"Clinical Expertise” in Hypno-Psychotherapy

by Donald Robertson

In 2006, the American Psychological Association (APA) Task Force on Evidence-Based Practice in Psychology (EBPP) released a report on the future refinement of clinical practice. The Task Force acknowledged that previous recommendations had limited themselves by focusing upon empirically- supported treatment (EST) to the neglect of other variables which contribute to 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. (q.v. APA, 2006: 276-278)

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.

There are then very specific implications for clinical hypnosis in the light of efficacy and effectiveness considerations and the current task force position on EBPP [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)

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 both an art and a science, and the false dichotomy of these two terms has led clinicians at times to be overly-dismissive of the value of both research and individual personal qualities in effective hypnotherapeutic treatment. One definition of evidence-based practice in clinical hypnosis would therefore be that it pursues the Golden Mean between excessive romanticism and excessive scientism, by attempting to find a balanced position which recognises the role of both clinical expertise and informed intuition, on the one hand, and empirically supported treatment interventions, on the other.

Alladin, A., Sabatini, L. & Amundson, J.K. (2007). ‘What we ought to mean by empirical validation in hypnotherapy: evidence-based practice in clinical hypnosis’, IJCEH, Vol. 55, No. 2, April 2007.

American Psychological Association (APA). (2006). ‘Evidence-Based Practice in Psychology’, American Psychologist, 61, 271-285.