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1 This article was downloaded by: [University Of South Australia Library] On: 15 June 2015, At: 19:02 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: Registered office: Mortimer House, Mortimer Street, London W1T 3JH, UK International Journal of Mental Health Publication details, including instructions for authors and subscription information: Hypnosis Knowledge, Experience, Attitudes, and Beliefs among South Australian Psychologists, Counselors, and Physiotherapists Apoorva Madan a & Nadine Pelling a a School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, Australia Published online: 15 Jun Click for updates To cite this article: Apoorva Madan & Nadine Pelling (2015) Hypnosis Knowledge, Experience, Attitudes, and Beliefs among South Australian Psychologists, Counselors, and Physiotherapists, International Journal of Mental Health, 44:1-2, 11-32, DOI: / To link to this article: PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the Content ) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &

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3 International Journal of Mental Health, 44: 11 32, 2015 Copyright # Taylor & Francis Group, LLC ISSN: print/ online DOI: / Hypnosis Knowledge, Experience, Attitudes, and Beliefs among South Australian Psychologists, Counselors, and Physiotherapists Apoorva Madan* and Nadine Pelling School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, Australia Abstract: Various clinical health settings have benefited from the implementation of hypnosis, particularly when used in conjunction with other forms of therapy. However, commonly held misconceptions and negative attitudes toward hypnosis have resulted in its underutilization and misapplication by health professionals. Little research has been conducted on the attitudes and beliefs toward hypnosis held by health professionals in South Australia and its current use in therapy. This quantitative exploratory study investigated the current use of hypnosis, experience, knowledge, interest, and attitudes and beliefs toward hypnosis among three groups of health professionals in South Australia. A total of 121 Yellow Pages advertised psychologists, counselors, and physiotherapists completed the Valencia Scale on Attitudes and Beliefs toward Hypnosis-Therapist version (VSABH-T) via mail. Findings revealed that attitudes and beliefs toward hypnosis in the sample were generally positive. Using a one-way ANOVA, it was found that psychologists have significantly more positive attitudes and accurate beliefs than physiotherapists. Psychologists overall reported a higher level of knowledge, experience, and association with hypnosis. Knowledge was a significant predictor of positive attitudes and accurate beliefs, as revealed with the use of a multiple regression analysis. Currently, there is little use of clinical hypnosis by the sample, but an interest in acquiring more information about the technique was expressed. The study suggests that there is a growing interest in the use of hypnosis by South Australian health professionals, particularly counselors and physiotherapists, and, thus, a further need for education, training, and awareness of the benefits of clinical hypnosis and its application. Keywords attitudes; beliefs; clinical hypnosis; counselors; health professionals; knowledge; misconceptions; physiotherapists; psychologists; South Australia; training INTRODUCTION Hypnosis is a highly beneficial, yet underutilized, therapeutic technique [1, 2]. Much literature has supported the use of hypnosis in mental and general health contexts [2, 3]. It is a well-established approach in many clinical applications, such as pain management, medical treatment, treatment of anxiety disorders, and treatments of other psychological conditions, particularly when used in conjunction with psychological interventions [4]. *Clinical Psychology MA Student Address correspondence to Apoorva Madan, School of Psychology, Social Work and Social Policy, University of South Australia, St Bernards Road, Adelaide, SA 5072, Australia; madan_a@live.com

4 12 MADAN AND PELLING The purpose of hypnosis in therapy is to facilitate change through a focused state of attention. The South Australian Society of Hypnosis (SASH) defines hypnosis as a special state of focused attention used to enhance positive changes in mind and body [5]. Though there is no single agreed upon definition of hypnosis, some believe it to be an altered state of consciousness while others liken the experience of hypnosis to everyday activities such as being absorbed in a book or driving, a perspective that designates the phenomenon as a natural state [6]. Regardless of how hypnosis is conceptualized, fundamental to its success in health care is an emphasis on recognizing its efficacy and potential and identifying where it may be advantageous to implement the technique in therapy. Despite extensive empirical support for the efficacy of clinical hypnosis, common misconceptions and negative attitudes toward hypnosis within the general public and among health professionals have led to the underutilization and misapplication of the technique. These errors have consequences for both health professionals and their clients [7]. Myths are often perpetuated by media misrepresentations and false associations between hypnosis for entertainment (stage hypnosis) and clinical hypnosis [8]. Misconceptions and negative attitudes held by health professionals can potentially foster a dangerous therapeutic setting whereby therapists may engage in the iatrogenic use of hypnosis and greatly misguide clients. It is, therefore, essential that therapists are knowledgeable about clinical hypnosis and its potential, so they are able to inform clients that may benefit from the technique, facilitate successful treatment, and conduct themselves in a professional and well-informed manner that does not endanger client wellbeing. Professional Development and Deregulation Currently within Australia, numerous established organizations are involved in the education and training of hypnosis for health professionals as well as hypnotherapists. One of the largest of these organizations is the Australian Society of Hypnosis (ASH), which has state branches throughout Australia, including South Australia (The South Australian Society of Hypnosis [SASH]). ASH was formed in 1971 and is currently involved in providing direct training in hypnosis for any professionals who are registered with the Australian Health Practitioners Agency [9] as well as counselors listed in the Australian Register of Counsellors and Psychotherapists (ARCAP). Membership is open to a range of health professionals, including medical practitioners, dentists, nurses, midwives, optometrists, chiropractors, osteopaths, physiotherapists, psychologists, social workers, and speech pathologists. In July 2010, hypnosis was deregulated in South Australia by the Australian Health Ministers Advisory Council (AHMAC), following the establishment of the Australian Health Practitioner Regulation Agency and the creation of a National Psychology Board of Australia (M. Watson, personal communication, September 24, 2012). Prior to this date, hypnosis was regulated by legislation under the Psychological Practices Act 1973 (SA) [10], which restricted the practice of hypnosis to registered psychologists, medical practitioners, and dentists. Upon review, it was deemed that there was no evident risk of harm through the ill-use of hypnosis [11]. Literature in the field of hypnosis has, however, refuted such assertions [7, 12]. Certain misconceptions can influence the misapplication of hypnosis in therapy, which puts clients at risk. For example, health professionals commonly hold misconceptions about the nature of memory retrieval under hypnosis, believing that memories retrieved under hypnosis are more

5 HYPNOSIS AND SOUTH AUSTRALIAN PSYCHOLOGISTS 13 accurate and reliable than memories simply recalled [7, 13]. One study found that over 70 percent of participants indicated a belief that one can remember things under hypnosis that could not be remembered normally, and that one can be forced to tell the truth under hypnosis [14]. Practitioners who are unable to recognize, or who further perpetuate such fallacies, may invoke false expectations in clients [12]. Hypnotic sessions have the potential to lead to the retrieval of inaccurate memories or the formation of false memories, which can be harmful for clients, particularly if therapy content disclosed by clients is of a sensitive nature [7]. The deregulation of hypnosis means that no specific national board is able to receive or address reports of inappropriate conduct by health professionals and, hence, take action accordingly. Thus, the ethical application and competent use of hypnosis cannot be legally assured. The deregulation of hypnosis also has positive implications. The opportunity for various health professionals other than medical practitioners, psychologists, and dentists, to utilize clinical hypnosis now exists. Consequently, ASH and SASH have opened their membership to a broad range of practitioners [5], and in 2011, SASH began to train the first of the new members in its course (M. Watson, personal communication, September 24, 2012). Given the vast recognition of the benefits of hypnosis in a variety of health care settings, deregulation may prove to be highly advantageous for clients seeking therapy and, consequently, for health professionals who have the capacity to provide this form of therapy. With appropriate education and understanding of the current empirical literature concerning hypnosis, health professionals are able to make use of a beneficial clinical tool. Purpose of the Study The purpose of this study was to explore the attitudes and beliefs toward hypnosis held by psychologists, counselors, and physiotherapists in South Australia and compare and describe their involvement with the technique in terms of their knowledge, experience, training, and therapeutic utilization. To date, no published studies have examined the attitudes and beliefs of these Australian health professionals toward hypnosis. Given that hypnosis has been deregulated in many states in Australia, including South Australia, exploring the use of and perceptions toward hypnosis by practitioners in the country is an important area of research. Many studies conducted internationally have investigated the attitudes and beliefs of the general public [15], undergraduate students [13, 16], and a range of other health professionals [17 19]. International studies have shown that attitudes toward hypnosis do not vary to a great extent across countries [14]. However, Yu (2006) [19] has suggested that because of differences in education and conceptualizations of hypnosis across cultures, differences do, indeed, exist. One study investigated the attitudes and beliefs of students in four different countries, including Australia [14], and another study investigated the attitudes and beliefs of the adult general public in Brisbane, Australia [20]. As was predicted in both studies, results revealed a moderate to strong endorsement of some misconceptions about hypnosis, particularly the belief that hypnosis has the capacity to enhance memory and that subjects are unaware of their surroundings while under hypnosis. However, no research has investigated perceptions toward hypnosis in an Australian health professional sample. This study is the first, to our knowledge, to investigate the attitudes and beliefs of physiotherapists and counselors in particular and the first in South Australia since the deregulation of hypnosis.

6 14 MADAN AND PELLING Research Implications Given that little is known about the perceptions of South Australian health professionals in regard to hypnosis, this study s findings will have important practical and theoretical implications for the field. A broad understanding of the current use of hypnosis by health professionals will provide an idea of its current status and reputation in South Australia. An understanding of attitudes and beliefs, as well as knowledge and experience with hypnosis, provides an important process of identifying the likelihood of its misuse and iatrogenic use by ill-informed practitioners endorsing myth-based views. Thus, an understanding of perceptions can facilitate and inform education efforts toward the use of the technique where required, and/or efforts to increase awareness of the benefits of clinical hypnosis in cases where it may be underutilized. This is a major goal of SASH. Psychologists, counselors, and physiotherapists were of particular interest in this study. Historically, there has been a link between hypnosis and mental health treatment, as well as pain management [17]. These health professionals could, therefore, benefit from utilizing the tool of hypnosis in their work, and they are now in a position to do so in South Australia. Attitudes and beliefs are determinants of whether professionals choose to utilize hypnosis and how they apply the technique. Furthermore, they are also important in influencing the perceptions of clients and the wider public because of the significant role a therapist plays in portraying treatment options in health care [13]. Numerous studies have found that experience with hypnosis and knowledge about hypnosis are significant influential factors of positive attitudes and accurate beliefs, which consequently influence therapists motivation to use hypnosis [15 18, 21, 22]. Knowledge about hypnosis, however, should be based on up-to-date empirical literature, as opposed to unreliable sources such as television and stage shows, which are likely to further perpetuate myths and influence negative attitudes [17]. As there have been no studies conducted regarding the attitudes and beliefs toward hypnosis in a South Australian health professional sample, this study aims to investigate three major research questions: a) What is the involvement with hypnosis (in terms of training, use, knowledge, interest, and experience) of South Australian psychologists, counselors, and physiotherapists? b) What are the attitudes and beliefs toward hypnosis of these health professionals? c) Will attitudes and beliefs toward hypnosis differ between the three groups? Based on previous findings, it is expected that experience with hypnosis, greater of knowledge about hypnosis, and scientific or educational sources of knowledge about hypnosis will predict higher levels of positive attitudes and accurate beliefs. METHOD Participants One hundred and twenty one male and female registered health professionals from South Australia made up the total sample in the present study. Participants included 58 psychologists, 18 counselors, and 45 physiotherapists. Ages ranged from 24 to 75 years (M ¼ 50.81,

7 HYPNOSIS AND SOUTH AUSTRALIAN PSYCHOLOGISTS 15 SD ¼ 11.51). Participants were selected from the Yellow Pages via the World Wide Web, using the key terms psychologist, counselor, and physiotherapist in a search limited to South Australia [23]. All participants received the two-part questionnaire via postage. Participation was voluntary, and participants were not reimbursed. However, all individuals whose participation was requested were provided with free information about hypnosis (via a SASH brochure). Those who chose to participate could indicate if they would have liked to receive more information as well as a copy of the results of the study when completed. Measures and Materials Data were collected using a two-part questionnaire (Appendix A). The first section was designed to obtain demographic information about the participants as well as details regarding their knowledge about, and experience with, hypnosis. Questions relating to hypnosis were a mixture of closed, open ended, and scaling questions using a 7-point Likert scale: For example, How much do you know about hypnosis? where 1 ¼ Very little and 7 ¼ Very much. The second section obtained information about attitudes and beliefs toward hypnosis, using a preexisting scale, The Valencia Scale on Attitudes and Beliefs Toward Hypnosis Therapist Version (VSABH-T), developed by Capafons, Morales, Espejo, and Cabañas (2006) in Spain, but available in English [24]. The VSABH-T is an updated version of the Valencia Scale of Attitudes and Beliefs toward Hypnosis Client Version, modified for use with therapists [25]. The VSABH-T consists of an eight-factor structure comprising 37 items that are intended to measure general beliefs and attitudes toward hypnosis, based on common misconceptions. Factors include Fear (being, for example, under the control of the hypnotist or losing self-control under hypnosis), Memory (believing that under hypnosis individuals can access memories they could not otherwise recall), Help (describing hypnosis as a helpful technique), Control (indicating that hypnotized people have control of their actions), Collaboration (referring to the need for collaboration between the hypnotist and hypnotized individual in order to get hypnotic results), Interest (involving the interest that a person shows for hypnosis or being hypnotized), Magic (describing hypnosis as a magical solution to problems), and Marginal (indicating beliefs that hypnosis cannot be described through scientific research and that a hypnotized person has some abnormal characteristics). Responses are provided on a 6-point Likert-type scale in which participants rate their level of agreement with each statement, where 1 ¼ completely disagree, 2 ¼ disagree considerably, 3 ¼ disagree, 4 ¼ agree, 5 ¼ agree considerably, and 6 ¼ completely agree. High scores in the Help, Control, Collaboration, and Interest factors indicate positive attitudes and accurate beliefs (>24.5, >21, >10.5, and >10.5, respectively) while high scores in the Fear, Memory, Magic, and Marginal factors indicate negative attitudes and inaccurate beliefs, as indicated by percentage of items participants agreed or disagreed with in each factor (Table 5). Total scale scores were also calculated in the present study by negatively coding items belonging in the latter factors so that a high score on the scale (>129.5) indicated positive attitudes and accurate beliefs. An exploratory factor analysis of the VSABH-T was carried out in a previous study which revealed the 8-factor structure of the scale [24]. The study by Capafons et al. (2006) revealed that internal consistency for each of the eight factors was adequate and test-retest reliability was also sufficient [24]. A confirmatory factor analysis of the VSABH-T [3] revealed a further

8 16 MADAN AND PELLING statistical confirmation for the 8-factor structure. Each factor showed good internal consistency (>.8) and good reliability (.7 & above). However, factors Marginal, Magic, and Collaboration revealed lower test-retest reliability (r ¼.61,.50, and.62, respectively). Factors also correlate significantly with each other, except for Magic and Help. Overall, Capafons et al. (2008) confirm that the VSABH-T is a valid and reliable instrument in detecting attitudes and beliefs about hypnosis that are held by professionals [3, 4]. In the current study, however, the Cronbach alpha coefficients for the 8 factors were comparatively low, except for factors Help and Interest in which the internal consistency was quite high (>.9). Factors Fear, Control, and Collaboration were in the acceptable range (>.6); however, factors Memory, Magic, and Marginal revealed poor internal consistency (<.6). The overall scale, however, revealed good internal consistency (.92) in the current study. Inclusion and Exclusion Criteria Advertised practicing psychologists, counselors, and physiotherapists in South Australia who were individually identifiable and had a publicly available mailing address on the online Yellow Pages were included in the sample. Psychologists, counselors, and physiotherapists who were advertised under organizations and unable to be independently found for consultation through the Yellow Pages were not included in the study. Procedure Before commencing data collection, ethics approval was obtained for the research project from the University of South Australia s Human Research Ethics Committee. Data collection employed a multiple mailing survey method that had previously been found to increase response rates to surveys effectively [26, 27]. In June 2012, the Australian Yellow Pages was accessed via the World Wide Web [23]. Access was gained to a target population of 363 counselors, 458 psychologists, and 1,156 physiotherapists in South Australia. A sample of approximately 150 was required (50 per group), in order to provide sufficient power (.8) to detect a moderate effect (f ¼ 0.25) on attitudes and beliefs toward hypnosis at a significance level of a ¼ 0.05 [28]. Studies have found that average response rates of postal questionnaires can vary depending on various factors such as the length of the questionnaire, the level of sensitivity of the questions, and inclusion of stamped return envelopes [29]. The same multiple mailing technique had previously been found to achieve a 62.2 percent return rate [26], and short questionnaires (approximately four pages) have been found to result in a 48.7 percent return rate [30]. Puffer et al. (2004) also found no significant difference in response rates between single-sided and double-sided paged questionnaires and, therefore, recommended double-sided questionnaires for cost effectiveness. The questionnaire used in this study was fairly short in length (approximately four pages), double-sided, and did not include items of a sensitive nature [30]. A 50 percent return rate, therefore, was expected. Consequently, questionnaires were to be delivered to 300 participants (100 to each group) in anticipation of approximately 150 returns. Approximately every fifth psychologist and tenth physiotherapist with a publicly listed mailing address was selected from each of the target populations in the online Yellow Pages

9 HYPNOSIS AND SOUTH AUSTRALIAN PSYCHOLOGISTS 17 search listing. Each individually identifiable counselor was selected as there was an insufficient number of publicly advertised individual counselors. The selection procedure resulted in 277 individuals: 100 psychologists, 77 counselors, and 100 physiotherapists. Initially, participants were sent a postcard informing them of the study as well as the questionnaire that they would soon be receiving. After one week, the same sample received the initial questionnaire package. Two weeks after the package was sent, a postcard reminder was sent to those who had not completed the questionnaire. Two weeks after the reminders were sent out, a final questionnaire package was delivered to the remaining sample. The questionnaire package mailed to participants included an introductory information letter outlining the details of the study and its purpose, details about ethics approval and ethical concerns, contact information of researchers, and what participation involved. The two-part questionnaire, a flyer from SASH that provided further information to participants about hypnosis, and a stamped, self-addressed return envelope were also provided. Prenotifications, follow-ups, and inclusion of return envelopes have been found to increase response rates significantly [31 33]. In order to ensure no unnecessary additional deliveries, the return envelopes were numerically coded so that names could be removed from the mailing list once completed questionnaires were received. Envelopes also provided the option for participants to indicate whether they would like to receive results of the study, which was noted on the mailing list upon retrieval of the questionnaire. Questionnaires were immediately separated from the envelopes to maintain anonymity. The mailing list consisted of a table including details of the participant identification number, participant mailing details, whether questionnaire was deliverable or returned to sender, whether questionnaire was returned after initial delivery, reminder postcard delivery or final delivery, and whether the participant wished to receive results of the study. Design This study employed a quantitative, between subjects, exploratory design. Because of limited research into hypnosis and its therapeutic use by health professionals in South Australia, the study aimed to explore the current use of hypnosis and the knowledge, interest, experience, attitudes, and beliefs concerning hypnosis among the three groups. The professional groups were compared, and the sample as a whole was analyzed. Response Rate RESULTS Of the 277 sample members that were initially selected, 49 did not have a viable mailing address. Mail was undeliverable to these professionals, and no forwarding addresses were provided. Therefore, these professionals were inaccessible using the specified selection procedure. Out of these remaining 229 participants, 127 returned the questionnaires (N ¼ 127). This resulted in a 55.5 percent return rate. Sixty-four questionnaires were returned after the first questionnaire mailing (51.2%); 27 were returned after the postcard reminder (21.3%), and 37 were returned after the final questionnaire mailing (29.1%). Two of these were returned after the cut-off date for returns, however, and were excluded from the study. Of all the groups,

10 18 MADAN AND PELLING psychologists had the highest response rate; 62.6 percent versus 57 percent of physiotherapists and 30 percent of counselors. Data was collected over a four-week period. Data Screening Data were screened to check for outliers and missing values. There were no outliers in the data. For questions regarding experience with hypnosis, missing data occurred where questions did not apply to certain participants. For the scale measures (VSABH-T), missing data occurred where items were left blank, where participants indicated that they did not understand the item, or where two options on a single item were marked. Missing data appeared randomly distributed across different items and participants. Participants that did not have relevant information for specific statistical tests were excluded from the analyses. Demographic Characteristics The sample consisted of 37 males (30.6%) and 84 females (69.4%). Ages ranged from 24 to 75 years (M ¼ 50.81, SD ¼ 11.51). The average age for psychologists was years (SD ¼ 11.79); (SD ¼ 5.51) for counselors; and 46.2 (SD ¼ 10.83) for physiotherapists. There were more females than males in each group: 72.4 percent of psychologists were females, 83.3 percent of counselors, and 60 percent of physiotherapists. Professional identities were reported as 47.9 percent, psychologists (n ¼ 58); 14.9 percent, counselors (n ¼ 18); 37.2 percent, physiotherapists (n ¼ 45); and 3.2 percent identified themselves as other (n ¼ 4). Other professions were removed from the analyses. Six participants noted a dual profession; for example, meditation teacher was noted as an additional profession by a counselor, and one psychologist identified hypnotherapy as an additional profession. Professions that were relevant to the sample of interest were categorized into the three main groups of interest: psychologist, counselor, or physiotherapist. The majority of psychologists noted clinical psychology as their area of specialty while the most common area of specialty for physiotherapists was musculo-skeletal (35.6%). Counselors noted a variety of specialties including grief, relationship, developmental, occupational, and adolescent and child counseling. Of the highest level of education completed, 25.6 percent of the sample had attained a bachelor s degree; 12.4 percent, honors; 43 percent, master s,; 5.8 percent, doctorate; and 13.2 percent, other. Of the other categories, a graduate diploma was the most common level of education noted. The highest level of education attained most commonly for psychologists and counselors was master s (63.8% and 38.9%, respectively) and a bachelor s degree for physiotherapists (55.6%). The overall years participants were in professional practice or were registered ranged from 1 to 44 (M ¼ 50.84, SD ¼ 11.48). On average, physiotherapists had been in practice for a longer period of time, followed by psychologists and counselors (M ¼ 22.25, M ¼ 20.05, M ¼ 15.81, respectively). Experience and Knowledge Overall, 58.7 percent of the sample had reported yes to having been previously hypnotized, and 39.7 percent reported no. Within the professions, 89.5 percent of psychologists, 58.8 percent of counselors, and 22.2 percent of physiotherapists reported yes. One participant

11 HYPNOSIS AND SOUTH AUSTRALIAN PSYCHOLOGISTS 19 TABLE 1 Source of Hypnosis Information Information Source Frequencies (%) University training 23.1 Courses/workshops 41.3 Scientific journals 25.6 Reading other sources 40.5 TV 21.5 Other 36.4 Note: (Total N ¼ 121). claimed to be unsure. For psychologists, training was the most common reason for having been hypnotized. Other professionals commonly indicated personal reasons such as pain relief, smoking cessation, and stress relief. The average level of self-reported knowledge about hypnosis was 4.17 on a scale from 1 to 7 where 1 indicated little knowledge and 7 indicated a lot of knowledge (median ¼ 4, mode ¼ 2 and 5). The mean self-rated knowledge score for psychologists was 5.33, 3.69 for counselors, and 2.86 for physiotherapists. The most common source of information about hypnosis was courses and workshops, while the least common source was television (Table 1). Many indicated other sources of information, the most common being peer discussion (professionals, trainers, clients, friends, relatives, colleagues, and other individuals who had some form of experience with hypnosis). Some indicated personal experience as a common source, from either having been hypnotized or from having attended training courses. Overall, educational sources of information, such as university training, courses/workshops, and scientific journals, were more common than other sources, such as television, reading other sources, and peer discussion (68.6% versus 31.4%). Educational sources of information outweighed other sources of information for psychologists and counselors but not for physiotherapists (Figure 1). Practice, Association and Interest Of the overall sample, 39.7 percent indicated that they know how to practice hypnosis. Psychologists most commonly reported knowing how to practice hypnosis with 75.4 percent indicating yes. Of counselors and physiotherapists, 11.1 percent and 6.7 percent, respectively, reported yes. The mean level of self-reported competence in applying hypnosis was 2.89 (median ¼ 1, mode ¼ 1) on a scale of 1 to 7 where 1 indicated low competence and 7 indicated high competence. Thirty-seven participants practice hypnosis in therapy (30.6%), either regularly or intermittently (33 psychologists, 2 counselors, and 2 physiotherapists). Of those who reported using hypnosis in practice, 22.2 percent reported predominantly using formal/classical hypnosis, 25 percent reported using Eriksonian/conversational (n ¼ 9), 47.2 percent reported using both (n ¼ 17), and 5.6 percent reported other. Other styles utilized included Yapko s technique, a mixture of self-hypnosis with classical and conversational, and personal adaptations. The average number of years hypnosis had been practiced in this sample is (SD ¼ 9.79). Twenty-seven participants belong to a hypnosis association (22.3%). Psychologists are more commonly members of hypnosis associations (n ¼ 23) than are counselors (n ¼ 2) and

12 20 MADAN AND PELLING physiotherapists (n ¼ 2). The Australian Society of Hypnosis/South Australian Society of Hypnosis was the most common association reported (n ¼ 23). Other associations mentioned included the American Board of Hypnosis and the Australian Hypnotherapists Association. In terms of interest toward receiving hypnosis information, 46.3 percent were interested in receiving more theoretical information, 47.9 percent were interested in receiving more practical information, and 26.4 percent provided their details in order to receive training information from the SASH. Interest levels varied among the professions for the three different forms of information (Table 2). Attitudes and Beliefs FIGURE 1 Educational Sources versus Other Sources of Hypnosis Information The overall sample and each of the three professional groups attained high total scores on average on the VSABH-T (M > 129.5), indicating positive attitudes and accurate beliefs TABLE 2 Interest in Receiving Hypnosis Information Theoretical information Practical information SASH training information Psychologists N Frequency 43.9% 52.6% 24.6% Counselors N Frequency 50% 50% 33.3% Physiotherapists N Frequency 48.9% 42.2% 26.7% Overall N Frequency 48.3% 49.9% 26.4%

13 HYPNOSIS AND SOUTH AUSTRALIAN PSYCHOLOGISTS 21 TABLE 3 Total Mean Scores on the VSABH-T Profession Total Score on the VSABH-T Mean SD N Psychologist Counselor Physiotherapist Total (see Table 3). Overall mean scores for each factor were also within the range indicating positive attitudes and accurate beliefs (Table 4). The majority of participants obtained scores indicating positive attitudes and accurate beliefs toward hypnosis; however, there were instances of negative attitudes and inaccurate beliefs, as indicated by factor scores (Table 5). A one-way, between-groups analysis of variance was conducted to explore the impact of professional identity on attitudes and beliefs toward hypnosis, as measured by the VSABH-T. There was a statistically significant difference at the p <.05 level in VSABH-T scores for the three professions: F (2, 72) ¼ 3.4, p <.05. The effect size, calculated using eta squared, was.09. Post-hoc comparisons using the Tukey HSD test indicated that the mean score for psychologists (M ¼ , SD ¼ 21.94) was significantly different from the mean score for TABLE 4 Mean VSABH-T Factor Scores Psychologist Counselor Physiotherapist Total Fear M SD n Memory M SD n Help M SD n Control M SD n Collaboration M SD n Interest M SD n Magic M SD n Marginal M SD n

14 22 MADAN AND PELLING TABLE 5 Frequency of Agree versus Disagree in VSABH-T Factors % agree % disagree physiotherapists (M ¼ , SD ¼ 21.32). Counselors (M ¼ , SD ¼ 25.28) did not differ significantly from either psychologists or physiotherapists. A series of one-way ANOVAs were conducted in order to explore the impact of professional identity on each of the eight factors of the VSABH-T. Because of a large amount of missing data, case-wise exclusion of data resulted in a greatly reduced sample size, violating the multivariate analysis of variance assumptions. Thus, one-way ANOVAs were conducted with a Bonferroni adjustment of p ¼.006. In accordance with this adjustment, there were no significant differences between professions on either of the factors of the VSABH-T. Predictors of Attitudes and Beliefs Stepwise multiple regression was used to assess how well factors relating to prior experience and understanding of hypnosis (having been previously hypnotized, self-rated level of knowledge about hypnosis, and source of information about hypnosis) predict attitudes and beliefs toward hypnosis. The model including these three variables explained 30.1 percent of the total variance in attitudes and beliefs toward hypnosis. Of the three variables, self-rated knowledge about hypnosis made the largest and only statistically significant contribution (beta ¼.42). This variable made a unique contribution of 9 percent to the explanation of total variance in attitudes and beliefs toward hypnosis. Sex, age, and years in professional practice did not significantly correlate with attitudes and beliefs toward hypnosis. Response Rate Fear Memory Magic Marginal Help Control Collaboration Interest DISCUSSION The multiple mailing method used in this study achieved a high return rate, which exceeded the predicted rate of approximately 50 percent, as found in prior studies [30]. Psychologists and physiotherapists had the highest response rates. This finding may be an indication of varying interest among the professions as results showed that a larger number of psychologists had professional affiliation or previous experience with hypnosis, particularly in training, while physiotherapists had a high level of interest in receiving more information about hypnosis. Comparatively, counselors had a very low return rate. This result could have occurred for a number of reasons. Counselors within the sample had comparatively little experience with

15 HYPNOSIS AND SOUTH AUSTRALIAN PSYCHOLOGISTS 23 hypnosis, which could suggest that those interested in hypnosis were more likely to participate. Additionally, some psychologists were advertised as counselors on the online Yellow Pages, and consequently, these listed professionals returned questionnaires identifying themselves as psychologists, reducing the number of expected counselors. Due to the legally regulated nature of psychology, psychologists are able to call themselves counselors but counselors cannot call themselves psychologists unless they are registered. Experience and Knowledge It was revealed that, overall, psychologists had more prior experience and knowledge in regard to hypnosis than counselors and physiotherapists. Furthermore, knowledge about hypnosis for psychologists was derived more commonly from educational sources such as training, university courses and workshops, and scientific journals than it was from other sources. In contrast, physiotherapists obtained their information about hypnosis more commonly from sources such as reading material, television, and peer discussion. Although there was no significant correlation between information source and attitudes and beliefs toward hypnosis, the patterns presented are identical to previous research findings showing that information about hypnosis based on current empirical literature, as opposed to nonreliable sources such as television, is more likely to result in more accurate beliefs as well as positive attitudes [1, 17]. Sources such as stage shows and media tend to represent the common myths of hypnosis, which have adverse effects on not only beliefs about what capabilities hypnosis may have, but also on attitudes toward the technique [19]. This was the case in the current study as psychologists on average indicated a higher level of knowledge than the other two professions and resulted in a higher score on the VSABH-T. Use and Interest While 39.7 percent of participants reported knowing how to practice hypnosis, only 30.6 percent reported actually using it. Of those who provided reasons as to why they do not choose to utilize hypnosis, the most common reasons given were either lack of formal training or qualifications or a feeling of inadequate skill to apply hypnosis competently. Preferences for alternative methods (such as relaxation techniques and meditation) or a doubt toward the efficacy of hypnosis were also reasons for its lack of use in therapy. In Thomson s (2003) study [1], a similar finding revealed that most health professionals who preferred alternative techniques over hypnosis were likely to continue to use those techniques. Other reasons not to use hypnosis involved personal and cultural implications. One participant noted that it was against certain religious beliefs while another who specialized in female counseling, claimed, My practice is about empowering women, not the practitioner. This statement is interesting, indicating a common misconception about hypnosis regarding control [7], and it is an example of the kind of misconceptions that some health professionals expressed in the current study. However, such reasons were not common. Rather, results reflected that the lack of utilization of hypnosis among health professionals in South Australia can be primarily attributed to a lack of comprehensive understanding, skill, and knowledge of its application. Participants reported absence of knowledge was complemented by an expressed interest to acquire this knowledge. Close to 50 percent of participants expressed an interest in receiving more theoretical and practical information about hypnosis. Practical information about hypnosis was of

16 24 MADAN AND PELLING more interest, but only very slightly (47.9% compared to 46.3%). Interestingly, counselors expressed the most interest in receiving theoretical information about hypnosis, followed by physiotherapists, while psychologists were most interested in receiving practical information. Psychologists also indicated having the most experience and knowledge with hypnosis, which perhaps reflects the level of knowledge already existing in the field of psychology with regard to hypnosis, as opposed to a lack of interest. Given that psychologists could utilize hypnosis in therapy prior to its deregulation, there is a history of familiarity with the application in the field. The deregulation of hypnosis in 2010 has now provided the opportunity for health professionals, other than psychologists, to utilize hypnosis, and, hence, learn more about the tool. Despite the interest to acquire more information, only 26.4 percent of participants provided the details needed to receive more information about hypnosis training from SASH. While the number of participants actively seeking hypnosis information is large, it is low compared to the total number who indicated wanting more theoretical and practical information. This outcome could be the result of concerns regarding anonymity, or it may reflect reluctance within participants to seek information actively, which could highlight the importance of bringing to the public s awareness the potential of clinical hypnosis. This awareness could further encourage health professionals to seek more accurate information about hypnosis and be motivated to consider hypnosis as a tool in treatment. Attitudes and Beliefs The current study found that, on average, all health professional groups hold positive attitudes and accurate beliefs toward hypnosis. These findings differ from previous findings that found that health professionals such as medical practitioners and psychiatrists hold misconceptions about hypnosis that may be consequential to therapy outcome [19]. VSABH-T scores indicated that psychologists have a higher level of positive attitudes and accurate beliefs on average than counselors and physiotherapists. While there has been a limited amount of research investigating the attitudes and beliefs of health professionals regarding hypnosis, studies in the past have found psychologists to hold fewer misconceptions [17]. This finding is not unexpected, particularly within Australia, as prior to the deregulation of hypnosis, only psychologists, medical practitioners, dentists, and other professionals approved by the Australian Psychological Board were able to practice hypnosis legally [5]. Given that the deregulation of hypnosis in South Australia is a very recent event, it is expected that other health professionals will have comparatively little knowledge of the benefits of hypnosis in therapy and what hypnosis involves because of a lack of information and ability for these professions to utilize this clinical tool. Previously, this expectation was demonstrated by the significant difference found between psychologists and physiotherapists in attitudes and beliefs toward hypnosis. Moreover, knowledge about hypnosis was found to be a significant predictor of positive attitudes and accurate beliefs, a finding that is synonymous with results in previous studies investigating health professionals [15, 17, 18]. While counselors did not differ significantly from other health professionals, this group did have a lower mean VSABH-T score compared to psychologists. The lack of significance could have resulted from the low counselor sample size. Currently, evidence suggests that positive attitudes toward hypnosis are present among therapists using hypnosis, an important element involved in enhancing therapy outcome for clients [33]. In explaining why hypnosis was utilized in therapy, most participants reported that hypnosis was more rapid than other forms of therapy and/or effective in enhancing therapy. One participant

17 HYPNOSIS AND SOUTH AUSTRALIAN PSYCHOLOGISTS 25 claimed that it achieves results rapidly, meaning less session times for clients. Another participant claimed that hypnosis makes it easier for the subconscious to take on ideas and beliefs without the intellect getting in the way. The client s welfare is a primary concern for the therapist, whether in relation to the presentation of the problem in therapy or in relation to the client s time and money. With an increase in healthcare costs and an influx of expensive drug treatments, the public has been increasingly open to alternative health care methods such as hypnosis (Hammond 2010). Therapists play an important role in determining what treatments are provided to the public and how treatment options are, consequently, perceived. There has been a growing interest in rapid and cost-effective health care methods [34], and therapists are in an important position to provide these techniques for their clients, or they have adequate understanding to refer patients when necessary. Having the knowledge to recognize when a client may benefit from hypnosis is highly important, even if the particular therapist is unable to provide that treatment. Findings presented in this study are of great importance, particularly as the deregulation of hypnosis in South Australia allows for the incompetent and unethical use of hypnosis by misinformed or unskilled health professionals, which could have dire implications for professionals and their prospective clients [7, 25]. The current study suggests that health professionals currently practicing hypnosis are well informed. Furthermore, when professionals are uninformed, there is a deep interest in acquiring more theoretical and practical information, suggesting that the future use of hypnosis may be in the hands of competent and well-educated practitioners. An overall positive attitude, revealed by the VSABH-T, also reflects this interest in hypnosis. Furthermore, positive attitudes toward hypnosis have been strongly linked to the motivation to use clinical hypnosis [15]. Despite the evidence of positive attitudes and accurate beliefs among these health professionals, there is a growing need for further education in hypnosis, particularly for professionals who were unable to use it prior to its deregulation. It is believed that therapists treat patients on the basis of their own conceptualizations and philosophies of treatment methods, as opposed to the most current literature [13]. It is, therefore, of even more importance that therapists acquire accurate knowledge. While results indicate that, overall, health professionals are well informed about hypnosis, misconceptions are still evident. It was found that 16.3 percent of participants had scores indicating agreement with the Memory factor in the VSABH-T, that is, beliefs that hypnosis enhances the capacity for accurate memory retrieval, or that clients are unable to lie when under hypnosis. Misconceptions concerning memory in hypnosis were common among health professionals in the past [14, 18, 21] and may also pose the most risk to client wellbeing [7]. However, one of the drawbacks of the VSABH-T is that one of the items that makes up the Memory factor is item 33: hypnosis involves a trance state. A high score in the overall factor indicates a higher level of inaccurate belief and negative attitude. However, agreement with item 33 does not necessarily demonstrate an inaccurate belief; debate exists even within the field of hypnosis as to whether there is a unique distinguishable state in hypnosis, a stance that has divided many professionals involved with hypnosis [34 36]. In the current study, 70.4 percent of the sample agreed that hypnosis involves a trance state, a belief that is in line with one of the dominant contemporary theoretical perspectives of hypnosis [6]. Limitations One of the major drawbacks of the current study was the large prevalence of missing data in the VSABH-T. Many participants did not answer all the questions in the scale. This substantially