Undoubtedly, such is my preference for an evidence base in my hypnotherapy practice these days that I am a member of the Register of Evidence Based Hypnotherapists and Psychotherapists, though I still encounter huge swathes of hypnotherapists with no real idea of what this means and perhaps can offer very little evidence for the efficacy of the treatments they offer in their therapy rooms, other than subjective anecdotal experiences…
Evidence based hypnotherapy serves many valuable purposes for the hypnotherapist. Not only does it offer up credibility for the client and empirical evidence to support the techniques and strategies that you are utilising in therapy, it also keeps a hypnotherapist at the forefront of modern developments in the hypnotherapy field.
As a member of the NCH and the afore mentioned REBHP, I am automatically subscribed to the International Journal of Experimental and Clinical Hypnosis which I receive in paper format and offers all the up-to-date research in this field… You can also go read back dated copies online at their website, it makes for some enlightening and educational reading, the likes of which very few hypnotherapists tend to be able of offering up.
Indeed, I myself have only really considered the depth of this approach in recent years and having been a hypnotherapist for well over 10 years, that saddens me somewhat! No training I ever received in those early years offered up the depth of evidence that is included in my own trainings and those of many of my professional peers.
Even when I have attended numerous hypnosis conferences over the years, they have tended to often offer up proper evidence (double or triple blind research methodologies, with control groups and rigourously peer reviewed by respected journals) and those these events give the hypnotherapist the opportunity to hear from fellows and colleagues about what they believe works, they very rarely tend to be able to offer up this robust evidence for the techniques they employ in their consulting rooms or clinic.
Additionally, my own empirical evidence, as well as journals and websites, also tends to come from the large library of books that I own in my consulting rooms, man oh man, the book companies have had some cash off me over the years… Someone once told me that Paul McKenna was the most ‘un-read’ author in the UK, that is, he has sold more books that get placed on shelves without being read than anyone else… I may have been told that in the pub, so I have no evidence to support this…. Nonetheless, I encounter lots of hypnotherapists and practitioners of other kinds who when asked if they have read “such and such” a book, say it is on their bookshelf, but they have not got around to reading it… I have a very large collection of hypnosis text books from past and present… In fact, some of the old books I own are over 100 years old and though they offer little evidence that would stand up to todays scientific scrutiny, do show the development of evidence base that grew over the times… And how things have shifted and evolved in our field over those years!
Probably most importantly to my own work, I request feedback from all of my own clients. I email all my clients once their sessions are over and request that they offer some feedback in relation to the changes they have experienced – I record these (anonymously due to data protection) and it gives me some figures to gauge the level of success I am achieving through my own work, which techniques and strategies get the best results and as a result, I look at how I deliver the therapeutic interventions and which ones deliver the best results.
As hypnotherapists, we effect the techniques we employ as does the client and the nature of the issue being dealt with, so this kind of evidence is useful to me… though perhaps not the stuff that is going to be massively useful in the public forum.
So, lets get a bit more academic with this… In 2006, the American Psychological Association (APA) Task Force on Evidence-Based Practice in Psychology (EBPP) released a report on ways to enhance clinical psychological practice.
This Task Force recognised that previous recommendations had been limited because they have only focused upon empirically- supported treatment (EST) and had neglected a big bunch of other variables which contribute to therapeutic outcome.
They found that in addition to the use of empirically- supported treatment interventions, “eight other factors were necessary for psychological treatment to be maximally effective. These constitute the APA definition of “clinical expertise”,
1. Assessment, diagnostic judgement, systematic case formulation, and treatment planning.
2. Clinical decision making, treatment implementation, and monitoring of patient progress.
3. Interpersonal expertise.
4. Continual self-reflection and acquisition of skills.
5. Evaluation and use of research evidence.
6. Understanding the influence of individual, cultural, and contextual differences on treatment.
7. Seeking available resources as needed (e.g., consultation, adjunctive, or alternative services).
8. A cogent rationale for clinical strategies.” (APA, 2006: pages 276-278)
So in response to this, in their recent article, ‘What we ought to mean by empirical validation in hypnotherapy: evidence-based practice in clinical hypnosis’, Assen Alladin and his colleagues reviewed the role of these factors in clinical hypnosis and concluded that,
Empirical methods, research-informed practice, and evidence-based treatment, if they are to be central to the practice of clinical hypnosis, ought to be applied to both the content and process of treatment. (Alladin et al., 2007: 125).
In other words, the specific interventions used in clinical hypnosis should be derived from “content research” such as randomised controlled trials (RCTs) meeting the research-design criteria set by the Chambless Task Force for Empirically Supported Treatments (ESTs). However, clinical hypnosis should also assimilate research from the field of “process research” on the common inter-personal factors which contribute to positive outcomes across the board in a range of different therapies… A beneficial combination is recommended here…
There are then very specific implications for clinical hypnosis in the light of efficacy and effectiveness considerations and the current task force position on Evidence-Based Practice in Psychology. These professional considerations impact training and professional education, research, clinical practice, and hypnosis’s responsibility to the public. (Alladin et al., 2007: 125)
All htings which are of vital importance to an ethical and professional hypnotherapist, aren;t they?
Alladin and his colleagues provide the following list of the specific implications of evidence-based practice for the field of clinical hypnosis, concluding that it will become important for trainers and students to,
– Appreciate the importance of empirically supported treatment [EST] protocols in effective treatment.
– Appreciate the use of critical evaluation in limiting self or patient deception through theory-based or purely speculative models of treatment [e.g., psychodynamic theory].
– Utilise empirical perspectives to treatment proper so that each case can be considered an N of 1 [a single-patient trial] in service to process and outcome effectiveness.
– Understand process research –appreciation of the skills associated with better outcome generally– and see the relevance of such research to advancing hypnotherapy.
– Learn to situate and rationalise one’s practice generally through content and/or process research.
– Continually review the literature and/or state of the art regarding research of a critical nature.
– Neither succumb to undue romanticism (i.e., too much emphasis upon the art and indeterminate aspects of treatment) nor scientism (i.e., too narrow or limiting criteria related solely to efficacy.) (Alladin et al., 2007: 126)
Hypnosis is considered by some of my friends and professional peers as an art and by others as a science, all of whom I respect in equal measures… The problem is such though that the heavy belief in either extreme of these two terms has led many hypnotists and hypnotherapists on occasion, to rekect the real the value of both research and individual personal qualities in effective hypnotherapeutic treatment.
So maybe we can strike a balance to be most effective… To find a useful, effective and enjoyable balance between excessive romanticism and excessive scientism. Then hypnotherapists can have an equally balanced stance which recognises the role of both clinical expertise and informed intuition, on one side of the coin, and empirically supported treatment interventions, on the flip side…. Then hopefully, more and more hypnotherapists will find themselves being able to support their work with more than just anecdote and subjective experience.
I think that’d be a good thing, no?