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
Grohol, John M, PsyD. Why Don’t Current Psychotherapy Licensing Regulations Work? A Review and Suggestions for Change. March 1998; Reviewed: February 2004
http://psychcentral.com/archives/licensing.htm
Associations & Societies
Australian Traditional Medicine Society.
Psychotherapy And Counselling Federation of Australia
Australian 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
British Association for Counselling & Psychotherapy
http://www.bacp.co.uk/
Institute for Complementary Medicine
http://www.i-c-m.org.uk/
GUILLIATT, Richard Therapy in Turmoil: The Memory Controversy (part 2)
Sydney Morning Herald/February 2, 1995
http://www.rickross.com/reference/satanism/satanism75.html
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
Dr Tracie O’Keefe DCH, BHSc, ND, Clinical Hypnotherapist, Psychotherapist. Counsellor, PACFA registered Mental Health Professional and Naturopath In Sydney. You can get help by booking an appointment with her at Australian Health & Education Centre.
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