In this essay, I will outline my own ideas about hypnotherapy which will form the foundation of my private practice. Firstly, I will explain my background, values, and beliefs which will affect my practice. Then, I will describe the integrative approach to therapy I will take incorporating elements from humanistic therapy, cognitive-behavioural therapy (CBT), and psychodynamic approaches which I will combine with transformational hypnotherapy. I will explain my reasons and give evidence for my stance. It will be argued that integrative practice is the approach most likely to help the majority of clients with varying issues. I will then explore the argument taken by the NHS that cognitive-behavioural therapy is all that is necessary for modern psychotherapeutic treatment and find reasons to reject this argument.
Firstly, it is necessary for me to explain my own background as it is important for a therapist to work in a way which is comfortable for them and in line with their belief systems (Corey, 2001). This gives the therapist authenticity. I have a fairly academic background. My first degree was an MA in Philosophy which gave me a life long interest in ideas and the ‘big questions’ about the meaning of life and the nature of reality. I have a second degree which is a BSc in Psychology which was very science based and concerned with evidence. It was not particularly relevant to therapy. I am currently undertaking an MSc in Psychology which is concentrating on research methods and again is not particularly focused on therapy. This educational experience has given me the tendency to look for evidence to support the claims of different modalities but at the same time to be aware of the flawed nature of much evidence in psychology. I have had a long career in teaching which has given me a practical insight into human nature. I ended my career prematurely due to inability to cope with prolonged stress which also led to bouts of depression. This experience gave me an interest in mental health and I have received CBT, counselling and transformational hypnotherapy which have all helped me to manage my mental health. I sought training in hypnotherapy as I wished to help others who were undergoing similar issues to me. I have a particular interest in anxiety and depression. Recently, I became a Christian and before that I was a practising Buddhist. I now blend these two belief systems and think of myself as a Christian Buddhist. I have a daily spiritual practice and spirituality is an important part of my life and gives me meaning. My education, spiritual life, and life experience have informed my values. I believe that the purpose of life is to develop yourself as much as possible, to self-actualise, and then to help others by sharing your skills and knowledge. I am motivated by the values of kindness and compassion and I would like to see a more spiritual, caring society. I see therapy as a way of helping people with their life problems so enabling them to live more fulfilling lives and reach their personal potential. I would not wish to impose my spiritual beliefs on anyone but if it was wished by the client, he or she could find a safe space to explore these issues.
Contemplating my life story has led me to embrace some of the humanistic tradition in psychotherapy, particularly the ideas of Maslow (1993, cited in Joseph, 2010) and Rogers (1959, cited in Joseph 2010). I feel that the transpersonal approach to psychology, emphasising spiritual experience, is the one to which I feel most attracted. Rogers (1980, cited in Joseph, 2010) wrote that he felt he was most effective as a therapist when his inner spirit reached out and touched the inner spirit of another. The relationship transcends itself and becomes part of a larger phenomenon enabling deep growth and healing. Maslow (1968, cited in Joseph 2010) developed the idea of a hierarchy of needs beginning with physiological needs such as food and water and ending with self-actualization where individuals are self-directed, creative, and independent and are willing to try to understand other people’s point of view and are open to new experiences. Such experiences could be what Maslow calls ‘peak experiences’ which transcend ordinary human consciousness and can be spiritual in nature: beyond the person. The transpersonal approach also draws on the work of Jung (1957, cited in Joseph, 2010) who developed the idea of a collective unconscious that exists beyond the boundaries of space and time and reflects a cosmic intelligence. The collective unconscious provides an inner wisdom for healing. Some transpersonal notions have much in common with Buddhism as individuals come to an understanding that there is no real self. Clients can undergo a transformation where their current way of seeing the world is shattered and they realise the unity of all things (Wilber, 1998, cited in Joseph, 2010). Meditation techniques can form part of transpersonal approaches. The therapist is co-operating with the client to allow inner healing to take place. Transpersonal therapists are not much concerned with scientific evidence and it can be argued that their approach is difficult to research effectively. However, there is some research that suggests that humanistic approaches are just as effective as other forms of therapy (Grof, 2007). In spite of my enthusiasm for the transpersonal approach I am aware it will not be appropriate for all clients which is why I intend to practice therapy in an integrative way with the transpersonal approach underlying my broader range of techniques.
I am drawn to the integrative approach as much of the research into the effectiveness of psychotherapy has emphasised the importance of common factors between therapies. Ablon and Jones (2010) have shown that in practice skilled, experienced therapists integrate techniques belonging to several approaches, adapting to the individual needs of their patients. A positive relationship between the therapist and patient is of paramount importance in the success of the treatment. This is known as the therapeutic alliance (Grencavage and Norcross, 1990). It has also been suggested that successful treatment may depend on various non-specific therapeutic factors: the confidence of the therapist in the treatment, the patient’s perception of the therapist as skilled and confident, a patient’s expectation that the treatment will be successful, characteristics of the patient such as commitment to therapy, being able to formulate problems and a willingness to challenge themselves (Wampold, 2015), (Cuijpers, 2013), (Ablon and Marci, 2004). The genuine interest of the counsellor in improving another person’s quality of life is vital (Schneider and Langle, 2012). It is likely that it is these mechanisms of change that predict the success of psychotherapeutic treatment, rather than the type of therapy that is utilised. As a result of these findings, I intend to work on creating a strong therapeutic alliance where I collaborate with the client to find solutions to their issues. I also intend to incorporate Rogers’ core conditions from person centred therapy: congruence, empathy and unconditional positive regard (Rogers, 1959, cited in Joseph, 2010). Congruence means the therapist is being his or her real self which is also close to his or her idealised self and he or she is integrated into the relationship with the client. Empathy means the therapist understands the client’s feelings. Unconditional positive regard means that the therapist will accept and support the client whatever he or she does or says. There is a real warmth and respect in the relationship.
Some clients’ issues may not be suitable for humanistic therapy so I will also make use of cognitive-behavioural techniques (CBT). The therapy focuses on the present rather than the past, and on changing negative patterns of thinking and behaviour (Joseph, 2010). Theoretically, CBT is rooted in behaviourism. Behaviourists believed that only observable, measurable, outward behaviour was worthy of scientific inquiry (Skinner, 1974, cited in Joseph, 2010). This theory was further developed by Beck (1976, cited in House and Loewenthal, 2008), who added a cognitive element. My reason for choosing CBT is that it has an impressive evidence base in research which suggests it is as good as or superior to other psychotherapies (Barth, Munder, Gerger, Nuesch, Trelle, Znoj and Cuiijpers, 2013), (Cuijpers, van Straten, Andersson, and van Oppen, 2008), (King, 2007), (Elkin, Shea, Watkins, Imber, Sotsky, Collins and Parloff, 1989). The approach is appropriate for clients who want fast solutions to their presenting issues and don’t wish for greater self-knowledge, spiritual development or to revisit the past.
The third approach I will integrate into my psychotherapy practice is psychodynamic therapy. There is great emphasis placed on the relationship between the patient and the therapist (Joseph, 2010). This has the advantage of giving primacy to the interactions between the two, which can be analysed in the course of the dialogue, thus finding solutions. However, this emphasis has raised criticisms. Unethical practitioners have abused the therapeutic relationship with its inherent power imbalance and there have been cases of sexual abuse of patients and other humiliating experiences (Masson, 1992). There is a focus on defence mechanisms and transference of issues from the past onto the counsellor. The emphasis is on the unconscious mind and early childhood experiences. At its best, the patient and therapist form an equal partnership, where the patient makes a breakthrough by working through issues from the past, bringing the unconscious causes of behaviour into conscious awareness and thus relieving current symptoms and empowering the patient (Joseph, 2010). This emphasis on the past has been criticised, as some therapists have been accused of unwittingly planting false memories in patients, particularly of sexual abuse, which can seriously harm people (Masson, 1992). Psychodynamic therapy is grounded in the work of Freud, (1901, cited in Joseph 2010) which gives it a firm theoretical basis and long history (Milton 2008, cited in House and Loewenthal, 2008). Freud developed psychoanalysis from a small series of case studies of his patients in Vienna. He believed that human behaviour has its origins in the unconscious mind, which is full of irrational, conflicting needs. In recent times, Freud’s ideas have been heavily criticised as they are based on studies of a limited number of people and they lack empirical evidence (Eysenck and Wilson, 1973, cited in Joseph, 2010). The cultural values of Edwardian Austria may not apply across the world. In spite of these criticisms, psychodynamic therapy has a strong evidence base, particularly for depression (Shedler, 2010). I choose to integrate elements of this approach in my practice as it will be suitable for clients who wish to revisit the past due to traumatic experiences. Modern psychodynamic therapy can be delivered in relatively short time frames such as 10-16 sessions. I am drawn to this approach more than CBT as I have found revisiting the past has been helpful to me in my own personal therapy so I believe it will help others.
Finally, the fourth approach which will be an important part of my practice is transformative hypnotherapy. I was very impressed on the course with the work of Boyne (2018) as he could produce real change in a short period of time by revisiting traumatic events in the past and giving new more helpful ways of regarding them and new ways of living after the release of emotion from dealing with the past. I have had personal transformative therapy recently from Peer (2018) who has developed her own version and I found it very helpful to me. I would like to incorporate this into my own practice as well as using techniques from Milton Erickson (Rosen, 1982) such as hypnotic language and the use of stories and metaphor. I also wish to use the technique of guided imagery which has its roots in the work of Jung (1957, cited in Joseph, 2010) as I have seen the powerful, transforming effect of this method and I find Jung to have spiritual values which are similar to my own. There is a growing body of research which finds hypnotherapy is useful for a great many issues, even physical medical issues such as IBS especially when it is combined with psychotherapy (Kraft and Kraft, 2007).
There is a school of thought that only one therapeutic modality should be used, particularly by beginning practitioners, as the therapist needs a firm grounding in one technique and cannot hope to be expert in all therapies (Corey, 2001). Following this line, the NHS has decided that CBT is now virtually the only therapy it offers due to its strong evidence base and its value for money and speed (NICE, 2018). While I have some sympathy for this view I do not believe that CBT is appropriate for every person and every issue. It is far too reductive in reducing complex human states to merely thoughts and behaviour while ignoring emotions, the social context, the past and the unconscious mind. One argument against CBT is that it is telling people how to think and reprogramming them in line with the expectations of society. ‘Faulty’ individuals are to be made to fit in with the current culture rather than attempting to change the culture. Thus, CBT is not counselling, but just a series of tools to ‘fix’ symptoms. As a result, this treatment does not address the underlying issues of the client (Woolfolk and Richardson, 2008, cited in House and Loewenthal, 2008). As a consequence, CBT therapy becomes a political act, aligning with governmental needs for a healthy workforce. CBT is offering a kind of sticking plaster to control the emotional and behavioural impact of a lack of meaning and spirituality, rather than addressing such existential concerns. Furthermore, it is possibly unethical, as it is imposing solutions, rather than being patient-led. There is a power imbalance between the counsellor and patient (Brazier 2008, cited in House and Loewenthal, 2008).
Effective, integrative therapy has been summed up by Paul (1967, cited in Corey, 2001) as: ‘What treatment by whom, is the most effective for this individual with that specific problem, and under which set of circumstances?’However, there is a problem theoretically that the approaches are incompatible. For example, the humanistic approach believes people are basically good while the psychodynamic approach points to darker, irrational drives suggesting people have evil within them. My own belief is that people are neither good or bad but a mixture of both so I don’t fully subscribe to either theory though I lean to the humanistic. I am taking a pragmatic approach and using what works from each therapeutic modality in order to maximise my ability to help clients.
In this essay I have revealed that I intend to take an integrative approach to therapy using techniques from humanistic traditions, CBT, psychodynamic therapy and transformative hypnotherapy. This approach is underpinned by my belief in the value of transpersonal therapy as an overarching concept which will guide my practice. This is in line with my beliefs and values and enables me to help a great many people in the most effective way for them. I have supported my philosophy with research evidence.
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