17 September 2016
Following on from this YouTube video:
…are you an effective hypnotherapist?
How can you find out if what you are doing works?
Do you have enough confidence in your work to find out?
Is it worth the effort?
Why find out?
Measuring what you are doing can make you even more effective as a therapist and can lead to confirmation of good or best practice, or a change in one or more aspects of your usual interventions. This gives the therapist, and, at times, the client, a clear understanding of whether, given the assessment criteria, the intervention was effective and the outcome successful.
It can be useful to measure whether your approach is effective generally (outcome focused), and specific aspects of it (such as client perceptions of rapport), whether at the end of therapy or, for multiple sessions, assessment at intervals. In addition, you can compare approaches, such as whether a permissive or positive-focused approach to smoking cessation is more or less effective than an authoritarian, aversive-focused approach.
How can you find out if what you are doing is working? Even more, how well it is working? Whether there is lasting change? Which way was better? Assessment of therapeutic interventions is a good way of determining how effective and beneficial each therapy is for which types of disorders, situations or individuals, or, in other words, “what works?”
So how do I get started?
Effective hypnotherapy measurement starts before therapy even begins. It can be useful to include in your website information that you will be following up the session(s) with. This can also be reinforced in the pre-talk. By letting the client know that you have the confidence in your work to check up on how they are doing, this can enhance their perception of your professionalism and expertise. By making the follow up positively focused, not only are you avoiding ‘giving back the problem’ but are reinforcing positive change. If there are any negatives, the client is going to tell you anyway, without any prompting!
The very first step is to decide what you want to measure and how…
Outcome or ongoing assessment?
Tracking client progress may be perceived as undesirable by the client (giving them reminders of their problem), or desirable, indicating progress, and it can provide valuable depth of data. By having an ongoing programme of tracking progress or outcomes, this can give valuable feedback on the investments of time, effort, money and process.
Just measuring effectiveness outcomes gives a rather limited view, whereas measuring therapy progress and outcomes while engaged in therapy can be more informative. Although far from general practice, tracking progress for individuals in therapy is becoming more common.
What do I measure?
Given the eclectic, integrative, pluralistic and, at times, esoteric nature of hypnotherapy, it is often considered a mysterious, emotional, intuitive, and powerful process that may be difficult to quantify. However, it is not necessary to consider all possible influences. You decide what to measure!
Areas that may be considered include: what outcomes are considered effective (e.g. symptom reduction, behaviour change, quality of life improvement); whether or not hypnotherapy is effective; under what conditions is hypnotherapy effective; whether or not a particular approach within hypnotherapy is effective; whether one approach is more effective than another approach.
Within your chosen area, you can then choose a “sub topic” (or more than one). Topics may include: Therapist variables e.g. are you generally empathetic, permissive, dynamic, authoritarian?; Client variables e.g. age, gender, socio-economic background, education; The therapeutic relationship e.g. collaborative, authoritarian, coaching; Cultural variables e.g. cultural attitudes towards pain management may influence how you work with people; Process e.g. 3 session model for smoking cessation vs. 1 session model for smoking cessation; Mechanisms of change e.g. direct suggestion, metaphor, analysis, regression; Outcome e.g. client perceptions of success, therapist perceptions of success
This type of assessment can be defined as “a quality improvement process that seeks to improve client care and outcomes through systematic review of care against explicit criteria and the implementation of change”, or, more simply, to help you “get better by reviewing what you did”. To achieve this, some sort of measuring of therapy outcomes is undertaken.
How do I capture and analyse this information?
There are several methods for collecting this information (or ‘data’). The first choice to make is whether you like working with words or numbers.
Data collection methods:
Words e.g. Interviews, Comment-based questionnaires, Client-notes (feedback comments)
Numbers e.g. Number-based questionnaires, Client notes (scaling)
Data analysis methods:
Words e.g. Thematic analysis (looking for themes within comments / interview responses), Interpretative Phenomenological Analysis (IPA) (explores ‘lived experiences’ – so good for how someone copes with a condition)
Numbers e.g. Descriptive statistics (considers just the data e.g. average), Inferential statistics (considers how the data can apply to the broader population)
NOTE: It is possible to also take a ‘mixed methods’ approach and collect and analyse both word and number-based data.
What tools can I use to collect this information?
Would you like to ask the client questions (an interview) at the end of the therapy session? By phone some time after the session? Will you give clients questionnaires in paper form? By email? How will you collect responses? What works best for your communication with clients at the moment? If you are seeking a lot of text, then a qualitative approach, such as Thematic Analysis will be helpful. Whereas, if you are seeking numbers, scales and measurements, then it would be better to use quantitative, statistical analysis (both descriptive and inferential are possible).
If you have chosen a questionnaire (perhaps the easiest approach) you may decide to use an existing form or questionnaire, or you may prefer to create your own, giving you the option to make it very tailored to what you want to find out…
Asking questions with standard (established) questionnaires
Possibly the most common used questionnaire in health-case settings, and certainly a simple one, is the MYMOP2. The client decides which symptom is most problematic and rates the severity of it, together with what improvement is desired and their general state of wellbeing. A follow up questionnaire then gives a comparison. There is both an initial form and a follow up form.
The Patient Experience Questionnaire considers what the client values the most in terms of interaction, emotions and outcomes and is good for determining the quality of the therapeutic relationship.
The Care Measure is a person-centred process, focusing on perceptions of empathy.
The Short Form-36 (SF-36) is a 36 item questionnaire which measures Quality of Life (QoL) across eight topics, which are both physically and emotionally based.
Creating your own questionnaire
If you are creating your own questionnaire (also known as a survey), it is good to pilot it, to test that it really asks the questions you think it will. You can also check that you are able to analyse it the way you have planned to. In addition, it is important to know your ‘population’ (the group you are exploring), both the broader ‘overall population’ where your clients are located, and the more focused or specific client population.
You may design and print your own paper questionnaire, or use a programme such as ‘Survey monkey‘ where you can send out short questionnaires (up to 10 questions) to up to 100 people each month. There are also paid versions if you want to ask more questions or send to larger numbers. This programme is great as it plays nicely with others, it integrates with MailChimp, Eventbrite and other systems, helping you be more streamlined and efficient in your marketing.
Asking questions by interview
When asking interview questions you have three key approaches:
Structured – This is like a questionnaire but verbal, with detailed questions.
Semi-structured – Here you ask a question, and then gather further information with supplementary questions e.g. What did you find most helpful by completing your homework task?; how did it help?; what did that do?
Unstructured – Here there is often one general ‘tell me about…’ question and the client gives a broader answer e.g. ‘Tell me about your experiences of living with chronic pain’
Using this information (data) to inform and develop practice
By measuring effectiveness and using the gathered data and resulting insights, there is evidence that it can significantly improve therapy outcomes. You may focus on what works, what doesn’t, whether a different approach, focus, therapist or intervention would be more beneficial, or even alter the patient’s perceptions. Measurement can start at the initial enquiry, through to post-discharge.
– written by Dr Kate Beaven-Marks