Copyright © 2002, revised 2011
The cat is out of the bag.
After many months, I've finally been pushed to finish this article on questionable credentialing in hypnosis and "psychotherapy." A reporter from a major magazine wrote to "Dr. Zoe D. Katze" for input on an article she was writing on hypnosis for childbirthing. She had stumbled across Dr. Zoe's name on the American Association of Professional Hypnotherapists' website. I had to tell her the truth.
Dr. Zoe D. Katze, Ph.D., C.Ht. is a cat. In fact, she is my cat. Those familiar with basic German have probably already enjoyed a laugh. "Zoe Die Katze" literally translates to "Zoe the cat."
Dr. Katze's credentials look impressive. She is certified by three major hypnotherapy associations, having met their "strict training requirements" and having had her background thoroughly reviewed.
I was motivated to credential my cat by two circumstances. First, I have become increasingly heedful of all the questionable credentials out there, and I've grown tired of sounding defensive to therapist-shopping clients who confront me with something along the order of: "I found somebody with all these certifications and diplomas and he/she charges half of what you psychologists charge."
The last straw (and my moment of inspiration) came during an internet search for a colleague. I accidentally came upon the website of another "psychotherapist" who listed a doctoral degree from an infamous diploma mill. Along with his degrees, he listed a veritable alphabet soup of impressive-looking letters after his name, corresponding to various "board certifications" and his status as a "Diplomat [sic] and Fellow" of the "largest professional hypnosis association in the world."
I decided to credential my cat.
This was a surprisingly easy thing to do. First, since so many financial transactions are conducted by credit card, I had to get Zoe some credit. No problem; I just added her as an "authorized user" of one of my own credit cards. (The credit card agent asked for Zoe's social security number, but then cheerfully relented when I told him it would take me some time to search for it.)
The rest was equally as easy. In the nefarious world of quasi-credentialing and diploma scams, money talks. Or at least it meows. All I had to do was get Zoe her first credential, which I did by filling out an "application for certification" on a lay hypnosis association's website. I charged her application fee, and within a few weeks, Zoe had her first piece of paper. Since most lay hypnosis associations have a reciprocity agreement respecting each others' certifications, it was a snap to obtain additional (and very impressive sounding) certificates.
Zoe is (or was, since I doubt I will pay certification maintenance fees) certified by the National Guild of Hypnotists, the American Board of Hypnotherapy, and the International Medical & Dental Hypnotherapy Association. She is a Professional Member of the American Association of Professional Hypnotherapists.
Not bad for a cat who's not even purebred.
What do credentials mean, really? In most health professions, the basic credential is a license. Psychotherapy and hypnotherapy are activities that are difficult to regulate. With few possible exceptions--psychological testing may be the only one--they do not require an ability to utilize a clearly-defined or unique technology (like surgery) or a tangible asset (like pharmaceuticals). Instead, they rely primarily or exclusively on communication and human interaction. Ultimately, then, we are up against a seemingly impossible proposition: How does one "license" a form of human interaction? Licensing boards have taken on this improbable task, but they typically do not attempt to define or enforce any set of behaviors except upon those who submit to licensing. Of course, there are strong incentives to being licensed, like the ability to qualify for insurance reimbursement or for certain agency, healthcare service or government positions. But by and large one can get by without a license to practice, especially if one has other sources of income. Some unlicensed practitioners have succeeded quite handsomely, thank you; unlicensed therapist-cum-author John Gray is one of the prime examples, neurolinguistic programmer and motivational speaker Anthony Robbins is another.
And for the thousands of private practice "counselors" and "therapists" who are engaged in what is essentially a small part-time business or even a hobby (they do not need this income to survive), licensing is largely superfluous and--with its rigid experience requirements, laborious application and examination procedures, and continuing education requirements--perhaps even an irritant.
In psychology and mental health, research on whether licensing actually assures competence has yielded inconclusive results. Nevertheless, licensing and certification are minimally capable of doing two things: (1) guaranteeing that an individual possesses a journeyman's fund of basic information (at least at the time of the examination) and shares a somewhat common educational/training experience; (2) providing a system of accountability to the public.
Compared with the conservative, rigidly regulated and highly structured world of medicine, psychotherapy is the wild west of credentialing. When a physician claims board certification, her patients can be reasonably assured that their doctor has completed a fairly uniform course of training and has passed a tough examination. In mental health, credentialing is a far more varied and amorphous affair. Until relatively recently, "board certification" meant one was either Diplomated by the American Board of Professional Psychology (ABPP) or, if a social worker, by the American Board of Examiners in Clinical Social Work. There were also a small number of proficiency certifications available (e.g., rehabilitation counseling, career counseling) to those who completed substantial training requirements (and usually an examination) in that area.
But, in my opinion, something happened in the 1980s and '90s that led directly to the proliferation of credentialing (and pseudocredentialing) in mental health. First, the advent of managed care, coinciding with the proliferation of graduate school programs in mental health (especially at the masters degree level), led to uncontrolled growth in the supply of practitioners while demand became increasingly restricted. As a result, many mental health practitioners began to scramble for a means (any means) to distinguish themselves, to be perceived as above the common horde, to be singled out.
Second, the last 20 years have seen a proliferation of specialties and "techniques," some valid, others a bit dubious, and still others the peculiar invention of their creators. In some cases, like trauma treatment, neuropsychology and forensic psychology, specialties were essentially invented where none existed before, due primarily to advances in the science as well as the practice of psychology. However, other more arguably dubious credentials also came into existence, leading to the development of "certified specialists" from "energy therapist" to "alien abduction therapist" to "past life regression therapist."
How confusing this must be to clients and consumers of our services. And how frustrating this is to the legitimate clinician who might be left feeling "credential challenged" or even intimidated by the therapist who advertises him/herself with multiple impressive-sounding credentials.
Would additional laws help? In my opinion, probably not. In fact, l can not think of a legal or legislative solution that would positively impact credentialing without creating even worse problems. Unlike medicine, which often involves immediate life and death issues, mental health clinicians typically treat more subtle and (with the exception of a relatively small percentage of critical emergencies) less immediately dangerous situations. As a result, the public and our lawmakers are less likely to worry about the inflated or even implausible claims made by some therapists. In addition, we clinicians have traditionally operated under a kind of libertarian tradition. By and large we loathe guidelines, treatment manuals, or any external agent claiming to be able to judge or measure our competence. Nor do we want anything beyond broad and inclusive suggestions when it comes to external agents telling us what constitutes "good" vs. "bad" therapy. And for good reason. Human behavior and the "mind" are just more complicated than, say, the liver or a broken bone. What is "good" and "bad" for the psyche is not as easily defined as what is good for the liver or bad for the fibula. We psychotherapists continue to argue and debate these issues, and I for one value our disagreements. I hope we never come to completely understand the mind and what is "right" for it. (If we ever did, we would be a short skip and a jump away from a form of psychologically-sanctioned fascism that would make Orwell's 1984 seem like a hippie utopia.) Those who claim to know the absolute truth about the human psyche are more likely to be psycho-demagogues and therapy cult leaders than benevolent role models.
So it seems that, with the possible exception of the most outrageous forms of "certified therapies," we are doomed to tolerate an extremely broad array of credentialing bodies, from the legitimate to the questionable to those that are outright shams. It is up to each of us to examine our own motivations for obtaining credentials (both legitimate and dubious), to police ourselves and our own professions, and to do our best to educate the public.
Still, one has to ask: What value can a credential hold when it can be so easily obtained for a common household pet? I expect the unmasking of Dr. Zoe D. Katze, Certified Hypnotherapist, will make some people very, very angry. I hope they will find it within the purview of their anger to demand serious changes in the credentialing process employed by these associations.
Limiting a credential to homo sapiens would be a good start.
Zoe D. Katze, Ph.D., C.Ht.
Yes, really. I'm afraid so.
On 9/23/02, Dr. Katze received the following Membership Renewal Reminder from the NGH:
Your NGH Membership has lapsed
since April 2002 If you would like to renew your
membership Online, you may at
https://www.ngh.net/membershipapp.htm (our new SECURE ONLINE APPLICATION
!) Don't lose out on your NGH
Publications and New NGH Benefits!!! Renew your membership
today! https://www.ngh.net/membershipapp.htm -- National Guild of Hypnotists,
Inc. © -- PO Box 308 Merrimack, NH 03054 (603) 429-9438 Fax (603)
424-8066 email@example.com http://www.ngh.net
Your NGH Membership has lapsed since April 2002
If you would like to renew your membership Online, you may at https://www.ngh.net/membershipapp.htm
(our new SECURE ONLINE APPLICATION !)
Don't lose out on your NGH Publications and New NGH Benefits!!!
Renew your membership today!
-- National Guild of Hypnotists, Inc. © --
PO Box 308
Merrimack, NH 03054
(603) 429-9438 Fax (603) 424-8066 firstname.lastname@example.org
Immediately after, also on 9/23/02, Dr. Katze received this follow-up:
-Thank you Jereme Bachand -
Jereme Bachand - NGH
Oops, Zoe! You've been busted!!
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This Cat is not a Hypnotist
How to Find a Qualified Hypnotherapist
Steve K. D. Eichel, Ph.D., ABPP
Copyright © 2005
Felix, Fritz, Garfield and Morris. To this list of well-known cats I can add my own, Dr. Zoe D. Katze, Ph.D., C.Ht., DAPA. Although her Google hit count of 205 (as of 4/5/05) pales in comparison to Garfield's (over 735,000), it is nevertheless higher than many bona fide psychologists, including me.
A cat with a degree and certifications!? How can that be?
In 2002 as an experiment I applied for and obtained a variety of credentials on Zoe's behalf. To get her certified as a hypnotherapist by the National Guild of Hypnotists (NGH), the International Medical & Dentistry Hypnotherapy Association (IMDHA) and the American Board of Hypnotherapy (ABH) I only had to fill out online applications (with made-up information) and pay the application fee.
Originally, I only posted my article on my own website as well as the website I administer for the Greater Philadelphia Society of Clinical Hypnosis. But a year later Zoe's story was discovered by a writer for the American Bar Association's online journal, and after that, the kitty litter hit the fan.
Zoe's story has been snatched up by a plethora of online sources, including websites belonging to MacArthur Foundation "Genius Award"-winner James Randi, self-esteem psychologist Nathaniel Brandon, and "Dipscam" FBI consultant and bogus degree expert Dr. John Bear. The lessons taught by my "Cat Credentialing Project" have been incorporated into several graduate-level psychology classes, one forensic psychology program, and at least one state licensing board's training website.
Not all reactions have been positive. The IMDHA wrote a letter to my credit card company in which, bizarrely (since they were the recipients of my money), they tried to report me for fraudulent use of my own credit card! The letter was forwarded to me with an incredulous note indicating that the only one who could make such a complaint was, of course, me. (The IMDHA had no qualms about keeping my money, nor did any of the other associations.)
The National Guild of Hypnotists wrote a scathing editorial about me. I was also the subject of a lay hypnosis blog in which a well-known NGH member repeatedly referred to me as, among other epithets, "the dishonest, misrepresenting, liar named Steve K. D. Eichel." It took the threat of a libel suit to put an end to that diatribe.
Unlike medicine and law, which are tightly controlled by state and federal laws, mental health and hypnosis are in reality largely unregulated. (The reasons for this are too complicated for this article, but are addressed in the article I previously referenced.) What this means for consumers is that, when they find an online or Yellow Pages listing for a physician or an attorney, they can be reasonably certain that the professional has earned a legitimate graduate degree (M.D. or J.D.) and has a state-issued license to practice. This also means that, if something goes wrong, consumers have well-known avenues for redress.
Not so in mental health or hypnosis. Unless the professional is licensed by the state, there is no guarantee that your hypnotist or "therapist" has any background or training whatsoever. In the most extreme cases, you apparently don't even have a guarantee that your "professional" isn't, well, a nonhuman.
Just as anyone can be "ordained" as a minister in certain "religions" simply by filling out an online application form and paying a fee, it is absurdly easy to gain hypnosis and even psychotherapy credentials. To this day, the NGH and ABH accept online applications for certification; as far as I can tell, the only "new" requirement since the Zoe scandal has been for the NGH to require a photo driver's license. That requirement effectively keeps cats out of their certified membership, but what will keep your neighbor's 18 year-old daughter from becoming a "certified hypnotherapist" if she wants to (and does not mind misrepresenting herself)?
Licenses, certifications and graduate degrees do not guarantee a competent hypnotist/therapist, but they are a good start. Being properly credentialed at least means the professional is held somewhat accountable for his or her actions. Here are some pointers for the careful consumer:1. A graduate degree is not a graduate degree is not a graduate degree. Degrees, including Ph.D.s, can be purchased from "accredited" universities online. These schools fall under the general heading "diploma mills" or "degree mills." Most people incorrectly assume that when a school claims to be "accredited," it means accredited by an agency recognized by the Department of Education (DOE). This is not necessarily so; some of the more outrageous degree mills are "accredited" by organizations they created, and of which they alone are "accredited members." Others have banded together with like-minded institutions to form their own "independent accrediting" agencies. Many of these exist only as post office box numbers, or a filing cabinet in an office. Institutions affiliated with religious organizations are yet another matter. In the U.S., church-affiliated schools are or can choose to be exempt from many governmental regulations. Some of these schools are quite excellent, and refuse accreditation by DOE agencies on truly religious grounds. Others, however, exist primarily to grant their clergy ubiquitous "Doctor of Divinity" or other doctoral degrees primarily out of the belief that the title will gain respect for the title-bearer. (For an excellent source of information on bogus vs. legitimate post-secondary education, treat yourself to Dr. John Bear's superb website - http://www.degree.net/ . It is also worthwhile to read Dr. Bear's article on diploma mills, located at http://www.degree.net/html/diploma_mills.html .) In hypnosis and psychotherapy, which are largely unregulated, there are a variety of semi-legitimate and outright illegitimate diploma mills offering doctoral degrees in counseling, psychotherapy, and hypnotherapy. A relatively new development has been the "Doctor of Clinical Hypnotherapy" degree (DCH). As far as I know, nobody has thoroughly researched the legitimacy of this degree, although none of the institutions granting it appear to be fully accredited by agencies recognized by the DOE.
If you are uncertain about the legitmacy of the school that granted your potential therapist's degree, see if it is listed on the DOE's Office of Postsecondary Educations's website: http://ope.ed.gov/accreditation/Search.asp .
2. The basics of hypnosis are not hard to learn. When I was in college, I taught myself basic hypnosis from a book I bought in a used bookstore. Many lay hypnosis associations promise to certify people after a weekend course. Amost 10 years ago I wrote an article in which I called for the licensing and regulation of lay hypnotists (see http://APMHA.com/page9.htm). Under the supervision of an appropriate licensed healthcare professional, I see little reason to believe hypnosis paraprofessionals (i.e., lay hypnotists) should not be able to perform basic hypnosis interventions for many people. However, it is a stretch to believe that a weekend hypnosis certification course is sufficient training for a high school graduate to treat an individual with phobias, anxiety, depression or habit disorders (e.g., addictions). Clinical hypnosis is a skill built upon a foundation that consists of accepted medical and psychological practices, including the ability to evaluate and diagnose psychological problems. Lay hypnosis organizations like the National Guild of Hypnotists certify a broad range of members, some of whom are licensed healthcare professionals and many of whom are not. I've seen the description of many NGH training programs, and a large percentage of these involve clinical training. As far as I know, these programs are equally open to trained clinicians and untrained "lay" people. There does not seem to be any attempt to limit clinical training to appropriately licensed clinicians.
And, of course, the NGH and other lay hypnotist associations certified my cat, which does not speak well of their screening processes.
3. Licensing and legitimate graduate degrees may not guarantee competence, but they are a start. Moreover, going to a licensed professional at least guarantees some degree of accountability. If a psychologist or a licensed professional counselor behaves inappropriately, or engages in a questionable practice, there are state licensing boards and national professional associations who oversee these professionals, and with whom a client can file a complaint. All practicing psychologists are required to carry malpractice insurance. Not so with lay hypnotists. I have provided forensic psychological advise in several lawsuits involving lay hypnotists, and the bottom line is that, if a lay hypnotist misbehaves, the client may have no legal recourse, no way to rectify the situation or, if necessary, to have the therapist drummed out of the profession.
4. So where can I find a qualified professional trained in clinical hypnosis? In addition to word of mouth and referrals from other trusted professionals (always a good place to start), consult the membership directories of the American Society of Clinical Hypnosis (http://www.asch.net), the Society of Clinical and Experiment Hypnosis (http://www.sceh.us/) and the American Psychotherapy & Medical Hypnosis Association (http://APMHA.com/). All three require health profession licensure as a basis for membership; ASCH and APMHA additionally certify those members who have completed a prescribed training course. Zoe the cat would not have made it into membership in these organizations. Additionally, there are a handful of hypnosis-oriented websites (including this one) that will refer only to qualified practitioners.
I am sometimes asked about hypnosis tapes and CDs. Do they work? Which ones are the best? There is no question that people can be hypnotized using tapes; in order to provide a standardized induction, audiotapes have been used for years in university studies of hypnotic phenomena. Still, there is only limited research on the effectiveness of tapes and CDs. For certain goals (such as insomnia) with motivated subjects, taped hypnosis can be as effective, or almost as effective, as "live" hypnosis; for other concerns, live hypnosis has been shown to be consistently more effective. One study indicated that people who listen to hypnosis tapes tend to overestimate the beneficial effects of those tapes. That is, they believe it helped more than it actually did. Interestingly, there are several studies that indicate the most effective use of taped hypnotic suggestions is in addition to live hypnosis. The combination of taped and live hypnosis produced significantly more of the desired effect than either condition alone.
There is the potential for what I would term "unwanted" or even potentially harmful effects. Studies have shown that taped hypnotic suggestions that support "unusual" or controversial beliefs, such as past-life regression, can significantly alter a subject's belief system.
My general advice about hypnosis tapes and CDs is to approach them with caution. They can be quite helpful when purchased and used with planning and careful consideration. They are even more effective when used in combination with "live" hypnotherapy. I believe the following guidelines will increase the likelihood of making a safe and effective hypnosis tape or CD purchase:1. Look for the union label. Just as I suggested when looking for a "live" clinical hypnotherapist, your odds of purchasing a safe and effective hypnosis tape or CD are increased if you stick to those produced by licensed mental health or medical professionals who are appropriately trained and credentialed in clinical hypnosis. In my experience, clinicians who are members of (or better yet certified by) ASCH, SCEH or APMHA usually fit that description.
2. Go to a source you can trust. If you don't already know a qualified professional who produces hypnosis tapes and CDs, finding an online publisher may help. A good "quality control" check on a publisher is to review their website, paying particular attention to the qualifications of the people associated with it. Be wary of websites that employ obvious "hype" language (see below) and dubious claims. Check how they reference their claims. Does the publisher only cite anecdotal reviews (e.g., personal testimonials) or do they reference good, solid science? Publishers of quality will reference scientific studies in respected psychological or medical journals. Does the website provide information on hypnosis from reliable sources, and does it provide appropriate warnings about the misuse of hypnosis? It's also a good idea to use those publishers that provide samples of their tapes/CDs or have a solid refund policy.
3. Be very wary of hype and unsupported claims. Most people are familiar with sales hype, and generally know the old saying that if it sounds too good to be true then it probably isn't. That adage certainly applies to hypnosis as well. Hypnosis tapes (and practitioners!) claiming instant or super-fast results are probably misleading you. There are hypnosis tapes/CDs publishers run by outright hucksters. As a general rule, if the website seems to violate common sense, then have the sense to move on. It is also prudent to avoid tapes, CDs (and their promoters) who claim to be able to "cure" long-term problems, like alcoholism or chronic depression. If these tapes and CDs wind up delaying or preventing someone from obtaining real help, then they have not only failed to "cure," they may have caused actual harm.
4. Tapes and CDs can help but only to a degree. Many problems can not be remedied by tapes and CDs alone. Reputable publishers will note that clearly and plainly (not hidden in the small print), and provide guidance to the consumer who may benefit from obtaining qualified help. They will be clear about distinguishing between appropriate self-help and self-improvement and serious behavioral disturbances that need professional intervention. The better clearinghouses will utilize advisors of the highest caliber possible (with reputable credentials and background) to assist in this process.
With these guidelines in mind, consumers and potential clients will increase the likelihood of obtaining the help they truly want, and need. Limiting your choice of hypnosis materials (such as tapes and CDs) and clinical hypnosis practitioners referrals to appropriately trained and licensed health professionals are important first steps on the path to a successful hypnosis experience.
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