Heal Yourself Hypnotherapy: Informed Consent & Pre ...healyourselfhypnotherapy.weebly.com/uploads/5/6/2/... · My Approach to Hypnotherapy: * The therapeutic techniques that I employ

Heal Yourself Hypnotherapy - Noal Z. Fox-Stern - Certified Hypnotherapist 1

(360) 441-4444 or [email protected] www.HealYourselfHypnotherapy.Weebly.com

(Heal Yourself Hypnotherapy: Promoting Health and Mental Health as Basic Human Rights)

Heal Yourself Hypnotherapy:

Informed Consent & Pre-Induction Interview Documents (Heal Yourself Hypnotherapy: Promoting Health and Mental Health as Basic Human Rights)

Disclosure Information:

(Note: Foot Notes include relevant legal and ethical codes which are also included in

Appendix – I.)

I am required by law and ethics, for both your protection and mine, to disclose the

following information to each of my prospective clients.

* My name is Noal Z. Fox-Stern. I am a Washington State certified Hypnotherapist.

I call my practice Heal Yourself Hypnotherapy, and I can be reached at (360) 441-4444 or

[email protected]

My business address is: I have not current business address. I am currently available for

house calls within in the Bellingham and Seattle areas.

My website is www.HealYourselfHypnotherapy.Weebly.com2

* UBI # 602 607 773, Registration # RC00054829, Control # 0016433, License # 06-00028813

* I will keep all information, that you choose to share with me, strictly confidential: as

authorized by RCW18.19.180. This means that I may only disclose information that you share

with me to other parties with your written consent, or if I learn that you or somebody else are in

danger of harm; that is if you or someone you know of is in danger of committing suicide or

some other violent crime, or of taking unnecessary potentially life threatening risks. I will

maintain this high standard of confidentiality with all my clients, including clients with whom I

might happen to share mutual acquaintances.4

* I do not attempt to treat or diagnose disease or mental disorders of any kind. Hypnotism in no

way replaces standard medical procedures, but works in conjunction with them by freeing the

client of the feelings and attitudes that may be inhibiting his or her natural healing process.

Hypnotism helps to create a strong mental expectancy and to reduce stress, thereby normalizing

the action of the autonomic nervous system.5

1 “(a) The name of the certified counselor or certified adviser and the name of their firm, agency, or business, if any

(excerpt from WAC 246-810-031, WA Department of Health, Hypnotherapist, 2011).” 2 “(b) The certified counselor's or certified adviser's business address and telephone number (excerpt from WAC

246-810-031, WA Department of Health, Hypnotherapist, 2011).” 3 “ (c) The certified counselor's or certified adviser's Washington state credential number (excerpt from WAC 246-

810-031, WA Department of Health, Hypnotherapist, 2011).” 4 “(h) The limits of confidentiality under RCW 18.19.180 (excerpt from WAC 246-810-031, WA Department of

Health, Hypnotherapist, 2011).” 5 “(j) Disclosure that the certified counselor or certified adviser is not credentialed to diagnose mental disorders or to

conduct psychotherapy as defined in WAC 246-810-010(14) (excerpt from WAC 246-810-031, WA Department of

Health, Hypnotherapist, 2011).”

mailto:[email protected]

http://www.healyourselfhypnotherapy.weebly.com/

http://apps.leg.wa.gov/RCW/default.aspx?cite=18.19.180

http://apps.leg.wa.gov/WAC/default.aspx?cite=246-810-010




* I uphold both “The N.G.H Code of Ethics and Standards (Hunter, 2000 part-I p. 145 - 164),”

which is published by The National Guild of Hypnotherapists (NGH, 2010), and also the

American Counseling Association’s “ACA Code of Ethics, As approved by the ACA Governing

Council (ACA, 2011).”

* Also, all “Hypnotherapists in Washington State are legally required to follow the ethical

Uniform Disciplinary Code (Hunter, 2000 part-I p. 149),” which is also called the “Revised Code

of Washington - Uniform Disciplinary Act: (Uniform Disciplinary Act, 2009).”6

* You have the right to report any “Unprofessional Conduct” (as specified in the legal

publication “Counseling and Hypnotherapy Clients;” see Appendix-I.) to:

- Department of Health, Health Professions Quality Assurance, Contact Person: Linda

McCue, Policy Manager, Policy Office, P.O. Box 47860, 1300 S.E. Quince Street,

Olympia, WA 98504-7860, (360) 236-4986. Mon-Fri, 8am-5pm7

* You have the right to choose any counselor or hypnotherapist who best suits your own needs

and purposes.8

My Approach to Hypnotherapy:

* The therapeutic techniques that I employ include: “Diversified Client-Centered Hypnosis

(Hunter, 2000 part-I p. 5),” and communications exercises and charting strategies which I derive

from my “Coping Skills” experience and training (Fox & Serlin, 1996).

* Some of my preferred hypnotic induction and reframing techniques include: regression,

gestalt, parts therapy, progressive relaxation, safe-place relaxation, and object projection

(Hunter, 2000 part-II). A typical session with me will include a standard trance induction,

preceded and followed by reflective discussions, to assist each client in learning to make

varieties of life changing decisions to improve health, confidence, and skills.

The number of sessions required for successful therapy depends on each client and each issue.

However, successful hypnotherapy typically requires fewer sessions than some other forms of

counseling, because in hypnotherapy issues are addressed at the subconscious level.9

6 “(i) Counselors practicing counseling for a fee must be credentialed with the department of health for the

protection of the public health and safety (ii) Credentialing of an individual with the department of health does not

include a recognition of any practice standards, nor necessarily imply the effectiveness of any treatment (iii) The

purpose of the Counselor Credentialing Act, chapter 18.19 RCW, is to: (A) Provide protection for public health and

safety; and (B) Empower the citizens of the state of Washington by providing a complaint process against those

counselors who would commit acts of unprofessional conduct (excerpt from WAC 246-810-031, WA Department of

Health, Hypnotherapist, 2011).” 7 “the name, address, and contact telephone number within the department of health for complaints (excerpt from

WAC 246-810-031, WA Department of Health, Hypnotherapist, 2011).”

“ (l) A copy of the acts of unprofessional conduct in RCW 18.130.180 (excerpt from WAC 246-810-031, WA

Department of Health, Hypnotherapist, 2011).” This can be found at

http://apps.leg.wa.gov/RCW/default.aspx?cite=18.130.080 and is also included in Appendix – I of this document. 8 “(iv) Clients have the right to choose counselors who best suit their needs and purposes (excerpt from WAC 246-

810-031, WA Department of Health, Hypnotherapist, 2011).” - “ (i) The cost for each counseling session (ii) Billing

practices, including any advance payments and refunds (iii) A statement that clients are not liable for any fees or

charges for services rendered prior to receipt of the disclosure statement (excerpt from WAC 246-810-031, WA

Department of Health, Hypnotherapist, 2011).”

http://apps.leg.wa.gov/RCW/default.aspx?cite=18.19






My History and Training:

* In 2003 I graduated from Bellingham Technical College’s hypnotherapy program that was

taught by Jamie Engholm. This program included a nine-month training course, designed by C.

Roy Hunter, which taught the hypnotherapy techniques of the renowned Charles Tebbetts, and

culminated with my certification to practice professional hypnotherapy through the American

Council Of Hypnotist Examiners (Hunter, 2000 parts 1 & 2).10

* In 2002 I worked with my father G. Kenneth Fox PhD, in the Mt. Vernon School district. At

this time I underwent training for, and gained experience in facilitating process groups for his

revolutionary “Coping Skills” dropout prevention program (Fox & Serlin, 1996). “Coping

Skills” is a uniquely successful approach to conducting client centered therapy that was designed

by Dr. Fox. Since Fox’s retirement in 2010, I remain one the few helping professionals who are

qualified to utilize and present “Copping Skills” curriculum and techniques.11

What is Hypnotherapy?

* Because misconceptions about hypnosis are common, hypnotherapy requires additional

emphasis on the informed consent process. Hypnotherapists share an ethical duty to educate

clients about the actual nature of hypnosis as an experience which exists within and that is

controlled by the mind of the person who is being hypnotized.

* Hypnosis is a natural state of mind that occurs several times per day for every human being.

* Hypnosis is ‘alpha consciousness,’ the level of brain activity between waking and sleeping.

* Hypnotherapy uses: words, sounds, language patterns, vocal rhythms, and visual and tactile

cues to deliberately invoke and maintain this natural ‘alpha consciousness’ state called hypnosis.

* A person who is hypnotized maintains control of his or her own mind. Hypnosis is not

something that a therapist does to a client. A hypnotherapist is only a guide. Hypnosis is what the

human brain does naturally when a person is ready to make some kind of healing change.

Billing Information:

Suggested Donation Rates:

For Individual Hypnotherapy Sessions: $75 per hour

- Pre-Induction Interview --- (included with first session)

For Workshop Participation: $35 per person for each 3-hour workshop

9 “(e) The name and description of the types of counseling provided by the certified counselor or certified adviser,

including the therapeutic orientation, methods, and techniques employed in their practice, and a list of resources

relevant to the therapeutic orientation. (f) The type and duration of counseling expected, if known at the time of

providing the disclosure information (excerpt from WAC 246-810-031, WA Department of Health, Hypnotherapist,

2011).” 10

“(d) The certified counselor's or certified adviser's education, training, and experience (excerpt from WAC 246-

810-031, WA Department of Health, Hypnotherapist, 2011).” 11

“C.2.b. New Specialty Areas of Practice Counselors practice in specialty areas new to them only after appropriate

education, training, and supervised experience. While developing skills in new specialty areas, counselors take steps

to ensure the competence of their work and to protect others from possible harm (ACA, 2011 p. 9).”




Billing Information Continued:

(I currently accept cash and local checks only.) (Donations must occur before the commencement of each session or workshop.

(Each client must read and sign this Treatment Agreement and these Informed Consent-

Disclosure documents before therapist may accept donations.)

(No refunds will be offered after each session or workshop has begun.)

(I, Noal Z. Fox-Stern, WA State Certified Hypnotherapist, currently choose to charge no

fees for my hypnotherapy services, yet still to offer my hypnotherapeutic services in

response to all serious inquiries and requests for help. This is because I believe that health

and mental health are basic human rights; not commodities to be bought and sold. I do ask

for each session and workshop participant to please donate according to your own means

and according to your own sense of value for the services that you receive. Your donations

help practices, like Heal Yourself Hypnotherapy, to continue to provide quality service for

persons who might otherwise be unable to afford health or mental health treatments or

learning opportunities. Your contributions also help practices, like Heal Yourself

Hypnotherapy, to uphold and promote the philosophy; that health and mental health are

basic human rights which ought to be available for everyone who seeks them.)

* For further information regarding Disclosure Requirements, and for clarification and

assurances of confidentiality and professional conduct see Appendix – I.

* You are also invited to review the enclosed publication by the Department of Health entitled

“Counseling and Hypnotherapy Clients,” see Appendix – I, or find it posted at my website,

www.HealYourselfHypnotherapy.Weebly.com.

---------------------------------------------------------------------------------------------------------

The prospective client _______________________________________, has read and

understood all information included in this disclosure package, which includes:

“Counseling and Hypnotherapy Clients,” RCW 18.19.60, WAC 246-10-31, WAC 246-810-

032, and all disclosure, charting, and pre-induction interview information for “Heal

Yourself Hypnotherapy.”

Client’s Signature:_______________________________________ Date: ____________

Therapist’s Signature: ______________________________________ Date: __________ (Noal Z. Fox-Stern)





Treatment Agreement:

I hereby state that I understand that hypnosis is a natural state of mind and I am utilizing these

services of my own free will. I am also aware that while under hypnosis it is impossible to coerce

anyone into any action that is against his or her own ethical and moral code.

I therefore agree that I will in no way hold Noal Z. Fox-Stern responsible for any personally

irresponsible, socially irresponsible, or criminal actions that I may commit after utilizing his

services.

I also agree that neither any member of my family now, or in the future, will make claims against

or initiate any suit against him or his representatives.

Client’s Signature: ____________________________________________ Date: __________




Supervisory / Consultation Agreement

I, Noal Z. Fox-Stern, as a Washington State Certified Hypnotherapist, request that you, as

my hypnotherapy client, grant me your permission to share information regarding and discussed

in our private and confidential therapeutic sessions, in confidential and private consultations with

the following person(s):

-

-

-

-

The above named person(s) is(are) my colleague(s) or supervisor(s), and will honor the same

confidentiality agreements, laws, and codes of ethics which I believe in, and to which I, as your

therapist, am also bound.

Client’s Signature:_______________________________________ Date: ____________

Therapist’s Signature: ______________________________________ Date: __________ (Noal Z. Fox-Stern)

“(i) Disclosure of the certified counselor's or certified adviser's supervisory or consultation

agreement as defined in WAC 246-810-025 (excerpt from WAC 246-810-031, WA Department

of Health, Hypnotherapist, 2011).”





Medical / Psychiatric Consent Form

Dear Doctor _______________________________,

Your patient ___________________________________________ has requested that I

use hypnotism to address the following:

I ask for your permission to use hypnotism with your patient in this situation. I offer this service

as an expert in my field. I am certified as a hypnotherapist by the American Council of Hypnotist

Examiners.

I do not attempt to treat or diagnose disease or mental disorders of any kind. Hypnotism in no

way replaces standard medical procedures, but works in conjunction with them by freeing the

patient of the feelings and attitudes that may be inhibiting his or her natural healing process.

Hypnotism helps to create a strong mental expectancy and to reduce stress, thereby normalizing

the action of the autonomic nervous system.

Your signature below authorizes me to use hypnotism with the above named patient.

Sincerely,

Noal Z. Fox-Stern, Certified Hypnotherapist

Doctor’s signature: _______________________________________________________

Date: ____________________________________

* “(j) Disclosure that the certified counselor or certified adviser is not credentialed to diagnose

mental disorders or to conduct psychotherapy as defined in WAC 246-810-010(14) (excerpt from

WAC 246-810-031, WA Department of Health, Hypnotherapist, 2011).”





Pre-Induction Interview Form:Date: ____________ Donations: $ ___________

Client’s Information: # of sessions: ___________

Name: _________________________________________________ ($75 per hour suggested)

Address: _______________________________________________

_______________________________________________

Phone # (s): _____________________________________________

_____________________________________________

e-mail: _________________________________________________

Reason for this visit: ________________________________________________

Length of symptom(s): ______________________________________________

Patterns of symptom(s): ______________________________________________

____________________________________________________________

____________________________________________________________

* The following information can be greatly beneficial to our therapeutic reframing processes.

Please answer thoroughly as many questions as you are comfortable discussing.

Occupation: _____________________________________________

Employer: _______________________________________________

- How long employed here? __________________________ Gender: __________ - Birth date __________ - Age: __________

How do you identify yourself culturally? ___________________________________________

- Aspects of your identified culture that are important to you: ______________

______________________________________________________________

______________________________________________________________

Are your parents: together _____ separate _____ (if separate, your age when they separated: ______)

- (Whom were you primarily raised by? __________________________________)

- # of siblings: _______ - Your birth rank (1st, 2

nd, 3

rd, etc…): _____ of: _____

Has anyone close to you died in your lifetime? ___________ Who? When? _______

____________________________________________________________

Is there any history of domestic violence in your immediate / nuclear family? _________

Please describe: ______________________________________________

___________________________________________________________

___________________________________________________________

Is there any history of substance abuse in your immediate / nuclear family? __________

Please describe: _____________________________________________

__________________________________________________________

___________________________________________________________

Is there any history of mental illness or emotional/behavioral disorders in your immediate or

extended family? ____________ If so please describe: ______________________

____________________________________________________________

____________________________________________________________

Have you ever been diagnosed with a mental health issue? ___________________



(Heal Yourself Hypnotherapy: Promoting Health and Mental Health as Basic Human Rights) Please describe: _______________________________________________

____________________________________________________________

____________________________________________________________

Are you currently undergoing treatment for the above issue? _________

From whom? __________________________________________________

Please describe: ______________________________________________

___________________________________________________________

___________________________________________________________

Have you ever undergone any surgeries? ________ When? _________________

Please describe: ______________________________________________

___________________________________________________________

___________________________________________________________

Please list any medications you are currently taking: _______________________

___________________________________________________________

For what condition(s) are you currently medicated? __________________

___________________________________________________________

If this session is for “pain management,” do you have a signed note of consent from your

physician? ________________________________________________________

Have you ever been hypnotized before? _________________________________

If so, please describe your experience: ____________________________

___________________________________________________________

___________________________________________________________

Expectations of hypnosis: _____________________________________________

____________________________________________________________

____________________________________________________________

Benefits of reaching your goal: _________________________________________

____________________________________________________________

____________________________________________________________

Do you have any fears or phobias? If so please describe: ____________________

____________________________________________________________

____________________________________________________________

What is your primary sensory mechanism (auditory, visual, or kinesthetic)? In other words, do

you usually think in terms of things that you hear, see, or feel? ________________

_____________________________________________________________

Please describe a place in which you can find safety and tranquility. (Perhaps a place you have been

or would like to go, indoors or outdoors, real or imaginary.) Please describe your safe place:

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

Is there any additional information that, as your therapist, you wish for me to know?

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

(-: Are you ready to Heal Yourself? ____________________ :-)




Dr. Ken Fox (Retired) – Psychology & Coping Skills

[email protected] or 360 734-7846 Retired From: Mount Vernon High School, 319 North 9th Street, Mt. Vernon WA 98273, 360 428-600,

[email protected]

Coping Skills Life-Support Checklist

Instructions (adapted for Heal Yourself Hypnotherapy): Rate your progress since your

last hypnotherapy session in each of the ten health areas reflected in the chart below. Use

a scale of 1 to 4 (4 being high and 1 being low). Add up your scores and divide by 10 to

find your average score. Choose one health area as your recent high score and one as

your recent low score. Choose one health area as homework for between now and your

next hypnotherapy session. Note your current score in your homework area from your

last hypnotherapy session. Note any affects toward your therapeutic goal(s).

Date Physical

Fitness

Nutrition Sleep

&

Rest

Assertive

Skills

Centering

&

Solitude

Fun Goal

Met

Support

Received

Support

Given

Creativity

“Art”

Average






Therapist’s Note Page:

Client’s eye movements as correspondent with thought patterns: Visual

Remembered (VR), Visual Constructed (VC), Auditory Remembered (AR), Auditory Constructed (AC),

Kinesthetic Remembered (KR), Kinesthetic Constructed (KC) (Derived from my “Coping Skills” trainings’ Reading List: Bandler &

Grinder 1979).

Therapist’s techniques employed: ________________________________ _____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

Therapist’s notes and observations:_________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

Client’s comment’s after session: __________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

Is a follow up session planned? Explain: ____________________________

_____________________________________________________________

_____________________________________________________________




Any additional notes: ___________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

____________________________________________________________...



(Heal Yourself Hypnotherapy: Promoting Health and Mental Health as Basic Human Rights) Appendix - I

* Regarding “Coping Skills:” “C.2.b. New Specialty Areas of Practice Counselors

practice in specialty areas new to them only after appropriate education, training, and

supervised experience. While developing skills in new specialty areas, counselors take

steps to ensure the competence of their work and to protect others from possible harm

(ACA, 2011 p. 9).”

* For further information regarding Disclosure Requirements, and for clarification and

assurances of confidentiality and professional conduct, you may also review:

* RCW 18.19.60 – Information Disclosure to clients, at

http://apps.leg.wa.gov/RCW/default.aspx?cite=18.19.060 which reads: “Certified

counselors and certified advisers shall provide clients at the commencement of any

program of treatment with accurate disclosure information concerning their practice, in

accordance with guidelines developed by the department, that will inform clients of the

purposes of and resources available under this chapter, including the right of clients to

refuse treatment, the responsibility of clients for choosing the provider and treatment

modality which best suits their needs, and the extent of confidentiality provided by this

chapter, the department, another agency, or other jurisdiction. The disclosure statement

must inform the client of the certified counselor's or certified adviser's consultation

arrangement or supervisory agreement as defined in rules adopted by the secretary. The

disclosure information provided by the certified counselor or certified adviser, the receipt

of which shall be acknowledged in writing by the certified counselor or certified adviser

and the client, shall include any relevant education and training, the therapeutic

orientation of the practice, the proposed course of treatment where known, any financial

requirements, referral resources, and such other information as the department may

require by rule. The disclosure information shall also include a statement that the

certification of an individual under this chapter does not include a recognition of any

practice standards, nor necessarily imply the effectiveness of any treatment. Certified

counselors and certified advisers must also disclose that they are not credentialed to

diagnose mental disorders or to conduct psychotherapy as defined by the secretary by

rule. The client is not liable for any fees or charges for services rendered prior to receipt

of the disclosure statement (WA Department of Health, Hypnotherapist, 2011).”

* WAC 246-10-31 – Disclosure statement to be provided to clients at

http://apps.leg.wa.gov/WAC/default.aspx?cite=246-810-031 which reads: “(1) Certified

counselors and certified advisers must provide a disclosure statement to each client prior

to starting a program of treatment.

(2) The following must appear in the disclosure statement:

(a) The name of the certified counselor or certified adviser and the name of their firm,

agency, or business, if any.

(b) The certified counselor's or certified adviser's business address and telephone





(Heal Yourself Hypnotherapy: Promoting Health and Mental Health as Basic Human Rights) number.

(c) The certified counselor's or certified adviser's Washington state credential number.

(d) The certified counselor's or certified adviser's education, training, and experience.

(e) The name and description of the types of counseling provided by the certified

counselor or certified adviser, including the therapeutic orientation, methods, and

techniques employed in their practice, and a list of resources relevant to the therapeutic

orientation.

(f) The type and duration of counseling expected, if known at the time of providing

the disclosure information.

(g) Fee information, including:

(i) The cost for each counseling session;

(ii) Billing practices, including any advance payments and refunds;

(iii) A statement that clients are not liable for any fees or charges for services rendered

prior to receipt of the disclosure statement.

(h) The limits of confidentiality under RCW 18.19.180.

(i) Disclosure of the certified counselor's or certified adviser's supervisory or

consultation agreement as defined in WAC 246-810-025.

(j) Disclosure that the certified counselor or certified adviser is not credentialed to

diagnose mental disorders or to conduct psychotherapy as defined in WAC 246-810-

010(14).

(k) All of the following:

(i) Counselors practicing counseling for a fee must be credentialed with the

department of health for the protection of the public health and safety.

(ii) Credentialing of an individual with the department of health does not include a

recognition of any practice standards, nor necessarily imply the effectiveness of any

treatment.

(iii) The purpose of the Counselor Credentialing Act, chapter 18.19 RCW, is to:

(A) Provide protection for public health and safety; and

(B) Empower the citizens of the state of Washington by providing a complaint process








(Heal Yourself Hypnotherapy: Promoting Health and Mental Health as Basic Human Rights) against those counselors who would commit acts of unprofessional conduct.

(iv) Clients have the right to choose counselors who best suit their needs and purposes.

(l) A copy of the acts of unprofessional conduct in RCW 18.130.180 and the name,

address, and contact telephone number within the department of health for complaints.

(m) Signature and date blocks for the client, and the certified counselor or certified

adviser, including an attestation that the client agrees that the required disclosure

statement has been provided and that the client has read and understands the information

(WA Department of Health, Hypnotherapist, 2011).”

* WAC 246-810-032 – Failure to provide client disclosure information at

http://apps.leg.wa.gov/WAC/default.aspx?cite=246-810-032 which reads: “ Failure to

provide to the client any of the disclosure information as set forth in WAC 246-810-030

and 246-810-031, and as required by the law shall constitute an act of unprofessional

conduct as defined in RCW 18.130.180(7) (WA Department of Health, Hypnotherapist,

2011).”

* RCW 18.19.180 - Confidential communications at

http://apps.leg.wa.gov/RCW/default.aspx?cite=18.19.180 which reads: “An individual

registered under this chapter shall not disclose the written acknowledgment of the

disclosure statement pursuant to RCW 18.19.060 nor any information acquired from

persons consulting the individual in a professional capacity when that information was

necessary to enable the individual to render professional services to those persons except:

(1) With the written consent of that person or, in the case of death or disability, the

person's personal representative, other person authorized to sue, or the beneficiary of an

insurance policy on the person's life, health, or physical condition; (2) That a person

registered under this chapter is not required to treat as confidential a communication that

reveals the contemplation or commission of a crime or harmful act; (3) If the person is a

minor, and the information acquired by the person registered under this chapter indicates

that the minor was the victim or subject of a crime, the person registered may testify fully

upon any examination, trial, or other proceeding in which the commission of the crime is

the subject of the inquiry; (4) If the person waives the privilege by bringing charges

against the person registered under this chapter; (5) In response to a subpoena from a

court of law or the secretary. The secretary may subpoena only records related to a

complaint or report under chapter 18.130 RCW; or (6) As required under chapter 26.44

RCW (WA Department of Health, Hypnotherapist, 2011).”

* RCW 18.130.080 at http://apps.leg.wa.gov/RCW/default.aspx?cite=18.130.080 which

reads:

“Unprofessional conduct — Complaint — Investigation — Civil penalty.

(1)(a) An individual, an impaired practitioner program, or a voluntary substance abuse

monitoring program approved by a disciplining authority, may submit a written













(Heal Yourself Hypnotherapy: Promoting Health and Mental Health as Basic Human Rights) complaint to the disciplining authority charging a license holder or applicant with

unprofessional conduct and specifying the grounds therefor or to report information to the

disciplining authority, or voluntary substance abuse monitoring program, or an impaired

practitioner program approved by the disciplining authority, which indicates that the

license holder may not be able to practice his or her profession with reasonable skill and

safety to consumers as a result of a mental or physical condition.

(b)(i) Every license holder, corporation, organization, health care facility, and state

and local governmental agency that employs a license holder shall report to the

disciplining authority when the employed license holder's services have been terminated

or restricted based upon a final determination that the license holder has either committed

an act or acts that may constitute unprofessional conduct or that the license holder may

not be able to practice his or her profession with reasonable skill and safety to consumers

as a result of a mental or physical condition.

(ii) All reports required by (b)(i) of this subsection must be submitted to the

disciplining authority as soon as possible, but no later than twenty days after a

determination has been made. A report should contain the following information, if

known:

(A) The name, address, and telephone number of the person making the report;

(B) The name, address, and telephone number of the license holder being reported;

(C) The case number of any patient whose treatment is the subject of the report;

(D) A brief description or summary of the facts that gave rise to the issuance of the

report, including dates of occurrences;

(E) If court action is involved, the name of the court in which the action is filed, the

date of filing, and the docket number; and

(F) Any further information that would aid in the evaluation of the report.

(iii) Mandatory reports required by (b)(i) of this subsection are exempt from public

inspection and copying to the extent permitted under chapter 42.56 RCW or to the extent

that public inspection or copying of the report would invade or violate a person's right to

privacy as set forth in RCW 42.56.050.

(2) If the disciplining authority determines that a complaint submitted under

subsection (1) of this section merits investigation, or if the disciplining authority has

reason to believe, without a formal complaint, that a license holder or applicant may have

engaged in unprofessional conduct, the disciplining authority shall investigate to

determine whether there has been unprofessional conduct. In determining whether or not

to investigate, the disciplining authority shall consider any prior complaints received by

the disciplining authority, any prior findings of fact under RCW 18.130.110, any






(Heal Yourself Hypnotherapy: Promoting Health and Mental Health as Basic Human Rights) stipulations to informal disposition under RCW 18.130.172, and any comparable action

taken by other state disciplining authorities.

(3) Notwithstanding subsection (2) of this section, the disciplining authority shall

initiate an investigation in every instance where:

(a) The disciplining authority receives information that a health care provider has been

disqualified from participating in the federal medicare program, under Title XVIII of the

federal social security act, or the federal medicaid program, under Title XIX of the

federal social security act; or

(b) There is a pattern of complaints, arrests, or other actions that may not have resulted

in a formal adjudication of wrongdoing, but when considered together demonstrate a

pattern of similar conduct that, without investigation, likely poses a risk to the safety of

the license holder's patients.

(4) Failure of a license holder to submit a mandatory report to the disciplining

authority under subsection (1)(b) of this section is punishable by a civil penalty not to

exceed five hundred dollars and constitutes unprofessional conduct.

(5) If a report has been made by a hospital to the department under RCW 70.41.210 or

an ambulatory surgical facility under RCW 70.230.120, a report to the disciplining

authority under subsection (1)(b) of this section is not required.

(6) A person is immune from civil liability, whether direct or derivative, for providing

information in good faith to the disciplining authority under this section.

(7)(a) The secretary is authorized to receive criminal history record information that

includes nonconviction data for any purpose associated with the investigation or licensing

of persons under this chapter.

(b) Dissemination or use of nonconviction data for purposes other than that authorized

in this section is prohibited (WA Department of Health, Hypnotherapist, 2011).”

* Or you may visit the website for the Washington State Department of Health’s laws

affecting the hypnotherapy profession and hypnotherapy client’s rights at

http://www.doh.wa.gov/hsqa/professions/Hypnotherapist/laws.htm

* You are also invited to review the enclosed publication by the Department of Health

entitled “Counseling and Hypnotherapy Clients,” which you may also find posted at my

website, www.HealYourselfHypnotherapy.Weebly.com








Counseling or

Hypnotherapy Clients

Client and Counselor Responsibilities and Rights

Counselors must provide disclosure information to each client in accordance with

chapter 18.19 RCW prior to implementation of a treatment plan. The disclosure

information must be specific to the type of counseling service offered; in language that

can be easily understood by the client; and contain sufficient detail to enable the client

to make an informed decision whether or not to accept treatment from the disclosing

counselor.

If you have concerns about being dependent upon your counselor or hypnotherapist,

talk to him or her about it. Remember, you are going to that person to seek assistance

that helps you learn how to control your own life. You can and should ask questions if

you don’t fully understand what your counselor or hypnotherapist is doing or plans to

do.

Requirement for Registration or Licensure

Your counselor or hypnotherapist must be either registered under chapter

18.19 RCW or licensed under chpater 18.225 RCW through the Washington State

Department of Health unless otherwise exempt. To be registered, a person fills out

an application and pays a fee. To become licensed, a person fills out an application

form and pays a fee, but he or she must also show proof of appropriate education

and training. There are some people who do not need to be either registered or

certified because they are exempt from the law. You should ask your counselor or

hypnotherapist if he or she is registered or licensed and discuss his or her qualifications

to be your counselor or hypnotherapist.

Definitions

Counseling means using therapeutic techniques to help another person deal with

mental, emotional and behavioral problems or to develop human awareness and

potential. A registered or licensed counselor is a person who gets paid for providing

counseling services.

Confidentiality

Your counselor or hypnotherapist cannot disclose any information you’ve told them

during a counseling session except as authorized by RCW 18.19.180:

2

1. With the written consent of that person or, in the case of death or disability, the

person’s personal representative, other person authorized to sue, or the beneficiary

of an insurance policy on the person’s life, health, or physical condition;

2. That a person registered under this chapter is not required to treat as confidential

a communication that reveals the contemplation or commission of a crime or

harmful act;

3. If the person is a minor, and the information acquired by the person registered

under this chapter indicates that the minor was the victim or subject of a crime,

the person registered may testify fully upon any examination, trial, or other

proceeding in which the commission of the crime is the subject of the inquiry;

4. If the person waives the privilege by bringing charges against the person

registered under this chapter;



(Heal Yourself Hypnotherapy: Promoting Health and Mental Health as Basic Human Rights) 5. In response to a subpoena from a court of law or the secretary. The secretary

may subpoena only records related to a complaint or report under chapter 18.130

RCW; or

6. As required under chapter 26.44 RCW.

Assurance of Professional Conduct

Thousands of people in the counseling or hypnotherapy professions practice their

skills with competence and treat their clients in a professional manner. If you and the

counselor agree to the course of treatment and the counselor deviates from the agreed

treatment, you have the right to question the change and to end the counseling if that

seems appropriate to you.

We want you to know that there are acts that would be considered unprofessional

conduct. If any of the following situations occur during your course of treatment, you

are encouraged to contact the Department of Health at the address or phone number

in this publication to find out how to file a complaint against the offending counselor

or hypnotherapist. The following situations are not identified to alarm you, but are

identified so you can be an informed consumer of counseling or hypnotherapy services.

The conduct, acts or conditions listed below give you a general idea of the kinds of

behavior that could be considered a violation of law as defined in RCW 18.130.180.

1. The commission of any act involving moral turpitude, dishonesty, or corruption

relating to the practice of the person’s profession, whether the act constitutes a

crime or not. If the act constitutes a crime, conviction in a criminal proceeding is

not a condition precedent to disciplinary action. Upon such a conviction, however,

the judgment and sentence is conclusive evidence at the ensuing disciplinary

hearing of the guilt of the license holder or applicant of the crime described in the

indictment or information, and of the person’s violation of the statute on which

3

it is based. For the purposes of this section, conviction includes all instances in

which a plea of guilty or nolo contendere is the basis for the conviction and all

proceedings in which the sentence has been deferred or suspended. Nothing in

this section abrogates rights guaranteed under chapter 9.96A RCW;

2. Misrepresentation or concealment of a material fact in obtaining a license or in

reinstatement thereof;

3. All advertising which is false, fraudulent, or misleading;

4. Incompetence, negligence, or malpractice which results in injury to a patient or

which creates an unreasonable risk that a patient may be harmed. The use of a

nontraditional treatment by itself shall not constitute unprofessional conduct,

provided that it does not result in injury to a patient or create an unreasonable risk

that a patient may be harmed;

5. Suspension, revocation, or restriction of the individual’s license to practice any

health care profession by competent authority in any state, federal, or foreign

jurisdiction, a certified copy of the order, stipulation, or agreement being

conclusive evidence of the revocation, suspension, or restriction;

6. The possession, use, prescription for use, or distribution of controlled substances

or legend drugs in any way other than for legitimate or therapeutic purposes,

diversion of controlled substances or legend drugs, the violation of any drug law,

or prescribing controlled substances for oneself;



(Heal Yourself Hypnotherapy: Promoting Health and Mental Health as Basic Human Rights) 7. Violation of any state or federal statute or administrative rule regulating the

profession in question, including any statute or rule defining or establishing

standards of patient care or professional conduct or practice;

8. Failure to cooperate with the disciplining authority by:

a. Not furnishing any papers or documents;

b. Not furnishing in writing a full and complete explanation covering the matter

contained in the complaint filed with the disciplining authority;

c. Not responding to subpoenas issued by the disciplining authority, whether or

not the recipient of the subpoena is the accused in the proceedings; or

d. Not providing reasonable and timely access for authorized representatives

of the disciplining authority seeking to perform practice reviews at facilities

utilized by the license holder;

9. Failure to comply with an order issued by the disciplining authority or a

stipulation for informal disposition entered into with the disciplining authority;

10. Aiding or abetting an unlicensed person to practice when a license is required;

4

11. Violations of rules established by any health agency;

12. Practice beyond the scope of practice as defined by law or rule;

13. Misrepresentation or fraud in any aspect of the conduct of the business or

profession;

14. Failure to adequately supervise auxiliary staff to the extent that the consumer’s

health or safety is at risk;

15. Engaging in a profession involving contact with the public while suffering from a

contagious or infectious disease involving serious risk to public health;

16. Promotion for personal gain of any unnecessary or inefficacious drug, device,

treatment, procedure, or service;

17. Conviction of any gross misdemeanor or felony relating to the practice of the

person’s profession. For the purposes of this subsection, conviction includes all

instances in which a plea of guilty or nolo contendere is the basis for conviction

and all proceedings in which the sentence has been deferred or suspended.

Nothing in this section abrogates rights guaranteed under chapter 9.96A RCW;

18. The procuring, or aiding or abetting in procuring, a criminal abortion;

19. The offering, undertaking, or agreeing to cure or treat disease by a secret method,

procedure, treatment, or medicine, or the treating, operating, or prescribing for

any health condition by a method, means or procedure which the licensee refuses

to divulge upon demand of the disciplining authority;

20. The willful betrayal of a practitioner-patient privilege as recognized by law;

21. Violation of chapter 19.68 RCW;

22. Interference with an investigation or disciplinary proceeding by willful

misrepresentation of facts before the disciplining authority or its authorized

representative, or by the use of threats or harassment against any patient or

witness to prevent them from providing evidence in a disciplinary proceeding or

any other legal action, or by the use of financial inducements to any patient or

witness to prevent or attempt to prevent him or her from providing evidence in a

disciplinary proceeding;

23. Current misuse of:



(Heal Yourself Hypnotherapy: Promoting Health and Mental Health as Basic Human Rights) a. Alcohol;

b. Controlled substances; or

c. Legend drugs;

24. Abuse of a client or patient or sexual contact with a client or patient;

5

25. Acceptance of more than a nominal gratuity, hospitality, or subsidy offered by

a representative or vendor of medical or health-related products or services

intended for patients, in contemplation of a sale or for use in research publishable

in professional journals, where a conflict of interest is presented, as defined by

rules of the disciplining authority, in consultation with the department, based on

recognized professional ethical standards.

This publication should not be considered as the final source of information. If you

want more information about the law regulating counselors and hypnotherapists or

want to fi le a complaint, please write to: Department of Health, Health Professions

Quality Assurance, PO Box 47869, Olympia, Washington 98504-7869.

If you want to contact someone by phone to discuss the law or talk about a possible

complaint, call (360) 236-4700 Monday through Friday, 8:00 a.m. to 5:00 p.m.

Additional copies of this publication or a camera-ready copy for your future use may

be obtained by writing to the address above or calling (360) 236-4700.




References

American Counseling Association, ACA, (2011). 5999 Stevenson Ave. Alexandria, VA

22304 http://www.counseling.org/Resources/CodeOfEthics/TP/Home/CT2.aspx

Bandler, R. & Grinder, J. (1979). Frogs into princes, neuro linguistic programming, Real

People Press, Box F, Moab, Utah 84532. ISBN: 0-911226-19-2

Bandler, R. & Grinder, J. (1975). Patterns of the hypnotic techniques of Milton

h.erickson, m.d.volume 1, Meta Publications. Cuperto, California 95014. Library

of Congres Card Number75-24584

Hunter, C.R. (2000) The art of hypnosis, third edition, part I of “diversified client

centered hypnosis”(based on the teachings of charles tebbetts),Kendall/Hunt

Publishing Company. ISBN: 0 7872-6828-3

Hunter, C.R. (2000) The art of hypnotherapy, second edition, part II of “diversified client

centered hypnosis”(based on the teachings of charles tebbetts), Kendall/Hunt

Publishing Company. ISBN: 0 7872-7068-7

Revised Code of Washington - RCW Title 18 Businesses And Professions – Chapter

18.130 Regulation Of Health Professions -- Uniform Disciplinary Act. (2009).

Retrieved from http://law.onecle.com/washington/businesses-and

professions/ch18.130.html

The Code of Ethics of the National Guild of Hypnotists (2010) The National Guild of

Hypnotists, Inc. Retrieved from http://ngh.net/wp-content/uploads/2010/12/

CodeEthicsStandards.pdf

Washington State Department of Health, Hypnotherapist (2011), Hypnotherapist revised

code of washington (RCW), Washington State Department of Health , Health

http://www.counseling.org/Resources/CodeOfEthics/TP/Home/CT2.aspx

http://law.onecle.com/washington/businesses-and

http://law.onecle.com/washington/businesses-and

http://ngh.net/wp-content/uploads/2010/12/



(Heal Yourself Hypnotherapy: Promoting Health and Mental Health as Basic Human Rights) Professions & Facilities 243 & 310 Israel Rd SE P.O. Box 47865 Olympia,

Washington, 98504-7865, Retrieved from:

