Be Careful What You Wish For

The following is the tail end of an exchange that took place as a series of comments in Facebook. I felt the last entry deserved a fuller answer and, perhaps, a wider audience than the thread allowed.

" @Barry - am too sensitive about the RCT comments. e.g. in the recent issue of the NCH Journal a Chartered Psychologist (no less) says "Hypnotherapists are, en masse, desperate for recognition. This can be seen in a constant alignment of ourselves with the medical profession, the latest fads in psychotherapy (CBT) and research that we think will convince those with greater status and respect (e.g. randomised control trials)."

"Arrrgh!
Like maybe if had more solid RCTs under our belt we'd get on recommended treatments list with NICE more often - and God forbid - actually get a flow of work from the NHS (never mind the benefit to the public from greater acceptance and access to hypnotherapy treatments.)
And how can you be confident in what you do if never measure it... and check it against normal remission and placebo and non-specific factors etc...
To see hypnotherapists writing off vast dedicated labours of research studies... because it doesn't fit with the way they got trained... When you see how carefully some researcher has designed the study... really trying to find out if there is effect and what is the therapeutic factor.... and someone just goes - oh that research stuff is bollocks I know what works with my clients.... Arrrgh!"

The 'research stuff', might not be bollocks, but it's a bit of a red herring. There is not a single hypnotherapist alive who could guarantee to replicate what I do with one patient, for another patient. I know that for a fact, not because I am especially skilled but because I cannot guarantee to replicate what I am able to do with one patient for another one. I can see two people suffering from phobias in the same day, cure one and not the other. I am the same clinical hypnotist for both of them, but they are different. I know what worked for my last patient, but I have no idea what is going to work for my next patient and anyone who thinks they do is deluding themselves.

Research that relies on the reading of scripts or the playing of recordings to induce 'hypnosis', that is preceded by repeated demands for social compliance is insufficiently rigorous. Too much of it is compounded by having been conducted academics who believe hypnosis is a state of relaxation (as, indeed, do the vast majority of hypnotherapists). Relaxation is a state of relaxation. Hypnosis is a state of hypnosis. The two things are not the same, as any hypnotist knows.

I did a full Harvard Scale session with a volunteer in one of my group supervision sessions at Kingston Hospital. The volunteer (a hypnotherapist) acted some of the tests because that's what the script demands, but nothing actually worked. The whole thing took an hour. Immediately afterwards I hypnotised the volunteer properly (in seconds) and all the tests that had not worked in the conduct of the Harvard Scale, worked when she was actually hypnotised. The depressing truth is that the Harvard Scale, in the hands of a good hypnotist, failed to hypnotise a good hypnotee. The session was filmed.

I'm very keen for hypnosis to be researched properly but for that I suspect the design must involve both the hypnotist and the hypnotee being wired to brain scanners so their neurological activity can be recorded and analysed. I am keen on this research for reasons of academic interest: not because I need it to confer on me some spurious legitimacy.

The Chartered Psychologist (“no less”) has a point. I cannot think of any other profession – with the possible exception of bouncers – quite so desperate to improve its public sense of legitimacy. You only have to see how many hypnotherapy FAQs feel the need to announce how the BMA recognised hypnotherapy as a mainstream medical practice back in the fifties if you want confirmation. It's indicative of the massive inferiority complex suffered by so many hypnotherapists, and the profession generally. Unnecessarily so, in my view.

Why do hypnotherapists want NICE recognition? So they can “actually get a flow of work from the NHS.” And why do they want a flow of work from the NHS? Presumably because they don't get enough work otherwise. After all, why would a hypnotherapist working in private practice want to treat NHS patients for half their usual sessions fees, with externally imposed caps on how many sessions they could do, and all the practical restrictions that come from working under the auspices of the NHS? I can think of only one reason: it's better than sitting on your arse looking at an empty diary.

But get this. Hypnotherapy is already legitimate enough.

I am a clinical hypnotist. I work in private practice at the Mindsci Clinic. I also work as a clinical hypnotist with the Occupational Health Department of Kingston Hospital (NHS) Trust, and have done so since 2003.

By virtue of various parts of the NHS subcontracting their occupational health provision to Kingston Hospital, I am also the house clinical hypnotist for a couple of primary care trusts and the Royal Hospital for Neuro-Disability. Amongst other things I do monthly group hypnotherapy sessions at the hospital, which have been attended by several hundred staff, nurses, consultants and executives. I also give lectures on clinical hypnotism for the post-graduate medical centre.

Thanks, directly, to my relationship with the NHS, 40% of my new patients come through my being recommended to them by medical professionals. NB, the patients are not referred to me. The NHS does not pay for members of the public to be treated using hypnotherapy. Instead of referring, GPs and Consultants recommend me to patients who then contact me themselves and are treated by me in private practice. GPs even phone asking me to supply them with more leaflets. Thus, I get the desired 'flow' without the undesirable constraints of working under referral, and have treated NHS-sent patients for conditions ranging from anxiety disorders, through hyperhydrosis, to the neuropsychological sequale of a bilateral, intraventricular subarachnoid haemorrhage.

There is no reason why any other sufficiently competent hypnotherapist cannot have the same relationship with the NHS that I have. It does not require any more RCTs. It does not matter what a chartered psychologist does or does not say about hypnotherapy or its practitioners. And any hypnotherapist who doesn't have that relationship with the NHS mustn't blame NICE. They have only themselves to blame.