I recently had the great pleasure of attending the 2009 Society for Clinical and Experimental Hypnosis conference in Reno, Nevada. My primary purpose in attending was to serve on the faculty for the Introductory Workshop in Clinical Hypnosis. I had spent the previous weeks helping workshop co-chair Dr. Edward Frischholz in preparing an updated curriculum for the workshop. Dr. Frischholz’ vision for the new training model is to enhance the workshop’s focus on empirically validated methods of assessment, treatment, and training.
As a faculty member I was in the esteemed company of Dolores Bjorkman, Dabney Ewin, Ed Frischholz, Hedy Howard, Steve Kahn, Rick Kluft, Dave Patterson, Steve Pauker, and Eric Willmarth. My role as a faculty member was to provide supervision during each of the five supervised small group practice sessions, and to assist in the scheduled demonstrations of hypnotic induction and hypnotic phenomena.
As the least experienced member of the faculty, I did not present any didactic material. However, I received 22 CEU credit for my attendance at these workshop sessions and am now competent in the provision of introductory clinical hypnosis training. There are plans for the Chicago Society of Clinical Hypnosis to offer a basic workshop this winter, and I will be on faculty for this event as well.
Outside of workshop hours, I also had an opportunity to attend a few presentations and one scientific paper session. I was excited to see Dave Wark present on alert, eyes-open hypnosis. I am very interested in the potential use of alert hypnosis, particularly in performance-enhancement and coaching scenarios.
I also has the pleasure of seeing Ron Pekala present his ideas on the conceptualization and measurement of the phenomenology of consciousness. I was trained in provision of the Phenomenology of Consciousness Inventory Hypnotic Assessment Procedure (PCI-HAP) during my own introductory hypnosis training under Dr. Ian Wickramesekera II.
Hey, David:
I am excited that Dr. Frischolz is focusing on evidence-based practice with the new curriculum, and look forward to attending in Chicago. This is, generally, a missing component in a lot of hypnosis training. Nice to see you have addressed it!
Thanks for your comment, Scott. There was a lot of talk at SCEH about the need for the hypnosis community to amp up our research program and our marketing program. We need to work on portraying ourselves as providers of an evidence based practice within the medical community. The new president of SCEH, Elvira Lang, apparently has a background in business and said one of her goals for the year is to improve the marketability of clinical hypnosis.
There was a big uproar at the conference because the AMA recently scolded someone for saying hypnosis was an “AMA approved treatment” for all the things the AMA has previously recognized it as being a good treatment for. So now we’re not allowed to say that anymore, which is unfortunate. It also seems that the AMA is now lumping all ‘hypnotists’ together, so that clinicians using hypnosis are afforded no higher status than lay hypnotists.
As you know, the clinical practice of hypnosis deserves a lot more recognition and utilization than it currently gets. Hopefully these events will be an impetus for the community to place more emphasis on publicity for new and existing research for these highly effective clinical tools. It turned out to be a perfect time to start rethinking the standards of clinical training.
When I ran a lay hypnosis practice in NYC, I was also friends with a couple of psychiatrists. Need I say, they had no idea what the heck hypnosis was, or the differentiation between myself and licensed mental health professionals. That is partially because they are 1. largely indifferent to psychotherapy on the whole, being providers of pharmaceutical, 2. will hire anybody that might work successfully with their patients’ more difficult issues, and 3. lay hypnosis organizations and many individuals blur the distinction between psychotherapists and themselves.
I think that the distinction needs to be better established for medical and psychiatric professionals, and part of that will be creating at least some kind of guidelines, and generating more data and evidence from our practice. As someone who counts himself in the so-called Ericksonian style of practice, or at least works toward it, I understand the pitfalls of individual ways of practice among this relatively “trippy” art/science. But I think that it will be the way to re-establish ourselves.
Perhaps taking a cue from Practice Based Evidence from Miller and Hubble will be a way for more experiential therapists using hypnosis as a way to go?
http://heartandsoulofchange.com/measures/
Ah well, onward and upward!
I want to say that I disagree completely with this direction. I think that hypnosis, and the discipline of psychotherapy in general, needs to move away from being part of the, “medical community”. To contextualize hypnosis in this way is a deal with the devil. We are our own discipline, and are not in need of a status boost by defining ourselves in this way. The viewing of psychological problems as medical issues is what has got us into the situation we find ourselves in today.
Operating within the context of the medical model, leads the public to interpret their struggles as biochemical and the answer to that is medication. No need to struggle with what it means to be human, no need to examine empty life styles and unsatisfying work. No need to bother with lack of community. You have an illness. Take a pill and you will feel better.
Another problem here is that a rigid approach leads to a lack of creativity in treatment. I cover this issue in an article I am currently working on. Here are the first few paragraphs. It is still in rough draft form, but I think you will get the idea.
“Dust off those rusty strings just one more time. Gonna make em shine.”
The Grateful Dead’s album, Live Dead is one of my all-time favorite rock and roll records. It epitomizes the ecstatic wonder of creation in the moment. It’s not like they didn’t have song structures, they did. But, those structures were jumping off points for wild improvisational excursions. The Dead’s music was relational in nature. They were not simply communicating with their audience, but the audience was also communicating with them in a kind of rock and roll feedback loop.
As Bradford Keeney in “The Creative Therapist: The Art of Awakening A Session states, “I propose that creativity — rather than theory, method, technique, or research — is what awakens meaningful and transformative therapy.” He goes on to suggest that “rather than replicating or reproducing a template to be hammered out for every clinical situation, creative therapy custom builds a therapeutic encounter as the patient and occasion calls it forth.” How can we bring that creative spark that is exemplified by Keeney and the Dead into our hypnotic sessions? What if we contextualized hypnosis as a creative performance one which is improvisational in nature? Not that we just do things randomly, but rather responding creatively to the total situation in which we find ourselves as hypnotists.
The notion of hypnosis as a creative performance is bound to come up against much well-meaning resistance. Almost from its inception, hypnotism has been denounced as fraudulent. Mesmer’s theories were challenged in Paris by a committee made up of eminent scientists of the day including Benjamin Franklin. To make matters worse there is the tradition of stage magicians who focus on making volunteers act in a silly manner, and advertisements for how to seduce women with the power of hypnosis. Hypnotists can feel a bit insecure and find themselves wishing for a big dose of credibility that they hope that science can provide. There has been a recent clamor for what is called evidence-based hypnosis. In many of these studies, the idea is to create standardized protocols, administer these protocols in a precise manner, and then measure the results. But what if good therapy is not the result of standardized protocols, but rather emanates from the creative and individualized interaction between client and hypnotist? How are we going to measure that? My fear is that this movement toward standardized protocols may lead us in the wrong direction; to lifeless and rigid practice rather than alive creative performance.
So how can we wakes up our hypnosis? How can we bring more aliveness and creativity into the work that we do?
Wow, what a great comment! Thanks for weighing in on this, Bob.
I agree that clinical hypnosis, like psychotherapy, is and should be an artform. I don’t like the popular idea that the ingenuity of the therapist is unrelated to the treatment outcome. I just don’t buy it. But I also think that our artful interventions should be informed by science.
The problem is that a lot of the folks who are most interested in the science lack artfulness, and a lot of the folks who are most interested in the art of therapy lack the motivation or rigor to perform and publish scientific studies. There are some fantastic exceptions, of course, but I think a lot of the clinical research out there is not terribly useful right now. The interventions being studied are, as you say, dead.
Meanwhile, the idea of evidence-based practice is becoming unavoidable in clinical work, for better or for worse. I think there are two plausible approaches that a therapeutic artist can take:
1. Use the science as a set of basic guidelines (or at least talking points) and continue on making up artful treatments that basically fit within the framework. This works great because, really, who can tell you what CBT is these days? Hell, the professional clinical & experimental hypnosis organizations still can’t even agree on what hypnosis is. A neat corrolary of this is that you can generally assume that study results are telling you what kind of results you can get if you’re just barely even trying to do treatment.
2. The second, complementary approach, is for the artists to stop avoiding the scientific dialog. We need to prove and then publicize the effectiveness of custom-built treatments, demonstrating what basic elements make them effective in practice. We also need to develop and help to popularize new methodologies that are more favorable to clinical reality. I like the practice-based evidence model and the idea of continuous quality improvement in clinical settings.
Overall, I think psychiatrists and physicians are also getting frustrated with the inadequate rigor of so-called EBP. The process is too corrupted, and health professionals across the board are clamoring to figure out how to justify the preventative and life-enhancing treatments they’d rather be introducing into their practices, as opposed to the Pharma-sponsored HMO crap that’s been foisted on them.
Particularly when it comes to hypnosis, which has such broad and empirically validated applications to medical conditions, I don’t see any way to separate from the medical mothership. Instead we will have to help demonstrate that the Western disease model is simply not the optimal paradigm for the practice of psychological or physiological medicine. In fact, it may be the increasing recognition of psychological interventions as effective primary and adjunctive treatments for medical illnesses that is helping to drive the paradigm shift in medicine. These things always take longer than you’d like them to.
Bob,
Great comment, can’t wait for the whole article. I agree, protocols should be used as guidelines only. I am turned off by the use of them, and find the thinking less than aligned with my way of working with clients.
This comment reflects my sentiments exactly:
“But what if good therapy is not the result of standardized protocols, but rather emanates from the creative and individualized interaction between client and hypnotist? How are we going to measure that? My fear is that this movement toward standardized protocols may lead us in the wrong direction; to lifeless and rigid practice rather than alive creative performance.”
Good therapy is not the result of standardized protocols, but the interaction. The Common Factors model of psychotherapy does points to 40% of the contributing factor coming from the client, 30% from the relationship between the client and therapist.
Do most people point to this when they tout evidence-based practice? No, they point to randomized controlled trials, which emphasize psychotherapy as a technique, really, like a pill. It ain’t a pill, and factor analysis points to only 15% of the outcome connected to technique.
I think turning the tables on the way we study outcome is important. The debate about this is bound to reach hypnosis crowds. And if we don’t use it to shift how things are studied, the HMOs will walk away richer, and our clients the poorer for it.