associations and training institutions agree with the cohort’s opinion (questions 12, 14, 14s, 17 and 148) that quality assurance is required within the profession, there exists the possibility of developing the procedures that the AQF consider a foundation of education (AQFC, 2013).
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8.2.2
Governance: Professional recognition
The cohort’s expert opinion is that good governance will affect professional recognition. The data do not identify the areas from which this recognition will occur. The data were inconclusive in the responses related to recognition and both professional credibility and public demand. See Table 6: Results Details Table for detailed results.
Discussion: Three questions directly dealing with professional recognition and governance were included in the survey. The cohort demonstrated consensus in identifying the relationship between good governance and external recognition but not with the other questions. The relationship between qualifications and credibility may relate to the issuance of qualifications using the same title (e.g. Diploma) from ASQA accredited institutions and from non ASQA institutions. With quality assurance processes unable to be established with recognition awarded by professional associations, the professional credibility of the award cannot easily be established. Public demand provides income to the clinical hypnotherapist which could be interpreted as a form of recognition. However with the changing industry (e.g. membership requirements, supervision and continuing education) the profession is addressing some of these issues.
Changing industry requirements and job roles were identified in a New South Wales Community Services and Health Industry Training Advisory Body (CSH-ITAB) submission to the Productivity Commission (Scrowcroft, 2010). The comments reflect the changing features on the clinical hypnotherapy profession. Whether these changes have been the ‘result of’ something or ‘a desire to achieve’ something would need to be determined by analysing each change individually. The fact that the cohort achieved consensus only on governance affecting professional acknowledgement and failed to achieve consensus on the questions of professional credibility and public demand was interesting. Considering
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the cohort was in high agreement that ‘external recognition of clinical hypnotherapy is based upon commercial considerations’ may relate to the health fund rebates. If health fund members use clinical hypnotherapy and agitate to health funds for rebates the commercial consideration of the health fund is directly related to their membership and the recognition of clinical hypnotherapy.
The formation of a single national clinical hypnotherapy peak body has demonstrated the profession acknowledges the need for cohesion. This is reflected in the consensus being achieved on ‘good governance …receives professional acknowledgement’. The peak body, as well as other associations, have desired recognition for the profession and its practitioners (HCA, 2013b). The peak body quickly established minimum standards of education (HCA, 2012c) while others have raised educational standards (AHA, 2011c) and advised their members that they may need to upgrade their qualifications (ASCH, 2011a) which indicates they believe there is a need to do so. With an acknowledgement of a reciprocal arrangement for recognition of qualified supervisors (AHJ, 2013a), it seems that qualified professionals are acknowledged by the professional associations. However, the nomenclature of qualifications can be an issue with the profession. With the terms certificate, diploma and advanced diploma able to be used by any teaching institution, the reliance on qualification nomenclature is questionable. This matter will be considered further later in this thesis.
Research has demonstrated that tertiary qualifications significantly enhance employment prospects (ACER, 2001) although this does vary from industry to industry. As the majority of clinical hypnotherapists are self-employed, the issue of qualification only relates to the perception of those seeking their services, or other health practitioners referring to that practitioner. Therefore, whether or not qualifications in clinical hypnotherapy are an issue, is yet to be determined. However, with the announcement of a health fund requiring minimum qualifications to be Diploma or Advanced Diploma qualifications from an
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Australian Registered Training Organisation (RTO) (AHA, 2011b; Bupa, 2009), the maintaining of industry currency with rapidly changing job roles is a constant challenge (Scrowcroft, 2010). The cohort is not convinced that public demand for clinical hypnotherapy services is based upon qualifications. Whether the Australian Council for Educational Research (ACER) research can be extrapolated to clinical hypnotherapy qualifications is subject to conjecture, as it is uncertain whether the public are aware of the existing variations.
Although the survey question ‘professional credibility is based upon qualifications’ did not achieve consensus in this study, the 72.9% agreement indicates that a significant proportion of the cohort believe that credentials are an issue for the profession. Whilst this may not be an issue currently, and the clients of clinical hypnotherapists continue to attend consultations, recognition may be an issue when other proponents for the ‘mental health dollar’ such as counsellors, psychologists and psychotherapists achieve benefits (such as WorkCover (WC-NSW, 2012) that enhance their profession and practice and clinical hypnotherapists are excluded.
8.2.3
Governance: VET sector accredited
Although 51 respondents reported that governance was within their expertise, only 36 participants responded in the area of entry level qualifications. See Table 6: Results Details Table for detailed results. Entry level into the profession currently varies. There are no specified requirements to commence practice, and each association defines its own membership criteria (AHA, 2013d; ASCH, 2013f) which may or may not match the minimum education guidelines of the peak body (HCA, 2012c). Some associations do not publish membership requirements (PCHA, 2013).
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Discussion: The cohort response to VET sector accreditation may reflect the comparative ‘newness’ of clinical hypnotherapy’s exposure to formalised educational processes. Clinical hypnotherapy has only been exposed to VET sector accreditation since 1998 (AAH, 1998). Processes such as recognition of prior learning, articulation, educational pathways, award nomenclature, self-regulation and the concept of uniformity were present but not focussed upon. The questions relating to entry level into the profession, qualifications, use of qualification titles and the position of the profession as a stand-alone modality were presented with predominantly consensus not being achieved.
The cohort achieved consensus that entry into the profession should be an industry defined standard but failed to achieve a definitive consensus on the nature of that standard. The cohort achieved consensus in that the entry level for the profession requires an accredited Advanced Diploma (86.1%) but the high agreement for a Degree (80.5) not being the professional entry level. Additionally there was no consensus for educational pathways to universities, but there was consensus for recognition of prior learning. This response to recognition of prior learning seems appropriate as associations have been acknowledging VET qualifications and proposing that an upgrade to RTO issued qualifications may be beneficial (ASCH, 2011a). The simplest mechanism to transition from professional non-RTO qualifications to accredited RTO qualifications would be via recognition of prior learning.
There was consensus in the area of nomenclature. The consensus (88.9%) in the second round nominated a self-regulatory mechanism of clinical hypnotherapy nomenclature. As the awarding of qualifications entitled certificate, diploma or advanced diploma is available to VET accredited and non-VET accredited teaching instructions alike, some confusion can occur. ASQA and AQF legislation covers accredited qualifications but does not have
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any jurisdiction over non-accredited training (AQF, 2013; ASQA, 2013c). The data show that the cohort agreed that self-regulation is required. The determination of what that selfregulation is to achieve, is yet to be determined. If the cohort believes that some confusion occurs with both accredited and non-accredited institutions using the same nomenclature then what self-regulatory action can be taken? The use of the award titles of certificate, diploma and advanced diploma are not illegal, therefore there would need to be agreement between all associations to adhere to the same standard regarding use of award names. In reality, at the present time this is an unlikely and unworkable scenario.
Another question relating to the independence of the profession was asked in the survey. The question surveyed was “Clinical hypnotherapy is a subset of other professional modalities”. Inherent in the question is the differing opinions related to profession titles (e.g. hypnotist or clinical hypnotherapist) and the techniques embedded within those titles. The cohort was undecided in relation to a consistent position held by one association; that hypnosis is a subset of other professions and hypnosis alone is insufficient as a standalone modality (ASH, 2010, 2013d). The cohorts indecision may reflect the attitude of an second association which for a brief time supported this viewpoint (ASCH, 2011c), but later reviewed its position and restated the view that hypnosis could be both an independent science, and / or an adjunct (ASCH, 2011d, 2014f). This divergence of opinion raises the question of the necessity to define the terms hypnosis, clinical hypnosis, hypnotherapy and clinical hypnotherapy. There were two questions related to this issue. One question asked in the survey was about ‘clinical hypnotherapy’ being a subset of other modalities and the expert opinion was; agree 18 (48.6%) and disagree 19 (51.3%). The second question asked if ‘hypnosis’ was an independent science or an adjunct to other therapies. The cohort responded with an agreement by 23 (55.8%) and disagreement by 18 (43.9%). It can be argued that the training of existing health practitioners is not at the same level as that of clinical hypnotherapists who complete ASQA accredited diplomas or advanced diplomas (AAH, 2013b; ACH, 2013) which
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specialise in clinical hypnotherapy. It is agreed that clinical hypnotherapy can be used as an adjunct within existing health modality models. Training of existing health professionals (ASH, 2013d) is not required to be as substantial as they hold existing health competencies. It is the ancillary training (ASH, 2014c) which provides limited skills in clinical hypnotherapy which necessitates the use of clinical hypnotherapy as an adjunct to their existing professional skills. The participants in this survey obviously have different opinions on the questions asked in the survey. Clarification of these opinions would require more targeted research possibly undertaken by the peak body.
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9 Concepts 9.1
Concepts: Counselling and psychotherapy
The cohort achieved consensus on all questions related to counselling and psychotherapy to be part of clinical hypnotherapy training. The relationship between counselling, psychotherapy and hypnotherapy is yet to be determined by those with sufficient expertise in these area. It is acknowledged that clinical hypnosis has shared elements with other psychotherapies (Ismail, 2011) and the peak body for psychotherapy and counselling accept clinical hypnotherapy associations as members (PACFA, 2014b). Definitions of counselling and psychotherapy contain the fundamental elements of clinical hypnotherapy.
There has been a need to clarify the terms counselling and psychotherapy to ensure that the general public, Government, other agencies and the counselling and psychotherapy professions have a cohesive understanding (Strasser, 2009a). Various definitions are available being “ACA defines a 'counsellor' as a professional having completed a recognised course of training in counselling that has led to a qualification of a Diploma, Degree, Graduate Diploma, Masters, Doctorate or a PhD in counselling.” (Armstrong, 2014, p. 1)
Psychotherapy and counselling are professional activities that utilise an interpersonal relationship to enable people to develop self-understanding and to make changes in their lives. Professional counsellors and psychotherapists work within a clearly contracted, principled relationship that enables individuals to obtain assistance in exploring and resolving issues of an interpersonal, intrapsychic, or personal nature (Strasser, 2009b, p. 1).
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Psychotherapy is the informed and intentional application of clinical methods and interpersonal stances derived from established psychological principles for the purpose of assisting people to modify their behaviors [sic], cognitions, emotions, and/or other personal characteristics in directions that the participants deem desirable. (Norcross, 1990, p. 218-220 ) (APA, 2012b)
These definitions impact on clinical hypnotherapy as the ACA definition precludes clinical hypnotherapists as their qualifications are in the domain of clinical hypnotherapy rather than counselling or psychotherapy. The ACA conducts the College of Counselling Hypnotherapists (ACA, 2009) that requires a minimum ACA membership level 1 to become a member of the college (ACA, 2013). This college provides an opportunity for counsellors to extend their skills in clinical hypnotherapy but requires initial counselling qualifications.
When clinical hypnotherapy is taught as a primary modality, curricula often contain counselling and psychotherapy components. The counselling and psychotherapy are integrated as part of the clinical hypnotherapy rather than being an additional or separate component (AAH, 2013a). Clinical hypnotherapy association’s (including the peak body) membership criteria require components of counselling and psychotherapy (AHA, 2013d; ASCH, 2013e; HCA, 2012c).
The HCA was established as a peak body for clinical hypnotherapy (HCA, 2011b) and has associations and teaching institutions as its members (HCA, 2014b). Sections of the profession consider clinical hypnotherapy as part of psychotherapy and consider reliable research would facilitate clinical hypnotherapy being validated as a psychotherapy (Alladin & Alibhai, 2007). Opinions such as “... we would generalize to clinical practice under common or trans-theoretical factors, and suggest an analogy that psychotherapy
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generally, and hypnotherapy in particular, is to mental health practice what oncology is to medicine.” (Amundson, Alladin, & Gill, 2003, p. 22) further demonstrates the integral relationship between hypnotherapy and psychotherapy.
The relationship of clinical hypnotherapy to counselling and psychotherapy is identified in the literature (Ismail, 2011; Schoenberger, 2000), and counselling and psychotherapy requirements have been part of some associations membership criteria since 1996 (Yeates, 1996) and other associations for several years (AHA, 2011c; ASCH, 2010b; HCA, 2012c). The survey included questions about the inclusion of counselling and psychotherapy as part clinical hypnotherapy education. See Table 6: Results Details Table for detailed results.
Discussion: The responses support inclusion of counselling and psychotherapy within clinical hypnotherapy education and the use of counselling within a clinical hypnotherapy paradigm. All questions related to counselling and psychotherapy achieved consensus in round 1 or round 2.
The data indicate that counselling and psychotherapy is required within clinical hypnotherapy training with a structured process being taught and that counselling should be practised within the training. The approach of the counselling and psychotherapy inclusions would be dependent upon the paradigm within which the clinical hypnotherapy training institution places itself. If the institution believed in a client-centred counselling approach, then the counselling would resemble that style to allow a smooth transition from the counselling to the clinical hypnotherapy strategies. Different institutions have different opinions regarding which psychotherapies should be included within the training, and their curriculum reflects those opinions (AAH, 2013a; ACH, 2013; AHS, 2013). Reviewing the data and including question 129 indicates that practising the counselling and
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psychotherapy processes is required. The practical work would therefore provide an opportunity to integrate the counselling, psychotherapy and clinical hypnotherapy techniques whilst still in the training phase and prior to the commencement of professional practice. The question becomes how do we differentiate between clinical hypnotherapy, counselling and psychotherapy methodologies?
9.2
Concepts: Clinical hypnotherapy adjunct techniques
The concepts covered in this section relate to therapeutic techniques used within clinical hypnotherapy that have been derived from other mental health modalities. In research, clinical hypnotherapy is often grouped with other psychological methodologies such as counselling and psychotherapy (Bisson & Andrew, 2007). As counselling is covered separately it is excluded from this section.
As a primary health professional (AMA, 2010), clinical hypnotherapists require sufficient proficiencies to appropriately treat their clients. Clinical hypnotherapy training incorporates medical sciences, fundamental psychology and other psychotherapy techniques such as Eye Movement Desensitisation Reprocessing (EMDR), Gestalt, Neuro-Linguistic Programming (NLP), Transactional Analysis (TA) and other psychotherapies (AAH, 2013a; ACH, 2013; CA, 2013a; Phoenix, 2013). Professional clinical hypnotherapy associations nominate various psychotherapy techniques as membership requirements (AHA, 2013d; ASCH, 2013f). Many clinical hypnotherapists include their psychotherapy qualifications on their profiles and national registers (ANHR, 2014; NHRA, 2010). See Table 6: Results Details Table for detailed results.
Discussion: The cohort achieved consensus on all but two questions. It was agreed that knowledge of psychotherapy and psychology were required within training. The inclusion of these areas within some association membership criteria (AHA, 2013d; PHWA, 2013) may be the
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impetus for the consensus. There is no such requirement for medical sciences so it may not be viewed in the same regard. Neuro-Linguistic Programming (NLP) is popular with clinical hypnotherapists, as is evidenced by their profiles, and is a modality commonly used adjunctively. This is evidenced by the number of clinical hypnotherapists who include NLP in their profiles (ANHR, 2014; NHRA, 2010) and the training institutions that include it in their curriculum (AAH, 2013a; ACH, 2013). The lack of consensus may hinge on the word ‘required’ but there are no data to validate that assumption. The fact that it did not achieve consensus may indicate that the popularity of the modality is decreasing. More research would be required to establish the reason for the result.
9.3
Concepts: Suggestion
Over many years suggestion has been recognised as a foundational aspect of clinical hypnotherapy (Barber, 1978; Holden, 2012). Definitions of hypnosis (Araoz, 2005; Joseph P Green et al., 2005) commonly include suggestion as a key ingredient (Montgomery, Schnur, & Kravits, 2013). During the hypnotic session the practitioner (or the client in selfhypnosis) proposes changes in thoughts or behaviours (Anbar, 2009; APA, 2012a).
Suggestion has various forms and training usually encompasses a variety of those forms (AAH, 2013a; AHS, 2013; D. M. Wark & Kohen, 2002). The commonality of language to describe the types of suggestion can vary. In some cases the type of suggestion reflects the purpose of suggestion such as ego strengthening (Hammond & Elkins, 1994), whereas other names describe the style such as authoritarian, direct, indirect ,permissive and posthypnotic (Hammond & Elkins, 1994; Hilgard, 1973; Lifshitz, Campbell, & Raz, 2012; D. M. Wark & Kohen, 2002). Wark and Cohen (2002) reiterate comments by Hammond and Elkins (Hammond & Elkins, 1994) in required aspects of training which was the foundation for American Society of Clinical Hypnosis – Standards of Training in Clinical Hypnosis (Hammond & Elkins, 1994).Suggestion is an agreed commonality by all sectors of the
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profession as a foundation of the profession. The application of suggestion in clinical practice has the potential to change the subjective experience of the client and aid healing (Kirsch et al., 2011). See Table 6: Results Details Table for detailed results.
Discussion: The cohort reflected comments in the literature that suggestion is a foundational competency by achieving consensus on all but one question. Various questions relating to the formation and creation of suggestion and post hypnotic suggestions achieved consensus in the first round. There was, however, some dissention in relation to suggestion being the mainstay of clinical hypnotherapists. Question 39 ‘Direct suggestion is the primary methodology for clinical hypnotherapists’ posited that ‘direct suggestion’ was the primary methodology of the practitioner and achieved consensus with 39 (90.7%) in disagreement. Question 37 ‘Suggestion is the primary methodology for clinical hypnotherapists’ did not achieve consensus but did achieve 69% (29) agreement. The second question posited that ‘suggestion’ rather than ‘direct suggestion’ was the primary methodology of the practitioner. The variation may hinge on the word ‘direct’. Direct suggestion is one specific style of suggestion within the general category of suggestion. Whilst the cohort disagreed that direct suggestion was a primary methodology there was considerable support for suggestion being the primary methodology.
The data indicate that suggestion in both a theoretical and practical format are considered essential within clinical hypnotherapy training. The data also show that suggestion remains an intrinsic part of clinical hypnotherapy training and a primary methodology for the clinical hypnotherapist.
9.4
Concepts: Business and marketing
Clinical hypnotherapists are running small businesses and to operate successfully they require skills and competencies in small business management. The available data from
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clinical hypnotherapy associations shows rising membership (AHA, 2011a, 2014) which indicates increasing competition for clients. With more competition for clients, business and marketing skills have an increased importance for a clinical hypnotherapy practice to be financially viable. The conduct related to the maintenance of a clinical hypnotherapy business has been addressed by government and the profession (AHA, 2013f; HCA, 2013a; HCCC (NSW), 2012) Some emphasis has been placed on ethical advertising, forming the basis for successful marketing of professional services. One major association has acknowledged they have received some complaints regarding advertising, and the president has moved to address the issues directly (Matarasso, 2014). With business and marketing skill training being required by associations (ASCH, 2013e), it is evident that these skills are becoming important within our profession.
The literature does not discuss the issues of marketing within the clinical hypnotherapy sector. Using data from articles in related mental health professions a perspective becomes apparent. The concept of commercialism in psychotherapy and other health sectors is considered unethical (AMA, 2014) and lacks authenticity (Gottleib, 2012). The viewpoint that ‘duty’, ‘responsibility’ and ‘public service’ take precedence over commercialisation, self-promotion and financial gain, leave peers feeling disenfranchised if they cannot achieve the same goals (Loewenthal, 2002). Feldenstein, as quoted in Getzlaf (1988), perceives that ‘hypnotists’ may target specific conditions and make therapeutic claims not made by psychotherapists to gain clients. Howard as noted in Green’s (1998) review , the inference is that operating within a commercial sector is unprofessional.
The promotion of clinical hypnotherapy mental health activities to the public is a major concern for the profession. Associations have moved to provide professional guidelines in a similar manner to the guidelines provided by the Australian Health Practitioners Regulatory Authority (AHPRA) website (AHPRA, 2010) and the NSW Health Care
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Complaints Commission (HCCC (NSW), 2012). Psychology being analogous to clinical hypnotherapy can be used as a paradigm for clinical hypnotherapy (AHPRA, 2010). AHPRA states: The National Law does not contain a definition of ‘advertising’. Therefore, for the purposes of these guidelines, advertising includes but is not limited to all forms of printed and electronic media, and includes any public communication using television, radio, motion pictures, newspapers, billboards, books, lists, pictorial representations, designs, mobile communications or other displays, the Internet or directories, and includes business cards, announcement cards, office signs, letterhead, telephone directory listings, professional lists, professional directory listings and similar professional notices.
Advertising also includes situations in which practitioners make themselves available or provide information for media reports, magazine articles or advertorials, including where practitioners make comment or provide information on particular products or services, or particular practitioners.
This definition excludes material issued to persons during consultations where such material is designed to provide the person with clinical or technical information about health conditions or procedures, and where the person is afforded sufficient opportunity to discuss and ask questions about the material. However, the information should not refer to services by the practitioner that could be interpreted as promoting that practitioner’s services as opposed to providing general information to the patient or client about a procedure or practice. Also, this definition is not intended to apply to material issued by a person or organisation for the purpose of public health information, or as part of a public health program or to health promotion activities (e.g. free diabetes screening, which confer no promotional benefits on the practitioners involved). The definition does not apply to
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tenders, tender process, competitive business quotations and proposals, and the use of references about non health services in those processes, provided the relevant material is not made available to the general public or used for promotional purposes (e.g. published on a website). (AHPRA, 2010, p. 2) In essence, codes are similar with a focus on aspects that are the mainstay of that profession or government department. A common theme is consumer protection, with emphasis on only providing information and comments on treatment efficacy which can be substantiated (HCCC (NSW), 2012). All codes promote ethical advertising that informs and provides the consumer with accurate facts on which to base an informed health care choice.
The survey questions on business management and marketing directly relate to the person entering the clinical hypnotherapy profession by providing them with foundational attitudes, skills and behaviours on which they will base their practice. See Table 6: Results Details Table for detailed results.
Discussion: Barletta and Watson (2001) argue that counsellors and psychotherapists seem reluctant to sell themselves and the research may support this view. The data showed consensus on the necessity for clinical hypnotherapists to have business and marketing skills, and knowledge of the legal requirements for a health practice. High agreement was shown for the inclusion business and marketing within a training course. There was no consensus on marketing skills being required by clinical hypnotherapists and the application of practice management skills. A contradiction was evident in that there was no consensus for marketing skills being required by clinical hypnotherapists but high agreement for the inclusion of those skills in a training course.
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If clinical hypnotherapists’ attitudes reflect those of counsellors and psychotherapists, it may explain the anomaly of requiring business and marketing skills and a reluctance to apply those skills within training and then the commercial sector. Assuming that the clinical hypnotherapist is motivated by public service and a sense of duty, the research data reflect those attitudes. The need to blend those attitudes with commercial realities and professional ethics is made apparent by government authorities (HCCC (NSW), 2012) and clinical hypnotherapy associations (AHA, 2013d; ASCH, 2013e), that acknowledge both attributes within their documentation. Clinical hypnotherapists, unlike many counsellors, are self-employed and the reality of running a financially viable clinical hypnotherapy practice within commercial and professional guidelines requires the application of business skills. Difficult economic times have seen insolvencies within the categories of professional, scientific & technical services (65) and health care & social assistance (46), as reported by the Australian Securities and Investments Commission (ASIC, 2014). For clinical hypnotherapists to conduct ethical professional practices, a review of attitudes may be required. Should the data indicate a variance to current accepted attitudes then targeted training could assist with modifying behaviours to current professional standards.
9.5
Concepts: Practical work in general
There are no established curriculua for clinical hypnotherapy within Australia. A search of training.gov.au (DEEWR., 2012) confirmed that clinical hypnotherapy training is made up of individual courses rather than a government recognised training package. The peak body and professional association provide only brief training guidelines (AHA, 2013c; ASCH, 2013d; HCA, 2012c) so training content and practical work within that content remains the responsibility of the training institution. The practice of techniques would depend on factors such as the attitudes of the institution, topics and the length of training.
As the details of privately owned courses are considered commercial-in-confidence, the specific data pertaining to practical work for each course is unavailable. Literature
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acknowledges that practical training is designed to give the practitioner experiential learning (Hagspiel & Sulz, 2011) but also there is little opportunity for practice (Fellows, 1996). With no current data, no conclusions can be drawn. See Table 6: Results Details Table for detailed results.
Discussion: Respondents concluded that the practice of techniques was required within clinical hypnotherapy training with consensus in all but two questions. The two questions related to rehearsing practice management skills and rehearsing scripts. The area of practice management including business, legal and marketing was briefly investigated. The data showed consensus on the necessity for clinical hypnotherapists to have business skills and the development of those skills within a training course. Questions on rehearsing practice management skills demonstrated a lack of consensus. It seems an anomaly to develop a skill and not practice that skill in a supervised environment where it can be honed, but the survey participants may deem the skill as necessary but do not perceive the practice of that skill as required. The anomaly is explained but not resolved if attitudinal considerations are taken into account. If clinical hypnotherapist’s attitudes resemble those of counsellors and psychotherapists, the concepts of ‘duty’ public service’ and ‘responsibility’ may curb self-promotion for personal gain (Barletta & Watson, 2001; Getzlaf & Cross, 1988; Gottleib, 2012; Loewenthal, 2002).
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9.6
Concepts: Scripts
The data showed that opinion was divided on whether scripts were considered an integral part of training 69% (29) which demonstrated consistency of opinion when compared with the rehearsing of scripts receiving 65.9% (29) agreement. See Table 6: Results Details Table for detailed results.
Discussion: Scripts have been used for many years and are still acknowledged by the literature , teaching institutions and associations (ASH, 2013c; CA, 2013b; Cyna, Andrew, & Whittle, 2008; Hammond, 1990; HS, 2012; Macintosh, 2008; Waxman, 1989). Some have voiced disagreement with scripts (Yapko, 2011) but scripts continue to be used and acknowledged. The question is why- if scripts are integral - should they not be practiced?
9.7
Concepts: ‘Hypnosis’ and ‘hypnotherapy’
The Parliament of South Australia has concluded there is no accepted definition of “hypnotherapy” and “hypnosis” (PoSA, 2009b). Some articles use hypnosis and others use hypnotherapy. It is further complicated when the terms hypnosis and hypnotherapy are used interchangeably (Abramowitz, Barak, Ben-Avi, & Knobler, 2008; Alladin & Alibhai, 2007; Burrows, Stanley, & Bloom, 2002; PoSA, 2009c) in a variety of professional publications. This interchangeability was addressed (Frischholz, 1995, 1998) by the editor of the American Journal of Clinical Hypnosis. As editor, changes were made to the American Journal of Clinical Hypnosis’ priorities for accepting manuscript submissions in that manuscripts which continued to use ‘hypnotherapy’ without clear definitions, treatment rationales and techniques would be returned for correction prior to being reviewed (Frischholz, 1995). It was reported that members of the American Society of Hypnosis were disappointed that they were discouraged from using hypnotherapy and the
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use of ‘hypnotherapy’ was accepted provided there was a specific definition in the introduction section of the manuscript (Frischholz, 1998).
Frischholz has written extensively (Frischholz, 1995, 1997, 1998; Frischholz & Spiegel, 1983) on the use of ‘hypnosis’ rather than ‘hypnotherapy’ and the interchangeability of the terms. He perceives ‘hypnotherapy’ as too general for the scientific community and states that hypnosis is a form of focused concentration rather than a form of therapy (Frischholz & Spiegel, 1983). This view is supported by the ASH and the ASCH. ASH “... views hypnosis, not as an independent science, but as an adjunct to the range of treatment modalities for a wide range of medical, psychological, and dental applications” (ASH, 2010, p. 1) and, The Society views hypnosis, not as an independent science, but as an adjunct to the range of treatment modalities for a wide range of medical, psychological, dental and therapeutic applications. The Society encourages members, located in every state, to participate in conferences, workshops and other specialist trainings in their areas, designed to foster clinical skills development across a range of applications of hypnosis in health, psychological, dental and therapeutic settings. (ASCH, 2011c) The ASCH reviewed its comment and changed it to read: The members of the Society use hypnosis, as an independent science, and / or as an adjunct to the range of treatment modalities for a wide range of medical, psychological, dental and therapeutic applications. The Society encourages members, located in every state, to participate in conferences, workshops and other specialist trainings in their areas, designed to foster clinical skills development across a range of applications of hypnosis in health, psychological, dental and therapeutic settings. (ASCH, 2011d) There is support for hypnosis being an adjunct therapy, and Frischholz makes the point that the members of the American Society of Hypnosis are not hypnotherapists as they
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have years of training and expertise in other health disciplines and believes they need to be differentiated from clinical hypnotherapists (Frischholz, 1995). His point is well made and the courses generally undertaken by existing health professional are adjunctive to existing skills.
With no universally accepted definition of hypnosis (PoSA, 2009b), and confusion regarding the use of the terms hypnosis and hypnotherapy, it can be postulated that the profession requires clarification on these issues. See Table 6: Results Details Table for detailed results.
Discussion: The data provide evidence that the cohort does not believe that hypnotherapy and hypnosis mean the same thing which supports Frischholz’s perspective (Frischholz, 1995, 1998) by disagreement that the terms mean the same thing. The underpinning reasoning was not investigated in the survey. The results clearly state that ‘hypnosis’ is not the same as ‘hypnotherapy’.
The term clinical hypnotherapist should be reserved for those graduates who have completed extended study in recognised clinical hypnotherapy courses and have attained a level by which they could use clinical hypnotherapy as their primary modality.
9.8
Concepts: Research
Clinical hypnotherapy training is available in the vocational sector and research methodology is taught in the higher education sector. This indicates that research is conducted by university graduates who come to clinical hypnotherapy once they have completed university studies. This assumption appears accurate as the research in the literature is conducted by practitioners already holding a university health qualification rather than a vocational qualification. A search of course documentation showed only one
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organisation that covered basic research methodology within their Advanced Diploma training (AAH, 2013a). Research is placed at Bachelor Honours Degree (level 8) of the AQF qualification type learning outcomes descriptors (AQFC, 2013). Although the term research is not used prior to level 8 the Bachelor Degree AQF level 7 criteria skills required for does use terminology such as: Skills Graduates at this level will have well-developed cognitive, technical and communication skills to select and apply methods and technologies to: •
analyse and evaluate information to complete a range of activities
•
analyse, generate and transmit solutions to unpredictable and sometimes complex problems
•
transmit knowledge, skills and ideas to others (AQFC, 2013, p. 47)
This indicates that conducting research is not a learning outcome up to level 7, but analysis and evaluation - which are research skills - are required at level 7 but are not a required learning outcome for lower levels (AQFC, 2013). The explanation of why research is being conducted by professionals who have clinical hypnotherapy as an adjunct to their existing health qualification does not reduce the contribution of the research. It simply indicates a different perspective that that of a health professional whose primary health modality is clinical hypnotherapy. See Table 6: Results Details Table for detailed results.
Discussion: The cohort was divided regarding the teaching of research within training. The question was targeted towards designing and conducting clinical research that exceeds existing educational standards. The cohort was comprised of participants across the sector so it is understandable that this division would occur.
The division of the cohort regarding research may be based in their educational backgrounds. Much of the cohort completed their education within the VET sector and
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others would have completed higher education. There is little exposure to research concepts in the VET sector but in higher education exposure to research is common. Allowance must also be made for the question itself. Currently, clinical hypnotherapy training is conducted within the VET sector which is not usually where research is conducted. Research design and conducting research is an academic pursuit of higher education, whereas vocational education is directed towards manual and practical activities (Agbola & Lambert, 2010). However, with governments, regulatory authorities and other organisations (e.g. health funds) requiring evidence of clinical hypnotherapy efficacy (DOHA, 2013a, 2013b), research is now a vital component for the emergence of a profession (McLeod, 2001) and the issue of research needs to be addressed by the profession.
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10 Clinical hypnotherapy education: Discussion Education in clinical hypnotherapy is the process of the acquisition of specialist knowledge (Ntshoe, 2012). This may be part of new knowledge and/or the development of lifelong learning (Cornford, 1999). Whichever the case, knowledge is what a graduate understands, and skills is what the graduate can do (AQFC, 2013). For clinical competency, a practitioner requires the integration of knowledge, skills and attitudes (VanderVeen, Reddy, Veilleux, January, & DiLillo, 2012).
Knowledge and skills can be taught at differing levels of depth, breadth and complexity (AQFC, 2013) and the application of professional competencies is expressed in terms of autonomy, responsibility and accountability (Katz, 2000). Therefore, knowledge and skill levels can be expressed by the learning outcomes which denote the degree of competency in relation to autonomy, responsibility, and accountability (AQFC, 2013). An example of this process can be demonstrated using self-hypnosis. Differing levels of knowledge and skill would enable the clinical hypnotherapist to utilise ‘self-hypnosis’ at different levels. At a fundamental level self-hypnosis can be taught to a client as an individual technique to practice. This can occur on the first consultation and be designed to relax the client between consultations. At an intermediate level of self-hypnosis, the client can be taught a variety of induction, deepening and suggestion techniques to enhance therapy outcomes. At an advanced level, the practitioner would have skills to teach individuals or groups a range of self-hypnotic techniques and have developed a self-hypnosis training course. These examples demonstrate the differing levels at which self-hypnosis could be used in a clinical setting and differing levels of education and competency by the practitioner.
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The concepts, techniques and practical components are available to be taught across the whole spectrum of clinical hypnotherapy education. Where the particular concept, technique or practical aspect is placed within the syllabus often depends on the discernment of the educational institution. The survey did not include the categorisation of the skills and competencies into levels of knowledge or depth of learning. The inclusion of topics within the fundamental, intermediate or advanced categories is dependent on the necessity of that skill or competency to practice clinical hypnotherapy. Skills and competencies that are essential to the practice of clinical hypnotherapy have been placed into the fundamental category. The other skills and competencies outlined in the survey questions have been placed in accordance with the levels of knowledge and learning inherent within the survey question. It is acknowledged that the placement of the skills and competencies into the fundamental, intermediate and advanced categories would vary depending on which clinical hypnotherapy educator was undertaking the placement.
The literature is sparse regarding details of training programs. Published documents provide some information (Dane & Kessler, 1998; Hammond, 1996; Oster, 1998; Stanley et al., 1998; Taub-Bynum & House, 1983; Watkins, 1998), but one paper provides significant detail on training being provided by the American Society of Clinical Hypnosis (Hammond & Elkins, 1994). The American certification program was designed to provide a voluntary self-regulated credentialing program for qualified medical practitioners, psychologists, osteopaths, podiatrists, dentists, doctoral level social workers and nurses, and Masters degree level social workers, psychologists, nurses, marriage and family therapists, and mental health counsellors. Internationally and within Australia, associations have established their own ‘Society of Hypnosis’ and training which was based the American model (ASCH (USA), 2014; ASH, 2013a) and certified that the practitioner had met fundamental educational training requirements in clinical hypnosis. The categories used by Hammond and Elkins are ‘Beginning’, ‘Intermediate’ and ‘Advanced’, each subject assigned a related set of ‘recommended learning objectives and
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recommended content’. This thesis will use ‘foundational’ rather than ‘beginning’, as the term denotes not only a ‘beginning’ or starting point but also a underpinning of essential knowledge, skills and attitudes for clinical hypnotherapy practice. It is acknowledged that the primary reference document is from 1994 but no more recent document of the same standard is available in the literature. The current version of the course documentation is not published on the American (AmericanSCH, 2014) or Australian branch (ASH, 2014b) association websites. The Australian course is available to members of the professions of Chiropractic, Dentistry, Medicine, Midwifery, Nursing, Occupational Therapy, Optometry, Osteopathy, Physiotherapy, Podiatry, Psychology and Social Work (ASH, 2014b) and same content appears taught to be all participants.
The current Australian version of the original course (ASH, 2014e) provides limited insights on pedagogy. The lack of information such as depth of knowledge/skills, foundational knowledge and skills, learning outcomes, levels, lifelong learning, range, recognition of prior learning and volume of learning makes assessment in relation to the survey data impractical. Table 23: AQF pedagogical terms outlines the pedagogical terms as defined by the AQF.
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Depth of
Depth of knowledge/skills indicates an advanced degree of difficulty or
knowledge/skills
complexity
Foundational
Foundational knowledge and skills are initial or introductory knowledge and
knowledge and
skills upon which further development can be built
skills Learning
Learning outcomes are the expression of the set of knowledge, skills and the
outcomes
application of the knowledge and skills a person has acquired and is able to demonstrate as a result of learning
Levels
AQF levels are an indication of the relative complexity and/or depth of achievement and the autonomy required to demonstrate that achievement. AQF level 1 has the lowest complexity and AQF level 10 has the highest complexity
Lifelong
Lifelong learning is the term used to describe any learning activities that are
learning
undertaken throughout life to acquire knowledge, skills and the application of knowledge and skills within personal, civic, social and/or employment-related contexts
Range
Range is the area between the limits of variation as in a narrow or a broad or limited range of knowledge/skills
Recognition of
Recognition of prior learning is an assessment process that involves
prior learning
assessment of an individual’s relevant prior learning (including formal, informal and non-formal learning) to determine the credit outcomes of an individual application for credit (National Quality Council Training Packages glossary)
Volume of
The volume of learning is a dimension of the complexity of a qualification. It is
learning
used with the level criteria and qualification type descriptor to determine the depth and breadth of the learning outcomes of a qualification. The volume of learning identifies the notional duration of all activities required for the achievement of the learning outcomes specified for a particular AQF qualification type. It is expressed in equivalent full-time years Table 23: AQF pedagogical terms (AQFC, 2013, pp. 92 - 101)
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The next section will draw on two education models from very limited research into clinical hypnotherapy curricula (Elkins & Hammond, 1998). One specialist model used, facilitated the development of the initial American Society of Clinical Hypnosis (ASCH(USA)) course which grouped topics in categories of fundamental, intermediate and advanced (Hammond & Elkins, 1994) and the second is the Australian Qualifications Framework (AQF) which has been used to achieve accreditation for Certificate IV Diplomas and Advanced Diplomas in the vocational sector (AQFC, 2013).
There are distinct issues with both models. The ASCH (USA) model presents limited pedagogy supporting the choices for the placement of topics into beginning, intermediate or advanced categories. The AQF model has been used to develop commercial in confidence courses, so no pedagogy directly related to clinical hypnotherapy is available. The available data are the AQF framework for all educational endeavours (AQFC, 2013). As courses are accredited at the Certificate IV, Diploma and Advanced Diploma levels it is appropriate to use these criteria. The information provided informs the development of courses at each AQF level (AQFC, 2013).
The AQF accommodates a diversity of purposes of Australian education and thus specific pedagogy required by clinical hypnotherapy and other disciplines. This then requires each modality to infuse profession specific terminology for their pedagogy. Confusion can occur when terms such as ‘broad’ are used at each level in different domains of learning. To some degree this issue has been overcome by the development of training packages which contain qualifications, industry derived competencies and assessment guidelines (Wheelahan & Carter, 2001). As clinical hypnotherapy has no training package and industry derived competencies, course development is reliant upon the course owner and if the goal is to achieve AQSA accreditation - the AQF guidelines. Within this framework
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topics can be at varying levels dependent on the depth, range and volume of learning each nominated topic. Each topic will be categorised within this framework.
10.1
Clinical hypnotherapy: Introduction to categories
This overview is a prelude to all the categorisation of topics. Contents of curricula vary between training courses. As there is no training package, clinical hypnotherapy courses are written as individual programs, and topics are customised to the philosophies of the course developer. Each ASQA accredited course is significantly different even though there are accredited through the same regulatory authority (AAH, 2013a; ACH, 2013; AHS, 2014; CA, 2013a; Phoenix, 2013). Professionally recognised courses also set their own curricula (AICH, 2014; ATP, 2014; IET, 2041; MD, 2014). In addition to the training institutions, consideration must also be given to the criteria required for membership of associations (AACHP, 2012; AHA, 2013d; ASCH, 2013f; PACFA, 2014a). This range of clinical hypnotherapy strategies are acknowledged within the peak body’s mission statement ‘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, 2012e)
With such diversity characterising clinical hypnotherapy education, the range of concepts is broad. The selection presented within the survey was gleaned from the various training institutions and association membership criteria.
The clinical hypnotherapy concepts will be grouped into sections for ease of reading. It is acknowledged that the category titles (Fundamental, Intermediate and Advanced) are open to discussion, being put forward as labels rather than a prescribed indication of educational pathway or degree of competency. The locating of topics within those titles was not a specific topic of this research and is offered as a guide rather than a prescription, especially as topics can be taught at differing levels of complexity dependent
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on the desired learning outcomes (AQFC, 2013, p. 97). Fundamental competencies and skills are essential for anyone entering the profession of clinical hypnotherapy and are irrespective of previous training, be it in health or not. This is evidenced by the teaching of a universal curriculum to a range of health practitioners (ASH, 2013d). The curriculum provides no variation for the different health professionals or automatic credit for existing competencies, but does provide a provision for recognition of prior learning should the candidate wish to apply. These entry level competencies and skills are used as the foundation for more complex proficiencies in the same way that the AQF increases complexity from level 1 to level 10 (AQFC, 2013). Making comparison between the AQF and the diversity of clinical hypnotherapy training is not a logical comparison. As some health funds have acknowledged ASQA accredited qualifications and one association’s membership criteria has now responded, it seems logical that the starting point should be the lowest level of training, being AQF (level 4) accredited Certificate IV (AQFC, 2013, pp. 35-37). The intermediate level would then follow as an AQF (level 5) accredited diploma (AQFC, 2013, pp. 38-40) and the advanced diploma would be the AQF (level 6) advanced level training (AQFC, 2013, pp. 39-41).
10.1.1
Clinical hypnotherapy category: Fundamental (AQF level 4 – Certificate IV)
Fundamental competencies and skills could be interpreted as those proficiencies without which a clinical hypnotherapist could not or should not practice. They encompass topics which provide safety for the client and the practitioner. Opinion on what constitutes the fundamental level differs greatly within the profession and has changed over a period of time. Increasing standards are required for professional association membership (AHA, 2011c) and the increase in health fund Provider Recognition Criteria (AU, 2013; Bupa, 2009). Training institutions have also changed, but this change is less obvious because only some institutions have quantified the changes in their literature e.g. courses being accredited to advanced diploma level with ASQA (t.g.au, 2012). An example of the criteria
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for what could be considered as a fundamental level would be the Certificate IV level as described in the AQF (AQFC, 2013, p. 35). Summary
Graduates at this level will have theoretical and practical knowledge and skills for specialised and/or skilled work and/or further learning
Knowledge
Graduates at this level will have broad factual, technical and some theoretical knowledge of a specific area or a broad field of work and learning Graduates at this level will have a broad range of cognitive, technical and
Skills
communication skills to select and apply a range of methods, tools, materials and information to: • complete routine and non-routine activities • provide and transmit solutions to a variety of predictable and sometimes unpredictable problems Application of
Graduates at this level will apply knowledge and skills to demonstrate
knowledge and
autonomy, judgement and limited responsibility in known or changing
skills
contexts and within established parameters Table 24 : AQF level 4 criteria (AQFC, 2013, p. 35)
An older peer reviewed publication (Hammond & Elkins, 1994) outlines the curriculum, some pedagogy (learning outcomes and recommended content) and the fifteen topics being: 1. Definition, history, and theories of hypnosis 2. Myths and misperceptions of hypnosis; hypnosis and memory 3. Assessment, presenting hypnosis to the patient, and informed consent 4. Hypnotic phenomena and their therapeutic applications 5. Principles and process of induction and realerting; principles in formulating hypnotic suggestions 6. Demonstrations of Hypnotic Inductions
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7. Demonstration or Video Demonstration of Eliciting Hypnotic phenomena 8. Supervised small group practice of hypnotic inductions 9. Concepts of Hypnotic Susceptibility, Stages of Hypnosis, and Methods of Deepening Hypnotic Involvement 10. Self-hypnosis: How and What to Teach Patients 11. Treatment Planning, Strategy and Technique Selection in Hypnotherapy 12. Strategies for Managing Resistance to Hypnosis 13. Introduction to Hypnotic Susceptibility Scales 14. Ethical principles, professional conduct, and certification 15. Integrating hypnosis into clinical practice
The current statement of the syllabus for training prescribed by the Australian Society of Hypnosis Ltd. is: “COURSE SYLLABUS COMPULSORY CORE UITS [sic] Knowledge: History, phenomena of hypnosis, theories, hypnotisability and tests of it, memory & legal issues; ethics, myths, contraindications, suggestion styles, traditional & contemporary approaches Practice skills: Induction, deepening, reorientation, debriefing. Styles: Traditional, conversational. Therapeutic models: optional Applications to specific issues and populations Anxiety & generalised anxiety disorder · Panic · Phobias
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· PTSD · OCD Children Dentistry Depression Eating disorders Ego Strengthening Grief & Loss Habit Disorders – weight issues, smoking, addictions, etc. Obstetrics & gynecology [sic] Pain: Acute & chronic Sexual Health Sleep problems Specific illnesses · Cancer · Irritable bowel syndrome · Etc. Stress management” (ASH, 2014e, pp. 2-3) The ASH course syllabus provides the topics to be covered, but other information regarding depth of knowledge and skills, foundational knowledge and skills, learning outcomes and whether the topic is covered in a broad or narrow manner is limited.
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The survey questions which can be considered as fundamental skills are listed below. See Table 6: Results Details Table for detailed results.
#
Question
No (%)
Result
Agree 38.
Clinical hypnotherapy requires counselling skills
53
C2
(94.6%) 39.
Direct suggestion is the primary methodology for clinical hypnotherapists
hypnotherapists Practical work should be included in clinical hypnotherapy
Preparing the client prior to the first induction is required
History of hypnosis is required within a hypnotherapy training course
47.
NC
55
C1
(98.2%)
within a hypnotherapy training course 44.
29 (69.0%)
training 43.
C2
(18.6%)
37s Suggestion is the primary methodology for clinical
42.
4
54
C1
(98.1%) 50
C1
(89.3%)
Inductions are essential for clinical hypnotherapy training
53
C1
(96.3%) 49.
Psychotherapeutic concepts are required in clinical hypnotherapy training
50.
52
C1
(94.5%)
Clinical hypnotherapists require knowledge of psychology
47
C1
(85.5%) 51.
Clinical hypnotherapists require knowledge of psychotherapy
49 (89.1%)
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C1
52.
Clinical hypnotherapists require knowledge of medical sciences
53.
Clinical hypnotherapists require knowledge of
Clinical hypnotherapists require knowledge of
Clinical hypnotherapists require knowledge of
Clinical hypnotherapists require knowledge of susceptibility techniques
57.
60.
Clinical hypnotherapists require knowledge of
Clinical safeguards should not be included in
63.
C1
(100.0%) 50
47
4 (7.2%)
Scripts are an integral part of clinical
29
C1
C1
C1
NC
(69.0%)
Hypnotic phenomenon is a required part of
53
C1
(96.4%)
Training a client in self hypnosis should
39
be part of clinical hypnotherapist training
(92.0%)
A definition of hypnosis is required in training programs
64.
56
the training of clinical hypnotherapists
clinical hypnotherapy training 62s.
HA
(85.5%)
hypnotherapy training 61.
34
(89.3%)
hypnoanalysis 59.
HA
(81.0%)
legal requirements in a health practice 56.
34 (82.9%)
human sexuality 55.
HA
(82.5%)
pharmacology 54.
33
50
C2
C1
(90.9%)
Myths and misconceptions need to be discussed within a hypnotherapy training course
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56 (100.0%)
C1
65. Hypnotic phenomena & their potential usefulness is required within a hypnotherapy training course
52
C1
(88.1%)
67. Principles of induction are required within a hypnotherapy training course
55
C1
(100.0%)
68. Theories of hypnosis are required within a hypnotherapy training course
54
C1
(96.4%)
69. Awakening procedures from the hypnotic state is required within a hypnotherapy training course
53
C1
(98.1%)
70. Understanding the stages (levels) of hypnosis is required within a hypnotherapy training course
53
C1
(94.6%)
71. Deepening techniques are required within a hypnotherapy training course
55
C1
(98.2%)
72. Principles in formulating hypnotic suggestions are required within a hypnotherapy training course
56
C1
(100.0%)
79. Observation of actual client cases is required within a hypnotherapy training course
40
C2
(80.9%)
80. The word trance is confusing for clients
29
NC
(65.9%) 81. Self hypnosis for personal use is required within a hypnotherapy training course
38
C2
(88.4%)
83. Ericksonian hypnosis is required within a hypnotherapy training course
39
C2
(88.7%)
84. Health issues client intake sheet and treatment plan is required within a hypnotherapy training course 85. Working within a therapeutic framework is required within a hypnotherapy training course
51 (94.5%) 53 (94.6%)
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C1
C1
86.
Rapport building (Therapeutic Alliance) with the client is required within hypnotherapy
56
C1
(100.0%)
training 87.
Dealing with abreactions is required within a hypnotherapy training course
88.
C1
(100.0%)
Deepening the hypnotic state is required within a hypnotherapy training course
89.
55
Practice management forms (e.g. Client intake sheet) are required within hypnotherapy
54
C1
(98.1%) 52
C1
(94.6%)
training 90.
Treatment plans are required within a hypnotherapy training course
91.
Ethical issues are a required topic within a
Ego strengthening is required within a
Neuro Linguistic-Programming is required
Occupational health and safety policies are required within a hypnotherapy training course
95.
96.
C1
50
C1
(92.6%)
within a hypnotherapy training course 94.
56 (100.0%)
hypnotherapy training course 93.
C1
(89.1%)
hypnotherapy training course 92.
49
Work within a legal and ethical framework is
24 (58.5%) 49
C1
(87.5%) 56
required within a hypnotherapy training course
(100.0%)
A variety or hypnotherapeutic concepts is not
6
required within a hypnotherapy training course
(11.1%)
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NC
C1
C1
97.
Working within a structured counselling process is required within a hypnotherapy
37
C2
(88.1%)
training course 100.
Fundamental techniques should be included in clinical hypnotherapy training
101.
Practical application of techniques is required
Hypnoanalytical techniques should be included in clinical hypnotherapy training
103.
Training a client in self hypnosis is an essential part of clinical hypnotherapist training
104.
Demonstrating hypnotic inductions is required within a hypnotherapy training course
105.
Methods of ego-strengthening are required within a hypnotherapy training course
106.
Hypnotic techniques with pain are required within a hypnotherapy training course
107.
108.
109.
Hypnotic susceptibility techniques are required
54
C1
(100.0%) 51
C1
(94.6%) 31
NC
(75.6%) 55
C1
(100.0%) 48
C1
(92.3%) 52
C1
(98.1%) 48
within a hypnotherapy training course
(90.6%)
Formulating therapeutic suggestions is
55
required within a hypnotherapy training course
(100.00%)
Rehearsing scripts is beneficial for the practice
29
of clinical hypnotherapy 110.
C1
(100.0%)
in clinical hypnotherapy training 102.
54
C1
C1
NC
(65.9%)
Using hypnotherapy terminology to communicate with others is required within a hypnotherapy training course
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39 (86.7%)
C2
111.
Self hypnosis is required topic within a hypnotherapy training course
112.
114.
Susceptibility techniques are required within a
Induction and deepening techniques are
(98.1%)
Creating basic suggestions is required within a
53
Inductions are required within a hypnotherapy
Post hypnotic suggestion is required within a
C
53
C1
50
C1
(98.0%)
Creating suggestions is required within a
52
C1
(98.1%
Sensory language is required within a hypnotherapy training course
123.
C1
(98.2%)
hypnotherapy training course 122.
C1
(100.0%)
hypnotherapy training course 120.
53
required within a hypnotherapy training course
training course 118.
49 (90.7%)
hypnotherapy training course 116.
C1
(86.3%)
hypnotherapy training course 113.
45
48
C1
(92.3%)
Psychotherapy (e.g. NLP, Ego State Therapy
8
or Gestalt) techniques should not be practised
(14.9%)
C1
in clinical hypnotherapy training 124.
Counselling techniques should not be practised in clinical hypnotherapy training
125.
Composing patter for each individual client is required in clinical hypnotherapy training
127.
5 (9.5%) 43
C2
(95.6%)
Formulating hypnotic suggestions is required
55
activity within a hypnotherapy training course
(100.0%)
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C1
C1
128.
Demonstrations of deep trance phenomenon are required within a hypnotherapy training
48
C2
(88.4%)
course 129.
Practical work is not required in a clinical hypnotherapy training course
130.
131.
132.
Demonstrations and practical exercises are
(100.0%)
Preparing a treatment plan for case studies is
51
required within a hypnotherapy training course
(92.7%)
Make referrals to health care professionals is
Demonstration of practical skills is required
Assessment of practical skills is required within a hypnotherapy training course
137.
55
required within a hypnotherapy training course
within a hypnotherapy training course 136.
C1
(7.3%)
required within a hypnotherapy training course 135.
4
52
C1
C1
C1
(94.5%) 54
C1
(100%) 53
C1
(98.2%)
Case consultation conferences within a
44
workshop or class format is required in
(95.6%)
C2
hypnotherapy training 138.
Supervision is not required in a clinical hypnotherapy training program
8
C1
(14.5%)
Table 25: Fundamental Skills
Discussion: The cohort achieved consensus on what have been categorised as foundational topics from the survey in all but seven questions. The questions which did not achieve consensus related to suggestion, medical sciences, pharmacology, human sexuality,
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scripts, Neuro-Linguistic Programming and self-hypnosis. These non-consensus topics will be discussed as individual items
It was not agreed that suggestion was the ‘primary’ methodology for clinical hypnotherapists. In this situation the word ‘the’ or ‘primary’ may have caused dissention. Both words place a high emphasis on suggestion potentially above what the cohort considered reasonable. The ASCH(USA) course (Hammond & Elkins, 1994) includes suggestion in topic five, with several other references within the curriculum. The ASH documentation includes suggestion styles in their knowledge outline (ASH, 2013d). The ASCH include suggestion within their membership criteria as human suggestibility and structuring suggestions (ASCH, 2013f) but it is not mentioned in the AHA documentation (AHA, 2013a) or the HCA documentation (HCA, 2012c). The non-inclusion in professional associations documentation may relate to the belief in diversity of methodologies within the profession as outlined in the HCA mission statement (HCA, 2012e). The lack of consensus in the survey seems to support the views of the profession.
Medical sciences, pharmacology and human sexuality achieved high agreement but not consensus. The topics do not appear in the AHA, ASCH or HCA documentation (AHA, 2013a; ASCH, 2013f; HCA, 2012c) but some references to sexual issues appear in the ASH course (ASH, 2013d) and ASCH(USA) course (Hammond & Elkins, 1994) and there is only one specific reference to sexual health in the ASH course syllabus (ASH, 2013d). The lack of specific references in these topics may relate to the ASH minimum membership requirements being that of a health professional, so it is construed that there is pre-existing knowledge. The cohort has reflected the inclusion and lack of consensus within the profession on the issues of medical sciences, pharmacology and human sexuality.
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Scripts are used within clinical hypnotherapy training (CA, 2013b; Macintosh, 2008). The cohort did not achieve consensus on scripts or the rehearsal of scripts being integral within clinical hypnotherapy training. The Beginning Workshop Curriculum (Hammond & Elkins, 1994) do not use the word ‘script’ in their documents and it does not appear frequently within the clinical hypnotherapy education literature but the current Australian course (ASH, 2014e) includes an acknowledgement in their guidelines for case reports and reading list. The reason consensus was not reached may lie in the term ‘integral’ but the result was unexpected and further research would be required to ascertain the cohorts reasoning. If scripts are not required in clinical hypnotherapy training, it is obvious the rehearsing of those scripts is also not required.
The cohort was undecided regarding the word ‘trance’ The word ‘trance’ is used in the literature (Araoz, 2005), in book titles (Yapko, 2003), journal names (JET, 2014) and by associations (ASCH, 2013e). Some organisations use terminology such as ‘trance-like state’ (Boehm, 2011) to describe hypnosis. The data show the terminology may be causing some confusion. If the word trance is confusing to clients, the question becomes what action, if any, is required to address the issue?
Within the survey the one question (92) included on ego strengthening achieved consensus in the first round. The ASCH(USA) course relates ego strengthening to suggestion and metaphor (Hammond & Elkins, 1994, p. 13). The survey asked four questions directly related to suggestion. All achieved consensus except the question that proposed suggestion as the primary methodology for clinical hypnotherapists.
Suggestion is a primary tool of the clinical hypnotherapist. The cohort (in question 39) recognised that direct suggestion was not the primary tool and in question 37s that suggestion was not the primary methodology for clinical hypnotherapists. The ASCH (USA) course relates ego strengthening and suggestion which is apposite, however as
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suggestion is also used to convey instructions, present alternatives, implement techniques and a myriad of other uses within clinical hypnotherapy, the survey did not identify each individual use of suggestion.
The cohort rejected Neuro-Linguistic programming as a requirement within clinical hypnotherapy training. It is mentioned in the peak body’s minimum educational standards (HCA, 2012c) but not in the membership criteria of the AHA (AHA, 2013a) or the ASCH (ASCH, 2013f). A number of Australian courses include NLP in their curriculum (AAH, 2013a; ACH, 2013; AHS, 2013) but the topic did not achieve consensus. This may be due to the word ‘required’ within the question. As NLP is included in a number of clinical hypnotherapy training courses’ curricula it can be surmised that it may be desirable rather than required.
Self-hypnosis is an interesting case as the data provide contradictory evidence. The cohort achieved consensus on two of the three questions. The inclusion was for self-hypnosis to be included to enable the practitioner to teach their clients and for personal use. This acknowledges the issue of self-care for mental health practitioners. The literature identifies the issues of burnout, distress, fatigue and impairment as risk factors (Hartman & Zimberoff, 2012) and associations provide resources to assist (Knauss & J., 2009; Mead, 2006). The literature reports self-hypnosis being used as part of treatment regimens (Abdeshahi, Hashemipour, Mesgarzadeh, Shahidi Payam, & Halaj Monfared, 2013; Madden, Matthewson, Middleton, Jones, & Cyna, 2012). The inclusion of self-hypnosis provides an alternative to consultations and reinforcement between consultations (Elkins, Fisher, & Johnson, 2011). It was agreed that self-hypnosis was ‘required’ and ‘should be’ part of clinical hypnotherapy training. However, consensus was not achieved regarding self-hypnosis being an ‘essential’ part of clinical hypnotherapy training. The ASCH(USA) (Hammond & Elkins, 1994) course notes ‘self-hypnosis’ as an individual topic for training but not in the ASH course syllabus (ASH, 2013d). The ASCH identifies self-hypnosis in
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their educational requirements (ASCH, 2013e) but not the AHA or HCA. It appears that the word ‘essential’ elicited a response from a section of the cohort. Taken in context with the other two questions, it is likely that self-hypnosis should be part of clinical hypnotherapy training.
All other questions achieved consensus. The topics that achieved consensus and are considered ‘required’ by the participants within clinical hypnotherapy training are summarised to as: assessment of skills
hypnotherapy
psychotherapy
composing individual
terminology
referring
client’s patter
induction
self-hypnosis
counselling
legal requirements
sensory language
deepening
pain control
suggestion
demonstration
practical work
supervision
ego strengthening
practical work
susceptibility
history of hypnosis
psychology
treatment plans
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10.1.2
Clinical hypnotherapy category: Intermediate (AQF level 5 – Diploma)
The intermediate level is designed to build on existing knowledge and skills developed in the fundamental levels (AQFC, 2013, pp. 38-40; Hammond & Elkins, 1994). It is summarised in the AQF as level 5 (AQFC, 2013, p. 38) Summary
Graduates at this level will have specialised knowledge and skills for skilled/paraprofessional work and/or further learning
Knowledge
Graduates at this level will have technical and theoretical knowledge in a specific area or a broad field of work and learning
Skills
Graduates at this level will have a broad range of cognitive, technical and communication skills to select and apply methods and technologies to: • analyse information to complete a range of activities • provide and transmit solutions to sometimes complex problems • transmit information and skills to others
Application of
Graduates at this level will apply knowledge and skills to
knowledge and
demonstrate autonomy, judgement and defined
skills
responsibility in known or changing contexts and within broad but established parameters Table 26: AQF level 5 criteria (AQFC, 2013, p. 38)
Areas such as forensic hypnosis supplement foundational skills. Forensic hypnosis can be described as the intersection of clinical hypnotherapy and the law (Marchetti, 2012). Hypnosis was acknowledged for use in the forensic area (APA, 2012a) and at one stage the Los Angeles Police Department trained police officers, lawyers and one judge in hypnosis (Burrows, 1981). This was criticised as whilst the trainees were expert in their field of law, their competencies did not translate to application of forensic hypnosis as unexpected responses may occur (Burrows, 1981). Even though people can lie in the hypnotic state, forensic hypnosis has a place in the legal system in specific scenarios
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(Burrows, 1981). The application of these concepts enhances clinical hypnotherapy treatment regimens as they afford a multidimensional approach that can be applied for specific clients. One non specialist natural therapy association requires this level for membership (ATMS, 2012). The new proficiencies provide increased autonomy, judgement and with it additional professional responsibilities (Katz, 2000; Sim & Radloff, 2009; Watts, 2000).
The included topics also relate to the development of private professional practice as direct employment opportunities for clinical hypnotherapists are unlikely. The topics also include aspects of analytical and critical thinking to help the practitioner embrace their increasing seniority within the profession. #
Question
10.
Clinical hypnotherapy qualifications should be standardised across Australia
11.
Result
43
HA
(82.7%)
Clinical hypnotherapy should be registered by government
12.
No (%) Agree
24
NC
(46.2%)
Governance involves quality assurance guidelines
51
C1
(100.0%) 13.
Governance involves best practice guidelines
47
C1
(90.3%) 14.
Quality assurance is necessary within the profession of clinical hypnotherapy
14s.
C1
(88.5%)
Quality Assurance is not necessary for practitioners to receive health fund rebates
16.
46
Best Practice is necessary within the profession of clinical hypnotherapy
5 (14.7%) 43 (87.8%)
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C2
C1
17.
Quality Assurance is not required for associations giving recognition to teaching institution
18s.
29.
Best Practice is not necessary for practitioners to
6
HA
(17.1%)
Good governance will effect whether clinical
31
hypnotherapy receives professional acknowledgement
(88.6%)
Clinical hypnotherapy is a subset of other professional
18
modalities 30.
C!
(11.8%)
receive health fund rebates 19.
6
C2
NC
(48.6%)
Self regulation of clinical hypnotherapy is required
36
C1
(90.2%) 31.
Self regulation of clinical hypnotherapy ‘qualification names’ is required
32.
External recognition of clinical hypnotherapy is based
External recognition of clinical hypnotherapy is based
External recognition of clinical hypnotherapy is based
External recognition of clinical hypnotherapy is based
NC
8
HA
21
NC
(58.3%)
Business management skills are required by clinical hypnotherapists
41.
23
(22.2%)
upon public demand 40.
NC
(62.2%)
upon commercial considerations 35.
38 (76.0%)
upon peer reviewed research 34.
C2
(88.9%)
upon qualifications 33.
32
37
C1
(90.3%)
Marketing skills are required by clinical hypnotherapists
35
HA
(81.4%) 45.
Self hypnosis: how & what to teach patients is required within a hypnotherapy training course
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54 (96.5%)
C1
46.
‘Hypnosis is viewed not as an independent science, but
23
as an adjunct to the range of treatment modalities for a
(45.8%)
NC
wide range of medical, psychological, dental and therapeutic applications’ 48.
The terms ‘hypnosis’ and ‘hypnotherapy’ mean the same thing
58.
Clinical hypnotherapy should include training in past life
Clinical hypnotherapy training does not require national
Decision making strategies in selecting techniques is
Forensic & investigative hypnosis techniques are required within a hypnotherapy training course
76.
Working with group hypnosis is required within a hypnotherapy training course
78.
Working within a heath care team is required in clinical
C2
54
C1
(98.1%) 19
NC
(43.2%) 32
NC
34
HA
(77.3%)
Training to teach self hypnosis is required within a hypnotherapy training course
98.
6
(72.7%)
hypnotherapy training 82.
NC
(13.9%)
required within a hypnotherapy training course 75.
21 (48.7%)
standards 73.
C1
(5.7%)
work 62.
3
39
C2
(88.6%)
The depth of training in clinical hypnotherapy is important (e.g. reasons to use particular techniques)
115. Rehearsing practice management skills are required within a hypnotherapy training course 117. Rapid inductions are essential competencies for clinical hypnotherapy training
53 (96.3%) 25
NC
(62.5%) 25 (56.8%)
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C1
NC
67s
Rapid inductions should be part of clinical hypnotherapy training
35
HA
(83.3%)
119. Therapeutic metaphors are required within a hypnotherapy training course
49
C1
(92.4%)
121. Waking hypnosis is required within a hypnotherapy training course
45
C1
(86.5%)
133. Business planning is required within a hypnotherapy training course
36
HA
(81.8%)
134. Marketing is required within a hypnotherapy training course
36
HA
(78.2%)
141. Current educational standards are not impacting on the profession.
8
HA
17.4%)
142. Standardised clinical hypnotherapy training is not required in Australia
9
HA
(19.1%)
143. Clinical hypnotherapy educators do not require their skills and competencies to be assessed
7 (12.7%)
146. Recognition of Prior Learning (RPL) is not necessary
3
within the profession of clinical hypnotherapy
(5.3%)
148. Quality Assurance of training institutions is required in the profession of clinical hypnotherapy 151. Clinical hypnotherapy supervisors require specialised training
C1
50
C1
C1
(89.3%) 52
C1
(92.8%)
153. Clinical hypnotherapy trainers require higher level skills than those they are training.
54
C1
(94.7%)
154. Clinical hypnotherapy trainers require more practical experience than those they are training
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54 (96.4%)
C1
155. Clinical hypnotherapy supervisors require higher level skills than those they are supervising 156. Clinical hypnotherapy supervisors require more practical experience than those they are supervising 157. Vocational competency combined with relevant industry experience is all that is required to become a clinical
55
C1
(96.5%) 56
C1
(98.2%) 22
NC
(38.6%)
hypnotherapist Table 27: Intermediate Skills
Discussion As the clinical hypnotherapy profession develops, further questions will emerge. Issues of entry level competencies, standardised training and the place of clinical hypnotherapy within the health sector will need to be established. This is a different scenario to the topics presented by the ASCH (USA) curricula as the developers of the course considered themselves part of their own professions and their training was adjunctive to that training (Hammond & Elkins, 1994). The participants gained additional skills but remained part of their existing profession, but now with additional competencies. The topics which were considered intermediate or advanced within the early ASCH (USA) curricula (Hammond & Elkins, 1994) may not be considered the same currently or within training which uses clinical hypnotherapy as a primary rather than an adjunctive modality. This section will include topics from the ASCH (USA) course in relation to the survey data and where applicable, discusses the ASCH (USA) identified levels of intermediate and advanced.
The survey sought to identify the components that would be recommended within clinical hypnotherapy training. Some of these components would be unnecessary for the ASCH (USA) course as the participants are already health professionals. Participants of an already recognised profession would not need to consider questions of government
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recognition or pedagogical issues such as educational pathways, as these have been established for many years.
The areas which did not achieve consensus related to government regulation, external recognition, marketing and management skills, the position of clinical hypnotherapy in the health sector, past life work, forensic hypnosis, group hypnosis and the required criteria to enter the profession. Topics that received high agreement were standardised qualifications, best practice, external recognition, working as part of a health care team educational standards, marketing and business planning. Few of the topics have direct relevance to the day-to-day practice of clinical hypnotherapy, however they do relate to the profession as a whole and the development of the profession. It is conceivable that as an emerging profession, clinical hypnotherapy must consider some if not all of these issues and provide answers to the profession and those entities that posed the question. #
Question
No (%)
Result
Agree 11.
Clinical hypnotherapy should be registered by government
29.
Clinical hypnotherapy is a subset of other
External recognition of clinical hypnotherapy is
External recognition of clinical hypnotherapy is
External recognition of clinical hypnotherapy is based upon public demand
41.
NC
38
NC
(76.0%)
based upon peer reviewed research 35.
18 (48.6%)
based upon qualifications 33.
NC
(46.2%)
professional modalities 32.
24
23
NC
(62.2%) 21
NC
(58.3%)
Marketing skills are required by clinical hypnotherapists
35 (81.4%)
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HA
46.
‘Hypnosis is viewed not as an independent science, but as an adjunct to the range of
23
NC
(55.8%)
treatment modalities for a wide range of medical, psychological, dental and therapeutic applications’ 58.
Clinical hypnotherapy should include training in past life work
75.
Forensic & investigative hypnosis techniques are
Working with group hypnosis is required within a hypnotherapy training course
115.
157.
NC
(47.7%)
required within a hypnotherapy training course 76.
21
19
NC
(43.2%) 32
NC
(72.7%)
Rehearsing practice management skills are
25
NC
required within a hypnotherapy training course
(62.5%)
Vocational competency combined with relevant
22
industry experience is all that is required to
NC
(38.6%)
become a clinical hypnotherapist Table 28: Questions not relevant to day-to-day practice
Responses that achieved high agreement were: #
Question
10.
Clinical hypnotherapy qualifications should be standardised across Australia
15s.
Best Practice is not necessary for practitioners to
43
HA
6
HA
(17.1%)
External recognition of clinical hypnotherapy is based upon commercial considerations
78.
Result
(82.7%)
receive health fund rebates 34.
No (%) Agree
8
HA
(22.2%)
Working within a heath care team is required in clinical hypnotherapy training
34 (77.3%)
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HA
133. Business planning is required within a hypnotherapy training course
36
HA
(81.8%)
134. Marketing is required within a hypnotherapy training course
36
HA
(78.2%)
141. Current educational standards are not impacting on the profession.
8
HA
(17.4%)
142. Standardised clinical hypnotherapy training is not required in Australia
9
HA
(19.1%)
Table 29: Question with high consensus - not relevant to day-to-day practice
Topics with direct relevance to practitioner therapy competencies and skills were teaching self-hypnosis, past life work, forensic hypnosis, group hypnosis, decision making strategies working as part of a health care team, depth of training, rapid inductions, therapeutic metaphors and waking hypnosis. #
Question
45.
Self hypnosis: how & what to teach patients is required within a hypnotherapy training course
58.
Clinical hypnotherapy should include training in past life work
75.
Forensic & investigative hypnosis techniques are
Working with group hypnosis is required within a hypnotherapy training course
73.
54
C1
(96.5%) 21
NC
19
NC
(43.2%) 32
NC
(72.7%)
Decision making strategies in selecting techniques is required within a hypnotherapy training course
78.
Result
(47.7%)
required within a hypnotherapy training course 76.
No (%) Agree
Working within a heath care team is required in clinical hypnotherapy training
54 (98.1%) 34 (77.3%)
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C1
HA
82.
Training to teach self hypnosis is required within a
39
hypnotherapy training course 98.
(88.6%)
The depth of training in clinical hypnotherapy is
53
important (e.g. reasons to use particular techniques)
C1
(96.3%)
117. Rapid inductions are essential competencies for clinical
25
hypnotherapy training 67s
C2
NC
(56.8%)
Rapid inductions should be part of clinical
35
hypnotherapy training
HA
(83.3%)
119. Therapeutic metaphors are required within a
49
hypnotherapy training course
C1
(92.4%)
121. Waking hypnosis is required within a hypnotherapy
45
training course
C1
(86.5%) Table 30: Questions relevant to day-to-day- practice
The topics which achieved consensus related to areas in which clinical hypnotherapists practice on a daily basis. One area which achieved high consensus is an aspect of the health sector to which clinical hypnotherapists are unfamiliar. With a low level of recognition, clinical hypnotherapists are rarely included as part of a health care team. This lack of familiarity may have provided the impetus for the high consensus in the domain.
Topics with indirect relevance are quality assurance, best practice, and the competencies and training of both educators and supervisors. #
Question
14.
Quality assurance is necessary within the profession of clinical hypnotherapy
14s.
No (%) Agree
Result
46
C1
(88.5%)
Quality Assurance is not necessary for practitioners to receive health fund rebates
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5 14.7%)
C2
15s.
Best Practice is not necessary for practitioners to receive health fund rebates
16.
HA
(17.1%)
Best Practice is necessary within the profession of clinical hypnotherapy
17.
6
43
C1
(87.8%)
Quality Assurance is not required for associations giving recognition to teaching institution
6
C1
(11.8%)
Table 31: Questions with indirect relevance
Clinical hypnotherapists are trained in the vocational sector and their exposure to research has been limited. The profession of clinical hypnotherapy has developed and is further developing best practice and quality assurance procedures as they exist in other health professions (AHJ, 2014). Supervision is mandatory as part of association membership criteria and those that are acknowledged as supervisors are now required to undertake additional training to qualify for recognition (PHA, 2013b).
The ASCH (USA) course acknowledged topics in the intermediate category(Hammond & Elkins, 1994). There is no definition of their usage of the term ‘intermediate’ - only that it incorporates techniques subsequent to their ‘beginning workshops’ and prior to their ‘advanced’ level training. The Intermediate Workshop Curriculum (Hammond & Elkins, 1994) has 11 topics being: 1. Advanced and Specialized Hypnotic Inductions 2. Supervised Small Group Practice of Advanced Inductions and in Facilitating Hypnotic phenomena 3. Methods of Hypnotic Ego-Strengthening 4. Hypnotic Strategies and Techniques for Pain Management 5. The Nature of Hypnosis and Memory: Principles and Techniques of Age Regression and the Working Through of Trauma 6. Hypnosis in the Treatment of Anxiety and Phobic Disorders
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7. Hypnotic Treatment of Habit Disorders 8. Constructing Therapeutic Metaphors and Indirect Suggestions 9. Insight-Oriented and Exploratory Hypnotic Techniques 10. Ethics and Professional Conduct 11. Integrating Hypnosis into Clinical Practice
The applicant to the American Society of Clinical Hypnosis would complete the beginning course and progress to the intermediate course. There was then a requirement to complete five hours of training in at least two topics from the Intermediate/Advanced Topics list Intermediate/Advanced Topics: Hypnotic Inductions and Utilizing Hypnosis with Children. Practicum in Formulating Direct and Indirect Hypnotic Suggestions. Case Consultation in Integrating Hypnosis into Clinical Practice in Psychotherapy, Medicine and Nursing, or Dentistry). Demonstrations of the Administration of Hypnotic Susceptibility Scales. Practice in Administering Scales of Hypnotic Responsiveness. Ericksonian Hypnotherapy. Hypnosis in Behavioral [sic] Medicine and with Psychosomatic Disorders. Hypnoanalysis. Integrating Hypnosis and Psychotherapy. Recommended Topics: A.
Use of Ideomotor Signaling [sic] for Unconscious Exploration.
B.
Hypnotic Methods of Stress Management.
C.
Hypnotic Strategies and Techniques for Pain Management.
D.
Integrating Hypnosis and Psychotherapy.
Hypnosis in the Treatment of Dissociative Disorders. Hypnosis in the Treatment of Severely Disturbed Patients.
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Hypnotic Ego-State Therapy. Hypnosis in Sex Therapy. Hypnosis in Marital and Family Therapy. Hypnotic Preparation for Surgery, Childbirth, and Hypnoanesthesia. Hypnosis with Burns and Emergencies. Hypnosis with Cancer Patients and Autoimmune Disorders. Hypnosis with Sleep Disorders. Hypnosis with Eating Disorders Medical and Dental Hypnotherapy. Using Group Hypnosis. Practicum in Constructing Therapeutic Metaphors. Review of Clinical Research. Adjunctive Methods and Hypnotherapy (e.g., Autogenic Training, Mental Imagery). (Hammond & Elkins, 1994, p. 18) The term hypnotherapy has been used several times within the training document, Beginning Workshop: Treatment Planning, Strategy and Technique Selection in Hypnotherapy (Hammond & Elkins, 1994, p. 9) Intermediate/Advanced Topics: Ericksonian Hypnotherapy. (Hammond & Elkins, 1994, p. 18) Medical and Dental Hypnotherapy. (Hammond & Elkins, 1994, p. 18) Adjunctive Methods and Hypnotherapy (e.g., Autogenic Training, Mental Imagery).” (Hammond & Elkins, 1994, p. 18) and no differentiation between ‘hypnosis’ and ‘hypnotherapy’ is defined but this was prior to the editorial comments (Frischholz, 1995) that stated ‘hypnosis’ and ‘hypnotherapy’ should not be used interchangeably. That view was supported by the survey results. The reasons for this change in terminology can only be surmised. What is known, is that the voluntary credentialing program was only provided to some professionals (licensed and
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qualified physicians, psychologists, osteopathic physicians, podiatrists, dentists, doctoral level social workers and nurses, and Masters degree level social workers, psychologists, nurses, marriage and family therapists, and mental health counsellors) in order to meet fundamental training requirements for the society (Hammond & Elkins, 1994, p. 2). The publication of the documents would indicate the society was in agreement with the information it contained and the terminology it contained.
10.1.3
Clinical hypnotherapy category: Advanced (AQF level 6 – Advanced Diploma)
The AQF level 6 indicates that graduates have cognitive, technical and communication skills to analyse and interpret information and deal with complex skills as indicated in the summary (AQFC, 2013, p. 41). Summary
Graduates at this level will have broad knowledge and skills for paraprofessional/highly skilled work and/or further learning
Knowledge
Graduates at this level will have broad theoretical and technical knowledge of a specific area or a broad field of work and learning
Skills
Graduates at this level will have a broad range of cognitive, technical and communication skills to select and apply methods and technologies to: • analyse information to complete a range of activities • interpret and transmit solutions to unpredictable and sometimes complex problems • transmit information and skills to others
Application of
Graduates at this level will apply knowledge and skills to
knowledge and
demonstrate autonomy, judgement and defined responsibility:
skills
• in contexts that are subject to change • within broad parameters to provide specialist advice and functions Table 32: AQF level 6 criteria (AQFC, 2013, p. 41)
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In clinical hypnotherapy, this level is currently the highest ASQA level of training available. The qualification has only became available within approximately the last five years (AAH, 2013a; ACH, 2013) and is the first recognised qualification to impart analytical and interpretive skills. These were the skills required when responding to those 28 questions designated as advanced. Of the 28 areas of response, six achieved consensus, four achieved high agreement and 18 did not achieve consensus. Consensus was achieved in the areas of future recognition of standards, industry level entry level, standards and external stakeholders. High agreement was achieved in topics related to governance and entry level into the profession. No consensus topics were related to governance, future standards, professional credibility, entry level for the profession, level of training (VET or higher education), nomenclature, treating severe mental health cases, forensic hypnosis, group hypnosis, research, educational pathways and external stakeholders. These topics are outside the normal requirements of the day to day practice but are instrumental to the profession. #
Question
No (%)
Result
Agree 9.
Clinical hypnotherapy requires several self governing peak bodies
8s
NC
(42.3%)
Clinical hypnotherapy requires one self governing peak body
9s
22
21
NC
(60.0%)
Clinical hypnotherapy requires one peak body
25
NC
(69.4%) 10s
Clinical hypnotherapy requires several peak bodies
6
HA
(17.1%) 11s
Clinical hypnotherapy requires several self governing peak bodies
7 (19.5%)
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HA
20.
VET sector accredited qualifications will be the future standard for the clinical hypnotherapy profession
18s
21.
Accredited qualifications will be the future standard
23
NC
(63.9%) 32
for the clinical hypnotherapy profession
(88.9%)
Professional credibility is based upon qualifications
27
C2
NC
(72.9%) 22.
Entry level into clinical hypnotherapy should be at an industry defined training standard
23.
Entry level into clinical hypnotherapy should be a
Entry level into clinical hypnotherapy requires a government accredited Diploma standard
25.
Entry level into clinical hypnotherapy requires a government accredited Advanced Diploma standard
26.
Entry level into clinical hypnotherapy requires a government accredited Degree standard
27.
C2
(85.7%)
government accredited Cert IV standard 24.
30
11
NC
(30.2%) 11
NC
(31.5%) 5
C2
(13.9%) 7
HA
(19.4%)
Training in clinical hypnotherapy should be at the
14
Vocational Education Training level (TAFE level -
(38.9%)
NC
education based on occupation or employment called vocational education) 28.
Training in clinical hypnotherapy should be at the Higher Education level (University level)
36.
NC
(30.5%)
Use of ‘Diploma’ and ‘Advanced Diploma’ titles by non VET sector organisations is creating confusion.
74.
11
Hypnosis for treating severely mentally disturbed patients is required within hypnotherapy training
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28
NC
(73.7%) 17 (40.5%)
NC
77.
Designing and conducting clinical research is required within a hypnotherapy training course
144. Developing a clinical hypnotherapy educational pathway is not required in Australia (e.g. From non VET training to
19
NC
(43.1%) 12
NC
(26.0%)
VET training to Higher Education) 145. Articulation from non government accredited training into government accredited training is not required in Australia 152. Clinical hypnotherapy needs to consider external stakeholders (Health Funds/Professional Indemnity
13
NC
(27.6%) 51
C1
(91.1%)
Insurance) when considering professional standards Table 33: Advanced Skills
Discussion: The primary areas of the advanced section which did not achieve consensus are areas of governance in which clinical hypnotherapists have less experience. The practitioners do not concern themselves with governance, generally leaving those issues to their professional association. Until relatively recently (HCA, 2011b) there was no accepted peak body and each association implemented the governance procedures they deemed appropriate. Many associations were the offspring of training institutions, although this practice has predominantly ceased. By definition, the peak body must embrace the diversity of the whole profession, as is indicated within its mission statement (HCA, 2012e). There are still issues relating to governance issues such as standards, quality assurance between the peak body and their member associations and schools but those areas of demarcation will potentially be resolved as the profession develops.
Some of the topics within the Intermediate and Advanced sections of the ASCH (USA) (Hammond & Elkins, 1994) course were included with the survey. The survey was developed to identify the current competencies and - as expected - overlapped with the
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previous research. The intersection of the two surveys can be discussed within the limitations of the associated pedagogy.
The ASCH (USA) course devotes two topics to Supervised Small Group Practice of Advanced Inductions and in Facilitating Hypnotic phenomena. The advanced and specialized hypnotic inductions were identified in the ASCH (USA) course as “levitation, catalepsy, the eye opening and closing technique, naturalistic (conversational or interactive) inductions, confusional inductions, nonverbal inductions, surprise or rapid inductions, active-alert induction, or the progressive anesthesia [sic] induction” (Hammond & Elkins, 1994, p. 12).
All questions related to inductions achieved consensus except two, and these related to rapid inductions. #
Question
47.
Inductions are essential for clinical hypnotherapy training
67.
No (%) Agree
Result
53
C1
(96.3%)
Principles of induction are required within a hypnotherapy training course
55
C1
(100.0%)
104. Demonstrating hypnotic inductions is required within a hypnotherapy training course
55
C1
(100.0%)
113. Induction and deepening techniques are required within a hypnotherapy training course
53
C1
(98.1%)
116. Inductions are required within a hypnotherapy training course
53
C1
(98.2%)
117. Rapid inductions are essential competencies for clinical hypnotherapy training
25 (56.8%)
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NC
67s
Rapid inductions should be part of clinical hypnotherapy training
35
HA
(83.3%)
Table 34: Questions related to Induction
The cohort was evenly divided on the essential nature of rapid inductions in a training course, but achieved high agreement on the inclusion of rapid inductions as part of clinical hypnotherapy training. The surveyed data did not identify specific inductions as outlined in the ASCH (USA) course. It is questionable if those inductions identified by the ASCH (USA) would be considered advanced within current Australian clinical hypnotherapy training. Practicing and personal experience of hypnotic phenomenon was included as part of the ASCH (USA) training. It is assumed the aim was at experiential learning where the student would elicit and experience hypnotic phenomena. The survey posited four questions on hypnotic phenomenon and there was consensus on the inclusion of these topics within clinical hypnotherapy training. #
Question
61.
Hypnotic phenomenon is a required part of clinical hypnotherapy training
65.
Result
53
C1
(96.4%)
Hypnotic phenomena & their potential usefulness is required within a hypnotherapy training course
66.
No (%) Agree
Working with hypnotic phenomenon is required within a hypnotherapy training course
52
C1
(98.1%) 54
C1
(98.2%)
128. Demonstrations of deep trance phenomenon are required within a hypnotherapy training course
38
C2
(88.4%)
Table 35: Hypnotic phenomenon questions
The allocation of time to these areas indicates the importance of these areas to the course developers. It could also denote a fundamental difference between the concepts of ‘hypnosis’ and ‘hypnotherapy’ in the mind of the developers and those who acknowledged the course. The use of inductions is to initiate the hypnotic state which acts as an
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amplification of the applied therapeutic techniques. The emphasis on the induction may indicate that the depth of hypnosis is critical, as the ‘therapy’ is reliant on the depth of the p
The survey question (119) asked if metaphors were required in hypnotherapy and it achieved consensus in Round 1. #
Question
119.
Therapeutic metaphors are required within a hypnotherapy training course
No (%) Agree
Result
49
C1
(91.4%)
Table 36: Question on Metaphor
The ASCH (USA) course has included metaphors as a treatment strategy several times, related to suggestion and ego strengthening. The indication is that metaphor can be used in different methodologies. The data did not identify specific uses for metaphors only that they are required within clinical hypnotherapy training.
The cohort was asked to respond on the inclusion of pain management within clinical hypnotherapy training. #
Question
106.
Hypnotic techniques with pain are required within a hypnotherapy training course
No (%) Agree
Result
52
C1
(98.1%)
Table 37: Question on pain management
Consensus from the cohort would indicate that the data agree with the ASCH (USA) course which includes pain management as one specific topic, but has a number of references to pain management within the course being in the topic of self-hypnosis and integration of hypnosis into a clinical practice (Hammond & Elkins, 1994, pp. 8, 11). Within the course they outline the importance of interdisciplinary treatments, the limitations of hypnotic pain management and various methods of implementing pain management
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strategies. The survey data concur with the inclusion of pain management techniques being a required inclusion of hypnotherapy training.
The survey asked two questions related to hypnoanalysis that achieved consensus. The determining features of hypnoanalysis have been addressed in early literature. Hypnoanalysis has been described as psychoanalysis in a controlled environment (Wolberg, 1945) but he modified his stance by stating that hypnoanalysis is not an alternative to psychoanalysis (Wolberg, 1996). It has also been described as a rapid form of psychoanalysis (McCormack, 2010), an investigative procedure (Stewart, 2005), a specialised from of hypnotherapy (Araoz, 2005) and a method of facilitating the linking of current issues to past experiences (Araoz, 2005). Another concept is that there are three major schools of analytical hypnosis (hypnoanalysis) being Hypnoanalysis, Ego State Therapy and Medical Hypnoanalysis (Modlin, 2012). The components that differentiate hypnoanalysis from medical hypnoanalysis are that medical hypnoanalysis follows a medical protocol outlined as a detailed patient history, examination and specific treatment management (Modlin, 2012). With the addition of Dream Induction (Wolberg, 1996) the true nature of hypnoanalysis is still being discussed and determined. Other techniques have been identified within the literature and training institutions as hypnoanalysis. These include Progression, Regression/Age regression, Automatic Writing, Ideomotor Questioning/Signalling, Hypnotically Induced Dreams, play therapy, dramatics, mirror gazing, regression and revivification / Dream Induction, Hypnotic Drawing, Play Therapy, Dramatic Techniques, Regression and Revivification, Crystal and Mirror Gazing, Induction of Experimental Conflict (AAH, 2013a; CA, 2012; Dolan, 2009; Wolberg, 1996). Within the ASCH (USA) course emphasis is placed on Age Regression as it is given a topic area of its own. The data show consensus on hypnoanalysis and hypnoanalytical techniques being required within clinical hypnotherapy training.
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#
Question
57.
Clinical hypnotherapists require knowledge of hypnoanalysis
No (%) Agree
Result
47
C1
(85.5%)
102. Hypnoanalytical techniques should be included in clinical hypnotherapy training
51
C1
(94.4%)
Table 38: Questions on Hypnoanalysis and Hypnoanalytical Techniques
The literature describes rather than defines hypnoanalysis. The literature supports hypnoanalysis as a collection of techniques (AAH, 2013a; CA, 2012; Dolan, 2009; Wolberg, 1996). It was agreed that the hypnoanalytical techniques were required with the training. It is suggested that hypnoanalysis can significantly shorten psychoanalysis by removing barriers (Wolberg, 1996). The suite of techniques which comprise ‘hypnoanalysis’ are yet to be determined. Possible techniques are progression, regression, automatic writing, ideomotor questioning, dream therapy and ego state therapy (AAH, 2013a; Cowen, 2009; Modlin, 2012; Wolberg, 1996), These techniques can bring about an abreaction (an emotional cathartic release) within the client. The results suggest the three questions relating to hypnoanalysis, which achieved consensus, are in harmony with the question on depth of training. As the hypnoanalysis can potentially cause an abreaction the depth of training would be beneficial in both determining which is the most appropriate technique and then dealing with the abreaction should it occur. The discernment of hypnoanalysis is further complicated as an accepted definition of hypnosis and hypnotherapy is yet to be determined. That means the foundation of hypnoanalysis is uncertain and the literature reflects that uncertainty.
The ASCH (USA) course awards Age Regression a segment of its own (Hammond & Elkins, 1994) but gives no explanation for that decision. It can only be surmised that Age Regression was considered most efficacious at the time the course was developed. However, the literature denotes other techniques which were considered hypnoanalysis
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and using the descriptions proffered in the literature, those and other techniques may be considered hypnoanalysis
Using the proposed descriptions, many techniques from psychotherapy and counselling could be used within the hypnotherapeutic setting and classified as hypnoanalysis. If hypnoanalysis is psychoanalysis (Wolberg, 1945) and the other explanations are accepted as definitions, the relationship between hypnosis and hypnotherapy to psychotherapy and psychoanalysis needs to be determined. The survey achieved its aim by determining the cohort’s response regarding the inclusion of hypnoanalysis within a clinical hypnotherapy training course.
Summary The cohort was not questioned regarding the level of training at which these topics would be applied. The relationship between the topics in the Intermediate/Advanced section of the ASCH (USA) course (Hammond & Elkins, 1994, p. 18) and the selected survey questions can only be assumed as the survey did not include any pedagogical aspects although some characteristics are inherent within the questions. The ASCH (USA) Intermediate/Advanced course topics are listed as: A.
Hypnotic Inductions and Utilizing Hypnosis with Children.
B.
Practicum in Formulating Direct and Indirect Hypnotic Suggestions.
C.
Case Consultation in Integrating Hypnosis into Clinical Practice in Psychotherapy, Medicine and Nursing, or Dentistry).
D.
Demonstrations of the Administration of Hypnotic Susceptibility Scales.
E.
Practice in Administering Scales of Hypnotic Responsiveness.
F.
Ericksonian Hypnotherapy.
G.
Hypnosis in Behavioral [sic] Medicine and with Psychosomatic Disorders.
H.
Hypnoanalysis.
I.
Integrating Hypnosis and Psychotherapy.
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J.
Hypnosis in the Treatment of Dissociative Disorders.
K.
Hypnosis in the Treatment of Severely Disturbed Patients.
L.
Hypnotic Ego-State Therapy.
M.
Hypnosis in Sex Therapy.
N.
Hypnosis in Marital and Family Therapy.
O.
Hypnotic Preparation for Surgery, Childbirth, and Hypnoanaesthesia [sic].
P.
Hypnosis with Burns and Emergencies.
Q.
Hypnosis with Cancer Patients and Autoimmune Disorders.
R.
Hypnosis with Sleep Disorders.
S.
Hypnosis with Eating Disorders
T.
Medical and Dental Hypnotherapy.
U.
Using Group Hypnosis.
V.
Practicum in Constructing Therapeutic Metaphors.
W.
Review of Clinical Research.
X.
Adjunctive Methods and Hypnotherapy (e.g., Autogenic Training, Mental Imagery). (Hammond & Elkins, 1994, p. 18)
The delineation between Intermediate and Advanced sections becomes somewhat blurred when they are discussed under an ‘Intermediate/Advanced’ heading (Hammond & Elkins, 1994). The related notes indicate it is to allow flexibility in the curriculum and customisation to meet the needs of students and instructors. The complexity in determining the pedagogy of the associated competencies would reside in the accompanying materials of learning outcomes, range statements, assessments and volumes of learning (AQFC, 2013). To determine these competencies and the level at which they would be taught would require detailed research directly investigating these issues. With no associated pedagogy, the levels at which these intermediate/advanced topics are taught is open to conjecture. This illustrates that with a paucity of educational information available, the designation of topics to any level or categories is somewhat arbitrary.
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The survey data being grouped into educational levels is similarly arbitrary. Topics such as selecting techniques, working with a health care team, occupational health and safety policies and a variety of hypnotherapeutic concepts would all involve higher level competencies than those of a beginning practitioner. The reason for consensus in these and other questions could relate to the fact that within Australia, once a person has graduated as a clinical hypnotherapist, they immediately perceive themselves a primary health care provider (AMA, 2010) and perceive to have the associated skills. Some questions which received high agreement but not consensus related to working within a health care team. As clinical hypnotherapy is not recognised as part of existing primary health care, the opportunities to be a member of a health care team are limited. The response may be reflecting the clinical experience of the cohort and the potential for the inclusion of the competency.
10.2
Concepts: Past life work
Past life concepts exist within our society (Pyun & Kim, 2009) and have been linked to healing. The profession has acknowledged ‘past life work’ in several ways. Associations, training institutions and journals have included past life material in practitioner directories, on websites, in newsletters, journals and training (AHA, 2013e; AHS, 2014; ASCH, 2014e; HCA - EP, 2012; Lucchetti, Santos Camargo, Lucchetti, Schwartz, & Nasri, 2013; PHA, 2013a; Ramster, 1994). There is a concept that healing is entwined with the client’s subjective values, beliefs and ideals (Sointu, 2013). In some cultures, behaviours are attributed to spirits or demons (Nicholas P Spanos, Menary, Gabora, DuBreuil, & Dewhirst, 1991). The concept of past lives is drawn from philosophical and spiritual beliefs e.g. Korean Buddhism (Pyun & Kim, 2009) rather than empirical evidence. There are primarily two avenues from which the past life methodology is derived. The first is from the client-centred/person-centred approach (Cowen, 2008; Dolan, 2009; Hunter, 2007) and the second from the spiritual/religious/philosophical approach. There is significant evidence supporting client-centred therapy/person-centred care approach (Rogers,
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Cornelius-White, & Cornelius-White, 2005). Person-centred research facilities (GPCC, 2014) and journals (PCEPC, 2014) have been established to further develop the concept. Clinical hypnotherapists (HCA - EP, 2012) who support this approach use the client’s reality as a basis for therapy. If the client believes in ‘past lives’ then the therapist may use the belief as a basis for therapy (PHWA, 2007).Alternatively, clinical hypnotherapists who approach therapy from a spiritual/religious/philosophical perspective, approach therapy using the hypnotic state and allow the client to determine their own path to their therapeutic goals. Client’s with a past life belief system may reflect that conviction in their therapeutic responses (Pyun & Kim, 2009; Nicholas P Spanos et al., 1991). A paper (Lucchetti et al., 2013) relates the occurrence of rare medical conditions to past life memories. Other associated research supports the hypothesis that the recollections are reconstructions which are organised in accordance with the client’s (Nicholas P. Spanos, Burgess, & Burgess, 1994). No. Question 58.
No (%) Agree
Clinical hypnotherapy should include training in past life work
Result
21
NC
(48.7%) Table 39: Question - Past Life hypnotherapy
Discussion: The lack of consensus portrays the profession’s current position on the issue. The survey data were evenly balanced on inclusion of past life techniques being included in clinical hypnotherapy training. This is potentially due to the beliefs of individual practitioners. Overall, the literature refutes past life therapy (Frischholz & Scheflin, 2009; Hammond, 2004; Yapko, 2007), the scientific community requires evidence and those who believe in spirituality simply believe (Pyun & Kim, 2009). Some reference to intriguing cases showing relationships between suggestive past-life memories and rare medical conditions exist (Lucchetti et al., 2013). With no conclusive data a potential alternative is that research
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continues with the codicil ‘an absence of evidence is not evidence of absence’ (Kisely, Campbell, Yelland, & Paydar, 2012; Weiss et al., 2012).
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11 Practical: Demonstration of skills Practical skills and competencies are the cornerstone of vocational education (ASQA, 2014). The emphasis on practical work varies between training institutions and one institution requires a practical internship as part of their qualification (AAH, 2013a). Some professional associations acknowledge the requirement for professional practice (HCA, 2012c) and others require practical experience prior to being upgraded to clinical membership (AHA, 2013d). The import is directed towards the practitioner having the skills and competencies in a practitioner setting.
In the research which lead to the development of the ASCH (USA) course (although the article was a subsequent publication) (Elkins & Hammond, 1998) there are several questions in the survey which allude to practical work. Of the 57 questions, eight use an active verb as if they are involve a practical skill. The questions are: QUESTION 5 Demonstrating Basic Hypnotic Inductions QUESTION 24 Practice in Learning to Administer Susceptibility Scales QUESTION 28 Using Confusional Techniques QUESTION 31 Demonstrating Advanced Hypnotic Inductions QUESTION 32 Practice (Practicum) in Formulating Hypnotic Suggestions QUESTION 38 Using Time Distortion QUESTION 41 Doing Forensic & Investigative Hypnosis QUESTION 45 Using Hypnosis with Sports & Athletic Performance (Elkins & Hammond, 1998, pp. 59-63) However, in the course the practical work does not seem to eventuate. The ASCH (USA) course uses the term ‘demonstrate’ in their course (Hammond & Elkins, 1994). Whilst some recommended learning objectives require a demonstration of a skill, others require a demonstration of ‘understanding’ or ‘awareness’. In some instances, the demonstration
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is provided by the faculty or supervisors. The practical work focuses on inductions and deepening with demonstration of actual cases being viewed by the student on recorded examples. There is a five hour elective available within curriculum under ‘Intermediate/Advanced Topics’ for a practice in administering scales of hypnotic responsiveness, practicum in formulating direct and indirect hypnotic suggestion or a practicum in constructing therapeutic metaphors (Hammond & Elkins, 1994, p. 18).
Past or present, and whether the terminology is ‘practicum’, experiential training, client practice or practical applications, it is acknowledged that practical skills and competencies are an essential part of clinical hypnotherapy training (AHA, 2013a; ASCH, 2013e; Elkins & Hammond, 1998; Hammond, 1996; Hammond & Elkins, 1994; HCA, 2012c; Hoencamp, 2004).
#
Question
42.
Practical work should be included in clinical hypnotherapy training
101.
Practical application of techniques is required in
Demonstrating hypnotic inductions is required within a
Rehearsing scripts is beneficial for the practice of
54
C1
55
C1
29
NC
(65.9%)
Rehearsing practice management skills are required within a hypnotherapy training course
123.
C1
(100.0%)
clinical hypnotherapy 115.
55
(100.0%)
hypnotherapy training course 109.
Results
(98.2%)
clinical hypnotherapy training 104.
No (%) Agree
Psychotherapy (e.g. NLP, Ego State Therapy or Gestalt) techniques should not be practised in clinical hypnotherapy training
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25
NC
(62.5%) 8 (14.9%)
C1
124.
Counselling techniques should not be practised in
5
clinical hypnotherapy training 125.
(9.5%)
Composing patter for each individual client is required
43
in clinical hypnotherapy training 128.
Demonstrations of deep trance phenomenon are
38
136.
55
54
Assessment of practical skills is required within a
53
C1
(98.2%)
Clinical hypnotherapy trainers require more practical experience than those they are training
156.
C1
(100.0%)
hypnotherapy training course 154.
C1
(100.0%)
Demonstration of practical skills is required within a hypnotherapy training course
C2
(88.4%)
Demonstrations and practical exercises are required within a hypnotherapy training course
135.
C2
(95.6%)
required within a hypnotherapy training course 130.
C1
Clinical hypnotherapy supervisors require more practical experience than those they are supervising
54
C1
(96.4%) 56
C1
(98.2%)
Table 40: Questions related to 'practical' aspects
Discussion: The category of practice involves the development of applied real-world skills and competencies. It is the application of the theoretical concepts into a form that can be applied in a clinical setting. Overall the cohort achieved consensus in the specific skills required to conduct a clinical practice. The only areas where consensus was not achieved were the rehearsing of scripts and practice management skills. The reasons for the disinclination of a practical application in the areas of business, marketing and scripts can only be assumed. Some understanding from the literature in the area of business and marketing can be assumed but with no data regarding the issue of scripts no foundation is available on which to base assumptions and only hypotheses can result.
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The term practice can be somewhat of a misnomer. Theory is imperative to the accurate application of skills but the development of the associated practical skills in workshops after graduation and/or membership of a professional association and/or supervision can be inhibited (Dayal, 2013). Observationally, some workshop participants are reluctant to expose themselves by demonstrating their skills and competencies in a public forum. Kluft (2012) acknowledges the misgivings of some workshop participants and that unwanted responses can occur if reluctant participants are persuaded to go along with the process. This impediment may be overcome when an assessment is required and the learner is aware of this prior to engagement. Reluctance seems paramount when the demonstration of skills is a requested action of the participant and the activity can be refused. The problem escalates when the demonstration is required as part of an assessment. Refusal can impede the progression of the participant. Emphasis need to be focussed on changing student/participant behaviour rather than attitudes to ensure ongoing learning and resolution of the issue (Hicks et al., 2005). Once resolved the learner will fulfil their educational requirements.
Consensus in the area of practical work demonstrates the cohort’s belief in the need for experiential learning within clinical hypnotherapy training.
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12 Clinical hypnotherapy: Professional attributes Inherent within the concept of professionalism is safety and knowledge expansion via research (Hansen, 2006). The development of best practice, quality assurance and safety is provided by the specialist knowledge applied with a distinct code of conduct (Katz, 2000; Sim & Radloff, 2009; Watts, 2000). In clinical hypnotherapy the issue of safety is encompassed by legislative code(s) of conduct (HCCC (NSW), 2012; Swan, 2014) and the principles have been adopted and adapted by clinical hypnotherapy associations (HCA - EP, 2012). The concept of safety within clinical hypnotherapy is within associations’ codes of ethics (AHA, 2013f; ASCH, 2014d) and mandated within government codes of conduct (HCCC (NSW), 2012).
Established professions encompass the concepts of quality assurance of educational standards (Hansen, 2010) and best practice (Driever, 2002) based on research (Alladin et al., 2007). Educational standards differ from association to association. One Australian association membership criteria specifically caters for clinical hypnotherapy practitioners who hold degrees in health (ASH, 2012) and then provides additional training in clinical hypnotherapy whilst other professional associations accept members in line with their membership criteria (AHA, 2013d; ASCH, 2010d). In a South Australian government report it was noted that “only those who are properly trained and have met appropriate standards of education are able to practise hypnosis” (PoSA, 2009a, p. 3).
The question remains what is an appropriate standard of education? Are the VET sector educational requirements or membership requirements of professional associations (an industry standard) to be considered sufficient? The data show consensus for accredited qualifications being the future standard for the profession (question 18s) and entry level being a government accredited Advanced Diploma qualification (question 25). There was
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also high agreement for a degree to become entry level (question 26). With no entry level being required, the HCA has set the current minimum standard at 400 hours (HCA, 2012c) which is an industry standard. Some association’s membership criteria exceed the HCA guidelines and require higher hours of training (AHA, 2013d; ASCH, 2013e) which is a different industry standard. The ASH requires that members have a health degree and complete additional training.
When membership criterion is linked to the skills to conduct research an aspect of the profession becomes clearer. In Australia, clinical hypnotherapy research is primarily undertaken by professionals with higher education qualifications. The only association which requires their members to be registered health practitioners (which usually requires a university degree) is the ASH. Membership in 2014 of the major clinical hypnotherapy associations are; the ASH approximately 800 (ASH, 2014a), the AHA is 1019 (AHA, 2014) and the ASCH is 327 (ASCH, 2014a). Previous membership of the major associations was AHA (607), ASH (1,100) and ASCH (607) (AHA, 2011a; ASCH, 2011b; Stanley et al., 1998). Other professional associations have smaller membership numbers which have not been determined at this time. Overall membership figures are increasing but do not indicate that all of the clinical hypnotherapists who have university training desire to write professional articles or undertake research.
If the original assumption is correct, that research skills lie within university trained practitioners and that membership of the association for those with an existing health degree is approximately 800, then the capacity for Australian clinical hypnotherapy research would likely be restricted to a maximum of 800 plus those in other association with the required research skills. The editor of the Australian Journal of Clinical and Experimental Hypnosis eloquently describes additional issues regarding the publication of clinical hypnotherapy research. Universities require research to be published in highly ranked journals and publication in low ranked journals is discouraged (ASH, 2013b). The
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combination of factors being low numbers of clinical hypnotherapists having the necessary research skills, research funding and publication issues create an environment in which the underpinning relationship between education, research and best practice restrict the role expansion and (Sim & Radloff, 2009) the development of the profession. No.
Question
6
A Code of Practice is required by the profession of clinical hypnotherapy.
7
Ethical practice is required within the profession of
Quality assurance is necessary within the profession of
20.
Best Practice is necessary within the profession of
21.
56
C1
46
C1
43
C1
(87.8%)
Good governance will effect whether clinical
31
hypnotherapy receives professional acknowledgement
(88.6%)
VET sector accredited qualifications will be the future
23
standard for the clinical hypnotherapy profession 18s
C1
(88.5%)
clinical hypnotherapy 19.
56
(100.0%)
clinical hypnotherapy 16.
Result
(100.0%)
clinical hypnotherapy. 14.
No (%) Agree
Accredited qualifications will be the future standard
C2
NC
(63.9%) 32
for the clinical hypnotherapy profession
(88.9%)
Professional credibility is based upon qualifications
27
C2
NC
(72.9%) 132. Make referrals to health care professionals is required within a hypnotherapy training course 140. A clinical hypnotherapist requires specific skills to enter the profession
52
C1
(94.5%) 55
C1
(98.2%)
141. Current educational standards are not impacting on the profession.
8 (17.4%)
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HA
146. Recognition of Prior Learning (RPL) is not necessary
3
within the profession of clinical hypnotherapy
(5.3%)
148. Quality Assurance of training institutions is required in the profession of clinical hypnotherapy 152. Clinical hypnotherapy needs to consider external stakeholders (Health Funds/Professional Indemnity
50
C1
C1
(89.3%) 51
C1
(91.1%)
Insurance) when considering professional standards Table 41: Professional attribute questions
Discussion: The statement that professional attributes denote a profession seems fairly self-evident. However, if a profession exhibits some professional attributes and not others, are they still a profession? If education standards which lead to specialised knowledge - which is essential for a professional (Evetts, 2013) - becomes deficient, and if improvements are not immediately forthcoming (Agbola & Lambert, 2010), what are the ramifications? Differing educational standards and the associated credibility were the topics of two questions that did not achieve consensus. When considering future standards, the question of public recognition and professional credibility becomes factors (Hansen, 2010). Recognition of the profession by other professional entities such as private health insurance funds, allows the profession to be indirectly marketed by those funds. Funds have increased educational standards for practitioner rebates (AHA, 2011b; Bupa, 2009) and this is based on qualifications. With other private health insurance funds requiring qualifications issued by a registered training organisation (AU, 2013), it is hard to develop an argument that VET sector qualifications will not be the future standard for clinical hypnotherapy. Some possible scenarios could include that all accredited RTOs cease to trade and the only remaining qualifications are those acknowledged by the profession. In that situation a case can be made that as the only qualification is that of the profession it
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would become the standard. Another scenario is that the profession develops a quality assurance process that renders government accreditations redundant. This could result from a voluntary self-regulatory model that has already been utilised by the profession (HCA, 2012h; Khoury, 2009; PACFA, 2008). The quality assurance of training would be more than establishing educational standards (HCA, 2012c) as it would require processes to ensure the standards are being assured (Agbola & Lambert, 2010). The profession is moving towards professionalism (HCA, 2011a, 2011b, 2013a) by embracing the qualities of a profession being specialised knowledge through education, a distinctive code of conduct, autonomy and altruism (Katz, 2000; Sim & Radloff, 2009; Watts, 2000).
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13 Clinical hypnotherapy education Clinical hypnotherapy education is conducted across various durations and range of recognitions. At the date of this research (October 18, 2012) 39 training institutions in Australia provided clinical hypnotherapy training. Professional associations provide industry recognition of courses to match each individual association’s standards. Association websites publish lists of recognised training providers (AHA, 2013c; ASCH, 2014b) but the criteria to achieve that recognition is not available on the association websites. As the recognition criteria used by the associations is unavailable so the manner in which associations assess training cannot be evaluated.
Training courses range from two days (ASA, 2013) to 400-600 hours of training (AHA, 2013a; ASCH, 2013f; HCA, 2012c) to 600-1800 hours (approximately) within ASQA accredited Certificate IVs, Diplomas, and Advanced Diplomas (AAH, 2013b; ACH, 2013; AHS, 2013; CA, 2013a; Phoenix, 2013). To further complicate the educational issue some non-ASQA accredited teaching institutions (AHA, 2009; AHATS, 2012; AHJ, 2013b; AICH, 2011) use the same award nomenclature (e.g. Advanced Diploma) as ASQA accredited training and one non-ASQA accredited qualification has achieved articulation into a United Kingdom University (AHJ, 2013b). An accurate assessment of the clinical hypnotherapy training arena is therefore only available indirectly through ASQA accredited courses. A reflection of this standing may be the move by some private health funds to provide benefits only to those practitioners who hold ASQA accredited qualifications (AHA, 2011b; AU, 2013; Bupa, 2009).
If the quality assurance surrounding clinical hypnotherapy education can only be verified within ASQA accredited courses the question of reliability in clinical hypnotherapy education external to ASQA quality assurance procedures is raised. Educational issues
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such as articulation, assessment, Continuing Professional Development (CPD), Recognition of Prior Learning (RPL), and skill levels of practitioners and trainers are called into question. The research sought to establish initial attitudes to some of these questions. #
Question
140.
A clinical hypnotherapist requires specific skills to enter the profession
141.
Current educational standards are not impacting on the
Standardised clinical hypnotherapy training is not
C1
8
HA
9
HA
(19.1%)
Clinical hypnotherapy educators do not require their skills and competencies to be assessed
144.
55
(17.4%)
required in Australia 143.
Result
(53.6%)
profession. 142.
No (%) Agree
Developing a clinical hypnotherapy educational pathway is not required in Australia (e.g. From non VET training
7
C1
(12.7%) 12
NC
(26.0%)
to VET training to Higher Education) 145.
Articulation from non government accredited training
13
into government accredited training is not required in
(27.6%)
NC
Australia 146.
Recognition of Prior Learning (RPL) is not necessary within the profession of clinical hypnotherapy
147.
Assessment of competencies is required at all levels of training
148.
C1
(5.3%) 55
C1
(96.5%)
Quality Assurance of training institutions is required in the profession of clinical hypnotherapy
149.
3
Assessment is a method of ensuring competency in clinical hypnotherapy training
50 (89.3%) 55 (96.5%)
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C1
C1
150.
Clinical hypnotherapists require ongoing supervision
42
C2
(89.4%) 151.
Clinical hypnotherapy supervisors require specialised training
152.
52
C1
(92.8%)
Clinical hypnotherapy needs to consider external stakeholders (Health Funds/Professional Indemnity
51
C1
(91.1%)
Insurance) when considering professional standards 153.
Clinical hypnotherapy trainers require higher level skills than those they are training.
154.
Clinical hypnotherapy trainers require more practical
55
C1
(96.5%) 56
C1
(98.2%)
Vocational competency combined with relevant industry experience is all that is required to become a clinical
C1
(96.4%)
Clinical hypnotherapy supervisors require more practical experience than those they are supervising
157.
54
Clinical hypnotherapy supervisors require higher level skills than those they are supervising
156.
C1
(94.7%)
experience than those they are training 155.
54
22
NC
(38.6%)
hypnotherapist Table 42: Clinical hypnotherapy educations questions
Discussion Of the 18 questions in this category, the questions which did not achieve consensus or high agreement related to standardised training, articulation and educational pathways. Consensus acknowledged that specific skills are required to be a clinical hypnotherapist which should be assessed at all levels of training to ensure competency. There was high agreement that the lack of standardised training was impacting the profession and standardisation was required. This was in agreement with question 152 which indicates that external stakeholders need to be considered when discussing professional standards.
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Associations have publicised that private health insurance funds have raised their practitioner requirements for health rebates (AHA, 2011c; HCA, 2012h) and with two health funds now requiring government accredited qualifications (AHA, 2011b; AU, 2013) it is evident current educational standards are impacting on the profession.
The impact also relates to trainers and supervisors. The results demonstrate a clear consensus that the educators (trainers and supervisors) require higher levels of skills. The quality assurance of this aspect of training currently lies within the AQSA accredited courses. Compliance regulations require trainers to have current educational qualifications and continuing education in the specified vocation, and those skills need to be assessed. If quality assurance of the educational institutions was undertaken, then the issue of educator’s qualifications would be addressed. It does, however, raise the issue of determining the educator’s competencies of an emerging profession. As a profession emerges, the attributes of that profession (such as educators and specialised knowledge) also develop (PoSA, 2009a; Surdyk et al., 2003; Weiss-Gal & Welbourne, 2008). Current educator’s expertise is within clinical hypnotherapy and quality assurance of training institutions would expand that vocational knowledge into associated pedagogy.
The non-consensus in the areas of articulation and educational pathways is concerning. The data show that health funds have discerned practitioners by qualification and the cohort does not agree with the development of educational pathways. The result if this position continues could be that existing practitioners will have limited options in the upgrading of their qualifications. The cohort achieved consensus that RPL was necessary, but that process can be arduous in comparison to an educational pathway. The result may demonstrate a limited understanding of educational issues which could impact on the profession. The governmental focus on mental health, education and public safety (COA, 2009; COAG, 2006) is changing practice standards of both regulated and unregulated health professionals (AHMAC, 2014a). Clinical hypnotherapy is addressing these changes
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as they arise (HCA, 2014a) with submissions to government on relevant issues (AHA, 2013g; Cowen, 2013; HCA, 2013b).
Public safety is a focus of government and health professional alike. AHMAC is developing a single national Code of Conduct for unregistered health practitioners (AHMAC, 2014a). The data showed consensus that specific skills were required to enter the profession, but did not achieve consensus on those skills being vocational competency and industry experience. This demonstrates uncertainty in the area of required competencies to enter the profession. With the range of educational standards currently existing in clinical hypnotherapy, identifying an appropriate standard is a challenge. This is amplified as external stakeholders (AHMAC, 2014a; AU, 2013; Bupa, 2009; DOHA, 2011) make decisions on educational requirements and codes of practice to which the must profession adapt to comply.
The educational framework within clinical hypnotherapy is changing. Since the first government sanctioned vocational accreditation in 1998 (AAH, 1998), the professional has developed significantly. A peak body has been formed (HCA, 2012e), associations have increased standards (AAHCP, 2013; AHA, 2011c) and other teaching institutions have maintained or achieved vocational accreditation (AAH, 2013b; ACH, 2013; AHS, 2013; CA, 2013a; Phoenix, 2013). As these activities continue clinical hypnotherapy is establishing its area of speciality and practice (Weiss-Gal & Welbourne, 2008)
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14 Final comments These results provide a snapshot of the cohort’s views on clinical hypnotherapy training. Using the three major associations (AHA - 1019, ASCH – 284 and ASH - 800) membership numbers as a guide, the number of clinical hypnotherapists in Australia would range between 2000 – 2500 (AHA, 2014; ASCH, 2014a; ASH, 2014a) if allowance is made for multiple memberships and clinical hypnotherapists who chose not to hold membership of any professional association. The 87 participants would represent between 4.35% and 3.48% of the population. The survey data were designed to obtain general attitudes to various topics related to clinical hypnotherapy training, rather than indepth pedagogy. Existing research data in this area are limited and with some professional clinical hypnotherapy associations electing not to participate (HCA, 2012f) or simply not responding to the invitation, a cohort of 87 may reflect the changing attitudes to research in some areas of the profession.
The research sought to identify topics, competencies and attitudes surrounding clinical hypnotherapy training. Many areas achieved consensus in the first round. The Delphi methodology has allowed many areas that did not achieve first round consensus to be reflected upon by the cohort in the second round and then achieve consensus. The available pedagogy (Hammond & Elkins, 1994) has been used to highlight both similarities and differences at various educational levels within training.
The results show that clinical hypnotherapy training is multidimensional and has a diversity which is both a strength and a weakness. The diversity acknowledged in the peak bodies mission statement (HCA, 2012e) indicates the achievement of a unified curriculum will require cooperation and support (ABIM et al., 2002; Evetts, 2011) from all sections within the profession. The data confirm there are many areas of consensus on which a universally accepted foundation could be based.
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15 Results summary 15.1
Assessment of results
The cohort was comprised of 87 stakeholders from all factions of the profession of clinical hypnotherapy. The responded to a two round electronic survey comprising six categories being Ethics, Governance, Concepts, Techniques, Practical and Education. The cohort’s responses were ranked by allocating responses into groupings of consensus, high agreement or no consensus.
These results build upon sparse research foundations and identify the topics which the cohort of expert opinion rank as important for the profession. Many of these directly relate to educational content (skills and competencies) and others relate to the development of the profession. Ethical questions all achieved consensus in the first round. Governance involved areas of peak bodies, self-regulation, professional recognition, educational standards, professional standards, qualification nomenclature, quality assurance and best practice guidelines. Concepts and techniques somewhat overlapped in that mental health concepts from clinical hypnotherapy, counselling and psychotherapy often directly related to specific techniques. The data indicated counselling and psychotherapy techniques were required within clinical hypnotherapy training as was practical work. The comparison between previous research and current data showed some similarities and some major differences in the areas of topics, perceived levels of training and qualifications. Areas of education achieved consensus whilst some aspects did not. Consensus in areas of assessment for students and educators quality assurance of teaching institutions whilst developing educational pathways such as RPL and articulation were not required in the cohort’s opinion.
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There are key issues that has been identified from the data. These are: 1. Education standards (depth and level of training) 1.1. Entry level into the profession 1.2. Qualifications and the related nomenclature 1.3. The interchangeability of the terms ‘hypnosis’ and ‘hypnotherapy’ 2. No universally accepted definition of ‘hypnosis’ and ‘hypnotherapy’ 3. Quality assurance within the profession 4. Clinical hypnotherapists are a primary health professional 5. Hypnosis used as an adjunct and clinical hypnotherapy is a therapy 6. Scripts and suggestion not a primary methodology 7. Ethics in business and marketing 8. Lack of research in clinical hypnotherapy pedagogy
In isolation, the responses provide some interesting data regarding topics and attitudes related to clinical hypnotherapy training and the profession as a whole. However the questions researched do not occur in isolation. For example, taking quality assurance as the foundation, the application of quality assurance principles to governance, educational levels, educational pathways, nomenclature, professional recognition and professional attributes provides a far more complex narrative. The complexity within the data in relations to the categories is the subject of the final chapter of this thesis
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16 Conclusion The data provided useful data which may bear consideration by the clinical hypnotherapy profession and its stakeholders. The cohort of experts has provided data in response to the research question
What are the key competencies and skills required by commencing clinical hypnotherapists? The data clearly outlines the competencies and skills considered to be strategic to clinical hypnotherapy training. The questions which achieved consensus clearly indicate the cohort’s opinion that the topics in the question are required within clinical hypnotherapy training. A differentiation between questions which achieved consensus in round 1 and round 2 has not been undertaken as the objective was to establish the cohort's opinion within the parameters of the research rather than when during the research period the opinion occurred.
The data gathered give clear indications of the cohort’s opinion of topics which are required within clinical hypnotherapy training but the research data also revealed some key issues that relate to the profession of clinical hypnotherapy practice and its development. These issues when considered in relation to the key competencies and skills provide a snapshot of the cohort’s expert opinion on the profession and provide data which can inform the profession’s development. The issues that have been identified from the data are: 1. Education standards (depth and level of training); 1.1. Entry level into the profession; 1.2. Qualifications and the related nomenclature; 1.3. The interchangeability of the terms ‘hypnosis’ and ‘hypnotherapy’; 2. No universally accepted definition of ‘hypnosis’ and ‘hypnotherapy’; 3. Quality assurance within the profession;
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4. Clinical hypnotherapists are a primary health professionals; 5. Hypnosis used as an adjunct and clinical hypnotherapy is a therapy; 5.1. Scripts and suggestion not a primary methodology; 6. Ethics in business and marketing; 7. Lack of research in clinical hypnotherapy pedagogy.
The interaction of these issues with the competencies and skills provides data on clinical hypnotherapy training and the interrelationship between the training, the profession and external stakeholders. The issues combine with other considerations inherent within an emerging profession such as professional/association hierarchy, organisational bureaucracy, quality assurance, output evaluation, performance measures and best practice considerations (Evetts, 2011). The determination of an educational entry level is far more complex if considerations of current competencies and skills, future stakeholder requirements and preservation of the profession are included. For example the relationship between the entry level into the profession and recognition by external stakeholders such as private health providers, professional indemnity insurance underwriters and government/semi government agencies (e.g. WorkCover) may influence some decisions. The multiplicity of interactions indicates the benefit of a vision statement to provide a cohesive trajectory for the development of the profession policies in crucial areas such as governance, recognition, professionalism and pedagogy.
16.1
Why is the study important?
No sector within Australia has universal agreement regarding the required competencies to enter the profession of clinical hypnotherapy. The profession has established a national peak body which has put forward minimum educational guidelines for those entering the profession. Associations and teaching institutions educational requirements differ significantly from these guidelines. This research has provided data based on expert opinion in a variety of areas within the clinical hypnotherapy profession. Additional to
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providing data into educational competencies and skills, responses provided insight into development, organisational and procedural issues within clinical hypnotherapy. The insights into the key skills and competencies required by commencing clinical hypnotherapists and the other areas can be used by the profession as an expectation of existing stakeholders in the profession, of the profession.
These insights provide data in areas of public safety, professional development, recognition of the profession, and development of the profession. With a sparse research base the chosen methodology relied on stakeholders within the profession to give their expert opinion to questions posed in a two round survey. This data were collated into areas of consensus, high agreement and no consensus. It may be argued that the rankings of consensus above 85%, 77% - 84.99% are too high and a lower ranking should be applied. The implication is that areas which did not achieve consensus would in reality have majority support. The argument is valid but with an emerging profession majority support may be insufficient. Only with a high level of consensus could the profession embrace contentious developmental issues such as educational standards, governance, compliance, recognition and quality assurance. One such area considered was the entry level to the profession.
In the reporting of the competencies and skills it is acknowledged that question wording was ambiguous as to allow the competencies and skills to be combined. However this ambiguity has not diminished the concordance in determining the topics on which the competencies and skills are to be based. The level at which the competencies and skills should be taught (AQFC, 2013) has not been determined by the data. This would be determined in pedagogy once topics and the interrelationship between those topics has been established.
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16.2
Areas of Consensus
The questions where consensus (above 85% agreement) was achieved indicating the prevailing view of the cohort at that time. It does not indicate that the opinion is correct or incorrect only that the cohort agrees (Keeney et al., 2001). The areas of consensus provide evidence of the cohort’s attitudes in the areas identified in each question.
16.2.1
Ethics
# Question
Result
3 Ethics needs to be taught within clinical hypnotherapy training.
C1
4 Ethical safeguards should be included in the training of clinical
C1
hypnotherapists. 5 Ethical considerations are required within a hypnotherapy training course.
C1
6 A Code of Practice is required by the profession of clinical hypnotherapy.
C1
7 Ethical practice is required within the profession of clinical hypnotherapy.
C1
Table 43: Consensus – Ethics
16.2.2
Governance (summary and questions)
#
Question
Result
12.
Governance involves quality assurance guidelines
C1
13.
Governance involves best practice guidelines
C1
14.
Quality assurance is necessary within the profession of clinical
C1
hypnotherapy 14s.
Quality Assurance is not necessary for practitioners to receive
C2
health fund rebates 16.
Best Practice is necessary within the profession of clinical hypnotherapy
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C1
17.
Quality Assurance is not required for associations giving recognition
C1
to teaching institution 19.
Good governance will effect whether clinical hypnotherapy receives
C2
professional acknowledgement 18s
Accredited qualifications will be the future standard for the clinical
C2
hypnotherapy profession 22.
Entry level into clinical hypnotherapy should be at an industry
C2
defined training standard 25.
Entry level into clinical hypnotherapy requires a government
C2
accredited Advanced Diploma standard 30.
Self regulation of clinical hypnotherapy is required
C1
31.
Self regulation of clinical hypnotherapy ‘qualification names’ is
C2
required Table 44: Consensus – Governance
16.2.3
Concepts (summary and questions)
#
Question
Result
38.
Clinical hypnotherapy requires counselling skills
C2
39.
Direct suggestion is the primary methodology for clinical
C2
hypnotherapists 40.
Business management skills are required by clinical
C1
hypnotherapists 42.
Practical work should be included in clinical hypnotherapy training
C1
43.
Preparing the client prior to the first induction is required within a
C1
hypnotherapy training course
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44.
History of hypnosis is required within a hypnotherapy training
C1
course 45.
Self hypnosis: how & what to teach patients is required within a
C1
hypnotherapy training course 47.
Inductions are essential for clinical hypnotherapy training
C1
48.
The terms ‘hypnosis’ and ‘hypnotherapy’ mean the same thing
C1
49.
Psychotherapeutic concepts are required in clinical hypnotherapy
C1
training 50.
Clinical hypnotherapists require knowledge of psychology
C1
51.
Clinical hypnotherapists require knowledge of psychotherapy
C1
55.
Clinical hypnotherapists require knowledge of legal requirements in
C1
a health practice 56.
Clinical hypnotherapists require knowledge of susceptibility
C1
techniques 57.
Clinical hypnotherapists require knowledge of hypnoanalysis
C1
59.
Clinical safeguards should not be included in the training of clinical
C1
hypnotherapists 61.
Hypnotic phenomenon is a required part of clinical hypnotherapy
C1
training 62.
Clinical hypnotherapy training does not require national standards
C2
63.
A definition of hypnosis is required in training programs
C1
64.
Myths and misconceptions need to be discussed within a
C1
hypnotherapy training course 65.
Hypnotic phenomena & their potential usefulness is required within
C1
a hypnotherapy training course 66.
Working with hypnotic phenomenon is required within a hypnotherapy training course
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C1
67.
Principles of induction are required within a hypnotherapy training
C1
course 68.
Theories of hypnosis are required within a hypnotherapy training
C1
course 69.
Awakening procedures from the hypnotic state is required within a
C1
hypnotherapy training course 70.
Understanding the stages (levels) of hypnosis is required within a
C1
hypnotherapy training course 71.
Deepening techniques are required within a hypnotherapy training
C1
course 72.
Principles in formulating hypnotic suggestions are required within a
C1
hypnotherapy training course 73.
Decision making strategies in selecting techniques is required
C1
within a hypnotherapy training course 79.
Observation of actual client cases is required within a hypnotherapy
C2
training course 80.
The word trance is confusing for clients
NC
81.
Self hypnosis for personal use is required within a hypnotherapy
C2
training course 82.
Training to teach self hypnosis is required within a hypnotherapy
C2
training course 83.
Ericksonian hypnosis is required within a hypnotherapy training
C2
course 84.
Health issues client intake sheet and treatment plan is required
C1
within a hypnotherapy training course 85.
Working within a therapeutic framework is required within a hypnotherapy training course
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C1
86.
Rapport building (Therapeutic Alliance) with the client is required
C1
within hypnotherapy training 87.
Dealing with abreactions is required within a hypnotherapy training
C1
course 88.
Deepening the hypnotic state is required within a hypnotherapy
C1
training course 89.
Practice management forms (e.g. Client intake sheet) are required
C1
within hypnotherapy training 90.
Treatment plans are required within a hypnotherapy training course
C1
91.
Ethical issues are a required topic within a hypnotherapy training
C1
course 92.
Ego strengthening is required within a hypnotherapy training course
C1
94.
Occupational health and safety policies are required within a
C1
hypnotherapy training course 95.
Work within a legal and ethical framework is required within a
C1
hypnotherapy training course 96.
A variety or hypnotherapeutic concepts is not required within a
C1
hypnotherapy training course 97.
Working within a structured counselling process is required within a
C2
hypnotherapy training course 98.
The depth of training in clinical hypnotherapy is important (e.g. reasons to use particular techniques) Table 45: Consensus - Concepts
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C1
16.2.4
Techniques (summary and questions)
#
Question
Result
100.
Fundamental techniques should be included in clinical
C1
hypnotherapy training 101.
Practical application of techniques is required in clinical
C1
hypnotherapy training 102.
Hypnoanalytical techniques should be included in clinical
C1
hypnotherapy training 62.
Training a client in self hypnosis should be part of clinical
C2
hypnotherapist training 104.
Demonstrating hypnotic inductions is required within a
C1
hypnotherapy training course 105.
Methods of ego-strengthening are required within a hypnotherapy
C1
training course 106.
Hypnotic techniques with pain are required within a hypnotherapy
C1
training course 107.
Hypnotic susceptibility techniques are required within a
C1
hypnotherapy training course 108.
Formulating therapeutic suggestions is required within a
C1
hypnotherapy training course 110.
Using hypnotherapy terminology to communicate with others is
C2
required within a hypnotherapy training course 111.
Self hypnosis is required topic within a hypnotherapy training
C1
course 112.
Susceptibility techniques are required within a hypnotherapy training course
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C1
113.
Induction and deepening techniques are required within a
C1
hypnotherapy training course 114.
Creating basic suggestions is required within a hypnotherapy
C
training course 116.
Inductions are required within a hypnotherapy training course
C1
118.
Post hypnotic suggestion is required within a hypnotherapy
C1
training course 119.
Therapeutic metaphors are required within a hypnotherapy
C1
training course 120.
Creating suggestions is required within a hypnotherapy training
C1
course 121.
Waking hypnosis is required within a hypnotherapy training
C1
course 122.
Sensory language is required within a hypnotherapy training
C1
course 123.
Psychotherapy (e.g. NLP, Ego State Therapy or Gestalt)
C1
techniques should not be practised in clinical hypnotherapy training 124.
Counselling techniques should not be practised in clinical
C1
hypnotherapy training 125.
Composing patter for each individual client is required in clinical hypnotherapy training Table 46: Consensus - Techniques
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C2
16.2.5
Practical (summary and questions)
#
Question
Results
127.
Formulating hypnotic suggestions is required activity within a
C1
hypnotherapy training course 128.
Demonstrations of deep trance phenomenon are required within a
C2
hypnotherapy training course 129.
Practical work is not required in a clinical hypnotherapy training
C1
course 130.
Demonstrations and practical exercises are required within a
C1
hypnotherapy training course 131.
Preparing a treatment plan for case studies is required within a
C1
hypnotherapy training course 132.
Make referrals to health care professionals is required within a
C1
hypnotherapy training course 135.
Demonstration of practical skills is required within a hypnotherapy
C1
training course 136.
Assessment of practical skills is required within a hypnotherapy
C1
training course 137.
Case consultation conferences within a workshop or class format is
C2
required in hypnotherapy training 138.
Supervision is not required in a clinical hypnotherapy training program Table 47: Consensus - Practical
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C1
16.2.6
Education (summary and questions)
#
Question
Result
140.
A clinical hypnotherapist requires specific skills to enter the
C1
profession 143.
Clinical hypnotherapy educators do not require their skills and
C1
competencies to be assessed 146.
Recognition of Prior Learning (RPL) is not necessary within the
C1
profession of clinical hypnotherapy 147.
Assessment of competencies is required at all levels of training
C1
148.
Quality Assurance of training institutions is required in the
C1
profession of clinical hypnotherapy 149.
Assessment is a method of ensuring competency in clinical
C1
hypnotherapy training 150.
Clinical hypnotherapists require ongoing supervision
C2
151.
Clinical hypnotherapy supervisors require specialised training
C1
152.
Clinical hypnotherapy needs to consider external stakeholders
C1
(Health Funds/Professional Indemnity Insurance) when considering professional standards 153.
Clinical hypnotherapy trainers require higher level skills than those
C1
they are training. 154.
Clinical hypnotherapy trainers require more practical experience
C1
than those they are training 155.
Clinical hypnotherapy supervisors require higher level skills than
C1
those they are supervising 156.
Clinical hypnotherapy supervisors require more practical experience than those they are supervising Table 48: Consensus - Education
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C1
16.3
Areas of High Agreement
The questions which achieve high agreement (77% - 84.99%) provide indications of areas which the cohort considers important but did not achieve consensus. These topics are noteworthy considering the level of agreement achieved is what other studies would consider consensus (Benton et al., 2013; Low-Beer et al., 2010). It is recommended that these areas be considered when evaluating topics for clinical hypnotherapy training.
16.3.1
Ethics (summary and questions)
No questions in the area achieved ‘high agreement’ 16.3.2
Governance (summary and questions)
#
Question
Result
10s
Clinical hypnotherapy requires several peak bodies
HA
11s
Clinical hypnotherapy requires several self governing peak bodies
HA
10.
Clinical hypnotherapy qualifications should be standardised across
HA
Australia 15s.
Best Practice is not necessary for practitioners to receive health
HA
fund rebates 26.
Entry level into clinical hypnotherapy requires a government
HA
accredited Degree standard 34.
External recognition of clinical hypnotherapy is based upon commercial considerations Table 49: High Agreement - Governance
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HA
16.3.3
Concepts (summary and questions)
#
Question
Result
52.
Clinical hypnotherapists require knowledge of medical sciences
HA
53.
Clinical hypnotherapists require knowledge of pharmacology
HA
54.
Clinical hypnotherapists require knowledge of human sexuality
HA
78.
Working within a heath care team is required in clinical
HA
hypnotherapy training Table 50: High Agreement - Concepts
16.3.4
Techniques (summary and questions)
#
Question
Result
67s
Rapid inductions should be part of clinical hypnotherapy training
HA
Table 51: High Agreement - Techniques
16.3.5
Practical (summary and questions)
#
Question
Results
133.
Business planning is required within a hypnotherapy training
HA
course 134.
Marketing is required within a hypnotherapy training course
16.3.6
HA
Education (summary and questions)
#
Question
Result
141.
Current educational standards are not impacting on the profession.
HA
142.
Standardised clinical hypnotherapy training is not required in
HA
Australia Table 52: High Agreement – Education
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16.4
Areas of No Consensus
Less than 77% was within this research was categorised as no consensus and potentially demonstrated the diversity within the profession reflected in the cohort. Delphi methodology suggests a wide range within the panel of experts to ensure all opinions are included (Yousuf, 2007). The cohort self-described as practitioners, educators and students, some with clinical hypnotherapy as their primary role and other with specialist training as an adjunct to their primary role but all acknowledged being stakeholders within the profession.. This diversity is demonstrated with the lack of consensus in questions such as levels of education required to enter the profession.
16.4.1
Ethics
No questions in this area achieved ‘no consensus’
16.4.2 Governance (summary and questions) #
Question
Result
9.
Clinical hypnotherapy requires several self governing peak bodies
NC
8s
Clinical hypnotherapy requires one self governing peak body
NC
9s
Clinical hypnotherapy requires one peak body
NC
11.
Clinical hypnotherapy should be registered by government
NC
20.
VET sector accredited qualifications will be the future standard for the
NC
clinical hypnotherapy profession 21.
Professional credibility is based upon qualifications
NC
23.
Entry level into clinical hypnotherapy should be a government
NC
accredited Cert IV standard 24.
Entry level into clinical hypnotherapy requires a government accredited Diploma standard
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NC
27.
Training in clinical hypnotherapy should be at the Vocational Education
NC
Training level (TAFE level - education based on occupation or employment called vocational education) 28.
Training in clinical hypnotherapy should be at the Higher Education
NC
level (University level) 29.
Clinical hypnotherapy is a subset of other professional modalities
NC
32.
External recognition of clinical hypnotherapy is based upon
NC
qualifications 33.
External recognition of clinical hypnotherapy is based upon peer
NC
reviewed research 35.
External recognition of clinical hypnotherapy is based upon public
NC
demand 36.
Use of ‘Diploma’ and ‘Advanced Diploma’ titles by non VET sector
NC
organisations is creating confusion. Table 53: No Consensus – Governance
16.4.3
Concepts (summary and questions)
#
Question
Result
37s
Suggestion is the primary methodology for clinical hypnotherapists
NC
41.
Marketing skills are required by clinical hypnotherapists
NC
46.
‘Hypnosis is viewed not as an independent science, but as an adjunct to
NC
the range of treatment modalities for a wide range of medical, psychological, dental and therapeutic applications’ 58.
Clinical hypnotherapy should include training in past life work
NC
60.
Scripts are an integral part of clinical hypnotherapy training
NC
74.
Hypnosis for treating severely mentally disturbed patients is required
NC
within hypnotherapy training
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75.
Forensic & investigative hypnosis techniques are required within a
NC
hypnotherapy training course 76.
Working with group hypnosis is required within a hypnotherapy training
NC
course 77.
Designing and conducting clinical research is required within a
NC
hypnotherapy training course 80.
The word trance is confusing for clients
NC
93.
Neuro Linguistic-Programming is required within a hypnotherapy training
NC
course Table 54: No Consensus – Concepts
16.4.4
Techniques (summary and questions)
#
Question
Result
103.
Training a client in self hypnosis is an essential part of clinical
NC
hypnotherapist training 109.
Rehearsing scripts is beneficial for the practice of clinical
NC
hypnotherapy 115.
Rehearsing practice management skills are required within a
NC
hypnotherapy training course 117.
Rapid inductions are essential competencies for clinical hypnotherapy training Table 55: No Consensus – Techniques
16.4.5
Practical (summary and questions)
No question in the practical achieved ‘no consensus’.
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NC
16.4.6
Education (summary and questions)
#
Question
Result
144.
Developing a clinical hypnotherapy educational pathway is not
NC
required in Australia (e.g. From non VET training to VET training to Higher Education) 145.
Articulation from non government accredited training into
NC
government accredited training is not required in Australia 157.
Vocational competency combined with relevant industry experience
NC
is all that is required to become a clinical hypnotherapist Table 56: No Consensus – Education
16.5 16.5.1
Educational standards: Depth and level of training Entry level into the profession
The cohort was clear that and entry level for the profession was required but undecided about the level at which that should occur. Responses ranged from consensus to high agreement and no consensus clearly indicating divided opinion in this area. These responses to what is a foundational issue for the profession demonstrates the necessity for further research in the area of clinical hypnotherapy education to provide a base from which consensus can be determined. The cohort demonstrated a range of responses being: #
Question
Result
22.
Entry level into clinical hypnotherapy should be at an industry defined
C2
training standard 23.
Entry level into clinical hypnotherapy should be a government accredited Cert IV standard
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NC
24.
Entry level into clinical hypnotherapy requires a government accredited
NC
Diploma standard 25.
Entry level into clinical hypnotherapy requires a government accredited
C2
Advanced Diploma standard 26.
Entry level into clinical hypnotherapy requires a government accredited
HA
Degree standard Table 57: Entry level into the profession
The current diversity within the profession (HCA, 2012c, 2012e) is not just around concepts and techniques it also encompasses the level of training required to be a clinical hypnotherapist. Standards of training range from a weekend (ASA, 2013) to ASQA accredited Advanced Diplomas (AAH, 2013a; ACH, 2013). Association memberships also vary dramatically from no actual criteria being published (PCHA, 2013) to 600 hours of training (AHA, 2013a) with few pedagogical parameters. The AQF uses ‘volume of learning’ rather than hours (AQFC, 2013) it would be acknowledged that there is a significant variation between the volume of learning required to complete an Advanced Diploma and 600 hours of training.
The question of what competencies and skills are required to practice may hinge on beliefs related to the commencement of practice. Different competencies and skills relate to the variety of beliefs surrounding entering the profession. There is no data specifically outlining the beliefs regarding entry into the profession. If all that is required is the ability to perform specified techniques the entry level is vastly different to entry level designed to ensure public safety. If the issue is to ensure public safety then what depth of knowledge is required to confirm public safety and what issues of professionalism are required? There are many concepts regarding the level at which a clinical hypnotherapist can practice safely. Where are the competencies and skills sufficient to provide benefit to their client and ensure safety? With the range of training available and similarly a range of
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associations acknowledging those qualifications, the question of entry level becomes complex. The profession has moved to answer this question with the formation of the HCA (HCA, 2012g). This new peak body has moved to develop minimum standards of education. These published standards (HCA, 2012c) are currently 400 hours of training with limited associated pedagogy. This raises a further issue. The peak body has developed a set of minimum standards which many in the profession exceed. The argument that these are minimum standards but have been developed to embrace all sectors of the profession is compelling as a peak body is required to deal with the diversity of the profession within their governance structure. As with any emerging profession the pace of development is essential. If development is too fast the existing practitioners will fail to keep pace and if it is too slow professional recognition will not occur until external stakeholders deem the profession to have achieved the required levels. The manner in which these levels are assessed depends on those making the assessment. They could be based on association memberships, qualification(s) or other mechanisms yet to be determined.
16.6
Qualifications and the related nomenclature
If that recognition is based on qualifications another issue arises. Qualification nomenclature of Certificate, Diploma and Advanced Diploma are available for all teaching institutions to use regardless of training quality. This makes assessing competencies and skills by qualification title unreliable. The AQF or ASQA does not have legislative power to protect the titles of Certificate, Diploma or Advanced Diploma (AQF, 2013; ASQA, 2013c). The AQF states “Issuing organisations offering a Diploma qualification must meet the requirements of the AQF Qualifications Pathways Policy.”(AQFC, 2013, p. 39) and “A Diploma qualification may only be issued by an organisation that is authorised by an accrediting authority to do so, and meets any government standards for the sector.” (AQFC, 2013, p. 40). This seems to be a protection however the statements only refer to
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accredited qualifications and accredited training organisations as AQF and ASQA have no authority outside the accredited arena (personal communications 2013).
Qualifications are awarded using titles of ‘hypnosis’ or ‘hypnotherapy’. With no accepted definition of either term and the interchangeability of the terms ‘hypnosis’ and ‘hypnotherapy’ occurring in the literature qualifications could use either term. The lack of definition between the terms would potentially have little impact within qualifications as the consumer of product and potentially the practitioner will be unaware of any variation of skill that the qualification may infer and the impact on the entry level to the profession would be minimal. In my opinion clinical hypnotherapy should follow other health modalities and have a title which reflects the primary work role. From my perspective, hypnotherapy is the fusion of hypnosis with psychotherapeutic techniques and it would seem appropriate that the senior term e.g. clinical hypnotherapist should be reserved for graduates who specialise in the area and have completed extended study in recognised courses and using hypnosis/hypnotherapy as their primary modality.
16.7
The ‘hypnosis’ and ‘hypnotherapy’ debate - or lack of it!
The debate is around defining hypnosis which is an integral step to differentiate clinical hypnotherapy from other forms of therapy. However there is less debate concerning the use of the terms ‘hypnosis’ or ‘hypnotherapy’. The cohort believes that the terms ‘hypnosis’ or ‘hypnotherapy’ do not mean the same thing. #
Question
Result
48.
The terms ‘hypnosis’ and ‘hypnotherapy’ mean the same thing
C1
Table 58: Terms ‘hypnosis’ or ‘hypnotherapy’
Within Australia the use of these terms may have additional meaning part of which could relate to the title and identity of the practitioner. If clinical hypnosis is the methodology then the therapist would be a clinical hypnotist. The term ‘hypnotist’ connotes ‘stage
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hypnosis’ which is different to therapeutic hypnosis (PoSA, 2009a) whereas if the terminology was clinical hypnotherapy the practitioner title would be clinical hypnotherapist. The definition of terms is important at a practitioner level but educationally an accurate definition of hypnosis will allow the profession precisely identify itself in the mental health domain.
A 2005 definition of hypnosis (Joseph P Green et al., 2005) was crafted over years with input from numerous experts in the profession and nine years later it is being contested (E. Woody & Sadler, 2014). The progression harks of an old adage ‘the camel is a horse designed by a committee’ (Hoda & Kaplan, 2013, p. 310) and appears in trying to conform to the needs of researchers and practitioners, has lasted less time than it took to conceive. The importance of defining hypnosis has been the subject of several articles (Cardeña, 2014; Connors, 2014; Kirsch, 2014; Laurence, 2014; Lynn, Malaktaris, Maxwell, Mellinger, & van der Kloet, 2012; O'Neil, 2014; Polito, Barnier, & McConkey, 2014; Terhune, 2014; Wagstaff, 2014a, 2014b; E. Woody & Sadler, 2014). Some 1998 views held on a definition of hypnosis have now been changed (Wagstaff, 2014b; E. Woody & Sadler, 2014). The articles posit various viewpoints expertly argued on defining ‘hypnosis’. One article uses the term hypnotherapy (Wagstaff, 2014b) whilst other articles cite references (Cardeña, 2014; Lynn et al., 2012; Wagstaff, 2014b) which refer to hypnotherapy but most articles avoid the term. The American Society of Hypnosis and their associates refute the use of hypnotherapy stating that hypnosis is the vehicle through which therapy occurs (Frischholz, 1995). Yet authors, despite objections raised by Frischholz as editor of the American Journal of Hypnosis continue to use the terms interchangeably (Frischholz, 1998). The members of the Australian Society of Hypnosis refer to the methodology as clinical hypnosis whilst other factions of the profession use the term clinical hypnotherapy. It will be interesting to review the evolution of the debate in in another nine years (E. Woody & Sadler, 2014).
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The debate over the terms ‘hypnosis’ or ‘hypnotherapy’, and the attempt to find a universally accepted definition will continue within the profession. This may be a debate fraught with contradictions as there is a belief that no objective evidence can be used to identify the hypnotic state (Dyer & Hawkins, 1997). A summary of the debate may best be addressed by Green and his colleagues (2005) noted that the Division 30 definition of hypnosis evolved carefully over a period of nearly a decade, with input from over two dozen of the world’s foremost experts on hypnosis. Thus, writing this critique offers, Polite Applause for the APA Div. 30 Definition of Hypnosis in one fell swoop, an unparalleled opportunity to offend nearly every important expert in the field. (E. Woody & Sadler, 2014)
To the clients who experience this form of therapy the term would largely be idiomatic. As long as they receive the treatment outcomes they desire the name of the therapy or the title of practitioner title is immaterial.
16.8
Quality assurance within the profession
Quality assurance encompasses every facet of the profession from the techniques selected by the practitioner, to the training (and continuing education) undertaken by the practitioner, to the associations and peak bodies that administer the profession. The fact that whilst 51 participants acknowledged governance was within their expertise and only 36 responded the survey questions could easily indicate that the cohort had not considered these topics, as the non-consensus could imply. If that is the case and is indicative of the profession then accepting the profession’s diversity rather than addressing governance issues such as quality assurance at least in the short term.
Although no research exists it is possible that there is confusion surrounding the issuing of qualifications. In the USA credentialing has been an issue (Eichel, 2009). Credentials
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issued without the practitioner achieving prescribed competencies raises ethical and consumer issues (Getzlaf & Cross, 1988; R.H. Woody, 1997). As clinical hypnotherapy has emerged standards are rising and within the framework of voluntary self-regulation the issue of professional competencies and the quality assurance of those competencies must be raised to reduce qualification naming confusion, increase public surety and provide a firm professional foundation. (Chu et al., 2012).
Issues such as quality assurance around entry level to the profession may already have ramifications as health funds are changing or removing practitioner rebates from their policy holders (AU, 2013; Bupa, 2009, 2014). It is not clear that the action is due to educational standards such as entry level criteria but in previous correspondence (AU, 2013; Bupa, 2009) the raising of education standards was presented as an issue for rebates to occur. Other mental health professionals (e.g. counsellors) who are in a similar non-legislative structure to clinical hypnotherapists have achieved professional benefits such as WorkCover (WC-NSW, 2012). These comparisons can be misleading as the underpinning criteria for professional recognition by various organisations such as WorkCover or health funds are often not disclosed and some professions gain access to benefits at different times than others and benefits may not be available to those at the profession’s identified entry level.
The identification of competencies has been achieved albeit in an ad hoc format by a variety of entities with differing perspectives. The question remains, who is/are the organisation(s)/individual(s) to determine the valid competencies? The candidates remain the existing stakeholders being the clinical hypnotherapy profession, government, commercial entities, the public or some combination of these groups. When considering which entities could take part in determining clinical hypnotherapy competencies it is relevant to briefly outline factors from each perspective.
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The cohort agreed that the profession’s entry level should be industry defined but does not identify that level. For an industry defined standard there are a number of factors to be considered. Within the profession there are various stakeholders being a peak body, associations, government accredited teaching institutions, professionally accredited teaching institutions and practitioners. Round 2 of the survey demonstrated that 30 of 35 respondents (85.7%) agreed that clinical hypnotherapy entry level qualifications should be at an industry defined standard. There was consensus by 31 of 36 respondents (86.1%) that entry level should be a government accredited Advanced Diploma and also high agreement by 29 of 36 respondents (80.5%) that entry level requires a government accredited degree standard. These results were achieved with 56.6% (30) of the cohort describing their primary working role as a clinical hypnotherapist and challenges the existing entry levels within all sections of the profession. The peak body advocates 400 hours of training, professional association’s membership criterion range between 1080 hours (ATMS, 2012) to 500 hours (AHA, 2013d, p. 10) to 450 hours (ASCH, 2013e) and one does not publish (PCHA, 2013) their criteria. The diversity between associations is also reflected across teaching institutions. With no agreed training standards the ASQA accredited (AAH, 2013b; ACH, 2013; AHS, 2013; CA, 2013a; Phoenix, 2013) teaching institutions have individually accredited courses, the non-ASQA accredited courses with and without association professional recognition (AHA, 2013c; ASA, 2013; ASCH, 2013c) have developed their individual curricula. For the profession to define standards they would need to consensus across a broad range of factions within the profession some of which have had competencies and standards accredited by government accredited authorities.
The question remains as to the level of quality assurance applied to the entry level qualifications. Professional accreditations (those provided by professional associations) are available within the profession. Professional association recognition criteria are not published so it can only be assumed that the process is to compare the course seeking recognition to existing membership criteria. As the professional do not publish their criteria
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the rigor and quality assurance applied in the professional recognition may vary from association to association and may not adhere to that of other vocational accreditations.
16.9
Clinical hypnotherapists: Primary health professional
Using the AMA definition (AMA, 2010), clinical hypnotherapists are primary health care providers. As a primary health care professional it is assumed that the workforce is suitably trained (AMA, 2010). This raised the question of competencies and skills required by a practitioner at the commencement of practice. Different competencies and skills relate to the variety of beliefs surrounding entering the profession. There is no data specifically outlining the beliefs regarding entry into the profession. If all that is required is the ability to perform specified techniques the entry level is vastly different to that where entry level is to ensure public safety. If the issue is to ensure public safety then what depth of knowledge is required to confirm public safety and what issues of professionalism are required. There are many concepts regarding the level at which a clinical hypnotherapist can practice safely.
The establishing of criteria which will demonstrate competency is a complex issue especially when there are no universally accepted competencies. It also raises the question of how the criteria on which clinical hypnotherapy competency will be based can be determined.
To determine competency, consideration must be given to the perspective of those doing the assessment which influences data interpretation (Clauser et al., 2012). Stakeholders within a sector wish to achieve different outcomes and therefore have differing perspectives dependent upon that outcome. These include the government perspective to regulate (AHMAC, 2011), professional peak bodies to advance the profession whilst providing guidelines for the profession (HCA - EP, 2012; HCA, 2012c), associations to support their members (AHA, 2013b; ASCH, 2010f), teaching institutions to earn a living by
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training clinical practitioners (AAH, 2013a; ASA, 2013) commercial enterprises (e.g. Private Health Insurers and Professional Indemnity Insurers) to make profit based on commercial decisions and practitioners who require competency to provide a safe and efficacious service to their clients.
The definition of competency within the vocational education sector is “… the possession and application of both knowledge and skills to defined standards, expressed as outcomes, that correspond to relevant workplace requirements and other vocational needs” (AQF Advisory Board, 2007, p. v). This definition accommodates the view of preexisting standards which do not exist within the Australian clinical hypnotherapy profession (PoSA, 2009a, p. 8). With no national competencies identified for clinical hypnotherapy the pathway to become a clinical hypnotherapy practitioner is less defined (Charmichael, 1993) and the stakeholders have addressed the issue in a variety of ways. The state governments which had legislative restrictions have commissioned reports (PoSA, 2009a, p. 15) which have led to that legislation being repealed. The recently formed clinical hypnotherapy peak body has defined a minimum standard of education which give broad competencies for the whole profession (HCA, 2012c). Professional associations each have their own membership criteria (AHA, 2013d; ASCH, 2013e) which outline their beliefs in the required competencies to practice with some advocating that clinical hypnotherapy is a subset of existing health professions (ASCH, 2011c; ASH, 2010). Teaching institutions can be categorised into ASQA accredited (AAH, 2013b; ACH, 2013; AHS, 2013; CA, 2013a; Phoenix, 2013), non-ASQA accredited some of whom have association recognition (AHA, 2013c; ASCH, 2013c) and those who do not advertise association recognition (ASA, 2013). These delineations are not intended to determine the competency of the practitioners simply as a guide related to the level to which the training has been assessed. Commercial enterprises have used association members or government accreditations as a guide to determine the competency of the practitioner as a health provider. The private health fund providers determine their own policies regarding rebates for clinical hypnotherapy. Two
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private health insurers(AU, 2013; Bupa, 2009) have chosen to adopt a policy of providers requiring a government accredited qualification. The fact that this policy has been adopted does not imply that these funds currently (or in the future) provide rebates for clinical hypnotherapy simply that the stakeholder has determined a definition of competency which they believe is valid and one primary criteria is a government endorsed and quality assured qualification.
Clinical hypnotherapy courses have government accreditations within the VET sector (t.g.au, 2012). With mental health care and public safety a primary concern (COAG, 2006, 2008a; HCCC (NSW), 2012) and clinical hypnotherapists being a primary health provider, if the government was to regulate it seems most logical to follow existing processes and use the VET sector to establish a training package for clinical hypnotherapy. A training package is defined as “… a nationally endorsed, integrated set of competency standards, assessment requirements, Australian Qualifications Framework qualifications, and credit arrangements for a specific industry, industry sector or enterprise” (COA, 2012, p. 9). The associated qualifications would then be validated and included for the provision of clinical services as appropriate within government programs such as WorkCover (TAC, 2012) and the National Action Plan on Mental Health (COAG, 2006). The Department of Health and Ageing (DOHA) called for submissions (DOHA, 2012) as part of review of the Australian Government Rebate on private health insurance for natural therapies underpinned by an evidence base and can continue to be subsidised by the rebate. Submissions were presented by several clinical hypnotherapy entities (AHA, 2013g; Cowen, 2013; HCA, 2013b). DOHA has commissioned the Natural Therapies Review Advisory Committee (NTRAC) to review all submissions. If NTRAC recommends removing clinical hypnotherapy from the Medicare rebate it may not have a direct impact upon clinical hypnotherapy yet it increases the disadvantage being placed upon the profession. This potential disadvantage was acknowledged by the Australian Competition and Consumer Commission (ACCC, 2013) by calling for submissions regarding anticompetitive practices
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by private health providers. When a government department or some commercial entities make a decision (directly or indirectly related to clinical hypnotherapy) it does so to achieve a purpose. That decision may be directed at consumer safety or health fund rebates or other natural therapies but in reality that decision has the potential to become part of a cumulative whole within the impact on clinical hypnotherapy.
Whilst having no legislative powers or specialist knowledge two commercial sectors have a direct impact on the profession of clinical hypnotherapy. The health insurance funds and professional indemnity insurers have long provided services to the profession. This is noted in the AHA ‘s A Set of Competency and Proficiency Standards for Australian Professional Clinical Hypnotherapists (Yeates, 1996, p. 3). With other health professionals undertaking training in clinical hypnotherapy and private health insurers offering rebates to those professions, regardless of the clinical hypnotherapy competency, clinical hypnotherapists are at a commercial disadvantage (PoSA, 2009a, pp. 2-3). With health funds promoting rebates of the counselling, psychotherapy and psychology professions (Bupa, 2012) which use clinical hypnotherapy as an adjunct the public perception of clinical hypnotherapy may be disadvantaged. Consensus (85.3%) was achieved within the survey when respondents agreed that quality assurance was not a factor for a practitioner to receive a health fund rebate and 82.8% agreed that best practice was not required.
The consensus the cohort achieved is an accurate reflection of the current status regarding quality assurance and best practice. Quality assurance within clinical hypnotherapy is primarily undertaken by the professional associations. The issues of quality assurance and best practice are hidden within other processes (e.g. membership renewal) and are only apparent when some audit procedure is undertaken. Health fund rebates are conditional on membership of a professional association which has inherent quality assurance procedures. Quality assurance in clinical hypnotherapy is split into two sectors ASQA and professional. ASQA publish the rigorous educational criteria that must
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be satisfied. Associations do not publish their assessment criteria. It can only be assumed that the assessment process is a comparison between the course curricula and the association’s standards. In both cases once the criteria is met the recognition is awarded. An issue with both assessments is the competencies of the assessors. With ASQA recognition the assessment criteria are vocationally based and industry specific so assessors are required to assess in vocational areas, within which, they may not be experienced. With professional recognition (through associations) both the criteria under which the assessment will occur and the competencies of those assessing needs to be established. Quality assurance and best practice procedures inherent within clinical hypnotherapy albeit they may not be documented. These procedures have provided surety for organisations such as health funds, professional indemnity insurers to include clinical hypnotherapy within their commercial endeavours and arguably safety for the public at large (PoSA, 2008, 2009a).
The public’s use of clinical hypnotherapists was sufficient to warrant the South Australian government to commission a report on hypnosis to ensure that the lifting of legislative restrictions should not put the public at risk. The report stated that “the evidence of a high risk of harm to the public does not appear sufficient to warrant a prohibition on practise (PoSA, 2009a, p. 3). The report also stated “Furthermore, the Committee notes the report’s findings that there is some ‘emerging and promising evidence regarding the benefits and safety in the use of hypnosis as an adjunctive therapy’ ” (PoSA, 2009a, p. 15) The report recommended that the practice of hypnosis should be deregulated (PoSA, 2009a, p. 7). The commissioning of the South Australian report raises the issue of public protection. .The survey asked about recognition of the profession and public demand. Consensus was not achieved when the issue of recognition from public demand was raised. Slightly over half (58.3%) agreed that external recognition was based on public demand. With governments and government agencies (AHMAC, 2014b; HCCC (NSW),
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2012; PoSA, 2008) demonstrating concerns over protection of the public, public demand for clinical hypnotherapy imparts a quasi-recognition of the profession.
Being a primary health care professional raises the question of competency standards and the associated question of who determines validity of those standards. The survey sought to identify some of the complexity surrounding competency and the associated ethical and educational issues. The recognition of these issues by the HCA (HCA - EP, 2012; HCA, 2012c, 2012h) demonstrates the profession’s resolve to address these topics and promote the clinical hypnotherapist as a primary health care provider within Australia’s health sector.
16.10
Clinical hypnotherapy as a therapy or hypnosis as an adjunct therapy
The cohort was undecided regarding whether hypnosis was a subset of other professional modalities or was an adjunct to other treatment modalities. The two questions asked gave an equal distribution for across both agree/disagree evaluations. #
Question
Result
29.
Clinical hypnotherapy is a subset of other professional modalities
NC
46.
‘Hypnosis is viewed not as an independent science, but as an
NC
adjunct to the range of treatment modalities for a wide range of medical, psychological, dental and therapeutic applications’ Table 59: Clinical hypnotherapy is a subset of other professions.
The questions appear non ambiguous so the non-consensus can only be taken as it appears. The majority of the profession sees clinical hypnotherapy as a profession in its own right (HCA, 2012g), however other factions have a different opinion. One association changed its view from
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The Society views hypnosis, not as an independent science, but as an adjunct to the range of treatment modalities for a wide range of medical, psychological, dental and therapeutic applications. The Society encourages members, located in every state, to participate in conferences, workshops and other specialist trainings in their areas, designed to foster clinical skills development across a range of applications of hypnosis in health, psychological, dental and therapeutic settings. (ASCH, 2011c).
The members of the Society use hypnosis, as an independent science, and / or as an adjunct to the range of treatment modalities for a wide range of medical, psychological, dental and therapeutic applications. The Society encourages members, located in every state, to participate in conferences, workshops and other specialist trainings in their areas, designed to foster clinical skills development across a range of applications of hypnosis in health, psychological, dental and therapeutic settings. ASCH, 2011b) and a second association perceives hypnosis as an adjunct to a range of treatment modalities (ASH, 2012).
The cohort was undecided as to whether hypnosis/clinical hypnotherapy is an adjunct or a or a subset to other health modalities. This may revolve around an educational issue and quality assurance. If the respondent has done little training in clinical hypnotherapy they would have limited competencies and skills in this area. As their range of application is limited to induction, deepening, suggestions and awakening they may perceive their scope is limited and therefore reflect that conclusion in their response. If the training they undertook is basic and adjunctive to an existing health discipline then it is obvious that they would use hypnosis rather than the full extent of techniques which converts hypnosis to clinical hypnotherapy. With limited training and expertise the ability to integrate hypnosis into more complex treatment strategies e.g. counselling or psychotherapeutic
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techniques or Progression, Regression, Automatic Writing, Ideomotor Questioning and Dream Therapy (PRAID) or Hypnotic Empty Chair (HEC) would be unable to be accessed. This limitation would be most profound in individuals with no other mental health training but is also evident within existing practitioners as is indicated by the ASCH (USA) comment: Certification does not automatically imply competence or guarantee the quality of a practitioner's work. It does indicate, however, that the practitioner: 1) Has undergone advanced professional training in his/her profession to obtain a legitimate advanced degree from an accredited institution of higher education; 2) Is licensed in his/her state or province, or certified in his/her profession; 3) Has had his/her education, training and skills in clinical hypnosis reviewed by qualified peers and approved consultants; and 4) Has been determined to have received the minimum educational training that the ASCH, the largest such interdisciplinary professional organization in North America, considers as necessary for utilizing hypnosis. (Hammond & Elkins, 1994, p. 2) In Australia a course is administered by the Australian Society of Hypnosis which only accepts health practitioners who are: “Chiropractors, Dentists, Medical Practitioners, Midwives, Nurses, Occupational Therapists, Optometrists, Osteopaths, Physiotherapists, Podiatrists, Psychologists, Social Workers & Speech Pathologists” (ASH, 2012). These specialist health providers all undertake the same “compulsory core units” the same training of approximately 200 hours irrespective of their underpinning discipline. The course syllabus is described as “Applications to specific issues and populations” , “Practice skills: Induction, deepening, reorientation, debriefing, Styles: Traditional, conversational,. Therapeutic models : optional” (ASH, 2014e). This indicates that the training is adjunctive to underpinning skills and may be comprised of scripts and direct suggestions. If the training was advanced and specialist in focus all health practitioners
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would be required have the same underpinning mental health training e.g. counselling/psychology education.
This is in accord with the statement on their website (ASH, 2012) that the training is a adjunctive to existing proficiencies and is as they describe clinical hypnosis rather than the more advanced and complex techniques indicative of clinical hypnotherapy.
This could also be the reason that the cohort responded to questions regarding the use of suggestion as the primary methodology. #
Question
Result
39.
Direct suggestion is the primary methodology for clinical
C2
hypnotherapists 37s
Suggestion is the primary methodology for clinical hypnotherapists
NC
Table 60: Primary methodology
As a clinical hypnotherapist increases their competencies the use of suggestion remains important but ceases to be ‘primary’. The integration of other more complex therapeutic strategies into therapy becomes commonplace. The cohort may have identified this evolution and acknowledged this fact by disagreeing that direct suggestion was primary and still acknowledging the importance of suggestion as a support for the more complex techniques.
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17 Ethics: Business and marketing The cohort achieved consensus on all ethics questions in the first round with an average on all questions of 98.92%. #
Question
Result
3
Ethics needs to be taught within clinical hypnotherapy training.
C1
4
Ethical safeguards should be included in the training of clinical
C1
hypnotherapists. 5
Ethical considerations are required within a hypnotherapy training
C1
course. 6
A Code of Practice is required by the profession of clinical
C1
hypnotherapy. 7
Ethical practice is required within the profession of clinical
C1
hypnotherapy. Table 61: Business and marketing - Consensus
Additionally the cohort had high agreement that marketing and business skills are required within clinical hypnotherapy training. #
Question
Result
41.
Marketing skills are required by clinical hypnotherapists
HA
133.
Business planning is required within a hypnotherapy training
HA
course 134.
Marketing is required within a hypnotherapy training course Table 62: Business and marketing - High Agreement
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HA
Yet there was no consensus when it came to applying the practice management skills (which include marketing skills) within the structure of a training course. #
Question
Result
115.
Rehearsing practice management skills are required within a
NC
hypnotherapy training course Table 63: Business and marketing - No Consensus
Ethical codes of conduct a have been established in all areas of the health sector (e.g. clinical practice and advertising) for many years and have evolved over time (Clements, 1992). This evolution of ethical standards is also apparent within the clinical hypnotherapy profession with the publishing and updating of ethical policies (AHA, 2013f; ASCH, 2014d; HCA - EP, 2012). An attempted search of the New South Wales Fair Trading website did not facilitate the finding of any complaints related to hypnosis or hypnotherapy. Clinical hypnotherapy peak bodies and associations have published ethical marketing guidelines (HCA - EP, 2012; HCA, 2012h) and some accepted the HCCC (NSW) Code of conduct for unregistered health practitioner (HCCC (NSW), 2012) as the basis for a national code .
The AHA has taken misleading advertising very seriously and published comments about these issues (AHJ, 2014). Whilst no dismissing unethical advertising, they raise possible reasons for changes in advertising as ‘one size fits all’ therapy franchises or increased competition. They also call upon teaching institutions and professional associations to mentor students, graduates and members. The author reminds us that self-regulation means we need to act professionally in every facet of our activities from practitioners to teaching institutions and professional association. This quality assurance will increase professionalism in the profession (AHJ, 2014).
As stated previously quality assurance pervades every aspect of the profession. The high agreement to include ethical marketing and business practices provides a clear indication
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of the cohort’s position on this matter. The behaviour of some members of the profession demonstrates that consideration should be given the rehearsal of marketing and management skills within a training scenario.
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18 Clinical hypnotherapy pedagogy: Lack of research A key aspect within this research was the realisation that there was effectively no data relating specifically to clinical hypnotherapy education. There are some papers which outline the inclusion of clinical hypnotherapy training but little on any pedagogy. This limits the scope of research methodology and makes a Delphi methodology a valid alternative (Hasson et al., 2000; Hsu & Sandford, 2007a; Linstone & Turoff, 2002). How can a discussion take place on what does not exist?
With the scarcity of literature available on clinical hypnotherapy education data must be drawn from other sources. The cohort has provided direction from their expertise and this is invaluable, but pedagogical information from clinical hypnotherapy educators is not in the literature or the survey so it can only be assumed. At the start of this research 39 clinical hypnotherapy teaching institutions were identified within Australia. It is understandable that their course material is commercial-in-confidence and with the clinical hypnotherapy training community so diverse (HCA, 2012e) it will be a difficult task to find uniformity within that diversity. The AQF (AQFC, 2013) is an attempt to provide guidelines for a broad range of educational structures.
Using the AQF guidelines and National Skills Standards Council (NSSC) documents (AQFC, 2013; NSSC, 2012a, 2012b, 2012c) it is feasible that with good faith and under the auspices of the peak body, clinical hypnotherapy could produce guidelines for an entry level course which would fulfil educational, governmental and professional requirements. The development of an entry level course would provide a foundation from which the clinical hypnotherapy sector in other countries could develop their own structures.
The diversity within clinical hypnotherapy training provides an opportunity to identify the range of training topics clinical hypnotherapy associations believe are required for entry
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into the profession. By surveying association membership criteria it can be discovered what the profession considers are entry level topics. If these are then compared with training institutions curricula, topics can be identified and a compilation developed which may considered to be entry level. These levels may then be applied as an agreed entry level criteria. However, the professions diversity in association membership criteria (AACHP, 2014; AHA, 2013a; ASCH, 2013e) and training institutions curricula ASQA accredited (AAH, 2013a; ACH, 2013; AHS, 2013; CA, 2013a; Phoenix, 2013) and non ASQA accredited (AHATS, 2012; AHS, 2014; MM, 2010a) finding common ground will be a challenge as there are also differences in what is considered to be hypnosis and hypnotherapy.
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19 Limitations of the research data There is no existing research on the practitioners within clinical hypnotherapy. Training in clinical hypnotherapy training is at the VET level and indicating much of the profession is unfamiliar with research. Additionally, the sample was drawn from a small population of stakeholders. The data provided by personal communication from two associations shows (AHA, 2014; ASCH, 2014a) they have 1338 jointly. The membership of another association who use hypnosis as an adjunct to existing health skills is available on their website stands at 800 and may be inexact. If these membership figures are taken as accurate and allowance is made for six other much smaller associations and clinical hypnotherapists who do not hold professional membership or hold multiple memberships we can estimate approximately 2000 – 2500 clinical hypnotherapists within Australia. The research cohort of 87 would represent between 3.48% and 4.35%.
The current research adopted the Delphi methodology (Benton et al., 2013; Hsu & Sandford, 2007a; Low-Beer et al., 2010; Yousuf, 2007) to gather expert opinion to identify topics for inclusion in clinical hypnotherapy training. The cohort was not asked to provide the level at which each topic should be taught. The teaching level is required to determine related pedagogy such as the elements of the essential outcomes for a unit of competency, the related performance criteria, the required skills, knowledge, range statements and assessment material. The identified topics need precision for the associated educational to be appropriate.
The lack of research related to specific pedagogy in clinical hypnotherapy education is remarkable. One twenty-year old study (Hammond & Elkins, 1994) provided limited data. With no previous data available at that time the researchers were also forced to engage expert opinion to reach their conclusions on clinical hypnosis training components.
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To make the educational material relevant some general questions on topics such as marketing or psychotherapy within the survey used broad terms and would need to be more precise. To enable a topic to be part of a curriculum, a certain specificity is required. For example does marketing relate to ethical marketing, internet marketing, print media advertising or merchandising and areas issues all have legal and quality assurance in marketing issues (HCCC (NSW), 2012).
Conversely some topics were too precise. For example when a specific technique such as direct suggestion is identified within the question it inherently imposes tight parameters on the respondent. #
Question
Result
39.
Direct suggestion is the primary methodology for clinical
C2
hypnotherapists Table 64: Question too precise
The intended restriction may have created some ambiguity especially considering the range of training and experience within the cohort which illustrates the diversity in the profession
The location of clinical hypnotherapy within the health sector is an issue. The diversity within the profession is apparent (HCA, 2012e) as shown by the range of qualifications described by the cohort. With no standardised curricula, variation in qualifications is inevitable. The variation has implications for external stakeholder as they are uncertain of the competencies and skills achieved by those holding a qualification entitled of ‘Certificate’, Diploma’, or Advanced Diploma. One sector includes within their code of ethics (ASH, 2014d) restrictions on their members supporting the practice of hypnosis by individual they consider to be ‘lay’ hypnotists. Another sector for a short time indicated that
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clinical hypnotherapy is an adjunct of other treatment modalities (ASCH, 2011c). These views were in opposition to those who consider clinical hypnotherapy is a profession in its own right. Some questions had inherent qualities which may have posited the participant within a specific viewpoint but only one question was specific. #
Question
Result
46.
‘Hypnosis is viewed not as an independent science, but as an
NC
adjunct to the range of treatment modalities for a wide range of medical, psychological, dental and therapeutic applications’ Table 65: Question with inherent qualities
The aim of the question was not to place the respondent into a segment but to identify the opinion of the cohort within the range of perspectives. If the cohort had been segmented into factions data could have been more revealing.
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20 Summary This research has revealed a paucity of publications related to pedagogy and a multidimensional profession with diversity in areas of governance, educational standards, commercial interests and the beliefs surrounding pedagogy. These data show areas of consensus, high agreement and no consensus from which further deliberations can be undertaken on key areas such as educational standards, professional nomenclature, professional titles, clinical practice, professional issues such as ethics in marketing, lack of pedagogical research and the capstone, quality assurance.
Currently there is no legislation directly related to clinical hypnotherapy practice within Australia. With the repealing of state legislative restrictions, the establishment of a national peak body (HCA, 2012g) and related voluntary self-regulation processes provide an opportunity to develop the profession that has not previously existed.
The data provided is a foundation. It is the opinion of an expert cohort, which does not indicate the ‘correctness’ of the data, but demonstrates the attitudes and beliefs of those experts. From those beliefs further discussion and possible research themes may be determined. Possible themes for further development of the profession could include: •
A uniformly agreed national standard for clinical hypnotherapy training;
•
A universally agreed definition of ‘hypnosis’ and ‘hypnotherapy’;
•
Improved quality assurance in the profession;
•
Establishment of quality assurance processes;
•
Professional accreditation of courses;
•
Nomenclature of qualifications;
•
Implementation of professional advertising standards.
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21 Concluding comments The original research was to provide a synopsis of clinical hypnotherapy pedagogy; being the essential knowledge, essential skills and learning outcomes. These areas are intrinsically complex but with the diversity of the profession and when the additional attitudinal constraints of ‘factional attitudes’ is introduced the complexity is amplified. Educational standards are further complicated by the views of the profession. One perspective is that clinical hypnotherapy is a profession in its own right (Iphofen & Corrin, 2007). Another belief is that clinical hypnosis/clinical hypnotherapy is an adjunct to medical, psychological, dental and therapeutic applications (ASCH, 2011c; ASH, 2010). A variation of that view is presented in the revised position statement where hypnosis is an independent science, and also an adjunct to a wide range of medical, psychological, dental and therapeutic applications (ASCH, 2011d). These views impact clinical hypnotherapy education and practice. The view that clinical hypnotherapy is an adjunct is reflected within the training of existing health practitioners where the education is designed to complement existing skills (ASH, 2013d).
Issues of competencies and skills have been noted over many years (Moss, 1959; Watkins, 1998) but little research has been conducted to rectify any of the issues. Sheehan (1998) reviewed the major research themes since 1985 within the field of hypnosis. At that time comments were made regarding the under-representation of articles on education in the review and the necessity of educational guidelines. A number of articles give a variety of descriptive outline of curricula of hypnosis training but only one gives any in-depth pedagogy (APA, 1961; Bloom, 1993, 2001; Bourgeois, 1997; Coles, 2011; Dane & Kessler, 1998; Daniels, 1985; Elkins & Hammond, 1998; Fellows, 1996; Hammond, 1996; Hammond & Elkins, 1994; Hoencamp, 2004; Monroe, Lathrop, Cohen, & Miller, 1960; Oster, 1998; Parrish, 1975; Rodolfa, Kraft, Reilley, & Blackmore, 1982;
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Stanley et al., 1998; Taub-Bynum & House, 1983; Wald & Kline, 1955; Walling & Baker, 1996; Walling et al., 1996, 1998; D. M. Wark & Bloom, 2010; D. M. Wark & Kohen, 2002; Watkins, 1998; R. H. Woody et al., 1969; Yapko et al., 1998). The lack of a universally accepted definition of hypnosis and hypnotherapy is a limitation but not an impenetrable barrier to the development of educational standards for clinical hypnotherapy education. Experts with specialised clinical hypnotherapy education experience are available to provide guidance in the establishment of entry level, intermediate and advance training courses. I believe all would agree that to ensure efficacy a clinical hypnotherapist should have the most professional training possible (Stanley et al., 1998). With expert opinion being used to provide valid data (Hasson et al., 2000; Hsu & Sandford, 2007a; Low-Beer et al., 2010; Yousuf, 2007) educational parameters can be established.
Experts are divided on the definitions of hypnosis/hypnotherapy. One author acknowledges both terms (Araoz, 2005) and others use the terms interchangeably within professional publications (Abramowitz et al., 2008; Alladin & Alibhai, 2007; Burrows et al., 2002; PoSA, 2009c) despite the call for that practice to cease (Frischholz, 1995, 1998).
Within the multilayered facets of the profession research is needed to derive conclusions to the many issues being presented to the profession. Terminology or whether hypnosis/hypnotherapy is an art and a science (Greenleaf, 2010) can only be determined with a collegial approach (ABIM et al., 2002; Du Toit R, Palagyi A, & G, 2010; Evetts, 2011) to dealing with the issues facing clinical hypnotherapy as an emerging profession. A comment by Kirsch (2011) related to consensus of a definition: We could ignore the problem of dissociated definitions, as we have for decades. In the long run, however, the consequences for the field of hypnosis could be severe. If ostriches really did bury their heads in the sand, they might long ago have joined the dodo. The alternative is to make a choice between the broad and narrow
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definitions of hypnosis and make our definition of hypnotisability consistent with that choice. (Kirsch et al., 2011, p. 112)
The same quote with minor adaptations could also relate to the profession as a whole We could ignore the problem of dissociated factions, as we have for decades. In the long run, however, the consequences for the field of hypnosis could be severe. If ostriches really did bury their heads in the sand, they might long ago have joined the dodo. The alternative is to work to achieve consensus between the broad and narrow definitions of those that practise and make our definition of clinical practice consistent with that choice. (adapted from Kirsch et al., 2011, p. 112)
The research was designed to establish key competencies and skills which are required by clinical hypnotherapists entering the profession. The cohort has by virtue of the categories of consensus, high agreement and no consensus have provided data indicating their expert opinion on essential, required and optional topics within clinical hypnotherapy education. The research however did not establish the competencies surrounding each topic.
To establish the specific competencies and skills attached to each topic further development would be required. If the course was to reflect the entire profession part of the development would require additional research. Pedagogy such as depth of knowledge/skills, foundational knowledge and skills, learning outcomes, levels, lifelong learning, range, recognition of prior learning, volume of learning, delivery and assessment methodologies would need to be developed to have a truly integrated course.
The data provide guidelines from which the profession can develop educational guidelines and the associated pedagogy. It also provides the cohort’s expectations of the profession on governance and ethical issues. This research has provided a first step by identifying topics which would be considered essential within initial clinical hypnotherapy education.
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23 Appendices Appendix 1: Office of Research Services: Ethics Approval ...................................... 317 Appendix 2: Search Strategies..................................................................................... 318 Appendix 3: Survey Questions – Round 1 .................................................................. 330 Appendix 4: Survey Questions – Round 2 .................................................................. 339 Appendix 5 Cohort qualifications – raw data.............................................................. 344
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Appendix 1: Office of Research Services: Ethics Approval
Locked Bag 1797 Penrith NSW 2751 Australia
Office of Research Services Our Reference: 12/002315 H9510
8 January 2014
Ian Wilson School of Medicine And Leon Cowen School of Education
Dear Ian and Leon RE: Amendment Request to H9510 I acknowledge receipt of your email dated 6th of January 2014 concerning a request to amend your approved research protocol H9510 - Developing clinical hypnotherapy educational guidelines through consensus The Office of Research Services has reviewed your amendment request and I am pleased to advise that it has been approved as follows: 1. Extension of approval period until the 30th of December, 2014.
Please do not hesitate to contact me at
[email protected] if you require any further information. Regards
Stella Glover on behalf of the Human Ethics Officer Office of Research Services
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Appendix 2: Search Strategies Medline 1. *Hypnosis/ 2. "hypno*".ab,ti. 3. 1 or 2 4. *treatment outcome/ 5. treatment.ab,ti. 6. *evaluation studies as topic/ 7. 4 or 5 or 6 8. 3 and 7 9. (hypno* adj5 (treatment or evaluat* or effectiveness or efficacy)).mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier] 10. 8 or 9 11. limit 10 to (english language and yr="2002 -Current" and last 10 years) 12. hypnotic.mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier] 13. 11 not 12 14. limit 9 to (english language and last 10 years) 15. 13 or 14 16. "systematic review".ab,ti. 17. 15 and 16 18. "randomized controlled trial".ab,ti. 19. 15 and 18 20. limit 15 to (case reports or clinical conference or clinical trial, all or comparative study or controlled clinical trial or evaluation studies or meta-analysis or randomized controlled trial or "review")
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21. limit 15 to "prognosis (best balance of sensitivity and specificity)" 22. 17 or 19 or 21
Cochrane Library #1
MeSH descriptor Hypnosis explode all trees
547
edit
delete
#2
MeSH descriptor Hypnosis explode all trees
547
edit
delete
#3
(hypno*):ti,ab,kw
#4
(#2 OR #3)
#5
"treatment outcome":ti,ab,kw 82816
#6
MeSH descriptor Treatment Outcome explode all
trees
77815
4564 4773
edit
edit
edit
delete
delete edit
delete
delete
#7
(treatment):ti,ab,kw
287693 edit
delete
#8
(evaluat*):ti,ab,kw
161369 edit
delete
#9
(effectiveness):ti,ab,kw
#10
(efficacy):ti,ab,kw
#11
MeSH descriptor Evaluation Studies as Topic explode all
trees
80264
edit
44729 108107 edit
edit
delete
delete
delete
#12
(#5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11)
#13
(#4 AND #12)
#14
MeSH descriptor Hypnotics and Sedatives explode all
trees
2485
edit
2906
edit
428322 edit
delete
delete
#15
(hypnotic)
4174
edit
delete
#16
(#14 OR #15)
4174
edit
delete
#17
(#13 AND NOT #16)
#18
(#17), from 2002 to 2012
437
edit 186
Scopus
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delete edit
delete
delete
((TITLE-ABS-KEY(hypno*) OR TITLE-ABS-KEY-AUTH(hypno*) AND NOT (hypnotic)) AND (TITLE-ABS-KEY(treatment outcome*) OR TITLE-ABS-KEY(evaluation studies as topic) OR TITLE-ABS-KEY(evaluat*) OR TITLE-ABS-KEY(outcome*) OR TITLE-ABSKEY(effective*))) AND NOT (hypnozoite*) AND (LIMIT-TO(PUBYEAR, 2012) OR LIMITTO(PUBYEAR, 2011) OR LIMIT-TO(PUBYEAR, 2010) OR LIMIT-TO(PUBYEAR, 2009) OR LIMIT-TO(PUBYEAR, 2008) OR LIMIT-TO(PUBYEAR, 2007) OR LIMITTO(PUBYEAR, 2006) OR LIMIT-TO(PUBYEAR, 2005) OR LIMIT-TO(PUBYEAR, 2004) OR LIMIT-TO(PUBYEAR, 2003) OR LIMIT-TO(PUBYEAR, 2012) OR LIMITTO(PUBYEAR, 2011) OR LIMIT-TO(PUBYEAR, 2010) OR LIMIT-TO(PUBYEAR, 2009) OR LIMIT-TO(PUBYEAR, 2008) OR LIMIT-TO(PUBYEAR, 2007) OR LIMITTO(PUBYEAR, 2006) OR LIMIT-TO(PUBYEAR, 2005) OR LIMIT-TO(PUBYEAR, 2004) OR LIMIT-TO(PUBYEAR, 2003) OR LIMIT-TO(PUBYEAR, 2002)) AND (LIMITTO(SUBJAREA, "MEDI") OR LIMIT-TO(SUBJAREA, "PSYC") OR LIMIT-TO(SUBJAREA, "PHAR") OR LIMIT-TO(SUBJAREA, "BIOC") OR LIMIT-TO(SUBJAREA, "NEUR") OR LIMIT-TO(SUBJAREA, "NURS") OR LIMIT-TO(SUBJAREA, "HEAL") OR LIMITTO(SUBJAREA, "IMMU") OR LIMIT-TO(SUBJAREA, "SOCI") OR LIMIT-TO(SUBJAREA, "DENT") OR LIMIT-TO(SUBJAREA, "MULT")) AND (LIMIT-TO(EXACTSRCTITLE, "American Journal of Clinical Hypnosis") OR LIMIT-TO(EXACTSRCTITLE, "Journal of Alternative and Complementary Medicine") OR LIMIT-TO(EXACTSRCTITLE, "Australian Journal of Clinical and Experimental Hypnosis") OR LIMIT-TO(EXACTSRCTITLE, "Contemporary Hypnosis") OR LIMIT-TO(EXACTSRCTITLE, "Focus on Alternative and Complementary Therapies") OR LIMIT-TO(EXACTSRCTITLE, "International Journal of Clinical and Experimental Hypnosis") OR LIMIT-TO(EXACTSRCTITLE, "Australian Journal of Clinical Hypnotherapy and Hypnosis") OR LIMIT-TO(EXACTSRCTITLE, "American Journal of Gastroenterology") OR LIMIT-TO(EXACTSRCTITLE, "BMC Complementary and Alternative Medicine") OR LIMIT-TO(EXACTSRCTITLE, "Gut") OR LIMIT-TO(EXACTSRCTITLE, "Current Pain and Headache Reports") OR LIMITTO(EXACTSRCTITLE, "Explore the Journal of Science and Healing") OR LIMIT-
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TO(EXACTSRCTITLE, "Journal of Clinical Oncology") OR LIMIT-TO(EXACTSRCTITLE, "American Family Physician") OR LIMIT-TO(EXACTSRCTITLE, "Pediatrics in Review") OR LIMIT-TO(EXACTSRCTITLE, "Current Treatment Options in Neurology") OR LIMITTO(EXACTSRCTITLE, "Journal of Family Practice") OR LIMIT-TO(EXACTSRCTITLE, "Drugs and Aging") OR LIMIT-TO(EXACTSRCTITLE, "Complementary Therapies in Medicine") OR LIMIT-TO(EXACTSRCTITLE, "Expert Review of Neurotherapeutics") OR LIMIT-TO(EXACTSRCTITLE, "Gastroenterology") OR LIMIT-TO(EXACTSRCTITLE, "Paediatric Anaesthesia") OR LIMIT-TO(EXACTSRCTITLE, "Current Treatment Options in Gastroenterology") OR LIMIT-TO(EXACTSRCTITLE, "New Zealand Medical Journal") OR LIMIT-TO(EXACTSRCTITLE, "British Journal of Anaesthesia") OR LIMITTO(EXACTSRCTITLE, "Nature Clinical Practice Gastroenterology and Hepatology") OR LIMIT-TO(EXACTSRCTITLE, "Movement Disorders") OR LIMIT-TO(EXACTSRCTITLE, "Journal of Pediatric Gastroenterology and Nutrition") OR LIMIT-TO(EXACTSRCTITLE, "Clinical Journal of Pain") OR LIMIT-TO(EXACTSRCTITLE, "Psycho Oncology") OR LIMIT-TO(EXACTSRCTITLE, "Primary Psychiatry")) AND (LIMIT-TO(LANGUAGE, "English"))
EBSCO Host #
Query
Limiters/Expanders
Last Run Via
Results
Interface EBSCOhost Limiters - Published Date from: Search Screen 20010101-20121231; Peer - Advanced S18 S17
Reviewed; Exclude MEDLINE
340 Search
records; Language: English Database Search modes - Boolean/Phrase CINAHL Plus with Full Text
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Interface EBSCOhost Search Screen - Advanced S17 S5 and S16
Search modes - Boolean/Phrase
Display Search Database CINAHL Plus with Full Text Interface EBSCOhost Search Screen
S6 or S7 or S8 or S9 - Advanced S16 or S10 or S11 or S12 Search modes - Boolean/Phrase
Display Search
or S13 or S14 or S15 Database CINAHL Plus with Full Text Interface EBSCOhost Search Screen - Advanced S15 outcome*
Search modes - Boolean/Phrase
Display Search Database CINAHL Plus with Full Text Interface -
S14 evaluat*
Search modes - Boolean/Phrase
Display EBSCOhost
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Search Screen - Advanced Search Database CINAHL Plus with Full Text Interface EBSCOhost Search Screen (MH "Treatment
- Advanced Search modes - Boolean/Phrase
S13 Outcomes")
Display Search Database CINAHL Plus with Full Text Interface EBSCOhost Search Screen
(MH "Outcome
- Advanced Search modes - Boolean/Phrase
S12
Display Search
Assessment")
Database CINAHL Plus with Full Text Interface EBSCOhost S11 outcome assessment Search modes - Boolean/Phrase
Display Search Screen - Advanced
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Search Database CINAHL Plus with Full Text Interface EBSCOhost Search Screen (MH "Outcomes S10
- Advanced Search modes - Boolean/Phrase
(Health Care)")
Display Search Database CINAHL Plus with Full Text Interface EBSCOhost Search Screen - Advanced
S9
(MH "Evaluation")
Search modes - Boolean/Phrase
Display Search Database CINAHL Plus with Full Text Interface EBSCOhost Search Screen
S8
effective*
Search modes - Boolean/Phrase
Display - Advanced Search Database -
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CINAHL Plus with Full Text Interface EBSCOhost Search Screen - Advanced S7
treatment
Search modes - Boolean/Phrase
Display Search Database CINAHL Plus with Full Text Interface EBSCOhost Search Screen
(MH "Treatment S6
- Advanced Search modes - Boolean/Phrase
Outcomes")
Display Search Database CINAHL Plus with Full Text Interface EBSCOhost Search Screen - Advanced
S5
S3 NOT S4
Search modes - Boolean/Phrase
Display Search Database CINAHL Plus with Full Text
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Interface EBSCOhost Search Screen - Advanced S4
hypnotic
Search modes - Boolean/Phrase
Display Search Database CINAHL Plus with Full Text Interface EBSCOhost Search Screen - Advanced
S3
S1 or S2
Search modes - Boolean/Phrase
Display Search Database CINAHL Plus with Full Text Interface EBSCOhost Search Screen - Advanced
S2
hypno*
Search modes - Boolean/Phrase
Display Search Database CINAHL Plus with Full Text Interface -
S1
(MH "Hypnosis")
Search modes - Boolean/Phrase
Display EBSCOhost
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Search Screen - Advanced Search Database CINAHL Plus with Full Text
PsycARTICLES #
Query
Limiters/Expanders
Last Run Via
Results
Interface EBSCOhost Search Screen S10 S1 and S9
Search modes - Boolean/Phrase
28 Advanced Search Database PsycARTICLES Interface EBSCOhost
S2 or S3 or S4 or Search Screen S9
S5 or S6 or S7 or Search modes - Boolean/Phrase
Display Advanced Search
S8 Database PsycARTICLES Limiters - Year of Publication from: Interface -
S8
assessment*
2002-2012; Exclude Book
EBSCOhost
Reviews; Population Group:
Search Screen -
Human
Advanced Search
Search modes - Boolean/Phrase
Database -
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Display
PsycARTICLES Interface Limiters - Year of Publication from: EBSCOhost 2002-2012; Exclude Book Search Screen S7
outcome*
Reviews; Population Group:
Display Advanced Search
Human Database Search modes - Boolean/Phrase PsycARTICLES Interface Limiters - Year of Publication from: EBSCOhost 2002-2012; Exclude Book Search Screen S6
efficacy
Reviews; Population Group:
Display Advanced Search
Human Database Search modes - Boolean/Phrase PsycARTICLES Interface Limiters - Year of Publication from: EBSCOhost 2002-2012; Exclude Book Search Screen S5
effective*
Reviews; Population Group:
Display Advanced Search
Human Database Search modes - Boolean/Phrase PsycARTICLES Interface Limiters - Year of Publication from: EBSCOhost 2002-2012; Exclude Book Search Screen S4
evaluate
Reviews; Population Group:
Display Advanced Search
Human Database Search modes - Boolean/Phrase PsycARTICLES S3
evaluation
Limiters - Year of Publication from: Interface -
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Display
2002-2012; Exclude Book
EBSCOhost
Reviews; Population Group:
Search Screen -
Human
Advanced Search
Search modes - Boolean/Phrase
Database PsycARTICLES Interface -
Limiters - Year of Publication from: EBSCOhost 2002-2012; Exclude Book Search Screen S2
treatment
Reviews; Population Group:
Display Advanced Search
Human Database Search modes - Boolean/Phrase PsycARTICLES Interface Limiters - Year of Publication from: EBSCOhost 2002-2012; Exclude Book Search Screen S1
hypno*
Reviews; Population Group:
Display Advanced Search
Human Database Search modes - Boolean/Phrase PsycARTICLES
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Appendix 3: Survey Questions – Round 1
Questions 1 provided professional details of the participant. Other questions required a response of SA
= Strongly Agree
A = Agree D = Disagree SD 1.
= Strongly Disagree Please provide your details
Ethics Questions Round 1 2.
Is the ethics section of the survey relevant to your expertise
3.
Ethics needs to be taught within clinical hypnotherapy training.
4.
Ethical safeguards should be included in the training of clinical hypnotherapists.
5.
Ethical considerations are required within a hypnotherapy training course.
6.
A Code of Practice is required by the profession of clinical hypnotherapy.
7.
Ethical practice is required within the profession of clinical hypnotherapy.
Governance Questions – Round 1 8.
Is the governance section of the survey relevant to your expertise
9.
Clinical hypnotherapy requires several self governing peak bodies
10. Clinical hypnotherapy qualifications should be standardised across Australia 11. Clinical hypnotherapy should be registered by government 12. Governance involves quality assurance guidelines 13. Governance involves best practice guidelines 14. Quality assurance is necessary within the profession of clinical hypnotherapy 15. Quality assurance is not necessary for practitioners to receive health fund rebates 16. Best Practice is necessary within the profession of clinical hypnotherapy 17. Quality Assurance is not required for associations giving recognition to teaching
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institution 18. Best Practice is not necessary for practitioners to receive health fund rebates 19. Good governance will effect whether clinical hypnotherapy receives professional acknowledgement 20. VET sector accredited qualifications will be the future standard for the clinical hypnotherapy profession 21. Professional credibility is based upon qualifications 22. Entry level into clinical hypnotherapy should be at an industry defined training standard 23. Entry level into clinical hypnotherapy should be a government accredited Cert IV standard 24. Entry level into clinical hypnotherapy requires a government accredited Diploma standard 25. Entry level into clinical hypnotherapy requires a government accredited Advanced Diploma standard 26. Entry level into clinical hypnotherapy requires a government accredited Degree standard 27. Training in clinical hypnotherapy should be at the Vocational Education Training level 28. Training in clinical hypnotherapy should be at the Higher Education level (University level) 29. Clinical hypnotherapy is a subset of other professional modalities 30. Self regulation of clinical hypnotherapy is required 31. Self regulation of clinical hypnotherapy ‘qualification names’ is required 32. External recognition of clinical hypnotherapy is based upon qualifications 33. External recognition of clinical hypnotherapy is based upon peer reviewed research 34. External recognition of clinical hypnotherapy is based upon commercial considerations
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35. External recognition of clinical hypnotherapy is based upon public demand 36. Use of ‘Diploma’ and ‘Advanced Diploma’ titles by non VET sector organisations is creating confusion.
Concepts Questions – Round 1 37. Is the concepts section of the survey relevant to your expertise 38. Clinical hypnotherapy requires counselling skills 39. Direct suggestion is the primary methodology for clinical hypnotherapists 40. Business management skills are required by clinical hypnotherapists 41. Marketing skills are required by clinical hypnotherapists 42. Practical work should be included in clinical hypnotherapy training 43. Preparing the client prior to the first induction is required within a hypnotherapy training course 44. History of hypnosis is required within a hypnotherapy training course 45. Self hypnosis: how & what to teach patients is required within a hypnotherapy training course 46. ‘Hypnosis is viewed not as an independent science, but as an adjunct to the range of treatment modalities for a wide range of medical, psychological, dental and therapeutic applications’ 47. Inductions are essential for clinical hypnotherapy training 48. The terms ‘hypnosis’ and ‘hypnotherapy’ mean the same thing 49. Psychotherapeutic concepts are required in clinical hypnotherapy training 50. Clinical hypnotherapists require knowledge of psychology 51. Clinical hypnotherapists require knowledge of psychotherapy 52. Clinical hypnotherapists require knowledge of medical sciences 53. Clinical hypnotherapists require knowledge of pharmacology 54. Clinical hypnotherapists require knowledge of human sexuality 55. Clinical hypnotherapists require knowledge of legal requirements in a health practice
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56. Clinical hypnotherapists require knowledge of susceptibility techniques 57. Clinical hypnotherapists require knowledge of hypnoanalysis 58. Clinical hypnotherapy should include training in past life work 59. Clinical safeguards should not be included in the training of clinical hypnotherapists 60. Scripts are an integral part of clinical hypnotherapy training 61. Hypnotic phenomenon is a required part of clinical hypnotherapy training 62. Clinical hypnotherapy training does not require national standards 63. A definition of hypnosis is required in training programs 64. Myths and misconceptions need to be discussed within a hypnotherapy training course 65. Hypnotic phenomena & their potential usefulness is required within a hypnotherapy training course 66. Working with hypnotic phenomenon is required within a hypnotherapy training course 67. Principles of induction are required within a hypnotherapy training course 68. Theories of hypnosis are required within a hypnotherapy training course 69. Awakening procedures from the hypnotic state is required within a hypnotherapy training course 70. Understanding the stages (levels) of hypnosis is required within a hypnotherapy training course 71. Deepening techniques are required within a hypnotherapy training course 72. Principles in formulating hypnotic suggestions are required within a hypnotherapy training course 73. Decision making strategies in selecting techniques is required within a hypnotherapy training course 74. Hypnosis for treating severely mentally disturbed patients is required within hypnotherapy training
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75. Forensic & investigative hypnosis techniques are required within a hypnotherapy training course 76. Working with group hypnosis is required within a hypnotherapy training course 77. Designing and conducting clinical research is required within a hypnotherapy training course 78. Working within a heath care team is required in clinical hypnotherapy training 79. Observation of actual client cases is required within a hypnotherapy training course 80. The word trance is confusing for clients 81. Self hypnosis for personal use is required within a hypnotherapy training course 82. Training to teach self hypnosis is required within a hypnotherapy training course 83. Ericksonian hypnosis is required within a hypnotherapy training course 84. Health issues client intake sheet and treatment plan is required within a hypnotherapy training course 85. Working within a therapeutic framework is required within a hypnotherapy training course 86. Rapport building (Therapeutic Alliance) with the client is required within hypnotherapy training 87. Dealing with abreactions is required within a hypnotherapy training course 88. Deepening the hypnotic state is required within a hypnotherapy training course 89. Practice management forms (e.g. Client intake sheet) are required within hypnotherapy training 90. Treatment plans are required within a hypnotherapy training course 91. Ethical issues are a required topic within a hypnotherapy training course 92. Ego strengthening is required within a hypnotherapy training course 93. Neuro LinguisticProgramming is required within a hypnotherapy training course 94. Occupational health and safety policies are required within a hypnotherapy training course
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95. Work within a legal and ethical framework is required within a hypnotherapy training course 96. A variety or hypnotherapeutic concepts is not required within a hypnotherapy training course 97. Working within a structured counselling process is required within a hypnotherapy training course 98. The depth of training in clinical hypnotherapy is important (e.g. reasons to use particular techniques)
Techniques Questions – Round 1 99. Is the techniques section of the survey relevant to your expertise 100. Fundamental techniques should be included in clinical hypnotherapy training 101. Practical application of techniques is required in clinical hypnotherapy training 102. Hypnoanalytical techniques should be included in clinical hypnotherapy training 103. Training a client in self hypnosis is an essential part of clinical hypnotherapist training 104. Demonstrating hypnotic inductions is required within a hypnotherapy training course 105. Methods of egostrengthening are required within a hypnotherapy training course 106. Hypnotic techniques with pain are required within a hypnotherapy training course 107. Hypnotic susceptibility techniques are required within a hypnotherapy training course 108. Formulating therapeutic suggestions is required within a hypnotherapy training course 109. Rehearsing scripts is beneficial for the practice of clinical hypnotherapy 110. Using hypnotherapy terminology to communicate with others is required within a hypnotherapy training course 111. Self hypnosis is required topic within a hypnotherapy training course 112. Susceptibility techniques are required within a hypnotherapy training course 113. Induction and deepening techniques are required within a hypnotherapy training course
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114. Creating basic suggestions is required within a hypnotherapy training course 115. Rehearsing practice management skills are required within a hypnotherapy training course 116. Inductions are required within a hypnotherapy training course 117. Rapid inductions are essential competencies for clinical hypnotherapy training 118. Post hypnotic suggestion is required within a hypnotherapy training course 119. Therapeutic metaphors are required within a hypnotherapy training course 120. Creating suggestions is required within a hypnotherapy training course 121. Waking hypnosis is required within a hypnotherapy training course 122. Sensory language is required within a hypnotherapy training course 123. Psychotherapy (eg NLP, Ego State Therapy or Gestalt) techniques should not be practised in clinical hypnotherapy training 124. Counselling techniques should not be practised in clinical hypnotherapy training 125. Composing patter for each individual client is required in clinical hypnotherapy training
Practical Questions – Round 1 126. Is the practical section of the survey relevant to your expertise 127. Formulating hypnotic suggestions is required activity within a hypnotherapy training course 128. Demonstrations of deep trance phenomenon are required within a hypnotherapy training course 129. Practical work is not required in a clinical hypnotherapy training course 130. Demonstrations and practical exercises are required within a hypnotherapy training course 131. Preparing a treatment plan for case studies is required within a hypnotherapy training course 132. Make referrals to health care professionals is required within a hypnotherapy training
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course 133. Business planning is required within a hypnotherapy training course 134. Marketing is required within a hypnotherapy training course 135. Demonstration of practical skills is required within a hypnotherapy training course 136. Assessment of practical skills is required within a hypnotherapy training course 137. Case consultation conferences within a workshop or class format is required in hypnotherapy training 138. Supervision is not required in a clinical hypnotherapy training program
Clinical Hypnotherapy Education Questions – Round 1 139. Is the practical section of the survey relevant to your expertise 140. A clinical hypnotherapist requires specific skills to enter the profession 141. Current educational standards are not impacting on the profession. 142. Standardised clinical hypnotherapy training is not required in Australia 143. Clinical hypnotherapy educators do not require their skills and competencies to be assessed 144. Developing a clinical hypnotherapy educational pathway is not required in Australia (e.g. From non VET training to VET training to Higher Education) 145. Articulation from non government accredited training into government accredited training is not required in Australia 146. Recognition of Prior Learning (RPL) is not necessary within the profession of clinical hypnotherapy 147. Assessment of competencies is required at all levels of training 148. Quality Assurance of training institutions is required in the profession of clinical hypnotherapy 149. Assessment is a method of ensuring competency in clinical hypnotherapy training 150. Clinical hypnotherapists require ongoing supervision 151. Clinical hypnotherapy supervisors require specialised training
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152. Clinical hypnotherapy needs to consider external stakeholders (Health Funds/Professional Indemnity Insurance) when considering professional standards 153. Clinical hypnotherapy trainers require higher level skills than those they are training. 154. Clinical hypnotherapy trainers require more practical experience than those they are training 155. Clinical hypnotherapy supervisors require higher level skills than those they are supervising 156. Clinical hypnotherapy supervisors require more practical experience than those they are supervising 157. Vocational competency combined with relevant industry experience is all that is required to become a clinical hypnotherapist
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Appendix 4: Survey Questions – Round 2 Questions 1 – 4 provided professional details of the participant. Other questions required a response of SA
= Strongly Agree
A = Agree D = Disagree SD
= Strongly Disagree
No.
Question
1.
Please provide your details
2.
Please select your primary working role.
3.
Please select any other working role(s). You can select multiple categories.
4.
Is the ethics section of the survey relevant to your expertise
5.
Please use the text box below if you would like to make any comments
6.
Is the governance section of the survey relevant to your expertise
7.
Clinical hypnotherapy requires several self governing peak bodies
8.
Clinical hypnotherapy requires one self governing peak body
9.
Clinical hypnotherapy requires one peak body
10.
Clinical hypnotherapy requires several peak bodies
11.
Clinical hypnotherapy requires several self governing peak bodies
12.
Clinical hypnotherapy qualifications should be standardised across Australia
13.
Clinical hypnotherapy should be registered by government
14.
Quality assurance is not necessary for practitioners to receive health fund rebates
15.
Best Practice is not necessary for practitioners to receive health fund rebates
16.
Good governance will effect whether clinical hypnotherapy receives professional acknowledgement
17.
VET sector accredited qualifications will be the future standard for the clinical hypnotherapy profession
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18.
Accredited qualifications will be the future standard for the clinical hypnotherapy profession
19.
Professional credibility is based upon qualifications
20.
Entry level into clinical hypnotherapy should be at an industry defined training standard
21.
Entry level into clinical hypnotherapy should be a government accredited Cert IV standard
22.
Entry level into clinical hypnotherapy requires a government accredited Diploma standard
23.
Entry level into clinical hypnotherapy requires a government accredited Advanced Diploma standard
24.
Entry level into clinical hypnotherapy requires a government accredited Degree standard
25.
Training in clinical hypnotherapy should be at the Vocational Education Training level (TAFE level - education based on occupation or employment called vocational education)
26.
Training in clinical hypnotherapy should be at the Higher Education level (University level)
27.
Clinical hypnotherapy is a subset of other professional modalities
28.
Self regulation of clinical hypnotherapy ‘qualification names’ is required
29.
External recognition of clinical hypnotherapy is based upon qualifications
30.
External recognition of clinical hypnotherapy is based upon peer reviewed research
31.
External recognition of clinical hypnotherapy is based upon commercial considerations
32.
External recognition of clinical hypnotherapy is based upon public demand
33.
Use of ‘Diploma’ and ‘Advanced Diploma’ titles by non VET sector organisations is creating confusion.
34.
Please use the text box below if you would like to make any comments.
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35.
Is the concepts section of the survey relevant to your expertise
36.
Direct suggestion is the primary methodology for clinical hypnotherapists
37.
Suggestion is the primary methodology for clinical hypnotherapists
38.
Business management skills are required by clinical hypnotherapists
39.
Marketing skills are required by clinical hypnotherapists
40.
‘Hypnosis is viewed not as an independent science, but as an adjunct to the range of treatment modalities for a wide range of medical, psychological, dental and therapeutic applications’
41.
Clinical hypnotherapists require knowledge of medical sciences
42.
Clinical hypnotherapists require knowledge of pharmacology
43.
Clinical hypnotherapists require knowledge of human sexuality
44.
Clinical hypnotherapy should include training in past life work
45.
Scripts are an integral part of clinical hypnotherapy training
46.
Clinical hypnotherapy training does not require national standards
47.
Hypnosis for treating severely mentally disturbed patients is required within hypnotherapy training
48.
Forensic & investigative hypnosis techniques are required within a hypnotherapy training course
49.
Working with group hypnosis is required within a hypnotherapy training course
50.
Designing and conducting clinical research is required within a hypnotherapy training course
51.
Working within a heath care team is required in clinical hypnotherapy training
52.
Observation of actual client cases is required within a hypnotherapy training course
53.
The word trance is confusing for clients
54.
Self hypnosis for personal use is required within a hypnotherapy training course
55.
Training to teach self hypnosis is required within a hypnotherapy training course
56.
Ericksonian hypnosis is required within a hypnotherapy training course
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57.
Neuro Linguistic-Programming is required within a hypnotherapy training course
58.
Working within a structured counselling process is required within a hypnotherapy training course
59.
Please use the text box below if you would like to make any comments.
60.
Is the techniques section of the survey relevant to your expertise
61.
Training a client in self hypnosis is an essential part of clinical hypnotherapist training
62.
Training a client in self hypnosis should be part of clinical hypnotherapist training
63.
Rehearsing scripts is beneficial for the practice of clinical hypnotherapy
64.
Using hypnotherapy terminology to communicate with others is required within a hypnotherapy training course
65.
Rehearsing practice management skills are required within a hypnotherapy training course
66.
Rapid inductions are essential competencies for clinical hypnotherapy training
67.
Rapid inductions should be part of clinical hypnotherapy training
68.
Composing patter for each individual client is required in clinical hypnotherapy training
69.
Please use the text box below if you would like to make any comments.
70.
Is the practical section of the survey relevant to your expertise
71.
Demonstrations of deep trance phenomenon are required within a hypnotherapy training course
72.
Business planning is required within a hypnotherapy training course
73.
Marketing is required within a hypnotherapy training course
74.
Case consultation conferences within a workshop or class format is required in hypnotherapy training
75.
Please use the text box below if you would like to make any comments
76.
Is the practical section of the survey relevant to your expertise
77.
Current educational standards are not impacting on the profession
78.
Standardised clinical hypnotherapy training is not required in Australia
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79.
Developing a clinical hypnotherapy educational pathway is not required in Australia (e.g. From non VET training to VET training to Higher Education)
80.
Articulation from non government accredited training into government accredited training is not required in Australia
81.
Clinical hypnotherapists require ongoing supervision
82.
Vocational competency combined with relevant industry experience is all that is required to become a clinical hypnotherapist
83.
Please use the text box below if you would like to make any comments.
84.
If you would like to make any comments about the survey as a whole please use the text box below.
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Appendix 5 Cohort qualifications – raw data
Qualification(s)
Frequency Percent
Adv Practitioners Cert in Clinical Hypnotherapy
1
1.1%
Advanced Diploma of Clinical Hypnotherapy
1
1.1%
APDCH (Aust.), APCCH (Aust.), DHC (Aust.)
1
1.1%
B.A., Dip. T., Dip. App. Psych., Dip. Hyp.
1
1.1%
BA Grad Dip Ed Grad Dip Hyp
1
1.1%
BA Psych, Clinical Hypnotherapist
1
1.1%
BA Psychology & Sociology; Dip in Applied Psychology; Dip in Group
1
1.1%
BA, PGDipEd, Dip Clinical Hypnotherapy
1
1.1%
BA,DipAppPsych,GradDipGroupWork,DipClinHyp
1
1.1%
Bachelor of Psychology; Post Grad Dip Psychology
1
1.1%
Cert Hyp DipCH DipTPC CertIV TAE CMAHA B Com
1
1.1%
Cert IV Clin Hyp; Dip Clin Hyp
1
1.1%
Cert IV Clinical Hypnotherapy
2
2.3%
Cert IV Clinical Hypnotherapy, Adv Clinical Hypnotherapy
1
1.1%
Cert IV in Clinical Hypnotherapy
1
1.1%
Cert IV, Diploma clinical hypnotherapy
1
1.1%
Cert IV, Diploma in Hypnotherapy
1
1.1%
Certificate in Clinical Hypnotherapy
1
1.1%
Certificate IV Hypnotherapy (VIC)
1
1.1%
Certificate IV, Certified Practitioner and Master Practitioner
1
1.1%
Certificate, Advanced Certificate & Diploma
1
1.1%
Work; Dip in Hypnosis
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Certificate, Advanced Certificate, Cert of Power Hypnosis, Cert of
1
1.1%
clinical hypnotherapist
1
1.1%
Clinical Hypnotherapy
1
1.1%
D.Clin.Hyp&Psych., M.Sc., GDip. Soc.Sci(Counselling)., B.App.Sci.,
1
1.1%
DCH, ADCH, AUST/USA, DIP PSYCH, DIP COUNS,
1
1.1%
Degree in psychology. Specialist in Clinical Hypnosis. Bachelor of
1
1.1%
degree, Post graduate 4 years, Doctorate
1
1.1%
Dip Biofeedback Technology, Dip Clinical Hypnotherapy, Dip Master
1
1.1%
Dip Clin Hyp
1
1.1%
Dip. Hypnotherapy; PhD
1
1.1%
DipClinHyp
1
1.1%
Diploma
1
1.1%
Diploma of Hypnotherapy
1
1.1%
Diploma Clinical Hypnotherapy
1
1.1%
Diploma Clinical Hypnotherapy and Psychoterapy
1
1.1%
Diploma in clinical hypnotherapy
1
1.1%
Diploma in Clinical Hypnotherapy, Certificate in Ericksonian Hypnosis,
1
1.1%
1
1.1%
Diploma of Clinical Hypnotherapy
2
2.3%
Diploma of Hypnotherapy (30905 QLD)
1
1.1%
Hypnotic Field Therapy
Dip. T&A.
Science in Education. Master in Clinical Psychology and Health.
Hypnotist, Dip Clinical Psychophysics, Master of Arts (Psychology)
Certificate in Transformational Therapy, NLP and Hypnotherapy Master Practitoner diploma in hypnotherapy advanced diploma in counselling and psychotherapy
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Graduate Diploma in Applied Hypnosis
1
1.1%
M Psych (clinical) (also Yapko course_
1
1.1%
M.Cog.Sci., Dip Cl Hyp, Dip Transpersonal Counselling
1
1.1%
MA, PGCert(ClinSup), CertEd, ADHP(NC), ECP, ECCH
1
1.1%
Many
1
1.1%
Master Hypnotherapist, Master Pract NLP
1
1.1%
Master of Psychology
1
1.1%
MH, HT
1
1.1%
MPsych(Clin), DipClinHyp, CertClinHyp
1
1.1%
N/A
1
1.1%
post grad certificate
1
1.1%
Professional Clinical Hypnotherapist
1
1.1%
Registered Psychologist B.Sc Hons Psychology
1
1.1%
University Psychology Degree
1
1.1%
VETAB accredited Diploma of Clinical Hypnotherapy
1
1.1%
Vetab course American and uk training
1
1.1%
No Response to the qualifications question
28
Total
87
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