Published in HypnosisAustralia, May 2006
By Dr Tracie O’Keefe DCH
Whether those practising hypnosis for therapeutic purposes and clinical hypnotherapy should be registered with the government is often a topic of conjecture in many countries. In Australia from time to time this becomes very poignant and controversial too. Different states have had different approaches in the past, restricting hypnosis to medical and psychological practitioners.
Some health professions in some states have to be registered with government registration boards such as medical practitioners, psychiatrists, psychologists, nurses, social workers and dentists. Hypnotherapists, psychotherapists and counsellors practising hypnosis, however, do not have to be legally registered with state registration boards. This has many disadvantages, both for the professions themselves and for the public in trying to find a suitably qualified professional to carry out hypnosis-related treatments.
It means that hypnotherapists, counsellors and psychotherapists at times can be seen to be slipping under the net of minimum requirements from training in that profession, since there is no government-required minimum. Other healthcare professionals such as doctors nurses, psychologists and dentists do have to have minimum training standards administered in their primary professions, even though at times it can be ad hoc from state to state.
There are many extremely highly trained hypnotherapists, psychotherapists and counsellors in Australia practising hypnotherapy and hypnosis to a very high standard. Unfortunately there are also some very badly trained and unmonitored practitioners who do damage as well as good work. Legally, however, there is no way of distinguishing between the two. Certainly, many well trained and highly qualified practitioners belong to private origanisations that vet and monitor their members very carefully. The problem is, however, that the public often cannot tell one organisation from another, and in moments of crisis, it is difficult for them to choose.
Training in hypnosis-related treatments for psychiatrists, psychologists, nurses and dentists can also suffer from the same problem because they rely on the registration of their primary discipline to authenticate themselves. Some are well trained in hypnosis and some are not but still practise because they think they are protected by the government registration of their primary discipline. Some of these practitioners may also belong to hypnosis-related associations as well as the associations concerned with their primary disciplines, some may not.
How big does a profession have to be to become registered with the government at state or federal level?
In reality a profession does not have to be that big in order for it to apply to a government to get it registered. When we enquired in spring 2005 in NSW the osteopaths registration board was the smallest with 508 members.
Who is registered and how long have they been registered?
Some of the NSW Government controlled Board Registered Health professions:
“Chiropractors Registration Board 2001 (previously Chiropractors and Osteopaths Act 1991)
“Dental Technicians Registration Board 1975
“Medical Board 1838
“Nurses Registration Board 1924
“Optical Dispensers Licensing Board 1963
“Optometrical Registration Board 1930/ 2002
“Osteopaths Registration Board 2001 (previously Chiropractors and Osteopaths Act 1991)
“Pharmacy Board 1964
“Physiotherapists Registration Board original Act 1945, latest 2001
“Podiatrists Registration Board 1989 (previously under Chiropodists Registration Act 1962)
“Psychologists Registration Board 1989/2001”
Registration varies dramatically from state to state and in some states registration boards are limited and sometimes poorly formed and resourced. It has to be remembered that as Australia formed, different kinds of people, with different belief systems, from different cultures settled in different parts of the country. Many state-based politicians also hate to be dictated to by parliament in Canberra. Also because we are a sparsely populated country compared with our geographical size, state governments often lean backwards to supply services in rural areas by less qualified persons, just so they can be seen to supply such services.
Sometimes there can be federal agreements between states about certain professions and minimum required qualifications and experience for registration. Other times there are registration mechanisms and boards in one state but not in another. Registration or licensing of occupations is administered under the laws of state and territory governments.
The Board Registration Process
As an example the Psychologists Registration Board was established in 1989 in NSW following the enactment of the Psychologists Act of the same year. The introduction of this legislation was the result of many years of lobbying successive NSW state governments. NSW was the second-last jurisdiction to gain registration for psychologists in Australia, the last being the Australian Capital Territory. The 1989 Act has since been replaced by the Psychologists Act 2001.
The Board was established to provide a method of protecting the public from unqualified persons practising psychology and to provide an avenue of complaint against registered practitioners. The Psychologists Act allows the Board to determine minimum standards for the education and training of psychologists so that the public can be confident that persons using the title ‘psychologist’ hold these qualifications.
Previously the only form of vetting of qualifications of psychologists lay with the Australian Psychological Society, the peak national body for this profession. The society maintains a strong membership; however, this continues to be a matter of choice. Registration must be held by a practitioner in order to legally use the title ‘psychologist’.
The Board also concerns itself with the provisions of the Health Care Complaints Act, the Mutual Recognition Act and the Freedom of Information Act.
The following Acts and Regulations will be of interest:
“Psychologists Act 2001
“Psychologists Regulations 2002
“Mutual Recognition (New South Wales Act) 1992
“Trans-Tasman Mutual Recognition (New South Wales Act) 1996
“Health Care Complaints Act 1993”
Who is responsible for registering a profession?
The short answer is the profession themselves in that registration often only happens after the profession has continually lobbied state and federal government for years to get an act of Parliament passed to protect the right to use a professional title, state by state. Since Australia works on the common law system, a practitioner can call themselves a man in the moon therapist until such time as the right to use that title is government controlled through registration boards. Excellence is generally primarily controlled through peak professional bodies until such times as acts of Parliament say otherwise.
What are peak bodies for hypnotherapy?
At the moment in Australia there is a hotch potch of self-accredited associations representing hypnotherapists with wildly varying standards of training and experience required for membership. While those boards and membership may often have genuine intention, and even high standards, in reality the government, the public or other healthcare professionals cannot tell them apart. This does neither the profession of hypnotherapy nor the public at large any good whatsoever because it leads to ever decreasing circles of confusion. The truth is anyone can call themselves a hypnotherapist without any training whatsoever, which makes a mockery of those therapists who have trained for years and remain monitored through their professional careers.
For those healthcare professionals who practise hypnosis-related activities as a co-joint part of their primary disciplines it is the responsibility of those primary discipline organisations to ensure that their members are operating with sufficient training and monitoring in hypnotic skills.
If registration was a possibility who would do the lobbying?
The question of registration is so big that there needs to be a co-ordinated campaign, set of lobbying strategies and collective goals present within a profession to make it happen. There is no body large enough or sufficiently collectively representative of hypnotherapists in Australia to make that happen at the moment.
The fracturing of the profession of hypnotherapy means that different factions have divided themselves up to attach themselves to various interdisciplinary lobbying groups. Some organisations have attached themselves to counsellors and psychotherapists (eg PACFA), some to purely counsellors (eg ACA), and some to complementary, alternative, and traditional health and medicine groups (eg ATMS). Some groups of hypnotherapists have stayed separate from other’s disciplines, believing in the purity and need for separateness of the profession of hypnotherapy. Further groups have not hitched their associations to any larger groups of therapists because they would not meet those standards. Furthermore are hypnotherapists who belong to no professional groups at all, have no recognised training and sometimes no professional indemnity insurance.
Certainly when it comes to lobbying state or federal governments to register a profession the only two things that count are numbers and collectives. Governments do not have the time, interest or patience to deal with fragmented and argumentative professions who cannot decide standards among themselves.
What about the use of umbrella organisations and collective labelling?
One thing is for certain with all of hypnotherapy is that the profession does not want to lose its identity if it moves, at any time, towards registration. Hypnotherapy is a separate profession from counselling and psychotherapy, even though practitioners may be multiply trained in different therapies. To lose that title of hypnotherapist would be counterproductive.
The strongest and quickest way to get hypnotherapy registered as a profession would be to go into registration under a collective bill state by state with an added bill for interstate recognition. Joining disciplines together under a collective therapists’ bill would be ideal, just as the chiropractors and the osteopaths did when they were first registered. Later a second set of bills divided those professions and recognised them as separate professions. It was, however, numbers and collectives that got them registered in the first place.
Who is really a hypnotherapist?
Since hypnosis is sometimes indefinable, there is a need to define what constitutes a hypnotherapist in any legislation and what constitutes a the level of training and recognition needed to be able to use the tile of hypnoptherapist. The title hypnotherapist would need to be protected in law, just as medical doctor, dentist, nurse or chiropractor.
Objections and Reservations
Would control of the title of “hypnotherapist” benefit or enhance hypnotherapy services accessed by the public?
Yes because then the public would be assured of minimum standards of care.
Would it deprive those making living as a hypnotherapist who do not belong to any professional association?
Yes but since hypnotherapy deals with psychological and physical problems in general clinical practice, the public has a right to minimum standards of care.
Does the public need to be protected?
Professions that deal with such powerful tools as hypnosis need to be responsible and self-regulating. Self-regulation is not only a good precursor to government registration it is also a necessary adjacent mechanism in healthcare. The people of Australia cannot be guaranteed either of those two minimum standards of care at the moment.
Hypnotherapy is a complex set of skills that impact on people’s physical, mental, social and spiritual health and wellbeing. They have a right to be protected from improperly trained and poorly monitored practitioners.
Who would lose out through registration?
One of the problems in hypnotherapy is that many groups of hypnotherapists are often personality-led. Should the profession move towards registration, many of those personalities would have to stand aside and for them it would mean a loss of prestige and income.
Would there be less access for the public to consult hypnotherapists directly?
In England the public can consult hypnotherapists that are registered members of the UKCP (hypnotherapy section) and the BACP and get those services paid for by the NHS (equivalent to Medicare), once they have been referred by their GP. They can further get hypnotherapy from a medical practitioner or psychologist once again paid for by the NHS. They can also consult those hypnotherapists privately without a referral.
It can get more complicated, however, in some other countries were many referrals can only be made by GPs.
The public in Australia would need to retain the right to consult a hypnotherapist privately without a referral. It is likely, however, that should hypnotherapy become available by Medicare, the country’s national health service, that a patient would need to be referred by a GP to get Medicare refunds for hypnotherapy services by a registered hypnotherapist.
Conclusions and Recommendations
At the moment there are no official training standards or monitoring of hypnotherapists in Australia. There are groups, often very large, of interdisciplinary therapy professionals who have hypnotherapy sections within their organisation that require high standards of training and monitoring. Those, however, are very limited protection for the public because they are voluntary organisations for hypnotherapists that only operate self-regulation that is ultimately optional.
Moving toward registration of the profession of clinical hypnotherapy with state and federal authorities would give the profession of hypnotherapy more credence and respect. It would also help to protect the public from unscrupulous and ill-trained operators that are currently offering services throughout Australia. Registration would also help clients have better access to private insurance rebates because the insurance companies would be better informed about who was a registered practitioner of hypnotherapy. It would strengthen the argument for the exemption from charging GST for hypnotherapy services. There may even be the possibility that clinical hypnotherapy could be applied for through the Medicare system.
According to Iain Martin, principal legal officer (Legislation), Legal Branch, NSW Department of Health:
“In 1995 the Australian Health Ministers Advisory Council (AHMAC) agreed that for a particular occupation to be regulated by a formal statutory registration scheme the following six criteria must be addressed and answered in the affirmative:
1. Is it appropriate for Health Ministers to exercise responsibility
for regulating the occupation in question, or does the occupation more
appropriately fall within the domain of another Ministry?
2. Do the activities of the occupation pose a significant risk of harm
to the health and safety of the public?
3. Do existing regulatory or other mechanisms fail to address health
and safety issues?
4. Is regulation possible to implement for the occupation in
5. Is regulation practical to implement for the occupation in
6. Do the benefits to the public of regulation clearly outweigh the
potential negative impact of such regulation?
Any individual, group of individuals or professional body can approach
a Minister or AHMAC proposing statutory regulation for an occupational
Hypnotherapy associations need to be more open and communicate with each other about the kind of standards that would be acceptable for the whole profession. There is a need for associations to appoint an officer to communicate about standards to other organisations and form stronger links with other organisations. Hypnotherapy organisations need to keep an open mind about the ideas of registration of the profession of hypnotherapy and protection by registration of the title “clinical hypnotherapist”.
Copies of New South Wales legislation, including the various Acts and Regulations, may be obtained from: NSW Government Information Service Corner of Hunter and Elizabeth Streets, Sydney or 130 George Street, Parramatta or PO Box 258, Regents Park NSW 2143 or Phone (02) 9238 0950 or Toll-Free 1800 463 955 (NSW rural areas only). To find other legislation on-line, visit either the Australasian Legal Information Institute or www.legislation.nsw.gov.au (NSW legislation only).
ACA: Australian Counselling Association.
ATMS: Australian Traditional Medicine Society.
BACP: British Association of Counsellors & Psychotherapists.
GST: General Services Tax (Australian goods and services tax: 10% at point of purchase on hypnotherapy).
NHS: National Health Service (UK).
PACFA: Counselling and Psychotherapists Federation of Australia.
UKCP: United Kingdom Council of Psychotherapists.