This article was downloaded by: [McMaster University] On: 15 February 2015, At: 13:31 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
International Journal of Clinical and Experimental Hypnosis Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/nhyp20
Attitudes of child health professionals toward hypnosis: Implications for training G. Gail Gardner
a
a
University of Colorado Medical Center , Published online: 31 Jan 2008.
To cite this article: G. Gail Gardner (1976) Attitudes of child health professionals toward hypnosis: Implications for training, International Journal of Clinical and Experimental Hypnosis, 24:2, 63-73, DOI: 10.1080/00207147608405598 To link to this article: http://dx.doi.org/10.1080/00207147608405598
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.
Downloaded by [McMaster University] at 13:31 15 February 2015
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 & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
The Internutwnal Journal of Clinical and Erprirnental Hypnosis 1976, Vol. XXIV, No. 2, 63-73
ATTITUDES OF CHILD HEALTH PROFESSIONALS TOWARD HYPNOSIS: IMPLICATIONS FOR TRAINING1 G . GAIL GARDNER2s3 Downloaded by [McMaster University] at 13:31 15 February 2015
University of Colorado Medical Center
Abstract: A survey of child health professionals -pediatricians, pediatric nurses, child psychologists, and child psychiatrists - revealed that they have generally positive attitudes toward hypnosis but little knowledge of its specific advantages or applications. Recommendations are made for designing training opportunities in hypnosis which might enhance the probability that the professional will actually use hypnosis or refer a child elsewhere for hypnotherapy.
Hypnotherapy is valuable for many childhood problems, and children usually approach it with intrigue and enthusiasm (Gardner, 1974a).Although adults often have negative attitudes toward hypnosis (van der Walde, 1974), parents can usually overcome their own reservations about child hypnotherapy, provided the treatment plan is presented carefully (Gardner, 1974b). Clinical experience suggests that the greatest source of resistance to hypnotherapy for children comes from the child health professionals who are responsible for initiating the referral. Failure to refer a child for hypnotherapy may stem from several sources: (a) failure to realize that children are hypnotizable, Cb) negative attitudes about hypnosis, (c) ignorance about hypnosis generally, and (d) ignorance about the value of hypnosis for a particular problem. This paper reports a survey of attitudes toward hypnosis among four groups of child health professionals: pediatricians, pediatric nurses, child psychiatrists, and child psychologists. The goal of the survey was to learn more about attitudes and experiences in each of Manuscript submitted April 22, 1974; final revision received November 6, 1975. An earlier version of this paper was presented as part of the Introductory Psychotherapy Workshop a t the 24th annual meeting of the Society for Clinical and Experimental Hypnosis, Boston, October 1972. * The author thanks Donald W. Stilson for consultation regarding statistical analysis. Reprint requests should be addressed tg G. Gail Gardner, Department of Psychology, University of Colorado Medical Center, 4200 East Ninth Avenue, Denver, Colorado 80220. 63
64
G. GAIL GARDNER
these groups 60 as to allow formulation of specific recommendations designed to bring about more frequent consideration of hypnotherapy as a potentially useful treatment modality for children.
METHOD Questionnaires regarding attitudes toward hypnosis were mailed
Downloaded by [McMaster University] at 13:31 15 February 2015
to pediatricians, child psychologists, and child psychiatrists at the University of Colorado Medical School and in private practice in the Denver area, and to all nurses in the Pediatrics Department at Colorado General Hospital which is the teaching hospital at the University of Colorado Medical School. Of a total of 381 questionnaires sent out, 229 (60%) were completed, yielding samples of 100 pediatricians, 40 pediatric nurses, 60 child psychiatrists, and 29 child psychologists. Since the subsamples differed on some dimensions and since the reader’s interest may focus on some groups more than others, the results are presented for each of the four groups surveyed. Demographic characteristics of each of the groups are given in Table 1. Overall, the sample was predominantly male and relatively young, and the majority had completed their professional training.
RESULTS Data concerning training and experience with hypnosis for each of the subsamples are given in Table 2. As compared with the pediatricians and nurses combined, who are concerned with general health care, mental health specialists (i.e., psychologists and psychiatrists combined), had had more background and training in hypnosis, TABLE 1 PERCENT FREQUENCY DISTRIBUTION OF DEMOGRAPHIC CHARACTERISTICS OF FOUR SAMPLES SURVEYED Pediatricians
W = 100)
Nurses
W
= 40)
Child Psychia- Child Psycholotrista gists =
,
w = 29)
Sex
Male
Female Age 20-29 30-39 40+ Training Completed
Yes No
81 19
0 100
97 3
72 28
23 42 35
90 8
25 43
2
32
24 44 32
75 25
100 0
53 47
68 32
65
Downloaded by [McMaster University] at 13:31 15 February 2015
ATTITUDES TOWARD HYPNOSIS
evidenced by reading or courses (x2 = 22.29, p < .01)and were more likely to have had personal experience with hypnosis (x2 = 6.90, p < -01).Few in each group had ever referred for or treated a child with hypnosis. The low rate of referral for or use of hypnosis with children is probably not due to doubt that most children can experience the hypnotic state. Though several respondents refused to give an estimate, the majority in all subsamples agreed that a child can experience hypnosis at least by 6 years of age (see Table 3). As shown in Table 4, for all subsamples, overall attitudes toward hypnosis were predominantly positive. A clear majority agreed that hypnosis might be useful for selected problems, both emotional and medical, and about half thought it might sometimes be the treatment of choice. Yet the respondents had difficulty being specific about why hypnosis might be useful. About half thought hypnosis might shorten treatment; fewer agreed that hypnosis might allow a more thorough working through of problems or might sometimes be the only effective treatment. Negative attitudes also tended to be expressed globTABLE 2 TRAINING AND EXPERIENCE WITH HYPNOSIS Pediatricians W = 100)
Readings orcourses in hypnosis 20 Personallyexperiencedhypnosis 24 Referred a child for hypnosis 31 Used hypnosis with a child 9
Nurses
fN =
20 24 31 9
14 7 10 2
Child Psychiaurtrists = 60)
40)
35 18 25 5
32 20 9 6 1
Child Psychologists
IN
53 33 15 0
=
29)
17 14 1 6 2
58 48 3 1
TABLE 3 OPINIONSCONCERNING UTILITY OF HYPNOSIS AT DIFFERENT AGES Youngest age at which respondents believe a child might be described as being in hypnosis
P
f
9 ' 9
"
k
Below 1 year 1-2 years 3-4 years 5-6 years 7-8 years 9 years or older
22 27 5 6
9 9 22 27 5 6
No response
22
22
Child Psychin- Child Psycholof trists ~ ~ ~ W = 60) (P$%9)
$3 ~5
~
f
7 4 12
12 3 1
"
k
f
18
5 10 4 30 9 30 14 8 1 0 1 2 4
%
f
8 7 15 23 7 7
3 3 7 8 4 1
10 24 28 14 3
23
3
10
2
14
10
~
~~
1
%
66
G. GAIL GARDNER TABLE 4 GENERAL ATTITUDES TOWARD HYPNOSIS (Percent of Respondents) Pediatricians
W
= 100)
Nurses
W
=40)
Child Psychia- Child Psycholotrists gists = 60) (N = 29) ~
Downloaded by [McMaster University] at 13:31 15 February 2015
Overall Attitude: Strongly negative Moderately negative Moderately positive Strongly positive Agreement with descriptive statements about hypnosis: Useful for certain emotional problems Useful for certain medical problems Sometimes the treatment of choice May shorten treatment, with lasting benefit Allows more thorough treatment of certain problems Sometimes the only effective treatment Too dangerous to justify use Unethical to use hypnosis Not sufficiently effective to justify use Too threatening to patients to justify use Too little known to justify use Interest in learning more about clinical hypnosis: Yes, for general information only Yes, to use in clinical practic? No,or no response
3 16 69 9
0 2 78 20
0 35 53 9
4 16 60 16
69
85
92
80
77
80
92
76
34
48
50
68
43
55
37
56
32
50
28
24
27
30
27
12
0 1 1
0 0 2
0 0 10
4 0 8
1
0
2
0
4
2
0
0
53
63
32
34
26
35 2
55 13
52 14
21
ally, with few respondents agreeing with specific negative statements about hypnosis. Despite the vague ideas as to how hypnosis might be useful, the majority of respondents indicated a desire to learn more about it, if a suitable course were available, either for general information or with the intention of using hypnosis in clinical practice. This expression of
67
Downloaded by [McMaster University] at 13:31 15 February 2015
ATTITUDES TOWARD HYPNOSIS
interest is consistent with the generally positive attitude against a background of limited knowledge. When the respondents were given a list of developmental, behavioral, and medical problems-all of which have been reported to respond to hypnotherapy-and asked to indicate which ones might respond to hypnotherapy, either as a primary treatment modality or in conjunction with other forms of treatment, there were differences of opinion both across disciplines and across problems, as shown in Table 5 which indicates the frequencies and percentages of each group checking each problem. Omitting the nurses, it is interesting that the other three groups rarely showed more than a two-thirds majority in support of the possible value of hypnotherapy for any problem, even for such problems as asthma and multiple fears for which there are many reports of successful treatment with hypnotherapy. Thus, at this specific level, the respondents as a group were not fully aware of the ways in which they might appropriately utilize hypnosis. TABLE 5 FREQUENCIES AND PERCENTAGES IN EACHDISCIPLINE WHOTHOUGHT HYPNOSIS MIGHT BE USEFULFOR SPECIFICPROBLEMS Nurses Problem
Psychotic withdrawal Delinquent behavior Learning disorders Hyperactivity Disruptive behavior Drug addiction Psychogenic seizures Low self-esteem Hemophilia Separation anxiety School phobia Stuttering Sleep disturbances Obesity Severe burns Enuresis Multiple fears Non-organic pain Asthma Fear of injections
w = 100) 16 29 20 21 32 35 22 46 35 41 50 50 46 54 56 57 59 73 68 73
16 29 20 21 32 35 22 46 35 41 50 50 46 54 56 57 59 73 68 73
w = 40) 20 17 17 26 25 24 24 27 22 25 35 31 36 32 30 29 31 38 36 33
50 43 43 65 63 60 60 68 55 63 88 78 90 80 75 73 78 95 90 83
Child Psychiatrista = 60)
1 2 6 5 4 11 25 9 29 12 20 22 21 23 32 23 26 28 33 33
2 3 10 8 7 18 42 15 48 20 33 37 35 38 53 38 43 47 55 55
Child Psychologists
w = 29)
3 3 5 3 3 11 11 8 8 17 16 15 16 15 11 17 18 19 19 21
10 10 17 10 10 38 38 28 28 59 55 52 55 52 38 59 62 66 66 72
Downloaded by [McMaster University] at 13:31 15 February 2015
68
G. GAIL GARDNER
A two-way analysis of variance was performed, with problems and disciplines as independent variables and percent endorsing a problem as the dependent variable. The results showed significant differences between problems ( F = 14.98, d.f = 19/57;p < .Ol) and disciplines (F = 83.44, d.f = 3/57; p < .01). The latter showed that nurses most frequently endorsed problems as appropriate for hypnotherapy and psychiatrists least frequently. The differences between problems indicate that some problems were more likely than others to be thought appropriate for hypnotherapy, regardless of discipline. Generally, problems which present primarily as emotional, behavioral, or developmental disorders were least likely to be checked, while problems most often checked werewith the exception of multiple fears-either those with a primary physical component (asthma, burns) or those likely to be encountered or followed in a pediatrician’s ofice (fear of injections, non-organic pain). Rank order correlations (see Table 6) showed significant agreement across groups concerning the order of likelihood in which the 20 problems might respond to hypnotherapy. DISCUSSION Given the historical swings, from high to low regard, that have characterized professional attitudes toward hypnosis through the centuries, it is encouraging to see that the positive attitude which emerged several years ago continues, at least for the geographically limited population of child health professionals who responded to this survey. Yet while these people, as a group, have generally positive attitudes toward hypnosis and would like to know more about it, they are limited in knowledge about the particular ways in which hypnotherapy constitutes a useful treatment modality. That is, they think it is good for something, but they often do not know what or why. This TABLE 6 RANK ORDERCORRELATIONS AMONG DISCIPLINES’ FREQUENUIEB OF STATING THAT EACHOF 20 PROBLEMS MIGHTRESP~NDTO HYPNOTHERAPY Pediatricians = loo)
Nurses W = 40)
Child Psychiatrists (N = 60)
.a3*
-
.78* .87*
.59* .77*
.74*
w
Pediatricians Nurses Child Psychiatrists Child Psychologists
Child Psychologists
(N = 29)
-
-
Downloaded by [McMaster University] at 13:31 15 February 2015
ATTITUDES TOWARD HYPNOSIS
69
lack of knowledge probably contributes to their low rate of referral for and use of hypnotherapy, though of course the lack of adequate referral sources adds to the problem. Corollary to the general lack of knowledge is the fact that most of the respondents feel quite comfortable with other treatment modalities (e.g., pharmacological approaches, psychotherapy) and will logically use these before exploring something new or unfamiliar to them, even if the familiar approach is actually less efficient or effective than hypnotherapy. Of course the latter problem is also true for many other kinds of treatment, including behavior modification and certain drug therapies. It was especially interesting to the author that all groups of respondents- including the mental health or behavior specialiststended to consider hypnotherapy more often appropriate for essentially medical problems than for problems considered primarily emotional, behavioral, or developmental in nature. One might well argue that certain of the behavior problems, such as hyperactivity or psychotic withdrawal, are better approached with other treatment modalities. Yet, it would seem generally acceptable to consider hypnotherapy as a treatment of choice for such problems as separation anxiety or low self-esteem, not just to achieve amelioration of the symptoms, but also as an adjunct in dynamically-oriented therapies. One might hypothesize that the respondents may think of hypnotherapy primarily as a symptom-oriented approach, especially when there is acute distress, though the data are not sufficient to clarify the issue. It would be interesting to learn whether other therapies (e.g., client-centered therapy, behavior therapy, psychopharmacological treatment) would fare the same way. Consistent with the findings of many workshops and training centers, the fact that a person seeks formal training in hypnosis appears to be no guarantee that he will ever use it in actual practice. In the present survey, this was especially true of the psychologists and psychiatrists. Likewise, personal experience with hypnosis does not necessarily lead to using it as a therapeutic tool with others. Given the fact that good training opportunities are rare, the obvious waste of time and money is all the more significant. These findings have several implications for those who are involved in training child health professionals to use hypnotherapy: 1. Interest expressed by this sample seems to justify increasing the availability of training opportunities in hypnosis through workshops, seminars, and courses. In addition to training designed to familiarize the professional with the complexities of hypnotherapy for problems having a significant psychological component, there should be programs to train personnel in the far simpler technical task of assisting
Downloaded by [McMaster University] at 13:31 15 February 2015
70
G. GAIL GARDNER
in treatment of individuals where hypnosis is used to alleviate pain of an organic origin. The use of hypnosis to facilitate the changing of dressings in burns, to assist in reconstructive plastic surgery, or to ameliorate the pain and suffering of terminal cancer, are all instances where hypnotic intervention is uniquely effective in making a difficult situation more palatable for the patient. Though the assessment of whether hypnosis is appropriate in the treatment of a particular case and the initial induction should be carried out by a physician or psychologist with special training in the use of hypnosis, the maintenance of the hypnotherapeutic effects can be greatly facilitated by the manner in which the pediatric nurse handles the patient. The nursing staff might even be taught simple hypnotic reinduction techniques provided the use of hypnosis were carefully limited to problems within the bounds of their competence, much as they administer drugs and carry out other prescribed complex therapeutic procedures. Indeed, nurses already use a great deal of suggestive therapy as they describe procedures and work with their patients. One wonders whether nurses would not be more effective if they knew more about the principles underlying the suggestive methods they intuitively employ. Given careful teaching, the potential gain might well outweigh the risk of inappropriate use, which has been the major reason why nurses had not in the past been encouraged to use hypnosis. 2. For those training opportunities designed to equip a child health professional to do hypnotherapy, it might be useful to obtain some sort of statement, as part of the application or screening process, in which the applicant is required to state rather precisely the experiences which led to his seeking training in hypnosis, and the problems he has encountered in his practice which he hopes to approach more effectively with hypnotherapy. Thus, the applicant would be forced to crystallize his goals and could not simply coast along with the vague idea that “hypnosis might come in handy sometime.” 3. Lecture sessions, especially in advanced courses, might be more helpful if they go beyond historical and theoretical issues and techniques of induction and emphasize also specific applications and advantages of hypnosis, with ample use of case vignettes, tapes, and films. Both lecture and discussion sessions could address the specific goals set forth by the applicants, amplifying on appropriate goals and explaining why other stated goals are perhaps better reached by other treatment techniques. 4. For courses focusing on techniques of hypnotherapy, in addition to requiring trainees to practice induction and dehypnotization tech-
Downloaded by [McMaster University] at 13:31 15 February 2015
ATTITUDES TOWARD HYPNOSIS
71
niques in small supervised practice sessions, it may be useful to include some practice in dealing with specific problems, such as pain or anxiety. In order to avoid the problem of the students doing “wild psychotherapy” with people who are strangers both to them and to the instructors, it may be best to have the instructors themselves volunteer for this aspect of the training. For example, it would seem possible to conduct simple experiments with anxiety or pain which could be limited to the duration of the training session. This would allow the trainee, in a controlled setting, to experience using hypnosis for a valid purpose and would force him away from technique oriented self-consciousness into some measure of creativity and resourcefulness as he focuses on the needs and responses of his subjects. Of course, this model is much more feasible in a course lasting several weeks than in a workshop spanning only a few days, but even the short workshop might be designed to include some sort of introductory practical application, perhaps along the lines of problem-oriented discussion and/or demonstration. It seems that the closer the trainee can get to practical use of hypnosis during his training, the more comfortable he may feel Yrying his wings” on his own clinical practice. 5. As with other complex treatment modalities, continued supervision is essential after the initial training experience. Lack of followup supervision is perhaps the greatest weakness in many workshops and courses in hypnosis. The trainee completes the course and wants to try out what he has learned, but has no knowledge of how or where to find adequate supervision. Since this isolation may contribute significantly to the decision not to use hypnosis, even after training, it may be important for us to make a far greater effort to provide individual supervision after formal training is completed. On our part, we could provide the applicant with names of qualified persons in his area from whom he can seek supervision. If we send this information in response to the first inquiry, we could even urge the applicant to give us the name of a qualified person who has agreed to provide continuing supervision. This, along with the requirement of stated goals, would encourage that kind of commitment which the social psychologists have long known is most likely to lead to action. In summary, this survey suggests that child health professionals have positive attitudes and interest in hypnosis, but need training which more directly encourages them to grasp specific applications of hypnosis and to continue to use hypnosis after their formal training is ended. The extent to which the findings are applicable to other professionals is not known. Of course, it is also not clear how much
Downloaded by [McMaster University] at 13:31 15 February 2015
72
G. GAIL GARDNER
the results may be peculiar to the Denver area. For example, the finding that the psychiatrists ranked hemophilia very high (17th out of 20) on their list of problems which might respond to hypnotherapy probably owed to the fact that a Denver child psychiatrist is well known in the area for his use of hypnotherapy with hemophiliacs (La Baw, 1970); this finding is likely not generalizable to other cities. Also, there is no way of knowing the attitudes of the 40% of the original sample who did not respond to the questionnaire. On the other hand, it does seem reasonable to note that this survey supports the growing conclusion that there is a general need for continuing focus on issues of training and supervision. As more people become active in the field, it seems especially appropriate to consider developing advanced workshops devoted specifically to techniques of teaching and supervising hypnotherapy. Such workshops would help maintain high standards of training and would therefore maximize opportunities for professionals first seeking to understand or utilize hypnosis as a treatment modality.
REFERENCES GARDNER,G. G. Hypnosis with children. Znt. J. d i n . exp. Hypnosis, 1974,22,20-38. (a) GARDNER,G. G. Parents: Obstacles or allies in child hypnotherapy? Amer. J. d i n . Hypnosis, 1974,17,44-49. (b) LA BAW,W. L. Regular use of suggestibility in pediatric bleedings. Haematologia, 1970,4,419-425. VAN DER WALDE,P. H. Patient’s preference for treatment: Attitudes toward hypnosis. Znt. J . d i n . exp. Hypnosis, 1974,22,46-53.
fiber die Haltung von Fachleuten in der Kindergesundheitspflege gegeniiber Hypnose: Folgerungen f a r das Training G. Gail Gardner Abstrakt: Ein tfberblick iiber Fachleute in d e r KindergesundheitspflegeKinderBrzte, Kinderschwestern, Psychologen und Psychiaters fiir Kinder-erbrachte, dass sie im allgemeinen eine positive Haltung zu Hypnose einnehmen, jedoch wenig iiber ihre speziellen Vorziige und Anwendungen wissen. Es werden daher hier Empfehlungen f i r die Entwicklung von Trainingsmiiglichkeiten in Hypnose gemacht, die die Wahrscheinlichkeit steigern kiknten, dass Fachleute sich wirklich d e r Hypnose bedienen oder ein Kind wenigstens anderswo fiir Hypnotherapie iiberweisen.
ATTITUDES TOWARD HYPNOSIS
73
k s attitudes des professionnels de la sant6 des enfants face B I’hypnose: les implications pour un entrahement
Downloaded by [McMaster University] at 13:31 15 February 2015
G. Gail Gardner Resume: Un sondage effectuC auprbs de professionnels de la santb des enfantspediatres, infirmieres pbdiatriques, psychologues e t psychiatres pour enfants rkvble que ceux-ci ont gen6ralement un attitude positive h I’egard de I’hypnose, mais qu’ils connaissent bien peu ses avantages particuliers ou ses applications. I1 y a discussion des implications d e ces resultats dans la conception d e stages d‘entrainement a I’hypnose dans le sen8 d’un accroissement de la probabilite que le professionnel va reellement utiliser I’hypnose ou va rkfbrer I’enfant B quelqu’un d’autre pour une hypnothkrapie.
Actitudes de 10s profesionales de la salud infantil ante la hipnosis: implicaciones para la formaci6n G. Gail Gardner Resumen: Una muestra de profesionales de la salud infantil-pediatras, enfermeras pediatricas, psicologos infantiles y pedopsiquiatras-pone d e manifiesto la existencia, por lo general, d e actitudes positivas ante la hipnosis, per0 un escaso conocimiento d e s u s ventajas especificas o d e sus aplicaciones. Se tienen e n cuenta las implicaciones para la programacion de oportunidades d e formacion e n hipnosis, que podrian aumentar fas probabilidades d e que el profesional utilice el mismo la hipnosis o recomiende al niiio una hipnoterapia en otro lugar.
International Journal of Clinical and Experimental Hypnosis Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/nhyp20
Attitudes of child health professionals toward hypnosis: Implications for training G. Gail Gardner
a
a
University of Colorado Medical Center , Published online: 31 Jan 2008.
To cite this article: G. Gail Gardner (1976) Attitudes of child health professionals toward hypnosis: Implications for training, International Journal of Clinical and Experimental Hypnosis, 24:2, 63-73, DOI: 10.1080/00207147608405598 To link to this article: http://dx.doi.org/10.1080/00207147608405598
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.
Downloaded by [McMaster University] at 13:31 15 February 2015
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 & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
The Internutwnal Journal of Clinical and Erprirnental Hypnosis 1976, Vol. XXIV, No. 2, 63-73
ATTITUDES OF CHILD HEALTH PROFESSIONALS TOWARD HYPNOSIS: IMPLICATIONS FOR TRAINING1 G . GAIL GARDNER2s3 Downloaded by [McMaster University] at 13:31 15 February 2015
University of Colorado Medical Center
Abstract: A survey of child health professionals -pediatricians, pediatric nurses, child psychologists, and child psychiatrists - revealed that they have generally positive attitudes toward hypnosis but little knowledge of its specific advantages or applications. Recommendations are made for designing training opportunities in hypnosis which might enhance the probability that the professional will actually use hypnosis or refer a child elsewhere for hypnotherapy.
Hypnotherapy is valuable for many childhood problems, and children usually approach it with intrigue and enthusiasm (Gardner, 1974a).Although adults often have negative attitudes toward hypnosis (van der Walde, 1974), parents can usually overcome their own reservations about child hypnotherapy, provided the treatment plan is presented carefully (Gardner, 1974b). Clinical experience suggests that the greatest source of resistance to hypnotherapy for children comes from the child health professionals who are responsible for initiating the referral. Failure to refer a child for hypnotherapy may stem from several sources: (a) failure to realize that children are hypnotizable, Cb) negative attitudes about hypnosis, (c) ignorance about hypnosis generally, and (d) ignorance about the value of hypnosis for a particular problem. This paper reports a survey of attitudes toward hypnosis among four groups of child health professionals: pediatricians, pediatric nurses, child psychiatrists, and child psychologists. The goal of the survey was to learn more about attitudes and experiences in each of Manuscript submitted April 22, 1974; final revision received November 6, 1975. An earlier version of this paper was presented as part of the Introductory Psychotherapy Workshop a t the 24th annual meeting of the Society for Clinical and Experimental Hypnosis, Boston, October 1972. * The author thanks Donald W. Stilson for consultation regarding statistical analysis. Reprint requests should be addressed tg G. Gail Gardner, Department of Psychology, University of Colorado Medical Center, 4200 East Ninth Avenue, Denver, Colorado 80220. 63
64
G. GAIL GARDNER
these groups 60 as to allow formulation of specific recommendations designed to bring about more frequent consideration of hypnotherapy as a potentially useful treatment modality for children.
METHOD Questionnaires regarding attitudes toward hypnosis were mailed
Downloaded by [McMaster University] at 13:31 15 February 2015
to pediatricians, child psychologists, and child psychiatrists at the University of Colorado Medical School and in private practice in the Denver area, and to all nurses in the Pediatrics Department at Colorado General Hospital which is the teaching hospital at the University of Colorado Medical School. Of a total of 381 questionnaires sent out, 229 (60%) were completed, yielding samples of 100 pediatricians, 40 pediatric nurses, 60 child psychiatrists, and 29 child psychologists. Since the subsamples differed on some dimensions and since the reader’s interest may focus on some groups more than others, the results are presented for each of the four groups surveyed. Demographic characteristics of each of the groups are given in Table 1. Overall, the sample was predominantly male and relatively young, and the majority had completed their professional training.
RESULTS Data concerning training and experience with hypnosis for each of the subsamples are given in Table 2. As compared with the pediatricians and nurses combined, who are concerned with general health care, mental health specialists (i.e., psychologists and psychiatrists combined), had had more background and training in hypnosis, TABLE 1 PERCENT FREQUENCY DISTRIBUTION OF DEMOGRAPHIC CHARACTERISTICS OF FOUR SAMPLES SURVEYED Pediatricians
W = 100)
Nurses
W
= 40)
Child Psychia- Child Psycholotrista gists =
,
w = 29)
Sex
Male
Female Age 20-29 30-39 40+ Training Completed
Yes No
81 19
0 100
97 3
72 28
23 42 35
90 8
25 43
2
32
24 44 32
75 25
100 0
53 47
68 32
65
Downloaded by [McMaster University] at 13:31 15 February 2015
ATTITUDES TOWARD HYPNOSIS
evidenced by reading or courses (x2 = 22.29, p < .01)and were more likely to have had personal experience with hypnosis (x2 = 6.90, p < -01).Few in each group had ever referred for or treated a child with hypnosis. The low rate of referral for or use of hypnosis with children is probably not due to doubt that most children can experience the hypnotic state. Though several respondents refused to give an estimate, the majority in all subsamples agreed that a child can experience hypnosis at least by 6 years of age (see Table 3). As shown in Table 4, for all subsamples, overall attitudes toward hypnosis were predominantly positive. A clear majority agreed that hypnosis might be useful for selected problems, both emotional and medical, and about half thought it might sometimes be the treatment of choice. Yet the respondents had difficulty being specific about why hypnosis might be useful. About half thought hypnosis might shorten treatment; fewer agreed that hypnosis might allow a more thorough working through of problems or might sometimes be the only effective treatment. Negative attitudes also tended to be expressed globTABLE 2 TRAINING AND EXPERIENCE WITH HYPNOSIS Pediatricians W = 100)
Readings orcourses in hypnosis 20 Personallyexperiencedhypnosis 24 Referred a child for hypnosis 31 Used hypnosis with a child 9
Nurses
fN =
20 24 31 9
14 7 10 2
Child Psychiaurtrists = 60)
40)
35 18 25 5
32 20 9 6 1
Child Psychologists
IN
53 33 15 0
=
29)
17 14 1 6 2
58 48 3 1
TABLE 3 OPINIONSCONCERNING UTILITY OF HYPNOSIS AT DIFFERENT AGES Youngest age at which respondents believe a child might be described as being in hypnosis
P
f
9 ' 9
"
k
Below 1 year 1-2 years 3-4 years 5-6 years 7-8 years 9 years or older
22 27 5 6
9 9 22 27 5 6
No response
22
22
Child Psychin- Child Psycholof trists ~ ~ ~ W = 60) (P$%9)
$3 ~5
~
f
7 4 12
12 3 1
"
k
f
18
5 10 4 30 9 30 14 8 1 0 1 2 4
%
f
8 7 15 23 7 7
3 3 7 8 4 1
10 24 28 14 3
23
3
10
2
14
10
~
~~
1
%
66
G. GAIL GARDNER TABLE 4 GENERAL ATTITUDES TOWARD HYPNOSIS (Percent of Respondents) Pediatricians
W
= 100)
Nurses
W
=40)
Child Psychia- Child Psycholotrists gists = 60) (N = 29) ~
Downloaded by [McMaster University] at 13:31 15 February 2015
Overall Attitude: Strongly negative Moderately negative Moderately positive Strongly positive Agreement with descriptive statements about hypnosis: Useful for certain emotional problems Useful for certain medical problems Sometimes the treatment of choice May shorten treatment, with lasting benefit Allows more thorough treatment of certain problems Sometimes the only effective treatment Too dangerous to justify use Unethical to use hypnosis Not sufficiently effective to justify use Too threatening to patients to justify use Too little known to justify use Interest in learning more about clinical hypnosis: Yes, for general information only Yes, to use in clinical practic? No,or no response
3 16 69 9
0 2 78 20
0 35 53 9
4 16 60 16
69
85
92
80
77
80
92
76
34
48
50
68
43
55
37
56
32
50
28
24
27
30
27
12
0 1 1
0 0 2
0 0 10
4 0 8
1
0
2
0
4
2
0
0
53
63
32
34
26
35 2
55 13
52 14
21
ally, with few respondents agreeing with specific negative statements about hypnosis. Despite the vague ideas as to how hypnosis might be useful, the majority of respondents indicated a desire to learn more about it, if a suitable course were available, either for general information or with the intention of using hypnosis in clinical practice. This expression of
67
Downloaded by [McMaster University] at 13:31 15 February 2015
ATTITUDES TOWARD HYPNOSIS
interest is consistent with the generally positive attitude against a background of limited knowledge. When the respondents were given a list of developmental, behavioral, and medical problems-all of which have been reported to respond to hypnotherapy-and asked to indicate which ones might respond to hypnotherapy, either as a primary treatment modality or in conjunction with other forms of treatment, there were differences of opinion both across disciplines and across problems, as shown in Table 5 which indicates the frequencies and percentages of each group checking each problem. Omitting the nurses, it is interesting that the other three groups rarely showed more than a two-thirds majority in support of the possible value of hypnotherapy for any problem, even for such problems as asthma and multiple fears for which there are many reports of successful treatment with hypnotherapy. Thus, at this specific level, the respondents as a group were not fully aware of the ways in which they might appropriately utilize hypnosis. TABLE 5 FREQUENCIES AND PERCENTAGES IN EACHDISCIPLINE WHOTHOUGHT HYPNOSIS MIGHT BE USEFULFOR SPECIFICPROBLEMS Nurses Problem
Psychotic withdrawal Delinquent behavior Learning disorders Hyperactivity Disruptive behavior Drug addiction Psychogenic seizures Low self-esteem Hemophilia Separation anxiety School phobia Stuttering Sleep disturbances Obesity Severe burns Enuresis Multiple fears Non-organic pain Asthma Fear of injections
w = 100) 16 29 20 21 32 35 22 46 35 41 50 50 46 54 56 57 59 73 68 73
16 29 20 21 32 35 22 46 35 41 50 50 46 54 56 57 59 73 68 73
w = 40) 20 17 17 26 25 24 24 27 22 25 35 31 36 32 30 29 31 38 36 33
50 43 43 65 63 60 60 68 55 63 88 78 90 80 75 73 78 95 90 83
Child Psychiatrista = 60)
1 2 6 5 4 11 25 9 29 12 20 22 21 23 32 23 26 28 33 33
2 3 10 8 7 18 42 15 48 20 33 37 35 38 53 38 43 47 55 55
Child Psychologists
w = 29)
3 3 5 3 3 11 11 8 8 17 16 15 16 15 11 17 18 19 19 21
10 10 17 10 10 38 38 28 28 59 55 52 55 52 38 59 62 66 66 72
Downloaded by [McMaster University] at 13:31 15 February 2015
68
G. GAIL GARDNER
A two-way analysis of variance was performed, with problems and disciplines as independent variables and percent endorsing a problem as the dependent variable. The results showed significant differences between problems ( F = 14.98, d.f = 19/57;p < .Ol) and disciplines (F = 83.44, d.f = 3/57; p < .01). The latter showed that nurses most frequently endorsed problems as appropriate for hypnotherapy and psychiatrists least frequently. The differences between problems indicate that some problems were more likely than others to be thought appropriate for hypnotherapy, regardless of discipline. Generally, problems which present primarily as emotional, behavioral, or developmental disorders were least likely to be checked, while problems most often checked werewith the exception of multiple fears-either those with a primary physical component (asthma, burns) or those likely to be encountered or followed in a pediatrician’s ofice (fear of injections, non-organic pain). Rank order correlations (see Table 6) showed significant agreement across groups concerning the order of likelihood in which the 20 problems might respond to hypnotherapy. DISCUSSION Given the historical swings, from high to low regard, that have characterized professional attitudes toward hypnosis through the centuries, it is encouraging to see that the positive attitude which emerged several years ago continues, at least for the geographically limited population of child health professionals who responded to this survey. Yet while these people, as a group, have generally positive attitudes toward hypnosis and would like to know more about it, they are limited in knowledge about the particular ways in which hypnotherapy constitutes a useful treatment modality. That is, they think it is good for something, but they often do not know what or why. This TABLE 6 RANK ORDERCORRELATIONS AMONG DISCIPLINES’ FREQUENUIEB OF STATING THAT EACHOF 20 PROBLEMS MIGHTRESP~NDTO HYPNOTHERAPY Pediatricians = loo)
Nurses W = 40)
Child Psychiatrists (N = 60)
.a3*
-
.78* .87*
.59* .77*
.74*
w
Pediatricians Nurses Child Psychiatrists Child Psychologists
Child Psychologists
(N = 29)
-
-
Downloaded by [McMaster University] at 13:31 15 February 2015
ATTITUDES TOWARD HYPNOSIS
69
lack of knowledge probably contributes to their low rate of referral for and use of hypnotherapy, though of course the lack of adequate referral sources adds to the problem. Corollary to the general lack of knowledge is the fact that most of the respondents feel quite comfortable with other treatment modalities (e.g., pharmacological approaches, psychotherapy) and will logically use these before exploring something new or unfamiliar to them, even if the familiar approach is actually less efficient or effective than hypnotherapy. Of course the latter problem is also true for many other kinds of treatment, including behavior modification and certain drug therapies. It was especially interesting to the author that all groups of respondents- including the mental health or behavior specialiststended to consider hypnotherapy more often appropriate for essentially medical problems than for problems considered primarily emotional, behavioral, or developmental in nature. One might well argue that certain of the behavior problems, such as hyperactivity or psychotic withdrawal, are better approached with other treatment modalities. Yet, it would seem generally acceptable to consider hypnotherapy as a treatment of choice for such problems as separation anxiety or low self-esteem, not just to achieve amelioration of the symptoms, but also as an adjunct in dynamically-oriented therapies. One might hypothesize that the respondents may think of hypnotherapy primarily as a symptom-oriented approach, especially when there is acute distress, though the data are not sufficient to clarify the issue. It would be interesting to learn whether other therapies (e.g., client-centered therapy, behavior therapy, psychopharmacological treatment) would fare the same way. Consistent with the findings of many workshops and training centers, the fact that a person seeks formal training in hypnosis appears to be no guarantee that he will ever use it in actual practice. In the present survey, this was especially true of the psychologists and psychiatrists. Likewise, personal experience with hypnosis does not necessarily lead to using it as a therapeutic tool with others. Given the fact that good training opportunities are rare, the obvious waste of time and money is all the more significant. These findings have several implications for those who are involved in training child health professionals to use hypnotherapy: 1. Interest expressed by this sample seems to justify increasing the availability of training opportunities in hypnosis through workshops, seminars, and courses. In addition to training designed to familiarize the professional with the complexities of hypnotherapy for problems having a significant psychological component, there should be programs to train personnel in the far simpler technical task of assisting
Downloaded by [McMaster University] at 13:31 15 February 2015
70
G. GAIL GARDNER
in treatment of individuals where hypnosis is used to alleviate pain of an organic origin. The use of hypnosis to facilitate the changing of dressings in burns, to assist in reconstructive plastic surgery, or to ameliorate the pain and suffering of terminal cancer, are all instances where hypnotic intervention is uniquely effective in making a difficult situation more palatable for the patient. Though the assessment of whether hypnosis is appropriate in the treatment of a particular case and the initial induction should be carried out by a physician or psychologist with special training in the use of hypnosis, the maintenance of the hypnotherapeutic effects can be greatly facilitated by the manner in which the pediatric nurse handles the patient. The nursing staff might even be taught simple hypnotic reinduction techniques provided the use of hypnosis were carefully limited to problems within the bounds of their competence, much as they administer drugs and carry out other prescribed complex therapeutic procedures. Indeed, nurses already use a great deal of suggestive therapy as they describe procedures and work with their patients. One wonders whether nurses would not be more effective if they knew more about the principles underlying the suggestive methods they intuitively employ. Given careful teaching, the potential gain might well outweigh the risk of inappropriate use, which has been the major reason why nurses had not in the past been encouraged to use hypnosis. 2. For those training opportunities designed to equip a child health professional to do hypnotherapy, it might be useful to obtain some sort of statement, as part of the application or screening process, in which the applicant is required to state rather precisely the experiences which led to his seeking training in hypnosis, and the problems he has encountered in his practice which he hopes to approach more effectively with hypnotherapy. Thus, the applicant would be forced to crystallize his goals and could not simply coast along with the vague idea that “hypnosis might come in handy sometime.” 3. Lecture sessions, especially in advanced courses, might be more helpful if they go beyond historical and theoretical issues and techniques of induction and emphasize also specific applications and advantages of hypnosis, with ample use of case vignettes, tapes, and films. Both lecture and discussion sessions could address the specific goals set forth by the applicants, amplifying on appropriate goals and explaining why other stated goals are perhaps better reached by other treatment techniques. 4. For courses focusing on techniques of hypnotherapy, in addition to requiring trainees to practice induction and dehypnotization tech-
Downloaded by [McMaster University] at 13:31 15 February 2015
ATTITUDES TOWARD HYPNOSIS
71
niques in small supervised practice sessions, it may be useful to include some practice in dealing with specific problems, such as pain or anxiety. In order to avoid the problem of the students doing “wild psychotherapy” with people who are strangers both to them and to the instructors, it may be best to have the instructors themselves volunteer for this aspect of the training. For example, it would seem possible to conduct simple experiments with anxiety or pain which could be limited to the duration of the training session. This would allow the trainee, in a controlled setting, to experience using hypnosis for a valid purpose and would force him away from technique oriented self-consciousness into some measure of creativity and resourcefulness as he focuses on the needs and responses of his subjects. Of course, this model is much more feasible in a course lasting several weeks than in a workshop spanning only a few days, but even the short workshop might be designed to include some sort of introductory practical application, perhaps along the lines of problem-oriented discussion and/or demonstration. It seems that the closer the trainee can get to practical use of hypnosis during his training, the more comfortable he may feel Yrying his wings” on his own clinical practice. 5. As with other complex treatment modalities, continued supervision is essential after the initial training experience. Lack of followup supervision is perhaps the greatest weakness in many workshops and courses in hypnosis. The trainee completes the course and wants to try out what he has learned, but has no knowledge of how or where to find adequate supervision. Since this isolation may contribute significantly to the decision not to use hypnosis, even after training, it may be important for us to make a far greater effort to provide individual supervision after formal training is completed. On our part, we could provide the applicant with names of qualified persons in his area from whom he can seek supervision. If we send this information in response to the first inquiry, we could even urge the applicant to give us the name of a qualified person who has agreed to provide continuing supervision. This, along with the requirement of stated goals, would encourage that kind of commitment which the social psychologists have long known is most likely to lead to action. In summary, this survey suggests that child health professionals have positive attitudes and interest in hypnosis, but need training which more directly encourages them to grasp specific applications of hypnosis and to continue to use hypnosis after their formal training is ended. The extent to which the findings are applicable to other professionals is not known. Of course, it is also not clear how much
Downloaded by [McMaster University] at 13:31 15 February 2015
72
G. GAIL GARDNER
the results may be peculiar to the Denver area. For example, the finding that the psychiatrists ranked hemophilia very high (17th out of 20) on their list of problems which might respond to hypnotherapy probably owed to the fact that a Denver child psychiatrist is well known in the area for his use of hypnotherapy with hemophiliacs (La Baw, 1970); this finding is likely not generalizable to other cities. Also, there is no way of knowing the attitudes of the 40% of the original sample who did not respond to the questionnaire. On the other hand, it does seem reasonable to note that this survey supports the growing conclusion that there is a general need for continuing focus on issues of training and supervision. As more people become active in the field, it seems especially appropriate to consider developing advanced workshops devoted specifically to techniques of teaching and supervising hypnotherapy. Such workshops would help maintain high standards of training and would therefore maximize opportunities for professionals first seeking to understand or utilize hypnosis as a treatment modality.
REFERENCES GARDNER,G. G. Hypnosis with children. Znt. J. d i n . exp. Hypnosis, 1974,22,20-38. (a) GARDNER,G. G. Parents: Obstacles or allies in child hypnotherapy? Amer. J. d i n . Hypnosis, 1974,17,44-49. (b) LA BAW,W. L. Regular use of suggestibility in pediatric bleedings. Haematologia, 1970,4,419-425. VAN DER WALDE,P. H. Patient’s preference for treatment: Attitudes toward hypnosis. Znt. J . d i n . exp. Hypnosis, 1974,22,46-53.
fiber die Haltung von Fachleuten in der Kindergesundheitspflege gegeniiber Hypnose: Folgerungen f a r das Training G. Gail Gardner Abstrakt: Ein tfberblick iiber Fachleute in d e r KindergesundheitspflegeKinderBrzte, Kinderschwestern, Psychologen und Psychiaters fiir Kinder-erbrachte, dass sie im allgemeinen eine positive Haltung zu Hypnose einnehmen, jedoch wenig iiber ihre speziellen Vorziige und Anwendungen wissen. Es werden daher hier Empfehlungen f i r die Entwicklung von Trainingsmiiglichkeiten in Hypnose gemacht, die die Wahrscheinlichkeit steigern kiknten, dass Fachleute sich wirklich d e r Hypnose bedienen oder ein Kind wenigstens anderswo fiir Hypnotherapie iiberweisen.
ATTITUDES TOWARD HYPNOSIS
73
k s attitudes des professionnels de la sant6 des enfants face B I’hypnose: les implications pour un entrahement
Downloaded by [McMaster University] at 13:31 15 February 2015
G. Gail Gardner Resume: Un sondage effectuC auprbs de professionnels de la santb des enfantspediatres, infirmieres pbdiatriques, psychologues e t psychiatres pour enfants rkvble que ceux-ci ont gen6ralement un attitude positive h I’egard de I’hypnose, mais qu’ils connaissent bien peu ses avantages particuliers ou ses applications. I1 y a discussion des implications d e ces resultats dans la conception d e stages d‘entrainement a I’hypnose dans le sen8 d’un accroissement de la probabilite que le professionnel va reellement utiliser I’hypnose ou va rkfbrer I’enfant B quelqu’un d’autre pour une hypnothkrapie.
Actitudes de 10s profesionales de la salud infantil ante la hipnosis: implicaciones para la formaci6n G. Gail Gardner Resumen: Una muestra de profesionales de la salud infantil-pediatras, enfermeras pediatricas, psicologos infantiles y pedopsiquiatras-pone d e manifiesto la existencia, por lo general, d e actitudes positivas ante la hipnosis, per0 un escaso conocimiento d e s u s ventajas especificas o d e sus aplicaciones. Se tienen e n cuenta las implicaciones para la programacion de oportunidades d e formacion e n hipnosis, que podrian aumentar fas probabilidades d e que el profesional utilice el mismo la hipnosis o recomiende al niiio una hipnoterapia en otro lugar.
