To correctly address this question I may refer to the code of ethics of the GHR, where under the welfare section it describes in detail what constitutes the confidentiality agreement and how this needs to be articulated to the client to avoid any problems.

Particular attention and time need to be dedicated explaining to the client the principle behind the confidentiality agreement. It is the therapist’s responsibility to make the client aware of the limitations of the patient therapist confidentiality boundaries. For example, if the client has suicidal tendencies, expresses thoughts or desire of self-harming, confidentiality must be breached and the competent authority, or qualified personnel who have the skills to deal with those cases must be notified. It is good practise to stipulate a written therapy contract with the client right at the start. Some of the hypnotherapy bodies require the inclusion of a clause on confidentiality in the therapy contract, in accordance with their code of ethics. 

Another important factor to note is that there must be a conscious effort from the therapist to securely store any notes, assessment, and treatment plans. All reports in paper or electronic form must be used and stored in accordance with the terms of the Data Protection Act. It is also advisable not to add the full name in any report, but just use the client’s initials as a reference. It is important to make the client aware that sometimes the case details can be shared with other colleagues or supervisors for various reason, and that anonymity will be maintained, but also in these cases the consent must be obtained prior to disclosure. The therapist should receive written permission prior to starting any type of session recording.

If the client is perceived to be a threat to others, especially children, or the community at large the therapist has the responsibility to breach confidentiality and notify the authority. If at any stages of the therapy any of these thresholds are reached, then the situation and any repercussions need to be discussed with the client before proceeding. To give some context, if a client discloses he regularly gets beaten up, but asks me not to inform the police, then I’m not allowed to breach confidentiality, unless there are children closely involved that might get harmed.

Other cases when the confidentiality needs to be breached are when its access is requested via a court order. Although there are exceptions, where for example the parents of a minor request via a court order the disclosure of the delicate information. In this case the therapist can refuse its access if he deems that the information will harm the client’s health and safety. If uncertain on how to act in a situation that sits on a grey area it is advisable to call the insurance company you subscribe to, before breaking confidentiality and ask a medical lawyer how to proceed.

Maintaining confidentiality might be problematic at times for either the client or the therapist. In the client’s case they might not be fully open and therefore disclose valuable information after been informed of the details of the confidentiality agreement. The therapist on the other hand, even though there is no risk of harm to anyone, might find the information shared with him to be immoral and might break the working relationship and the ability to conduct a successful therapy. There is also the risk the therapist has his life threaten by one of the clients if he decides to disclose information.

There are several implications of the main laws that affect and govern the practice of hypnotherapy. To perform Stage Hypnosis for example, it is of particular importance the Hypnosis Act 1952 that provide guidance for local authorities exercising their licensing responsibilities. For Hypnotherapists treating single clients the law imposes the exercise of duty of care that provide adequate standard for any client. Any injury, including psychiatric harm, can be seen as professional negligence, and therefore subject to civil action against the hypnotherapist. Adequate adherence to the professional bodies code of ethics can help safeguard the professional, by way of interpretation of the term “Duty of Care”.

The therapist, under the Health and Safety at Work Act and the Management of Health & Safety at Work Regulations, needs to provide the best duty of care in terms of safety for any visiting patient. They are required to run basic risk assessment checks of their premises. Risk assessment should also include risk of stress due to factors identified in the therapy room, or the premises used. So, it is a requirement to have a public liability insurance in place, but also private indemnity insurance to cover themselves from civil actions.

It Is part of Duty of Care to treat all people, including people with disabilities, as equals and not discriminate against them by not making reasonable adjustments to accommodate their needs. The Data protection act 1998 also governs the therapist’s practise by issuing guidelines on how to process all types of information obtained from each client. It gives explicit directions on how to manage and store all clients’ data in a written, or electronic format.

The preservation of confidentiality is also key for any hypnotherapist, so it is advisable to stipulate with the client a therapy contract that always contain a confidentiality clause. This should be put in place when therapy commences, stating the limitations associated with the confidentiality agreement. Although these can be overruled if the therapist thinks there is a potential harm either to the subject under therapy, to children, or to the wider community, to name just a few.

Prior to any disclosure of data or specific client information with peer groups, other groups, or any other person, it is vital to get full consent, preferably in writing.

Another aspect of Informed consent relates to the client being given the adequate knowledge of what the therapy will entail, and that they understand the implications associated with the agreement for a course of treatment using hypnosis. This is an integral part of the legal duty of care to our clients.

There is another important aspect to cater for when we analyse the way we should provide Duty of Care, and this can be seen in cases where the condition treated with hypnosis might be a consequence of a physical ailment. In this case, the therapist should investigate the history of the condition and ask about any ongoing treatment that is under a general practitioner’s supervision. Where this link is not established, either refer to their GP, or to another professional. Always inform the client of the potential connection between an untreated condition and the symptoms the client wants to solve via hypnotherapy. Care should also be used to avoid intensifying any depressed mood by, for example, the use of regression therapy, which usually involves reliving unhappy memories. It is part of our duty of care to investigate, counsel, and therefore maximise client welfare.

The idea behind the Behavioural therapy is that it helps the clients to modify their behaviours and habits. The hypnotherapist will work closely with the patients to agree on the appropriate course of action. Hypnotherapy techniques and hypnotic suggestions are then used to support and embed these behavioural changes. This model enables the clients to follow the changes after the treatment is over, and it is considered the less intrusive, and one of the first go-to approach taken by therapists.

By comparison, the cognitive hypnotherapy (CH) techniques focus less on behavioural changes, and more on changing the thoughts and beliefs related to those behaviours. With CH, clients can change their beliefs subconsciously by thinking about things differently.

Hypno-Analytic Therapy comes from the analytical school of psychotherapy and its main focus is to determine the “why” clients have problems, and “why they behave in a certain way”. The aim is to find the “root cause” of the issue, to help the clients respond differently to the origin of the problem. In other words, the clients shine a light into themselves with an intent to find the answers they need to solve problems. Sometimes the answers are inside of them, but they are not aware of the possibility they have already answers for their issues.

Then we have Ericksonian hypnotherapy, which uses ‘indirect suggestions’, storytelling/metaphors, and more ‘unconventional’ approaches to create changes in clients, whether on a behavioural, cognitive or even analytical level. This approach can be highly effective, but sometimes it has been controversial. This is based on the therapist’s innate ability to judge what type of intervention clients need. Ericksonian hypnotherapy can be thought of as a combination of many different therapeutic approaches, but in its simplest form it refers more to metaphors and indirect suggestions.

What all these different types of therapies have in common is that they address the changes required in the clients’ mind. The commonality is that they all need a working alliance to work, and they adopt hypnosis has a tool to embed the required changes into the clients’ mind, to achieve therapeutic success.

There are various therapeutic techniques used in CBT, we might use cognitive restructuring or reframing when people tend to over-generalise, or when they assume the worst will happen in certain life situations. The identification of negative patterns can help in these cases, before it all becomes a self-fulfilling prophecy, this approach works most times, but could also open a flood gate if the client is unable to recognise the existence of a positive outcome.

Exposure therapy is used to tackle fears and habits by a gradual exposure to the cause of the fears and anxiety. Small increments are essential in these cases and produce more confidence in the coping skills and reduces the level of vulnerability. If this exposure is exerted recklessly, it might produce the opposite effect with long term consequences.

Relaxation and stress management techniques are used to help lower stress. They consist of a series of deep breathing exercises, muscle relaxation and imagery work, that with time can help clients to manage stressors such as phobias and social anxiety, to name just a few. If these techniques are not explained correctly to the clients, they might exacerbate their stressor, creating negative thoughts related to their perceived inability to learn or understand how to relax.

Neurosis and psychosis are two foundational concepts. Neurosis is when people recognise they have a problem. They might have a behavioural habit or perform a repetitive action that they cannot control. A classic example might be if they have a twitch. There is no biological reason why, but they cannot control it. That could be considered a neurotic problem.

There is an implication with neurosis that this may be driven in some way by an underlying problem and early life learning. It can be caused by a stressor of some sort, however there is also the possibility that the stressor that set up the problem has now gone away, but the problem has become habitual. This is a classic issue where the suffering patient has effectively one foot in and the other outside of reality.  They have a problem, they know they have a problem, but are unable to control it.

Psychosis by comparison, is when a person is out of touch with external reality, quite often it will be internally logical, but the client will be disconnected from the external world. So, to put this into prospective the subject has both feet outside of reality.

For Psychosis it is good practice to look for signs like, hallucinations, grandiose thinking, delusional thinking, rapid speech with resulting trailing off, loss of thought, etc.

These signs may signal the presence of psychosis, in which case the subject needs to be referred to a doctor. Neurosis is about the limit for treatment by a hypnotherapist.

There is some evidence to suggest that certain types of psychosis may have beneficial effects with therapy, but this type of work should only be undertaken by somebody who is specially trained, usually with a psychiatric background. Most of the hypnotherapists will stop at this point.

The major categories of anxiety disorder are phobias, posttraumatic stress disorders, obsessive compulsive disorders (OCD), Generalised anxiety disorders (GAD) and other anxiety disorders generated by medical condition, or by the use of induced substance.

Clinical hypnosis lends itself well as an adjunctive anxiety treatment modality. CBH treatment techniques such as imagery exposure, desensitisation, classical conditioning, and schema modification can all be incorporated within imagery visualization as hypnotic suggestions. Hypnosis can also be integrated with insight-oriented anxiety approaches, used to understand and work through the origins of anxiety symptoms. For example, hypnotic daydreaming is a way of generating natural projective ideas and images about the core needs, wishes, and fears of underlying anxiety.

The debate between State and Nonstate theory is still evident nowadays in modern therapy. The classic “State Theory” is based on a dissociation of patient control system, ultimately derived from Mesmer supernatural theory. The trance state is supported in this theory, where a subject is unable to represent itself in conscious awareness, as amnesic barriers are present. The hypnotic suggestion then works on the unconscious, the patient is aware of the results of the suggestions without knowing how they came about, or how they were applied. In other words, the suggestions of the therapist take the control away from the subject. In this state the alter state of consciousness of the client, while in trance, facilitate the responsiveness to suggestion. The hypnotherapist does all the work with no active participation from the subject. This theory also supports the idea that hypnosis can be dangerous and cannot be correlated to a placebo effect.

Contrary to this theory we have the more modern “Nonstate” view, where subjects are active “doers”, and they observe the suggested effects as an enactment rather than a happening to them. The client is doing most of the work under therapist supervision and guidelines, actively engaging the conscious mind while responding to suggestions. Non-state-based hypnosis is seen as something that can be learned, and any individual can increase their responsiveness with adequate skill training. So, there is no longer an altered state of consciousness that increase suggestibility, but a combination of motivation, social compliance, placebo effect, attitude, and expectations about hypnosis. As the subject is in full control, hypnosis is no more dangerous than any ordinary suggestions. Therefore, they can be ignored if not in line with person’s own beliefs. In other words, this can be compared to a non-deceptive mega placebo, somehow more powerful than other therapy, especially when combined with CBT.

Practically, for effective hypnotherapy, by bridging the gap between the two theories, we might have an answer to the debate. The two are somehow supporting each other, at some levels. If we analyse this closely, the client will produce responses which might look to be involuntary but are in fact a prior determined construct. In other words, a ‘hypnotic’ response is caused by the same process as a voluntary response, the only difference being in the patient’s experience. It has been acknowledged that the two theories of hypnosis tell part of the story, and the so called “phenomenon” is a combination of suggested responses together with a certain level of dissociated control.

Subjects respond to suggestions almost as well without hypnosis when they actively participate in the construct with positive thinking, attitude, and imagery, in support of the desired outcome. They will respond to suggestions, because they are motivated, have the right attitude, and built expectancy for their goal to materialise. They are ready for the changes. So, by means of suggestions, they are ready to alter their negative cognitions, which might have hindered their progress in the past. Non-state hypnosis is based on both a cognitive change, and social interaction, during which the hypnotist and subject come together to produce the hypnotic state.

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