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.

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.

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. 

Transference is a situation in which the feelings a person had about one thing, are subconsciously redirected or transferred to another. It could concern feelings from childhood to someone in the present day. Transference occurs when a person redirects some of their feelings or desires for another person to an entirely different person, for example if you observe characteristics of your father in a new boss and then attribute fatherly feelings to this new boss. They can be positive or negative feelings.

It can also happen when you first meet someone, you could instantly like or dislike someone based on something or someone in your past.

Something we have to be aware of is that transference can happen in our clinical sessions. Transference in therapy happens when a patient attaches anger, hostility, love, adoration, or a host of other possible feelings onto their therapist. Freud was aware of Transference and would use this as part of the therapy process.

Countertransference occurs when a therapist redirects their own feelings or desires onto their patients. This may be a reaction to the patient’s transference. It can also happen independently of any behaviours from the patient.

We are guided by strict professional ethical and moral codes, which work to maintain clear lines of professional behaviour between therapist and client, a therapist can’t be a friend outside of the therapy, we need to maintain a professional distance.

A good working relationship is vital in our chosen profession, we need clients to like us and that is all we need.

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!!!

Hypnotic depth scales or scales of Hypnotisability are used to measure how deep a client is in trance.

There have been many studies into this over the years and I will highlight some of the different scales.

The Stanford Scale is numbered from 0 to 12, the higher the number, the deeper the level of Hypnosis.

0 Eye Closure (not scored)
1 Hand Lowering (right hand)
2 Moving Hands Apart
3 Mosquito Hallucination
4 Taste Hallucination
5 Arm Rigidity (right arm)
6 Dream
7 Age Regression (school)
8 Arm Immobilization
9 Anosmia to Ammonia
10 Hallucinated Voice
11 Negative Visual and Auditory Hallucination
12 Post-Hypnotic Amnesia

Subjects were given a hypnotic induction, followed by different hypnotic suggestions. For example, one suggestion asks you to imagine your hand is so heavy that you cannot hold it up. If you can hold up your hand, you fail that item. Most people are able to perform the first few items but not many people make it to the end of the test. According to the scales, the farther you get, the more susceptible you are to hypnosis.

Joseph Friedlander and Theodore Sarbin developed the below scale to measure susceptibility to hypnosis with items increasing in difficulty in order to yield a score. The higher the score, the more responsive one is to hypnosis.

Arons Depth Scale creator Harry Arons, some refer to this as the “6 stages of hypnosis” or “6 levels of hypnosis”

Stage 1: Hypnoidal - Hypnosis in this stage is very light. Many clients don’t feel or believe they are even hypnotized and feel completely awake and aware. There are two types of hypnoidal states, hypnopompic and hypnogogic. Hypnopompic is similar to the state you are just before waking up in the morning, that sort of half-aware, “twilight” state. Hypnogogic is like the state just before you fall asleep. A slow transition between wakefulness and sleep.

Stage 2 - In this state, the mind and body come more under the control of the subconscious. Larger muscle groups can be controlled and manipulated with phenomenon such as Arm Catalepsy becoming possible. In this state, your ability to discern reality from fiction becomes impaired.

Stage 3 - is characterized by “Aphasia”, a loss of ability to understand or express speech. Subjects will be able to remember a word, letter or number, but can be instructed to not be able to say it

Stage 4 - In this stage, subjects start to exhibit greater phenomena including the beginning of true amnesic stages. A subject at this stage will “forget” very personal and deeply embedded information such as their name, phone number, and address.

Stage 5- This is where true somnambulism begins. Somnambulism literally means “sleep walking”, but in this context it refers to an easily identifiable disconnect of the mind from both the body and the outside world.

Stage 6- Profound Somnambulism, Subjects can experience Negative Hallucinations where they don’t see or hear things that actually do exist.

So, why are these scales important in the Solution Focused Hypnotherapists practice? There is research that suggests that people’s response to hypnotic suggestions is almost as strong without an induction as it is with one. In other words, subjects respond to suggestions even without hypnotic inductions. Therefore, induction may not have a significant effect. This brings up an important question, if induction is not important, what are all the suggestibility scales actually measuring? We know that we all go into trance in our day to day lives naturally and we have the ability to process thoughts and suggestions in a day dreaming state, so why do we need our clients to reach the higher numbers on the scales? The answer is simple, in the main we don’t!

Another challenge with suggestibility testing is that it may interfere with hypnosis, if it leads people to believe they are not hypnotisable. If a patient is given a suggestibility test and they score low, this may lead them to believe that they will not benefit from hypnotic treatment. This idea may or may not exist, but the mere thought in the client’s mind that it may exist can cause it to exist as we know the mind doesn’t know the difference between what is real and what is not. This is the essence of hypnotherapy, expectation becoming reality as a result of the existence of the expectation.  Expectations matter, and if expectations of the effectiveness of hypnosis are questioned, that may lead to a lack of confidence in the hypnotic process.

Deeper levels of trance would be required if a patient was to have surgery under hypnosis. The University Hospital Centre at Liège in Belgium has reported more than 12,000 cases where hypnosis was used to treat pain since 1992. Enabling patients to have quicker recovery times without the after effects of general anaesthetic.

Hypnotic suggestibility testing is almost always used in hypnosis research. For our use, however, it is often ignored. As many therapists feel, it is not necessary for a client to be suggestible for hypnosis to be effective as a treatment method, as we only need a light trance for our clients to allow their conscious and subconscious minds to come together to find solutions.

www.bestmindtherapy.co.uk

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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Suggestibility tests are used to identify how susceptible a person is to Hypnosis. These tests are not generally used or needed in the Clinical setting as a light relaxed trance is considered enough for most clients to be open to suggestion and to allow the conscious and unconscious mind to work together to find solutions. As solution focused therapists, we would not encourage suggestibility tests as we would not want the client to think they have failed if the required response is not shown, they may well then believe they cannot be hypnotised and then resist therapy.

These tests can be sometimes used with children as an ice breaker or something they could be taught to try on their parents. A particular favourite, is to hold both arms out, one holding a brick and the other being held aloft with balloons, not many clients fail to show a response to this. But this should not be used, in my belief, as a measure, just a little fun to sometimes relax a child.

Suggestibility tests are often used by stage hypnotists to find the next star of their show, a series of tests would be carried out on the audience to weed out the more suggestable audience members to allow a good display of riding imaginary horses or eating raw onions.

We utilise trance in our process that is induced by a guided relaxation piece that allows the client to enter a state of tranquillity to focus the mind on what has been discussed in the session and to feel rested and calm when brought back to wakefulness. We do not need clients to be too deep into hypnosis to achieve our and their goals.

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