APA Candidates Answer Our Questions

For at least a decade, Div. 30 has largely held an apolitical stance, both on a national level as well as in APA governance affairs. Having consulted with the Executive Committee, we feel that it is important that members make an informed choice when they cast their ballots in this upcoming APA election, a choice that hopefully caters in part to their professional and/or scholarly interests in hypnosis. To that end, we have decided that, while we, as a division, will not make any official or formal endorsements, we would pose some questions that relate to our divisional interests to the candidates for 2019 president-elect of APA. Four questions, along with an explanation of our intentions (described above) were sent on or around May 15, 2018, to the candidates using whatever email address that could be found (e.g., candidate website, professional website, etc.).

The questions are as follows:

  1. Do you have any professional experience or exposure to hypnosis? How familiar are you with the topic? 
  2. Some psychologists tend to focus part of their practice and research on topics that have great scholarly merit but are heuristically considered fringe by others. Hypnosis is an example of this, even though its use has been substantially validated by research. How would you as president help promote topics like hypnosis that could benefit from broader exposure? 
  3. Many in our division are clinicians who would like to make the use of hypnosis a reimbursable expense by insurance companies. Do you support this? If so, what would you do to help make this a reality? 
  4. How can APA support the development of clinical training and internship programs providing a focus on specialty areas like hypnosis? How can it support the efforts of divisions to do so?

Candidates were asked to submit their responses, if they chose to provide them, by June 8, 2018. We received responses from Sandy Shullman. PhD, and Armand Cerbone, PhD. Below is each candidate's verbatim response, only having been amended for font and formatting purposes. By a flip of a coin, Shullman's response to the first question was chosen to be listed first. Cerbone's response appears first to the second question and so forth. This is done to reduce any possible bias in the way in which responses are presented.

Again, Div. 30 will not officially endorse any candidate for president-elect, but we hope that this information guides you to make an informed decision in this election.

[Note: Cerbone provided preliminary and concluding remarks. The former is included as part of the answer to his first question response. The latter follows his response to the final question. Both are placed in brackets for context]:

Q1: Do you have any professional experience or exposure to hypnosis? How familiar are you with the topic?

Shullman: I was trained in the use of hypnosis in psychotherapy in the 1980s and used it when I was actively doing psychotherapy in the 1980s and 1990s, primarily for pain management and anxiety reduction. I have not done psychotherapy since that time, so I have not kept up with the use of the literature on the use of hypnosis and hypnotherapy in practice. I am generally familiar with the general history of hypnosis and changes in its definition over time. I have some exposure to the scientific evidence substantiating its use, especially for pain, palliative care and anxiety, recognizing that it has much broader, scientifically determined applicability. My experience also informs me of the stereotypes the public retains about hypnosis and the resulting challenges for hypnosis usage and reimbursement in the current healthcare system. I am also curious about the relationship amongst hypnosis, meditation, mindfulness, dissociation and other attentional states.

Cerbone: [Preliminary remarks: Thank you for this opportunity. I welcome it.

If I am making appropriate inferences, I think your division is contemplating new directions. I offer these responses to your questions in hopes they evidence my eagerness to help and do not betray my failure to fully appreciate the thrust of the questions.

I have no trustworthy content experience but more than enough knowledge of APA and its governance to offer you. I would be delighted to support your work.

Below are my first answers and recommendations. At the end I add some remarks to contextualize my answers. My recommendations are meant to provoke thought.]

I have no professional experience or personal exposure to hypnosis. My knowledge of hypnosis is limited to the role of hypnosis in the early history of psychology.

When a patient or client has asked about hypnosis to help with anxiety or smoking cessation, for instance, I have culled my sources to find a psychologist trained specifically in the applications of hypnosis. In one case many years ago a client, appreciating my ignorance, chose to transfer care from my practice to that of a psychologist with hypnosis expertise. I was very supportive of his decision as therapeutically appropriate.

Q2: Some psychologists tend to focus part of their practice and research on topics that have great scholarly merit but are heuristically considered fringe by others. Hypnosis is an example of this, even though its use has been substantially validated by research. How would you as president help promote topics like hypnosis that could benefit from broader exposure?

Cerbone: I have never regarded hypnosis as a fringe application of psychology. I have never had enough data to make such an assessment with any confidence.

My answer here reflects my limited understanding of hypnosis but is meant to suggest my considerable knowledge of APA governance and how to make it work for you. You will have to determine if my suggestions and recommendations would work for you.

First, assuming you see yourselves as an applied area of psychology, I would ask you to consider where and how your interests overlap with other divisions that provide opportunities for collaboration on applied concerns and interests.

Second, I would recommend that your leadership employ as many of APA’s resources as possible to address the issue of exposure. The following are ones that I have used and would recommend for you to consider:

  • CODAPAR is the governance committee that can best address your needs as a division. They have a number of programs, like grants for development that might address your interest in promoting awareness.
  • Ian King, Director of Membership Services, is eager to help divisions meet their missions and improve the experience for members. Talk to him directly or Christine Tipton in his office. Invite him to one of your meetings to advise you on which services he can offer. 
  • Your Council rep is in the best position to bring your mission to the attention of Council, our policymaking body. I would begin with the caucuses of Council. Joining the Association of Practicing Psychologists (APP), for instance, can provide opportunities to increase awareness of your division and its mission in smaller groups where extended discussions can take place. 
  • Developing a resolution, for instance, that is based on the research and data you have, citing how hypnosis is a valuable therapeutic tool that requires appropriate training, etc. and calls on APA and psychologists to conduct further research, inclusion in curricula and training, and promotion of inclusion in services reimbursable by insurance companies. Developing and lobbying Council to pass such a resolution requires significant investment of resources, mostly time and commitment from leadership. Lobbying for passage necessitates building the political support among the voting members of Council. (See bullet 3 above.) The major reason for developing and passing a resolution (apart from the visibility it creates throughout governance) is that it directs APA to use its resources to advocate for the interests of the resolution. 
  • Developing practice (not clinical) guidelines on the use of hypnosis in psychotherapy is another option. 
  • Consider establishing alliances with other associations who share your mission in the U.S. and other countries.

Shullman: As APA president, I would address this question in three ways:

  1. My role would include ensuring that information about all scientifically-supported psychological treatments are regularly updated and disseminated. Hypnosis is one such treatment. 
  2. I would actively discourage the use of the concept “fringe” for any scientifically-supported psychological treatment. Hypnosis would be in this category. 
  3. Most significantly, I would want to ensure that, during the development of APA guidelines, all treatments and modalities that are based on scientific support are considered when creating official APA documents. This approach should be a cornerstone of scientific inclusion and diversity and foundational to our guidelines development process. Hypnosis is an excellent example for consideration.

Q3: Many in our division are clinicians who would like to make the use of hypnosis a reimbursable expense by insurance companies. Do you support this? If so, what would you do to help make this a reality?

Shullman: My understanding is that hypnosis (CPT code 90880, under “Other Psychiatric Services and Procedures”) is currently reimbursable by a few insurance companies, but most do not cover hypnosis per se. Insurance companies may cover therapy that includes hypnosis, the most typical route taken by most clinicians who use hypnosis. Further, Medicare does have some history in covering “hypnotherapy’ under certain conditions. According to CMS data, relative few 90880 codes are billed, and the majority are billed by/for social workers.

There are two basic approaches I would recommend in supporting reimbursement for hypnosis:

  1. Advocate for psychologists being included in the CMS definition of “physician.” Psychologist is the only doctoral level provider designation in the U.S. healthcare system that is not considered “physician.” Our exclusion creates so many issues regarding reimbursement, autonomy, etc. Advocacy efforts regarding reimbursement for hypnosis and/or hypnotherapy would benefit greatly if they were built on a foundation of psychologists being included in the definition of “physician” in the healthcare reimbursement system. APA declined this opportunity many years ago and is working hard currently to correct this situation. Div. 30 should support this work as a foundational step towards hypnosis advocacy efforts. 
  2. Continue to explore the lack of recognition for “hypnotherapy” or refusal of reimbursement for the hypnosis procedure (CPT90880) as a scope-of-practice issue and work with legal and regulatory staff at APA to target the issue in specific jurisdictions and/or organizations. Psychology and APA should be vigilant in determination of what is considered as part of psychotherapy.

Cerbone: Having a goal like this is important. If I understand your question well enough, I would see this as a long-range goal and a very worthy one for the division to pursue. I would recommend developing a strategy that has intermediate objectives leading to this goal, like building the relationships across division and governance groups that can translate into support. (See bullet 3 as an example). If I my lack of knowledge is typical, developing strategies to educate those whose support is critical to your mission can be effective.

Admittedly a long-range strategy, I would suggest that an effective way to broaden awareness and support in divisions is to seed them with members from your division. Practice divisions, in particular, are always looking for volunteers. Once on a committee, your voice can monitor a division’s agenda for opportunities to introduce a proposal or a measure that advances your mission to promote hypnosis.

Q4: How can APA support the development of clinical training and internship programs providing a focus on specialty areas like hypnosis? How can it support the efforts of Divisions to do so?

Cerbone: [Note from John Mohl: Cerbone divided his responses into two, given that there were two questions. This is his response to the first part] I suggest collaborating with the Board of Education and with Jaime Granados-Diaz, the ED of the Education Directorate, to enlist their support for your efforts.

[Response to second part of question] A resolution documenting the effectiveness of hypnosis to achieving positive outcomes in psychotherapy and that encourages the inclusion in training curricula and externships and internships could be effective in achieving these long-range goals.

Promoting accurate understanding of hypnosis based on robust research has strong appeal to psychologists in APA.

Also, gaining seats on the committees and boards of other divisions provides significant opportunities to affect the agenda of the division as well as educating the boards members to the value of hypnosis.

[Concluding remarks: It may be apparent that I have inferred from the questions and criteria in your invitation that you are seeking to increase visibility for the discipline in healthcare and in APA.

Every suggestion I have made is based on personal experience in governance over many years. They had as goals promoting awareness and then support for LGBT concerns in APA and healthcare. In that they seem similar to your goals.

It took many years to develop and collect the data that would convince psychologists and policymakers of the merits of our initiatives. It took years to develop the trust of colleagues who would support policies critical to LGBT health and life. While we didn’t encounter strong resistance to our data, we faced other resistances.

The important point is to keep your eyes on the prize you have set for yourselves. I would be interested in what short-term objectives and long-term goals you have developed. Enlisting the support of APA presidents can be part of a sound strategy. Thank you for inviting me to comment.]

Shullman: Within the APA Education Directorate, the Board of Educational Affairs (BEA) and the Commission for the Recognition of Specialties and Proficiencies in Professional Psychology (CRSPPP) have sources of assistance to identify specialty practice areas and proficiencies within the broad and general context of internships in health service psychology. The Commission on Accreditation (COA) must, of course, maintain independence from APA to preserve its status with the U.S. Department of Education; given that, however, the COA has a mechanism to identify “developed practice areas” besides counseling, clinical and school specialties at the doctoral level. This may be an avenue for Div. 30 to consider, so that hypnosis is recognized within some training programs.

Postdoctoral training under COA includes both focus areas and recognized specialties. There could be an option for Div. 30 to gain APA assistance to help some postdoctoral residencies incorporate hypnosis into their training under the category of “focus area.” This would make possible the inclusion of advanced competencies in hypnosis and hypnotherapy in accredited residencies.