Strategic Eclecticism in Hypnotherapy: Effectiveness Research Considerations

American Journal of Clinical Hypnosis,  Jan 2008  by Amundson, Jon K,  Nuttgens, Simon A

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Abstract

Hypnosis is attempting to come to grips with the EST (Empirically Supported Therapy) revolution in mental health practice. However, there are ways to account for outcome outside of simple empirical validation of treatment models. In this light strategic eclecticism as a broader research-based consideration is used to illustrate empirical principles within Eriksonian hypnotherapeutic approaches.

Keywords: Erickson, empirical, eclectic, core and process variables in hypnosis.

The issue of empirically validated or supported treatment has generated considerable debate within clinical psychology (Beutler 1998, 2000; Beutler, Williams & Entwhistle, 1995; Borkovec & Castongauy, 1998; Clarke, 1995; Garfield, 19%; Hubble, Duncan, & Miller, 1999; Persons & Silbershatz, 1998; Walmpold, 2001). This issue has been paralleled by similar discussion in clinical hypnosis (Amundson, Alladin, & Gill, 2003; Alladin, Sabatini, & Amundson, in press).

Pursuit of empirically validated or supported therapy (Chambless & Hollan, 1998; Chambless et al., 1996, 1998) with standards related to rigorous, experimental design and random clinical trials (APA, 1995, 2002) has been referred to as efficacy-focused research. This research tradition "seeks to evaluate specific models and specific therapeutic protocols with the criteria/goal of achieving empirically supported merapy status" (Amundson, et al., 2003, p. 12). In fact a special issue of me International Journal of Clinical and Experimental Hypnosis (Nash, 2000) was devoted to a review of clinical hypnosis in light of such criteria.

In contrast to efficacy-focused research, there is effectiveness-focused research which aims to "identify those factors and dynamics that influence therapy...[and] increase the effectiveness of therapy regardless of models, protocols, or specific technique" (Amundson et al., 2003, p. 12). Efficacy-focused research emphasizes the specific aspects of a given treatment and whether it satisfies well-defined empirical criteria (Chambless & Hollan, 1998). Effectiveness-focused research is interested in identifying: (a) common factors (Beutler, 1998; Beutler & Harwood, 2000; Fishman, 1999; Frank, 1961; Hill, 1994; Hill & Corbett, 1993; Hubble et al., 1999; Lambert, 1998; Russell & Orlinsky 1996; Walmpold, 2001), (b) qualities of the therapeutic alliance (Najvits & Strupp, 1994; Norcross, 2002; Safran, Crocker, McMain, & Murray, 1990; Safron, Muran, & Samstag, 1994), and (c) expectancy and placebo effects (Evans, 2000; Frank & Frank 1991; Kirsch, 1994; Lambert, 1992).

The juxtaposition of efficacy and effectiveness research has resulted in the concept of evidence-based practice in psychology (APA, 2006) and, more specifically, evidence-based practice in hypnosis (Alladin et al., 2007). In both instances, evidence-based practice seeks to take what has been shown to produce successful treatment outcomes (that is, efficacious treatment protocol) and embed them within the larger, apparently more determinant principles associated with effectiveness research. It is within this conceptualization of evidence-based treatment that the concept of strategic eclecticism emerges.

What We Mean By Eclectic

The term "eclectic" first appears to have entered the literature in the 1960's. Thorne (1962) described how training in a single or particular approach to therapy was counterproductive given the diversity of circumstances, diagnosis, "personalities," and situations of ones' clients. One size to fit all, it seemed, did not accommodate the variety of circumstances associated with day-to-day clinical practice. This initial desire to expand treatment and training from a one method/model approach to a broader integrationist perspective led to further developments in the field of eclectic practice (Arkowitz, 1995). The emerging eclectic tradition was reflected in an emphasis upon utilizing diverse methods of intervention (Lazarus, 1971), extra-theoretical principles of clinical practice (for example, a relationship emphasis - see Norcross, 2002), and even the homogenization of theory, that is, integrationism (Norcross & Goldfried, 1992).

By the 1990's, when queried as to method, model, or preferred school of therapy, most practicing clinicians would, in fact, declare that they were "eclectic" (Jensen, Bergin, & Greaves, 1990). Nonetheless, eclectic often meant an engaged/chaotic clinical practice where a given clinician was more confused than methodical (Norcross, 1987). Early eclectic inclinations reflected practicing clinicians' intuitive sense that allegiance to a single model might not answer all questions nor serve all purposes all of the time. Research has shown that even with the most "manual-based" approaches clinicians vary widely in application. Therapists modify technique and adjust their therapies in the light of their personal experience and the cases they encounter. There is evidence to suggest this is equally true in hypnosis (Amundson, Alladin, Gill., 2003).