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 ... [Show full abstract] 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 The literature surrounding clinical hypnotherapy pedagogy is at best sparse providing little and out of date commentary (Hammond & Elkins, 1994).
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.
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.
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.
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.