When I make reference to many of the sources of evidence base that the field of hypnotherapy can proudly boast, I often receive a befuddled look. The truth of the matter is that the vast majority of the field of hypnotherapy have never been taught about any of the research that supports many applications of therapeutic hypnosis, have never heard of any of the prolific researchers of this field and still explain hypnosis in pseudoscientific ways that are largely unproven and simply perpetuate myth.
What a lovely uplifting way to open up a blog entry and ostracise myself from many of my regular readers who are hypnotherapists, eh?
When so many professionals in this field are unaware of the evidence base it ought to know about, you should then see the looks I get if I mention evidence based for the field of CBT (Cognitive Behavioural Therapy). The sheer volume of it dwarfs that of the field of hypnotherapy and means that CBT gets used within the NHS here in the UK.
Learn more about CBT and hypnosis:
Conventional Medical Units are Exploring the Combination of Hypnosis & CBT, Why Aren’t More Therapists?
Audio hynosis session:
Using Stoic Negative Visualisation with Hypnosis
The response I tend to get from hypnotherapists in particular if I ever mention CBT or some of it’s evidence base goes something along these lines,
“All my clients tell me it didn’t work for them.” or “Most people I see thought it was ineffective.”
These people were mainly seen by psychologists or practitioners employed by the NHS. There are a couple of reasons that I often give for not getting the best results from NHS employees:
– Their own business and livelihood do not depend on getting good results. They do not have to build a reputation in order to have a successful business, they will have numerous patients referred through to them for as long as the NHS budget continues to offer such. I know that certain targets are expected to be hit, but they are nothing like the same level of ownership you have for your work when you are representing your own business.
– The client/patient has not paid for the treatment. That is, they have not invested anything beyond the time spent there. They may not have the same level of ownership or commitment to the therapy as a result. CBT in particular requires the individual to adopt skills, practice them, apply the learnings to real-life situations and become more effective. There is less inclination for a patient to do this when they have not paid for it or invested anything of major value into it.
– Some of the techniques and strategies applied are very standardised due to time constraints and limited session times. The collaborative nature of the therapy is diminished, the working alliance and relationship between clinician and patient is potentially also diminished.
There are exceptions to this. Some people just want to get better and will of course invest themselves into the process as much as anyone seeking private services, and for some who simply cannot afford to seek out a private therapist or clinician, the NHS may be the only option. I hasten to add that I am a huge fan of the NHS and wholly respect anyone who chooses to work for them. The vast majority of staff working within the NHS are nothing short of excellent according to my personal and professional experience. With mental health, the framework is really important, how both the clinician and the patient perceive the process, value it and go on to develop relationships is vital.
However, there is even more to suggest that NHS psychologists may be in a worse position to help you…. Because they are quite likely to be depressed themselves.
That is according to the staff well being survey conducted by the British Psychological Society and the New Savoy Partnership. The study suggests that half of all NHS psychologists should actually be receiving some sort of treatment themselves having found high rates of depression within the profession. With CBT in particular, the clinician/practitioner/therapist becomes an important role model for the therapy, the techniques are advanced by the clinician being upbeat and we all know that study upon study upon study shows that efficacy of treatment is raised when a good working alliance is forged between patient and clinician – these are all likely to be absent (or diminished) if the clinician is depressed in the first instance.
The study cites shortage of funding in the NHS along with target driven results, clinicians suffering from burn-out, low morale and high levels of stress. The way the NHS treats it’s staff and how it introduces policy to deal with this is not my area of expertise at all and I certainly cannot claim to have the answers. It is such a shame that mental health is not more highly regarded by ministers who set budgets and make cuts in our public services here in the UK. There is no small irony, it would seem to me, that effective use of psychological interventions and treatments could actually lessen the amount of expensive drug expenditure by the NHS.
The reality therefore remains that I think when the same techniques and strategies are offered to you by someone in private practice, with career autonomy, who wants your success and with whom you have invested money to go and work with, I think it raises the chances of those techniques and strategies being effective and delivering benefit and results to the patient/client. If the evidence shows that something is effective in clinical experiments and research, then there must be reason and other potential structural issues that are meaning it is not working for some of these people.
The mechanisms are not wholly to do with the actual therapy, but the application of it and the wider structures that frame it. I think at times, the increasingly fragile structure of mental health services in the NHS here in the UK is reflected in the responses of those using it.
Fantastic article.
I know of 2 people who work in the IAPT services, both of whom claim the stress of hitting targets and getting people out of the door has a profound effect on them mentally and on their therapy goals.
I once looked into doing my training and qualifying with the NHS but was advised by those who had done it and worked in the services that it may be best to steer clear. It’s quite sad really.
What’s even more sad is for those clients that don’t benefit from the NHS IAPT services it then creates a bit of a stigma regarding CBT which can have a knock on effect on any therapy with us when we tell them we are Cogntive Behavioural Hypnotherapists!!
Thanks Matt, you are right, it is a shame. Most of the responses I’ve been getting from this are of shock at the prevalence and saying as you have that it is a shame – the NHS is such a beloved organisation to so many.
Always awesome hearing from you Daddy Davies, best wishes to you, Adam.
Agree with much of what you say.
I work in the NHS as a Cognitive Behavioural Psychotherapist who employs hypnotherapy within this process. I also see a significant number of individuals who claim to have had previous CBT and that it did not help. A couple of important issues come to mind. Firstly, much of the psychotherapy we now call CBT is offered through IAPT services who have constraints of time, budget and experience. CB Therapists are trained at different levels, and the majority of IAPT workers are trained at a lower level and are therefore expected to follow protocol based therapy and are limited to session number and duration. Even those trained at a higher level tell me that the pressure to complete work with each client is ever present.
Clients have complained that an average 30 minute session can be mostly taken up by form filling, with very little active treatment taking place.
Fortunately this is not the case in all of the NHS. I am privileged to be working in a department where needs are met according to a thorough assessment of the problem, and I have the flexibility to employ a more eclectic range of approaches, allowing me to strive for better outcomes with my clients.
I do agree though, that the development of such a role has been an uphill struggle at times, mainly due to to the need for empirical support, not just for hypnotherapy, but also when working with certain disorder types.
I certainly would like to see the tide turn over the next few years but suspect that, with budget cuts and redundancies, the opposite may occur.
Dave,
I’d like to thank you enormously for taking the time to write and share as you have done here. I really appreciate what you have written and hope it is read by many others.
My very best wishes to you,
Adam.
As Adam has said in his article some people cannot afford pruvate therapy. This is even more so now when we are in the midst of a pandemic when many more people are struggling simply to put food on the table and may indeed have to resort to food banks! However good having private therapy may or may not be it cannot of course be of the slightest use to someone who cannot afford it! Even in the best of economic times private therapy is not cheap – and I don’t say it should be – and this has the inevitable effect of excluding large numbers of people from accessing it to start with – this is a major drawback of private therapy!
Hi Melvin, yes I appreciate and understand that. It is a tough situation, therapists need to earn a living to be able to offer their services at all. And I think the NHS is really stretched enough as it is at the moment.
Thanks for taking the time to comment and share your thoughts, best wishes to you, Adam.