Todays blog post is not really for anyone other than hypnotherapists, therapists, trainers in these fields or related fields… I need to get something off mychest…
Those of us in the hypnotherapy field, especially us hypnotherapy trainers have noticed a shifting trend in our field recently… There is muchmore demand for advancing a scientific basis for hypnosis and hypnotherapy.
Recent articles in Newsweek and recently the Washington Post in the US have filtered there way over here and have advised therapy consumers that their therapist better be using techniques that have been “scientifically proven” to be effective. If not, the therapist may be behind the times, misinformed, or worst of all unethical.
I wanted to have a reality check for a moment today… I am in favour in putting the field of hypnotherapy under the microscope, don’t get me wrong and heck, just last week I wrote up a long list of hypnotherapy and hypnosis studies that gave this field a huge amount of credence and credibility…
Let’s look at the reality of things though… What the proponents of evidenced based treatment are talking about is randomised placebo controlled studies of treatment modalities. For example, take a population of patients with a simple phobia. Randomly assign them to three treatment categories: a placebo, a drug treatment or exposure therapy. See which group does best, and there’s your science, your evidenced based treatment. Let’s imagine, hypothetically but not improbably, that the results of the well run, placebo controlled, randomised study show that exposure therapy is most effective for the most people suffering from a simple phobia.
Keep in mind that in this hypothetical population, there is a minority for whom exposure therapy, at least in the conditions of the study, is not effective.
So now a imagine a client comes along – let’s say a 30 year old man- to see their GP, the hypnotherapist, psychologist, psychiatrist, or even a psychoanalyst (god forbid). He has a simple phobia. He also has some obsessive compulsive disorder, low self-esteem, and even some low level depression within the mix, and just went through a messy divorce. He describes his work life as deeply dissatisfying. He feels, in some vague way, that he is different from other men of a similar age to him… This is not hugely untypical of the clients I see in my consulting rooms.
What does the clinician who does not live in the cleanly dichotomous world of health policy and enthusiasts for evidence based randomised control studies do now?
Surely you treat the client, not a symptom or a set of disorders, no? Ideally, I believe, with a mix of approaches that fluidly adapts itself to the needs and capacities of the client at any given moment. I am a hypnotherapist and an NLP practitioner among other things, and I know that gradual exposure is one of the best ways to treat a phobia.
I would consider myself quite ridiculous if I decided to do some anchoring for that (though I have heard some people doing such)…. Now on the other hand, I also know that problems related to low self-esteem, whatever that may mean to an individual client, can be complex, subtle, pervasive and potentially crippling in life… And that going through divorce may affect ones belief in their own ability to have successful relationships and I might indeed recommend something different to this client…
Once again, I find myself wanting to plead, can’t we live with complexity and layers and multiple possibilities and nuance in mental health care, and avoid the dangers and false comforts of simple-simplistic-dichotomies. Like the tempting but false dichotomy, there is evidience or there is not evidence. Are things quite as black and white as that?
I understand and appreciate the scientific method, and value the data obtained by systemic, well designed studies with appropriate controls.Â But of necessity, these studies can generallyÂ test one element of a real person in real life, and their results must be used appropriately, in the context of a larger and more complex picture.
And by the way, can someone point me to the evidence basis that underlies the propositions that evidenced based studies are the best way to reach policy and clinical decisions that help people the most? What’s the control group? 😉