Considering
Registration for the Profession of Hypnotherapy
(Part 2)
Published
in HypnosisAustralia, November 2006
By
Dr Tracie O'Keefe DCH
Background
From time to time, issues of government regulation of practitioners involved
in health professions comes to the public's attention. With those industries
that may be involved in the use of therapeutic hypnosis, some professions
are already on state or federal registers such as medical doctors, nurses,
psychologists or dentists. In Australia, however, the professional titles
of counsellor, psychotherapist, hypnotherapist, clinical hypnotist, or
clinical hypnotherapist are not regulated (Guillatt, 1995).
The non-regulation of these professions impacts upon Australian society
in two ways. Firstly the public is unable to get an idea if those practitioners
who are not regulated are trained to a sufficient standard to be competent
as a healthcare professional. Despite the fact that many of the practitioners
advertising their services may have trained to an exceedingly high standard,
and belong to an array of professional industry associations that require
high standards to join; the public have no guarantee of quality of service.
The second
impact upon society is that the availability of those services to society
is often kept purely in the private sector and not available to people
though Medicare (the National Health Service) and private health insurance
will offer very limited cover. Private health insurance companies often
do not like dealing with unregulated professions because they are unable
to judge standards of operation.
The problem
for the government, public and private health insurance companies is that
standards of training for unregulated healthcare professions using hypnosis
varies wildly at the moment. Some people claiming to be professionals
trained in therapeutic hypnosis are profoundly well trained and others
have an appalling lack of education and clinical knowledge. The only real
way to have standards of training for persons calling themselves hypnotherapists
would be for the profession to be regulated and federal government to
keep a register of qualified and recognised professional hypnotherapists.
At the moment
the Australian federal government has no opinion or interest in regulating
hypnotherapists but that may not always be the case in the future. In
recent times there has been a deregulation of hypnosis in various states;
however, no state presently has protection of the professional title hypnotherapist.
Many unregulated healthcare professions may come under review in years
to come. In this article we look at how hypnotherapists might be placed
if regulation became a reality. We also look at the possible regulation
of the psychotherapy and counselling professions in Australia, both professions
that are presently unregulated and whose members often practise therapeutic
hypnosis.
"The laws in relation to hypnosis in Western Australia are governed
by the relevant psychologists acts in respect to those particular states.
For the most part, these relevant acts deem that the following practitioners
only can legally practise hypnosis:
" Psychologists
" Medical Doctors, and
" Dentists
However, probably because of the ambiguity of these state laws and the
inability of any person to show proof or evidence of exactly what a hypnotic
trance is, or is not, there has not been any successful recorded prosecution
regarding "Non Approved" people practising hypnosis.
While the Australian Capital Territory and the Northern Territory have
never had hypnosis regulation, in 1998 the state of Victoria quite rightly
de-regulated hypnosis. New South Wales has long allowed self-regulation,
which is responsibly and fairly guided by associations comprised mostly
of professional clinicians, who freely devote much time and input to ensure
high industry standards.
" The South Australian Government Review of Psychological Practices
Act 1973, in terms of Competition Principles Draft Report of the Review
Panel, dated October 1998, recommended that all references to hypnosis,
principally Section 39, be deleted from the Act. This was supposed to
happen NO LATER than June 2005; however, the South Australian Government
has dragged its heels and is now in breach of an agreement made in 1995
between the Federal Government and all State Governments which had regulations
regarding the practice of hypnosis, that they would remove all controls
over hypnosis from their relevant Psychology Acts. The South Australian
Government as at 1st June 2006 has been in breach of this agreement for
12 months and could face penalties from the Federal Government in excess
of $80 million.
" Proposed Tasmanian Legislation to replace the ageing Psychology
Registration Act will not have any restriction on hypnosis as a therapeutic
practice. Minister for Health Office November 1998.
" The recent Australian Health Minister's Advisory Council (AHMAC)
decision on this issue is that the "regulation on Hypnosis, as an
occupational group is not warranted at this time".
" Queensland's preferred position is that existing controls within
the Psychologists Act 1977 over the practice of Hypnosis be repealed as
recommended in the Draft Policy Paper September 1996. In accordance with
these recommendations the practice of hypnosis in Queensland was de-regulated
in May 2002.
" The regulations governing the practice of hypnosis and restricting
it to Doctors, Dentists and Psychologists, or other approved persons were
changed by the Western Australian Government on the 12th of December 2005,
and the relevant Psychologists Act in WA was amended in April 2006 removing
all previous controlling restrictions.
" The NSW decision was not to regulate Hypnosis and the debate appears
in Hansard 6797, 19 April 1989.
" The Northern Territory and ACT have never legislated to regulate
hypnosis and have no intention to do so.
" The Victorian deregulation was legislated in 1998 when the Psychologists
Registration Act 1967, relating to Hypnosis regulation, ceased to have
effect from 1 January 1998.
" There was a 1993 federal government decision to rescind the National
Health and Medical Research Council 1983 Report "Hypnosis in Clinical
Practice".
(The Australian Academy of Hypnosis website 4.6.06)
The Australian Traditional Medicine Society (ATMS), with over 10,000 members
has members who are counsellors, hypnotherapists, naturopaths, herbalists,
massage therapists. ATMS has declared it would like to see a joint registration
between unregulated health professions and the government for complementary
medicine practitioners (CAM) which would include hypnotherapy. This has
been their position for many years but the government seems to do as much
as it can not to be involved with regulation of industries in what it
sees as a free market economy. A spokesperson for the ATMS said, "Yes
every time there is an issue in the press about unregulated health practitioners,
the Minister for Health jumps up and down and feigns indignation but really
the government does not want the work of regulation."
The Psychotherapy And Counseling Federation of Australia (PACFA), represents
over 3000 psychotherapists, counsellors and hypnotherapists. PACFA has
worked hard over the past decade to bring together general consensuses
of its member organsations, from different sub-disciplines, becoming an
industry leader. Although PACFA has a small section that represents hypnotherapists
and hypno-psychotherapists - around a couple of hundred - it has not presently
managed to coax the larger part of the Australian hypnotherapy community
under its umbrella organisation to date. Its hypnotherapy member associations
are The Association of Solution Oriented Counsellors and Hypnotherapists
of Australia and the Australian Hypnotherapists Association.
The Australian
Counselling Association (ACA), with over 2500 members, again like PACFA
has member associations which specifically represent hypnotherapists.
Again it has member associations that are specifically sub-disciplines
of hypnotherapists, namely the Australian Society of Clinical Hypnotherapists
and the Professional Clinical Hypnotherapists of Australia.
All of the
above major industry associations keep a register of what they deem to
be accredited hypnotherapists, counsellors and psychotherapists practising
hypnosis. Each organisation has its own required standards of training
and ongoing supervision for entry onto their registers and continuing
professional education to remain a member.
Situation
abroad
In America
things vary vastly from state to state as each state has a history of
being settled by communities from different cultural backgrounds whose
values still often prevail today. In New York, for instance, hypnotherapists
can set themselves up and practise hypnosis without being regulated in
any way. In the rest of America the situation is also very confusing because
although psychologists and medical practitioners have to be registered
with governing state bodies, psychotherapists, counsellors and hypnotherapists
do not. Americans, however, often call psychotherapists psychologists
and vice versa, so the public becomes very confused over who is really
registered and regulated to do what, and who is not.
In the UK
the government is proposing to move towards registration and regulation
of psychotherapists and counsellors. A joint mapping process was commissioned
by the UK government between the United Kingdom of Psychotherapy (UKCP)
and the British Association of Counselling and Psychotherapy (BACP), the
major industry associations to find ways to form a government-regulated
register for those professions (Aldridge & Pollard, 2005 James).
This discussion
document seemed more than confused when it considered the differential
between hypnotists, clinical hypnotherapists and hypno-psychotherapists.
It said that there was only evidence of hypno-psychotherapy within the
two major organisations and rejected incorporating hypnotherapy within
any proposed regulatory bill. Instead it suggested that hypnotherapy considered
registration through the CAM (Complementary & Alternative Medicine)
council. There has been a long history of rejection by the UKCP of hypnotherapy
organisations that wished to join the UKCP so it is easy to see that this
discussion paper may have made hypnotherapy the sacrificial lamb on the
UKCP's path to respectability.
At the same
time, the UK government also funded an exploration of regulation of psychotherapists
separately from counsellors; which was spurred by the belief that psychotherapists
are generally trained to a higher standard than counsellors. That will
inevitably include the members of the Hypno-Psychotherapy Section of the
UKCP who also advertise their services as hypnotherapists.
The rejection
of the title hypnotherapist as a separate discipline to be included under
the same proposed UK legislation shows clearly that hypnotherapists cannot
rely on the counselling and psychotherapy professions to help them become
legitimised. While some UK hypnotherapists belong to the Institute of
Complementary Medicine (ICM), a voluntary umbrella organisation for complementary
medicine, many do not. In fact many hypnotherapists in the UK belong to
small industry associations that are not connected to the UKCP, BACP or
the ICM. This may leave those hypnotherapists totally isolated when legislation
to regulate counselling, psychotherapy and complementary medicine comes
into play.
When is
standard of practice not a standard?
The NSW Health
Minster Hon John Hatzistergos has announced changes for dealing with complaints
against unregistered healthcare practitioners but this does not address
the need for minimum standards for those practitioners using hypnosis
within a therapeutic context (PACFA eNews, 2006). Voluntary standards
will never cut the mustard as there will always be a rogue element of
people who set themselves up as practitioners with next to no training
in physical or mental health unless there is regulation.
The changes
will allow the NSW Health Care Complaints Commissioner's department to
investigate complaints against unregistered healthcare practitioners but
in reality only the discipline to which they belong can possibly set a
standard of education, practice or ethics for that discipline. If the
commission has no official benchmark to judge the standard of that practitioner
against, then an investigation into their practices becomes little more
than a witchhunt by any other name. Any complaint about standards of hypnotherapy
would be unprovable.
To treat
healthcare disciplines, that use such complicated processes as clinical
hypnosis, by the same kind of consumers goods principles as the sale of
toasters neither serves the public, government or healthcare practitioners;
but is simply a knee jerk reaction to media frenzy. To give the Commissioner
the ability to investigate a profession that has no particular official
standards is little more than Gestapo-type tactics by the government to
acquiesce to public paranoia about standards without actually doing much
about the situation of unregulated practitioners.
It is illogical
that a practitioner could be struck off a register that does not exist
and banned from practising in healthcare situations when the government,
state or federal, does not have a register for counsellors, psychotherapists
or hypnotherapists. Although they may not be able to call themselves a
psychologist or psychiatrist anymore they could easily set up 'The Divine
Mellon Head Guidance System'.
When might
any regulation take place and who would be involved?
When registration
for counsellors and psychotherapists will happen in Australia is as yet
simply a matter of conjecture. It could be five, 10, or 15 years from
now but one thing is for certain - after the developments in the UK, and
Canada and persistent rumblings from the press, it will inevitably arrive.
Which organisations
will be the large consultative bodies in the process in coordination with
the government is pretty plain to see even at this stage of affairs. Certainly
PACFA will be at the table, and although it presently talks about self-regulation,
it will in time just as the UKCP did, push for regulation.
Whether the
ATMS will be a major player is as yet unclear. At the moment the numbers
of counselling or hypnotherapists it has on its register is not in any
way comparable with PACFA or ACA but that could change in time.
The disparity
between the internal cultures of the ACA and PACFA has to date stopped
them from merging but whether that will be the case in the future is unknown.
A comparison, however, can be drawn between PACFA and the ACA and The
UKCP and BACP. While it can often be healthy to have more than one major
industry association, governments do not like dealing with multiples and
in the UK the government virtually knocked the heads of the BACP and the
UKCP together and forced them to work together in setting up regulation.
Hypnotherapy
as a single discipline in Australia
When regulation
arrives for counsellors and psychotherapists in Australia it is unlikely,
as things stand at the moment, that such regulation will include the professional
title of hypnotherapist. Just as has happened in the UK it is highly likely
that professional hypnotherapists will be left out of the loop. There
will be many regulated counsellors and psychotherapist advertising hypnotherapy
but the professionally well-trained hypnotherapist may well once again
prove to be the sacrificial lambs as they have become in the UK.
Hypnotherapists
in Australia need to learn from the UK experience. The publication of
the UKCP and BACP joint consultation document on regulation for counsellors
and psychotherapists in the UK clearly shows that both those bodies have
excluded hypnotherapists from registration (2005). While the UKCP has
a section which it calls the hypno-psychotherapy section in the consultation
document, it does not identify these practitioners as hypnotherapists.
In reality those practitioners are hypnotherapists and have been since
the formation of the UKCP to the full knowledge of the UKCP council. Even
some of the member organisations of the UKCP specifically have the title
"hypnotherapist" in their title.
At the time
of writing that document there were probably more hypnotherapists in the
UK outside the UKCP and BACP than there were in it. For this reason the
BACP/UKCP consultation document suggests the hypnotherapists should pursue
the CAM route of regulation. The same situation could happen in Australian
in years to come when consultation on regulating counselling and psychotherapy
eventually becomes a reality as inevitably it will.
As I write
this, I hear dissenters from the hypnotherapy communities saying 'this
is Australia, not the UK'. Although that is true, the government in Australia
will rely heavily on many of the lessons learnt by the UK government in
the regulation of counsellors, psychotherapists and maybe one day hypnotherapists.
A way
forward for Australian hypnotherapists
At this moment
in time certainly one of the best things that could happen would be for
all hypnotherapy associations and schools to begin to confer with each
other more to consider maintaining hypnotherapy as a singular discipline.
Historically this kind of inter-establishment communication has been very
difficult in Australia because there were often rivals and competitors
with commercialism overriding the long-term interests of the profession.
If the associations
do not do this, however, hypnotherapy will remain largely an unorganised
profession and when regulation for counsellors and psychotherapists arrives,
hypnotherapists will be left out in the cold. They will remain unregulated
professionals, with no GST relief and very little reimbursements from
the private health insurance market. What will be even worse is that many
of the regulated professions will be hanging their shingles out offering
hypnotherapy and the specialists in hypnosis - the hypnotherapits - will
be left high and dry.
A central
hypnotherapy council could be set up as a round table forum by industry
leaders with a representative from each association and school. It is
important for those industry leaders to realise that it takes many years
to organise a profession, so now would definitely be a good time to start
that initiative.
For those
in Australia who are solely hypnotherapists it would be good time to add
to your discipline via continuing professional development in psychology,
counselling, psychotherapy or nursing etc., and to also join one of the
large organisations to secure the future of your practice. It is important
to remember the way hypnotherapists have been purposefully and deliberately
left out of the loop in the UK by the UKCP and BACP. The presence of hypnotherapists
in the CAM market in Australia may not be strong enough to support regulation
via that route.
For those
beginning training in hypnotherapy it would be wise to work towards achieving
a postgraduate status in an additional health discipline of their choice
as well as the hypnotherapy training. It would also be advisable to be
a member of one of the larger healthcare organisations as well as perhaps
a smaller hypnotherapy-specific organisation.
Hypnosis
will always be used by the medical and psychological professions but the
title of hypnotherapist could wisely be reserved for those who have trained
specifically in that discipline. Should that title not be protected, in
years to come in Australia, many of the regulated disciplines, with little
more than a few hours training in hypnosis, will be practising hypnotherapy
and the hypnotherapists themselves will be relegated to the statues of
unregulated quackery.
Bibliography
Aldridge,
Sally, & Pollard, James. UKCP/BACP's Interim Report to the Department
of Health on Initial Mapping Project for Psychotherapy & Counselling.
UK 2005
http://www.mcfadz.fsnet.co.uk/therapy/reg/mapping_interim_report.pdf
Parker, Malcom
H, The regulation of complementary health: Sacrificing integrity?
MJA 2003; 179 (6): 316-318
http://www.mja.com.au/public/issues/179_06_150903/par10037_fm.html
New NSW complaints
law: Implementation of the Government Response to the recommendations
of the Expert Committee on Complementary Medicines in the Health System,
Progress Report. Australian Traditional Medicine Society, February
2006.
http://www.tga.gov.au/cm/cmresponse.htm
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http://psychcentral.com/archives/licensing.htm
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& Societies
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Traditional Medicine Society.
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And Counselling Federation of Australia
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Counselling Association
http://www.theaca.net.au/
Australian
Naturopathic Practitioners Association
http://www.anpa.asn.au/anpa_mambo/index.php
United Kingdom Council for Psychotherapy
http://www.psychotherapy.org.uk/
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http://www.bacp.co.uk/
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Sydney Morning Herald/February 2, 1995
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Australian Academy of Hypnosis, Australian Hypnosis Legislation Update
http://www.mindmotivations.com/article-3-hypnosis-legislation.shtml
NSW Review,
PACFA eNews, May 2006, ISSN.
http://www.pacfa.org.au/scripts/content.asp?pageid=NEWSLETTERPAGEID
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