As therapists, we reserve the right to choose who we work with. The reasons for not working with clients, should never be made on reasons of discrimination, if this would be the case, the therapist is in the wrong profession and is in breach of the code of ethics for the NCH and AfSFH.

There may be times when a therapist chooses not to work with a particular client for some of the reasons below,

If the therapist feels the clients’ needs are above his/her experience level.

If a client is aggressive or behaves inappropriately.

Clients that don't actually want to see a therapist and show extreme resistance to the process

Clients under the influence of drink or drugs.

Those clients taking medication that would need referring to a GP before the sessions continue.

Clients with strong beliefs that go against the therapists’ moral codes.

Clients that continually cancel appointments at short notice or don't settle their bills

Friends where it could be considered to change the dynamic of the future relationship.

It could be the client doesn’t want to attend and is being forced to attend sessions.

Those in a relationship with the therapist

All clients should be referred to another more suitable therapist in the event of any of the above and discussed at supervision to ensure we do not turn away anyone that needs our help. Helping them to find alternative therapy, could be more beneficial to the client in the long run.

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The initial consultation is one of the most important stages of the time we will be spending with our clients. It is an opportunity to build rapport and gather important information to ascertain what we will be helping them with and how we will deliver it. We utilise a specific information gathering form to complete this. Information gathered is used to adapt our workings of the mind presentation to allow us to make it relevant to the client’s needs, offering suggestions as to why they may be feeling like they do and what we can do to help. We follow the same structure, for the most part, with every Solution Focused Hypnotherapy session, but use client specific information to make it relevant to them.

We draw out information on how we can help, what is the client’s goal or goals if therapy is successful. This is vital as we have a starting point and an instant miracle question/ scaling conversation when we see the client at the next session. We can also review this goal regularly to keep the sessions on track and show them how they are moving towards that goal in a positive way.

Details on their immediate family is taken, which allows us to understand the workings of the family and to bring questions to the client for example “what would your husband John think if he saw you less anxious” “how would your children react” etc, allowing us also to understand the support network of our client.

Phobias, addictions, habits, sleep patterns are noted, as these could be causes, or side effects, of the issues that the client has decided to come and see us about. We know that poor sleep is a factor in reducing the brains’ ability to empty our “Stress Buckets” the more stress in that bucket, the less likely our clients are to have the capacity to lose their phobia or addiction or reduce general strass levels. Knowing these pieces of information give us clues to the direction to take.

We need to know details of the Drs Practice and whether the client is on medication, also what the medication is used for, there may be situations where therapy may not be continued until clarification from the GP is sought as to the suitability of our sessions, Psychotic or clinically depressed clients, for example.

It is also wise to find out what previous therapy they may have received, to enable us to build on this, or try something different.

We have to be sensitive in gathering information, we should take whatever is offered by the client and use what is helpful only. We should appear inquisitive, but not overtly nosey! If the client wishes not to give us the basic levels of information, we should be curious as to why, as they may be hiding something that could prevent us from continuing therapy. A discussion with our supervisor on this matter would be the best course of action.

Solution Focused Hypnotherapists can work without knowing all the facts, but having a basic understanding adds to our resources to ensure the best possible way forward for our clients.

“We can help……...!”  if we remember this phrase for the rest of our careers, we will rarely give false hope . What we do is hard to quantify, its difficult to measure, but we know it works for the majority of our clients. But we cannot ever promise results, its too reliant on the client working towards their own goals to be able to measure the therapists result, we just help them get to where they want to be. Any websites or general advertising needs to offer “help” to find solutions to problems, not a guarantee of an end result. We should avoid using percentages to describe the success rates, we should never suggest that everyone is “fixed” as this could well cause not only disappointment, if they have felt no benefit, but also this could damage their feelings of self-worth as they could well feel they have failed in some way.

But……… we need to give hope and encourage the client to use their intellectual brain to find solutions and stay positive, so maybe the phrase “I feel confident I can help you” or “I feel you have the strength inside you, to allow us to work together to help you make your life better” may be more appropriate.

How do we ensure that the client is getting value? The answer there lies with both the client and the therapist. We could assume if they turned up again to the following appointment, they are feeling some benefit. But it could be because we told them that they needed between 8 -12 sessions and they feel obliged and feel that this is how it should be. Having a good working relationship should allow the client to believe they can be honest as to when therapy is over, it may be prudent for the therapist to ask when the client may feel they are ready to stop, based on scaling or maybe when a phobia or symptom has gone. We should strive to ensure that the clients only have the number of sessions that they need and not one more.  We can of course suggest that a course of therapy may need to extend if we truly believe it is the right thing to do, but the client has the final decision.

There may be times when the therapist decides that therapy comes to an end. This could be because the client doesn’t engage in the therapy, it could be they regularly cancel or don’t show up for appointments. Maybe it is felt that the client is fulfilling an emotional need for something, rather than attending our sessions for a specific symptom, we cannot become paid friends to chat to, or allow the clients to get emotionally attached to us, we should leave no trace on their lives…

At times we may have a client who comes to us as a last resort, they may have been to a number of different therapies with no results. They could be very dismissal of every other therapy that they attended. Our views of these other failed attempts at therapy cannot be encouraged, we are only specialists in our own field and cannot suggest otherwise. Our methods encourage positive actions, positive interactions and positive thoughts, this in itself should and does not conflict with other principals of therapy, so we have the tools to find good in anything they may have tried before. Acknowledging that they know what hasn’t worked and they are strong and resilient enough to keep seeking help is already singing from our hymn sheet, so we should embrace this.

We should also bare in mind our limits of expertise in all areas, if deep down know we cannot help, after seeking advice from a supervisor, we should refer the client to someone more qualified. The person in front of us has come for help, we need to ensure we do just that and if telling them that we can’t help is the right thing for them, we must find the strength to do it. Our clients should never be viewed with pound signs on their heads………

As Clinical Psychotherapists, we are dealing with people, whether face to face, on the telephone or online. Some of these people will be vulnerable, some will be children, some may have caregivers who escort them to appointments, some may present behaviours that we feel may be dangerous to themselves and others. We don’t always know clients before we see them, our first hello at the Initial Consultation could be the first interaction we have had.

As we operate a confidential practice, we have to consider when this cannot be honoured. For instance, when we have to safeguard those that are vulnerable. Vulnerable adults may need a chaperone, children under the age of 16, should be accompanied by the primary caregiver, disabled clients may need permanent care and assistance.

This asks the question, “how do we remain confidential?” Firstly, informed consent should be sought for the session, this is taken at the Initial Consultation, giving agreement to receive Hypnotherapy. Future consent is applied consent, as they continue to attend appointments. At this point, the session will be discussed and the arrangements regarding who attends will be agreed. If a chaperone is to remain, this should be noted on the Initial Consultation document, if it is preferred that a chaperone not be present, it would be insisted upon that an open-door policy is agreed, where the client remains in the practice room, with the chaperone waiting closely outside, close enough to see inside the practice room, but not close enough to hear what is being said, the therapist keeping a working distance away from the client and never having any physical contact with them.

We have to also understand who is the client. Every effort is to be made to discuss issues with the client, rather than the caregiver/chaperone. Although at times their input maybe of importance, our concern is our clients’ thoughts and best interests. Some of the clients’ issues may well involve the caregiver, so during Miricle questioning and scaling, we have to be mindful that we allow the client freedom to discuss what is on their minds. Session rules should be discussed at the Initial Consultation, which will lead to a much more productive and beneficial session.

If we feel a vulnerable person or child is at risk, we are legally and morally bound to take action and report this to the relevant authority. It is advisable to have an Enhanced DBS check carried out to give confidence to those seeking a therapist.

Another issue to be considered would be that of insurance. Insurance to practice Hypnotherapy and insurance on the facility in which its being performed. We need to provide a safe environment and have public liability insurance in the event of any claims. If we follow the procedures of Solution Focussed Hypnotherapy, it is highly unlikely that there would ever be grounds for complaint as consent is always gained.

Discrimination of any sort, is also to be taken into account legally and morally. All humans are equal and should be treated as so.

If a therapist adheres to the code of conduct and ethics of their chosen professional body, they are signing up to a promise to ensure they give the upmost care and professionalism. Solution Focused Hypnotherapy is about doing good and making lives better, this we will do if we practice what we preach and stick to the rules, legally, ethically and morally.

Continuing Professional Development (CPD) is widely recognised as a fundamental way to improve the professional standards and skills of Therapists. It exists to ensure that an individual enhances their skills and abilities once they have qualified. CPD is important as it helps to ensure that further learning is progressed in a structured, practical and relevant way. CPD allows a therapist to focus on what specific skills and knowledge they require over a short-term period, maybe 12 months, in order to be confident that there is recognisable improvement in their proficiency and skill sets. As more people become professionally qualified with similar qualifications, CPD becomes more important as a means of separating yourself from the pack and being able to offer a greater level of professionalism. Thoughts, procedures and science moves on continually and we need to ensure we have the most update training and knowledge to best help our clients. A minimum of 15 hours of CPD is required by the AfSFH.

Whist knowing what you need to know is vital, doing what you need to do is more important. Giving our clients the very best professional care and attention is our aim. We must ensure we evaluate every session and challenge ourselves whether the session was the best it could be for the client. Learning points are recorded on our session logs and identified to allow us to build upon any weaknesses in the last session to ensure we give our very best next time. What could I have done differently? What should I have done differently? What did I miss? Did I give the best that I could? Am I adequately qualified for this situation? Do I need to change the approach? Did I speak too quickly? And the list goes on. Fundamentally we need to learn what was good and do more of it, identify what didn’t work and do something different. Once a client has ended their therapy sessions, the entire story of their journey should be evaluated to enable reflection and constructive criticism. This could identify weaknesses in the therapist’s ability, enabling them to plan future CPD, or it could be that it gives the therapist the joy in seeing that the sessions have helped, driving increased positivity and belief in themselves to strive to work even harder for the clients.

Evaluating our own performance is a great way to improve our skills. There may though, be more effective approaches that only come with experience. But should we wait to gain experience? Should we practice on our clients until we get proficient? The answer to these questions has to be no! Part of the code of conduct states we all have to undertake supervision from a qualified Supervisor. The AfSFH state a minimum of 6 hours. Supervision is an effective way of discussing cases, in a professional, confidential and constructive way. Individual cases can be discussed to allow the Supervisor to ascertain if the therapist is adhering to the code of conduct and to offer insight into what worked, what could have helped and what further training may be needed. No details of clients are given, to ensure privacy. Supervision is important when a new client presents issues that the therapist feels underqualified to help with. Discussions on the best course of action can be had to best serve our clients and to ensure they see we are doing our upmost to help.

To summarise, we need to do the best we can for everyone that chooses us to help them. We must constantly work towards having the most up to date knowledge, continually evaluate ourselves and be monitored by trained Therapists to ensure we give the best possible level of service to our clients. 

Being a therapist, regardless of the type of therapy or method that is practiced, having an ability to know your own limitations has to be fundamental to the wellbeing of the client. We would not expect a General Practitioner to offer open heart surgery at a routine appointment for Angina, or an airline pilot to fix a cavity in a painful tooth, we would seek the person most qualified to do the best for us.

Training and evidence of competence is a minimum requirement as a Solution Focused Therapist. Offering services that you have not been formally trained in, isn’t doing the best we can for our clients, at the least it could be very expensive and poor value for money for the client, it could be damaging to their wellbeing or not to mention extremely poor public relations for our profession.

The responsibility of the therapist begins as soon as he meets with the client. At the initial consultation, where information is gathered and the explanation of the workings of the mind is given, an assessment can be made on whether the Therapist feels He or She has the required experience to assist in making the clients life a better one. If it is thought that the therapist may be lacking in experience, there are two ethical routes that could be considered. He or she should explain this to the client and let the client help in the decision. The choices should be to refer the client to a more experienced Therapist, or allow the current therapist to seek supervision on the case presented, training could then be given to adequately qualify the therapist to help. Either way it shows a duty of care, which is our primary goal. Continual Professional Development is a requirement of the NCH, allowing therapists to train in areas where they may be inexperienced.

There may be instances where Solution Focused Hypnotherapy is not suitable as a stand-alone therapy, for instance if the client has self-diagnosed himself and is assuming his symptoms are something that they may not be. As therapists we should always seek to find out of any presenting problem has been diagnosed. A client may have symptoms of IBS, but has he been to the doctors to rule out other illnesses with similar symptoms? He or She may have what they feel is Migraine, but have brain tumours been ruled out first? Finding out if clients are on any medications and more importantly what they are used for, is also very important as we can asses if we need to contact their GP to clarify the treatment we may be offering as complimentary to the treatment the have prescribed, as in when a client is on strong anti-depressants. We cannot diagnose, we cannot recommend or dismiss any advice given to the client from His or Her GP, we can just support this with what we do. I had a client who came to me with Psoriasis that he believed was stress related, although stress can flare Psoriasis, the underlying condition of skin cells replicating themselves too quickly is sometimes only controlled by steroids and vitamin creams. After a diagnosis from his GP and medication prescribed, Solutions Focused Therapy was used to reduce anxiety in his life, the stress response that could, amplify the flare ups of Psoriasis were suitable reduced to allow the client to control his skin condition easier. 

What we say we can offer, on any website, flyer or business card, has to be the truth. We cannot advertise “Miracles”, although we may encourage the client to imagine what their life would be like if one happened! we cannot guarantee success rates that are unachievable, we cannot turn water into wine. But we can offer hope and explain the scope of the treatments given. We can help to reduce anxiety, we can help to reduce phobia, we can assist with helping clients seek a healthier lifestyle, but we cannot give guarantees. Those that want to be helped, will be helped, those that want their issue to go away with out playing a part in the process will be disappointed. What we offer is a working partnership to assist the client in making positive steps to a better life.

We have to keep the best interests of our client at the foremost of our minds, if we cannot help them, we must discuss this with them. If they need more specialist help, we can assist in finding this if appropriate. If they, or anyone else in is danger from there behaviours, we ethically and morally have to react in the most appropriate way. There is no place for vanity, we can admit that we are not experienced enough and we have to always think that if we fail, we have failed another human being who came to us for help…………. something we cannot do!!!

As Solution Focused Hypnotherapists, we must all have an inner want to do good. We are people who want to help people, we care, we want the very best for anyone that we meet, we should respect people and live by the highest achievable moral standards, that should be reflected in the way we work and present ourselves. Having our own Moral and Ethical code, although vital, is subject to individual interpretation, it is therefore, beneficial and professionally responsible to adhere to a uniform code, that is based on client interests and is available to all who seek our help to see, giving reassurance and clarity to the treatment they will receive from all those that commit to that code.

NCH members have a primary care to protect the health and wellbeing of their clients, to fulfil this duty, it is based on the following principals,

To respect their client’s dignity, individuality and privacy

We should at all times maintain a practice where our client’s information, discussions and treatment are strictly confidential. To gain the trust of those that we meet is the most important aspect of the client, therapist relationship. By keeping discussions private, we maintain the clients Dignity and privacy. We treat the client with respect and their challenges are acknowledge and never dismissed or ignored. We empathise and consider the best possible treatment plan for each individual as everyone is different.

To be sensitive to cultural differences

There is no place for any forms of Discrimination, we should embrace and respect all cultures, beliefs, races, genders, ages and any other “ism” Some changes in structure or wording may need to be incorporated, we may need to be mindful when asking a “Miracle” question for those cultures that believe only their god or profit can perform these. We may have to be sensitive to language and the beliefs of the client. Accepting each client as an individual and being unique. We keep an open mind and the professional ability to structure sessions unique to the human sat across from you, to ensure the best working relationship.    

To respect each client`s right to be involved in decisions about their therapy and care

We work at one step behind the client, we follow their lead in therapy sessions. Agreement for the most effective direction of therapy is sought and customers are required to sign a statement agreeing to receive the therapy that we specialise in. In the case of minors, we seek the agreement of not just our client, but the parent or responsible caregiver. We have also to be mindful of those adults that may also have a carer and may be classed as vulnerable. Cooperation is the key to success, but the client is paramount and their interests should always be the primary driver whist under our care. We seek agreement to continue with treatment and procedure on an ongoing basis.

To be trustworthy and honest

We treat every client with respect and at all times keep the client/therapist relationship at the upmost of professionalism. We commit to our code of practice to ensure this is demonstrated. All those adhering to the code would have to have an Enhanced DBS check and report. Any convictions are reported to the NCH as are any verbal or written cautions to ensure a record of such things are held and decisions can be made regarding the suitability of the practitioner.

We must also be mindful to follow through with any promises made, avoiding promises that would never be fulfilled. We cannot falsely state cures, success rates or remedies that may not materialise, we can though give hope.    

 To provide a good standard of Hypnotherapy practice

 Our working environments should be safe, appropriate, client focused and adequately comfortable to allow the clients to feel relaxed, whist promoting professionalism. We should continually develop our skills and seek regular supervisor assessment sessions to discuss process and best outcomes, whilst maintaining the client/ therapist confidentiality. If a client’s situation or problem is above the level of competence of the therapist, the client should be referred to a more appropriate and experienced therapist, with the permission of the client.

 To protect clients from the risk of harm

 The client’s welfare is at the forefront of everything we do. We allow clients to be the best judge of their lives and the decisions they make, but if we feel that the client is at risk of harming themselves or others, we reserve the right to inform the relevant authority or practitioner. This exception to confidentiality should be discussed with the client in the first instance and it may be appropriate to have a section on the GDPR notice highlighting this, for example

To cooperate with other healthcare colleagues as necessary

Permission to communicate with the client’s medical practitioner is sought at the initial consultation and is used only in circumstances where intervention or clarification from medical practitioners is in the best interest or requested by the client. 

The code of Ethical Conduct and Performance is a bench mark that we must adhere to. Any breaches in the code by ourselves or those that come to light from other practitioners must always be reported to ensure the integrity and professionalism of our governing body. By having rules we provide a framework to work to and ensure we provide the best service we can give to encourage our clients to live better lives… 

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Resistance is a psychoanalytical term; it is used to describe situations when a client actively or passively resists any change in behaviour. It is anything that stops therapeutic change.

This can take many forms, it could be that they keep cancelling appointments, they may not speak at sessions, they could be negative thinking when we are perusing positive thoughts, maybe a goal that was set to complete was ignored, they could resist trance intentionally, they could dismiss the SFH model and try to sway us in to more analytical methods, what ever it may be, it will slow their progress and could convince the therapist that the sessions are worthless. But, those “resistant” clients still attend, so maybe they are still getting a benefit from seeing their therapist.

So, what can we do?

Actively fighting resistance rarely works. Instead, the reason for the resistance should be discussed to explore what is causing it. Pointing out that a client appears to be exhibiting some resistance, allows you to process it and move beyond it. They may feel that the decision to attend therapy wasn’t theirs, this in itself opens up a vast SFH conversation and could get the client to buy back in, “so what small thing can you do to get your parents off your back?”

We need to explain to clients that they need to participate in the sessions, we could set ground rules, we could get the client to come up with solutions to their current resistance, “so what could we do differently to make these sessions more beneficial to you? “

It could well be that the therapist has got it wrong, we should not assume that it’s the client that is resistant until we have explored if we ourselves should have been doing something different to get the best out of our client. Our manner towards the client should be thought about, are we friendly, positive, professional, are we giving benefit and value? Rapport is so important!

We have a very well-structured process and we need to ensure that we adhere to it, to allow clients to make the very best progress. Sometimes it may be considered to do a back to the start session to remind the client what the process and structure can do for them.

Resistance comes in many forms and we should remain positive that we will over come it and if the challenge is a challenge too far, discuss with your supervisor as the therapist could well be missing some thing obvious and vital to get the client back on the same hymn sheet.