23 January 2019
Think for a moment about how many different professions you interact with on a regular basis. Doctors, dentists, nurses, pilots, drivers (lorry, bus, car), teachers and counsellors, to name but a few. A ‘profession’ is generally regarded as an occupation where there is specialised educational training; whereas a skilled trade tends to be those involving specific training together with some aspect of manual labour (e.g. carpenter, plumber, electrician). What do both professions and skilled trades have in common? Specialised training!
How would you like to go to a dentist who learned by reading a single book on the subject? How about visiting a relationship counsellor who did an online course (6 whole hours) last week and then set up in business? How would you feel if you were a passenger in a taxi, knowing the driver hadn’t had to undertake an official test? The answer to all 3 of those questions, for most people, is a resounding ‘no’, because they would not feel safe. Due to the fact that the public’s safety is of paramount importance, these days many professions are ‘regulated’ (overseen and held accountable) by an independent body (or more than one). However, originally the majority of professions were ‘self-regulated’ (e.g. Royal College of Physicians, founded in 1518).
There are several criteria that are thought to indicate whether something is a ‘profession’ including prolonged specialised training, codes of ethics, professional associations and rules/laws. Professions are also thought to have a high degree of autonomy (control over their own affairs) and self-regulation. Over time, regulation of some professions evolved. In the UK we now have both statutory and voluntary regulation, both of which are overseen by the Professional Standards Authority (PSA). Independent and accountable to UK Parliament, the PSA have a public protection role, with focus on regulation and registration of those who work in health and care.
The PSA work with organisations (‘regulators’) who regulate health and care professionals who work in occupations that Parliament deem must be regulated; such as, nurses, paramedics, pharmacists and doctors. These regulators set standards for competence, education and training, and investigate complaints about those registered.
Some professions, such as chiropractors, opticians, doctors and nurses have their own regulatory body (e.g. the General Medical Council for doctors). However, most fall within the Health and Care Professions Council (HCPC). As well as setting standards for education, training and practice, the HCPC also take action if those registered don’t meet required standards. Along with other statutory regulators, part of their role is to protect the ‘title’ of each profession that it regulates. For example, it is illegal for someone to call himself an Occupational Therapist or Radiographer if they are not on the register held by the HCPC. Anyone who says they are registered with the HCPC or uses a designated title must be entitled to use it or could be breaking the law (Article 39(1) of the Health Professions Order 2001). Conversely, anyone in the UK is legally allowed to call themselves a ‘hypnotherapist’, or even a ‘clinical hypnotherapist’, regardless of their level of training (yes, even if they have absolutely no training whatsoever). This is due to the fact that in the United Kingdom there is no statutory regulation for hypnotherapy, meaning the HCPC does not regulate hypnotherapy. So, as well as the unprotected title, this also means that there are no mandatory (statutory) training requirements for hypnotherapists in the way that doctors, dentists and numerous others working within healthcare are obliged to adhere to.
Will hypnotherapy become statutory regulated?
The government periodically considers which professions should be regulated. The latest statement relating to professional regulation is ‘Enabling Excellence; Autonomy and Accountability for Health and Social Care Staff’, published in February 2011. It indicates a Government strategy for simplifying the regulation of healthcare professionals in the UK. It talks of the regulatory framework being complex, expensive and requiring ongoing government intervention to keep it up to date. This paper also recognises that people are increasingly taking direct control over how their health care needs are met; the Government indicates a need to move power to the professions that serve those people. There is now a move towards voluntary, rather than statutory regulation. This is nothing new, remember the Royal College of Physicians in 1518.
Image credit: https://www.pastmedicalhistory.co.uk/
Are hypnotherapists ‘healthcare professionals’? Well that could be a topic for debate. Why? Because we are not ‘licensed’ nor are we bound by statutory regulation or protected titles. Yet we do work with the public addressing health and care issues, as well as the many hypnotherapists who are seeking high standards of professionalism and putting ourselves forward for voluntary regulation and independent professional scrutiny. This has been recognised in a joint publication between the PSA and the Royal Society for Public Health (RSPH) in ‘Untapped Resources: Accredited Registers in the Wider Workforce’. With nearly 80,000 healthcare professionals on accredited registers (at the time of publication of the report), it is considered that this workforce could have a huge impact on public health. It also recognises (this is the important bit) that whilst these practitioners are not required to be registered, they do so as a commitment to high standards and being part of a professional community.
In answer to the question ‘will hypnotherapy become statutory regulated?’, it’s unlikely to happen in the foreseeable future (if at all). So, unfortunately this means anyone can continue to call themselves a hypnotherapist, regardless of their skill and knowledge (or lack thereof). Whether they’ve read a book on the topic, done an online course and printed their free certificate, or even if they’ve just spent a couple of days on an equally un-regulated ‘hypnotherapy training course’, they can still have a shining brass name plate outside their therapy room. They might even get themselves a therapy room in the famed ‘Harley Street’, seeing paying clients, many of whom are unaware of their inadequate training and experience.
So, how do well-trained, professional hypnotherapists differentiate themselves from those who perhaps regard hypnotherapy as a hobby, interest or ‘a bit of fun’?
As well as the mandatory (statutory) regulation, the PSA also has a register of ‘Accredited Registers’. These are held by organisations who serve those health and care practitioners (such as hypnotherapists) who are not regulated by statutory law. One such ‘Accredited Register’ is managed by the Complementary and Natural Healthcare Council (CNHC). An independent organisation, established and initially funded by the UK Government, they provide a register of complementary health practitioners and define the standards of practice (Code of Conduct, Ethics and Performance). Each of the sixteen professions it holds registers for, has a Profession Specific Board (PSB) of which I am a board member for the hypnotherapy profession. There are a range of duties within this role relating to training and standards. The PSB, together with each profession, work on, develop and review the profession-specific ‘core curriculum’ to ensure there is a high standard of training for all voluntarily regulated hypnotherapists.
Hypnotherapy Core Curriculum
The hypnotherapy National Occupational Standards (NOS) define the standards of effective performance that a hypnotherapist must achieve in terms of underpinning theoretical knowledge and understanding, and in terms of their practical hypnotherapy skills. They were compiled by Skills for Health, in consultation with key hypnosis and hypnotherapy stakeholders and have been revised several times.
Two of the NOS relate to complementary therapies in general (not just hypnotherapy), those of exploring the client’s needs (CNH1) and developing therapy plans (CNH2). The final one (CNH23) is specific to hypnotherapy. The CNH1 guides a practitioner to assess whether it is appropriate for them to work with the client, how they should work and any adaptations to their work that might be required. The CNH2 focuses on the therapy planning and monitoring processes. The CNH23 covers the breadth and depth of hypnotherapy and requires that a hypnotherapist understands current methods (and benefits and limitations), how to select an approach, setting therapeutic goals, evaluation processes, rapport building, contra-indications, information about conditions, possible barriers to therapy, and much more.
The Hypnotherapy Core Curriculum indicates the minimum training needed to meet the standards of the 3 NOS mentioned above, as well as a number of additional points agreed upon by the CNHC’s profession specific board for hypnotherapy. In July 2017, following extensive consultation within the hypnotherapy profession, the revised Hypnotherapy Core Curriculum was published by the CNHC. This replaces the 2011 version agreed by the Hypnotherapy Regulatory Forum.
Beyond meeting the theoretical knowledge and practical skills standards set out in the NOS, the Hypnotherapy Core Curriculum also now covers some other key areas, including the ratio of theory to practical training and the fact that there are a vast range of theoretical models within the hypnotherapy field. For example, a predominantly hypno-analytical course may be more theoretical-based, whilst a hypno-behavioural course may be more practical in nature. The Hypnotherapy Core Curriculum acknowledges these differences, whilst recognising the need for practical skill engagement, thus indicates training should be a blend of theory (65-80%) and practice (20-35%).
The Core Curriculum requires that hypnotherapy training consists of (a minimum of) 450 hours of study. These 450 study hours are comprised of several elements. The first being ‘guided learning’. For hypnotherapy students, this must be a minimum of 120 hours in the immediate physical presence of a lecturer or tutor (i.e. ‘classroom hours’). Within these 450 hours, there must also be at least 165 hours of ‘directed learning’ (i.e. ‘homework set by a lecturer or tutor’). The remaining balance of hours are assigned to ‘independent study’. This means that the student can utilise the time to best serve their needs. Some students may wish to engage in more practical study, others exploring theories, concepts or models in greater depth. It may also be that they use some of these hours for the study of marketing, advertising, practice development, or business building.
Forming part of the ‘directed learning’ (homework) is a specific requirement for case studies. Some hypnotherapy courses in the past have advised students against working with people outside of their training course, until they qualify. Yet, it can be important for students to develop ‘real-world’ practical skills; case studies help develop that. The Hypnotherapy Core Curriculum requires that the student undertakes and submits a minimum of three case studies. One of those must be a single session (e.g. smoking cessation). The others must be two sessions or more. Not only will the student report on the intake, planning and treatment process, but also will give their rationale and learnings together with identifying any areas for future development. This helps the student develop and practice a wide range of essential and relevant hypnotherapy skills.
Another key aspect of the revised Hypnotherapy Core Curriculum is the formal assessment process. Many courses engage in ‘formative assessment’, which takes place as you go through the course. This could be formally, such as marked homework or interim quizzes or tests. Or, it could be informally, such as a lecturer observing your work during a practical activity and giving verbal feedback. The Hypnotherapy Core Curriculum also requires ‘summative assessment’ in the form of written and practical examinations.
There have been debates about to which academic level hypnotherapy should be taught. In the UK, the Regulated Qualifications Framework (RQF) has 9 qualification levels ranging from entry level and Level 1 (such as GCSE grades 3-1), to those most relating to hypnotherapy of level 3 (A level and HNC) and level 4 (cert HE and HND). They go up to level 8 (doctorate). The levels indicate the difficulty and complexity of the knowledge and skills associated with the qualification and are of different sizes (referred to as ‘Total Qualification Time’ or TQT) as a result of this. The Hypnotherapy Core Curriculum has a TQT of 450 hours and is set to the equivalent of level 4. This is more appropriate for hypnotherapy, rather than level 3, as a key component of level 4 qualifications is that of ‘analysis’. Analysis is a core skill that hypnotherapists need to understand in order to most effectively work with clients, such as when developing and modifying treatment plans.
Why select training that meets the Hypnotherapy Core Curriculum?
There are many courses on the topic of hypnotherapy that do not meet the requirements of the Hypnotherapy Core Curriculum. One common reason is that some courses are much shorter in duration, especially the ‘intensive’ type courses that only last a few days. It is true that a shorter course is likely to be cheaper (although not always). However, students often find it is false economy. At some point, often when they are working with clients and find they lack essential knowledge and skills, they are then likely to need to engage in further training to ‘fill in the gaps’. This can result in significantly higher training costs than if they were to choose a longer and more thorough initial training course. Another problem with intensive hypnotherapy training courses is that, where students don’t immediately start practising and using their skills, there can be rapid knowledge and skill fade, because there simply isn’t enough time to layer and reinforce knowledge and practical skills. This means they are more easily forgotten when not engaged with after the course, whereas with a course that requires 450+ hours of study, the constant reinforcement means students get a stronger understanding of both the theoretical and practical elements of hypnotherapy that will last a lifetime.
Some hypnotherapy courses don’t set homework, yet the Hypnotherapy Core Curriculum sets 330 hours of it! Is that really necessary? Well, yes! The homework given on a hypnotherapy course, when well designed, helps a student gain a deeper understanding of the course material, as well as giving an opportunity to practice core skills and get direct feedback from their tutors. This additional engagement helps them more easily remember the information taught in the classroom and to develop their knowledge and skills beyond the initial course material. Homework truly does help hypnotherapy students to evolve into competent professional hypnotherapists.
Another reason some courses may not meet the Hypnotherapy Core Curriculum is that they have an insufficient assessment process, or none at all. Who likes exams? Are they even necessary? Well actually, the exams have many positive benefits. They motivate students to actually engage in and learn core material. They provide a formal route to recording that the student has, on that day, a certain body of knowledge and/or skills. They also give the students an opportunity to demonstrate to themselves that they know what they know (which can really build confidence in their competence!).
Professional recognition is another key reason why selecting training that meets the Hypnotherapy Core Curriculum is beneficial. Whilst some minor professional associations will accept members who have only limited training, the majority of professional associations (such as the General Hypnotherapy Register, Federation of Holistic Therapists and British Institute of Hypnotherapy and NLP), all have a minimum training entry standard. This is generally that the prospective applicant’s training meets or exceeds the Hypnotherapy Core Curriculum. So, if you want the support and benefits of being a member of a recognised professional association, your training needs to meet or exceed the Hypnotherapy Core Curriculum’s recommendations.
Finally, coming around almost full circle in our discussion, when your training meets the Hypnotherapy Core Curriculum and you hold membership of a recognised professional association, you are then able to register with the CNHC (the voluntary regulator). This demonstrates that your training meets a recognised standard and that you take professional responsibility for your conduct and commit to upholding high standards of practice in your work. With many public and private organisations now seeking practitioners registered with the CNHC, therapists benefit from the trust associated with that registration. Indeed, the Department of Health has recommended that where people are looking for hypnotherapists, they should only use someone who is registered with the CNHC.
In closing, when selecting your hypnotherapy training, as well as the usual considerations of location, dates, course content and price, it is perhaps most important that in order to optimise your professional development and to give yourself the very best start possible as a professional hypnotherapist, that you ensure your training meets the UK Hypnotherapy Core Curriculum. You’ll be glad you did.
We hope that this blog on hypnotherapy regulation, training standards and the Hypnotherapy Core Curriculum has been helpful to you. If you have any more questions about this topic or anything else for that matter, do please get in touch, because we’re always happy to help!
– written by Dr Kate Beaven-Marks