Influence or Ignorance: An Analysis of the influence of the Hypnotherapy National Occupational Standards on Hypnosis and Hypnotherapy Teaching and Learning, and Professionalism in the UK. Kathryn Beaven-Marks A thesis submitted in partial fulfilment of the requirements of the University of Greenwich for the degree of Doctor of Education March 2013 i DECLARATION I certify that this work has not been accepted in substance for any degree, and is not concurrently submitted for any degree other than the Doctorate in Education (EdD) being studied at the University of Greenwich. I also declare that this work is the result of my own investigations, except where otherwise identified by references and that I have not plagiarised the work of others. Student _______________________________ (signature) Supervisor_____________________________ (signature) Supervisor_____________________________ (signature) ii ACKNOWLEDGEMENTS It is with sincere appreciation that I offer my thanks to the staff at the University of Greenwich for their teaching, support and guidance throughout the time of this research. In particular, the inspiration from Neil, Francia, Bill, Anneyce and Shirley. My heartfelt thanks go to my friends, including Mike Griffiths, for teaching me how to navigate the world of statistics, together with Joe, Simon, Cherie, George, Ildiko and Cherry for their unwavering support! A special acknowledgement also goes to all those in the hypnosis and hypnotherapy profession, both in the UK and internationally, for their support and contributions during this project. Finally, I would like to recognise the writings of another teacher, whose work reminds me just how much our words can achieve. “…there has been implanted in us the power to persuade each other, and to make clear to each other whatever we desire, not only have we escaped the life of wild beasts, but we have come together and founded cities, and made laws, and invented arts; and generally speaking, there is no institution devised by man, which the power of speech has not helped us to establish….” Isocrates ‘The Antidosis’ iii ABSTRACT This thesis analyses the influence of the Hypnotherapy National Occupational Standards (H.NOS) on teaching and learning, and professionalism, amongst four groups: hypnosis and hypnotherapy practitioners, researchers, educators and professional organisations. H.NOS describe effective performance of a role, in terms of the knowledge, understanding and actions. The hypnotherapy profession has recently encountered voluntary regulation with the Complementary and Natural Healthcare Council. Practitioners whose training meets H.NOS are eligible for registration. In response to government initiatives, there is a progression towards professionalism of hypnotherapy, yet wide-spread review of the literature considered the lack of agreed definitions for hypnotherapy and hypnosis, despite a long history and diverse applications. There is little current research investigating any potential influence of the H.NOS, despite implications for current and future practice. Online quantitative questionnaires completed over a nine-month period assessed awareness of H.NOS and the consultation process, together with their influence on teaching and learning, professional bodies, competence and professionalism. Developed for this study and a unique contribution, the T.A.P. model (Thought, Action, Professionalism), was employed in the questionnaires, to enable respondents to classify their past training in relation to the model, where the H.NOS fits into the model, and where qualifications for practitioners and researchers would be located. Exploration and inferential analysis with chi-square tests and textual analysis of questionnaire comment boxes, indicated positive outcomes for both research questions regarding the influence of the H.NOS on teaching and learning, and the influence of H.NOS on professionalism. Original contributions to knowledge and practice comprise the T.A.P. model; the review of a diverse range of literature, and the unique survey and resulting data analysis, together with a range of planned and potential disseminations. Future directions for research include greater research following raising of H.NOS awareness, together with deeper exploration of the potential of the T.A.P. model and surveying practitioners about engagement in research. Recommendations are for an increase in awareness of H.NOS, more access for practitioners to research, and for an externally verified Hypnotherapy National Vocational Qualification for all using hypnosis, undertaken prior to specialisation. iv CONTENTS Title page i Declaration ii Acknowledgements iii Abstract iv Contents v Figures viii Abbreviations x 1. Introduction chapter 1 1.1. Introduction 1 1.2. Background 2 1.3. Professional significance 6 1.4. Focus of previous studies 7 1.5. The journey 8 1.6. Aims and objectives: The research questions 10 1.7. Professional context 11 1.8. Originality 12 1.9. Introduction summary 13 2. Review of Literature chapter 14 2.1. Introduction 14 2.2. Definitions, historical overview and current understanding 15 2.3. Research, applications and modes of practice 30 2.4. Legislation, Regulation, Standards, Curriculum, Training 48 2.5. Assessment of practice 88 2.6. Professionalising hypnotherapy 95 2.7. Review of Literature summary 106 3. The T.A.P. Model chapter 108 3.1. Introduction 108 3.2. Rationale and development of the T.A.P. model 108 3.3. The T.A.P. model 116 3.4. The T.A.P. model and H.NOS 119 3.5. Use of T.A.P. model within this study 120 3.6. Hypnotherapy applications for the T.A.P. model 121 3.7. The T.A.P. model summary 122 v 4. Methodology chapter 123 4.1. Introduction 123 4.2. Research paradigm 125 4.3. Research methods 127 4.4. Survey research approach 128 4.5. Rigour, reliability and validity 134 4.6. Participants 137 4.7. Materials 140 4.8. Procedure 142 4.9. Data management 143 4.10. Research ethics 144 4.11. Methodology summary 147 5. Data Analysis chapter 148 5.1. Introduction 148 5.2. Influence of the H.NOS on teaching and learning 151 – Research Question No.1 5.3. Influence of H.NOS and professionalism 171 – Research Question No.2 5.4. Participant characteristics 192 5.5. Overview of a selection of respondents from each group 203 6. Discussion chapter 209 6.1. Introduction 209 6.2. Key findings 210 6.3. Reflections on the introduction and literature review 216 6.4. Methodological issues 221 6.5. Discussion summary 225 7. Conclusions and recommendations 228 7.1. Aims and objectives 228 7.2. Research questions 228 7.3. Findings in relation to the research questions 228 7.4. Findings in relation to the literature 228 7.5. Original contributions to knowledge, practice and dissemination 231 7.6. Personal development 233 7.7. Limitations of the research 233 7.8. Future research directions 234 7.9. Recommendations 234 7.10.Final conclusions 237 vi References 239 Appendices 275 A1 A simple guide to hypnosis theories 275 A2 CNH1 282 A3 CNH2 285 A4 Good Practice Guide 287 A5 CNH23 288 A6 T.A.P. Model 291 A7 H.NOS mapped to T.A.P. model 292 A8 Request for participation 298 A9 Ethics application 299 A10 Ethics approval 318 A11 Call for participation 319 A12 Participant information sheet 320 A13 Practitioner questionnaire 322 A14 Researcher questionnaire 335 A15 Educator questionnaire 348 A16 Professional body questionnaire 362 vii LIST OF FIGURES Figure 2.1 Atherton’s approaches to Curriculum 74 Figure 2.2 Dimensions of practice 94 Table 2.3 Is hypnotherapy a profession? Professional attributes and the 100 hypnotherapy sector Figure 5.1 Distribution of ages with normal distribution curve 150 Figure 5.2 H.NOS influence on training: Design and content 153 Figure 5.3 H.NOS influence on training: Provision and how taught 153 Figure 5.4 H.NOS influence on training: Student learning 153 Figure 5.5 Awareness of H.NOS and influence design and content 154 frequencies of response Figure 5.6 Awareness of H.NOS and influence on provision and how taught 155 frequencies of response Figure 5.7 Awareness of H.NOS and influence on student learning 156 frequencies of response Figure 5.8 Training met H.NOS (all groups) 158 Figure 5.9 Importance of initial training meeting H.NOS 159 Figure 5.10 Importance of practitioner training meeting H.NOS 160 Figure 5.11 Importance of advanced training meeting H.NOS 160 Figure 5.12 Importance of specialist training meeting H.NOS 161 Figure 5.13 Importance of CPD training meeting H.NOS 161 Figure 5.14 Awareness of H.NOS and the importance of initial training 162 meeting H.NOS frequencies of response Figure 5.15 Awareness of H.NOS and the importance of practitioner training 163 meeting H.NOS frequencies of response Figure 5.16 Awareness of H.NOS and the importance of advanced training 164 meeting H.NOS frequencies of response Figure 5.17 Awareness of H.NOS and the importance of specialist training 165 meeting H.NOS frequencies of response Figure 5.18 Awareness of H.NOS and the importance of CPD training 166 meeting H.NOS frequencies of response viii Figure 5.19 Professional body and educator use of H. NOS as criteria for 168 standards and training Figure 5.20 Professional body and educator training actions in response to 169 H.NOS Figure 5.21 H.NOS influence upon perception of professionalism 173 Figure 5.22 H.NOS influence upon extent of professionalism 173 Figure 5.23 Awareness of H.NOS and the influence of H.NOS on the 174 perception of professionalism frequencies of response Figure 5.24 Awareness of H.NOS and the influence of H.NOS on the extent 175 of professionalism frequencies of response Figure 5.25 H.NOS influence upon professional competence standards in the 177 UK Figure 5.26 Awareness of H.NOS and influence of H.NOS on professional 178 competence standards in the UK frequencies of response Figure 5.27 Group professional competence standards perceptions 180 Figure 5.28 Comparison of professional competence standards 180 Figure 5.29 Professional body changes to training criteria in response to 182 H.NOS Figure 5.30 Awareness of changes to professional standards and action taken 184 Figure 5.31 H.NOS relevance to hypnosis / hypnotherapy research 185 Figure 5.32 Group perceptions for T.A.P.