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.