ICBCH Basic24 EvalQuiz YellowSheet · T F 14. Public demonstrations of hypnotic phenomena are banned by the ICBCH. T F 15. Past-life regression is merely a speculative approach to

www.HypnotherapyBoard.org International Certification Board of Clinical Hypnotherapy

Evaluation of Learning Quiz Clinical Hypnotherapy

24 Hours Total of Approved Continuing Education Credit and Specialty Certification Designation

YELLOW SHEET Clinical Hypnotherapy: Evaluation of Learning Quiz Page 1 of 6

For 24 Hours of CE Credit, mail, email, or fax this packet to PeachTree. You may keep all other course materials.

PeachTree Professional Education 15560 N. Frank L. Wright Blvd, #B4-118 | Scottsdale, AZ 85260

Phone: (918) 236-6116 | Fax: (214) 550-2675 | www.HypnotherapyBoard.org

Please fill out the following information as neatly as possible to receive your CEU Certificate.

Name (as you want it displayed on your CEU Certificate): _________________________________________

List your professional license(s):

Type: _______________________________________________ State: ___________

Type: _______________________________________________ State: ___________

Address: _______________________________________________________________________

City: ________________________________ State: ________________ Zip: ______________

Daytime Phone: ________________________ Email: ___________________________________

The purpose of this Evaluation of Learning Quiz is to:

• Verify that you have viewed and read the required course materials.

• Demonstrate an understanding of the practical application of the course materials.

• Officially document your participation and completion of this course.

Please answer the evaluation of learning questions on the following pages.

• When successfully completed and returned, you will receive three CEU certificates. You will earn a 2-hour CEU certificate in Professional Ethics, a 2-hour CEU certificate for NSRI Assessment in Hypnotherapy and a 20 Hour CEU certificate for "ICBCH Basic Clinical Hypnotherapy Training."

• Each of the required segments of this course has its own True/False format quiz.

• You must earn a passing grade of 80% on each quiz to receive credit.

• If you do not pass the quiz on the first attempt, you will be notified and given the opportunity to retest without charge. If you fail more than twice, you will not be permitted to receive Certification or CEU credit without paying a second time and retaking the course.

• The questions are not difficult, and all come form the required coursework (live/video/text).

• Rarely do people fail our exams. If they do, it is usually because they did not adequately prepare for testing by completing all of the required coursework.

Note: The purpose of this quiz is merely to document your participation in this course and understanding of the material. The questions have been randomly picked from the course materials, and do not necessarily reflect that which is most important in this course, nor are these questions a complete representation of all that has been taught in this course.





Video One: Please circle the correct answer.

T F 1. I have watched the entire Disc 1 video presentation.

T F 2. Hypnosis is focused on the present rather than the past.

T F 3. Changing the subconscious mind is important because it is what guides us most of the time.

T F 4. Suggestions in hypnosis change subconscious associations.

T F 5. Hypnosis helps a person self-regulate the body.

T F 6. Hypnosis teaches specific skills for changing states.

T F 7. States are always only emotional in content.

T F 8. Hypnosis is too simple as a tool for cancer or heart disease treatment.

T F 9. There are five basic steps in the hypnotic process.

T F 10. Hypnosis, even if only used as a relaxation process, can be of value to many clients.

Video Two: Please circle the correct answer.


T F 2. Some people just do not have the capacity to experience hypnosis.

T F 3. Some people can become stuck in hypnosis and need medical attention to exit trance.

T F 4. Religion utilizes trance phenomena.

T F 5. Hypnosis has many risks and people can be harmed by hypnosis.

T F 6. 3-5 sessions is the average duration of hypnotherapy services.

T F 7. The best time to collect payment is AFTER the first session is complete.

T F 8. Payment of fees is the clients’ investment into their own recovery.

T F 9. A binaural beat sound file is used through the headphone system.

T F 10. A hypnotist must use headphones for success in achieving trance states.





Video Three: Please circle the correct answer.


T F 2. A convincer is done with every client during the pre-talk.

T F 3. We can incorporate what has worked in the past as a solution in the present.

T F 4. A “lemon drop” convincer usually manifests a physical response to creative thought.

T F 5. A confusion induction is useful with an analytical client.

T F 6. Directed concentration cannot facilitate trance.

T F 7. A formal induction gives a person a framework for practicing hypnosis.

T F 8. Autogenic training is a part of the basic induction strategy.

T F 9. Creating warmth is a way of connecting to the kinesthetic clients.

T F 10. A convincer can be brought into the induction during the autogenic training process.

Video Four: Please circle the correct answer.


T F 2. Physical stillness can be a sign of going into trance.

T F 3. A fluttering of the eyes under the eyelids is a sign of going into trance.

T F 4. You cannot do hypnosis if someone has their eyes open.

T F 5. A simple number count can be combined with fractionation.

T F 6. Fractionation is always a deepener, and cannot be used as an induction method.

T F 7. Reading from a script is unacceptable in professional hypnosis.

T F 8. Indirect suggestion can be a story, parable, poem or metaphor.

T F 9. Mindfulness meditation training can be integrated into hypnotherapy.

T F 10. An example of direct suggestion is giving a weight loss client a pedometer and the suggestion they will take more steps tomorrow than today, and increase their steps each day until the reach 10,000 steps per day.





Video Five: Please circle the correct answer.


T F 2. Direct suggestions can incorporate what they have already learned in the induction or even the pre-talk.

T F 3. Changing the submodalities is a strategy borrowed from NLP, and can be illustrated by altering the attributes of an image on a movie screen.

T F 4. Anchoring is a strategy that can be used in post-hypnotic suggestion.

T F 5. A post hypnotic suggestion that it is easier to go into hypnosis in successive sessions can cut the length of future sessions.

T F 6. If a person does not awaken from hypnosis it is always a sign of falling asleep.

T F 7. The number one issue holding back new hypnotists is confidence.

T F 8. Clients rarely come to a hypnotist in a state of desperation.

T F 9. Spontaneous Abreaction often occurs in many sessions and is a normal state.

T F 10. Freud was correct: We must understand the cause of each problem to make change today.

Video Six: Please circle the correct answer.


T F 2. Revivify means to create an imagination of something that never happened.

T F 3. Revivification plus abreaction can create intense emotional responses.

T F 4. The “whys” of abreaction should be fully explored before moving forward in hypnosis.

T F 5. Muscular catalepsy is when a person’s muscles become stiff and rigid.

T F 6. Muscular catalepsy can be used in clinical hypnosis as a process of releasing beliefs or emotions.

T F 7. We can use visual imagery to assist in changing “perceptual position.”

T F 8. Age regression has no place in smoking cessation scripts.

T F 9. Age regression can tap into our knowledge database.

T F 10. Hypnotically enhanced recall can be admitted as evidence in all 50 states.





Video Seven: Professional Ethics Please circle the correct answer.

T F 1. I have viewed the entire DVD video presentation titled “Professional Ethics for Hypnotherapists.”

T F 2. Autonomy means promoting individual client functioning apart from therapy.

T F 3. Justness refers to providing equal treatment to all people.

T F 4. Availability is a hallmark of fidelity.

T F 5. The greater the emotional response, the more effective therapy has been.

T F 6. The past should be ignored in favor of future-oriented approaches.

T F 7. Good therapy teaches skills.

T F 8. Moral, ethical and legal dilemmas have the same model for resolution.

T F 9. Ethical dilemmas are an emotional time for hypnotherapists.

T F 10. Talking to other professionals about clients is a violation of client confidentiality.

T F 11. Implementing ethical decisions can be difficult.

T F 12. It would be an exploitation of famous clients to reveal their names.

T F 13. Continuing education is essential for the hypnotherapist.

T F 14. Public demonstrations of hypnotic phenomena are banned by the ICBCH.

T F 15. Past-life regression is merely a speculative approach to hypnotherapy.

T F 16. What the mind cannot recall, the mind will create.

T F 17. Emotions can be deceptive experiences.

T F 18. Referral is not recommended since the referral resources will not accept or use hypnosis for treating clients.

T F 19. Treating psychiatric problems without a license is unacceptable.

T F 20. Informed consent is an essential part of hypnotherapy.





Client Strengths and Resources in Therapy - Using the N.S.R.I. Please circle the correct answer.

T F 1. I have read all of the required reading for this course.

T F 2. Strengths are internal assets.

T F 3. An example of a resource is “dependable.”

T F 4. The NRSI is a self-report.

T F 5. Clients are often acutely aware of the problems that they possess, but are unaware of their own strengths.

T F 6. In couples counseling, the application of strengths to the problem-solving process is quite clear.

T F 7. The “Treasure Chest” is an example of intervention in individual therapy.

T F 8. The self-report format helps a therapist define the client's strengths.

T F 9. The purpose of the Nongard Strength and Resources Inventory is to help the clinician understand our clients' perceptions of their strengths.

T F 10. Even with the most catastrophically ill clients, clinicians are able to draw on client strengths to begin a problem solving process.

T F 11. Personality Disorders are an Axis I diagnosis.

T F 12. Targeted interventions are important tools to develop in the therapeutic process.

T F 13. The Dependent Personality Disordered client is a loyal individual.

T F 14. Most couples come to counseling to start the mediation process.

T F 15. The Adolescent Version (A-NSRI) contains some statements or items that have been altered or modified for age appropriateness.

T F 16. The NSRI is conveniently presented on two pages, divided into two sections.

T F 17. The NSRI may be effectively re-administered to demonstrate and re-enforce positive changes, growth or progression.

T F 18. Because the NSRI focus on strengths, honesty is easily attained.

T F 19. The sixth section of the NSRI focuses on Situational Supports.

T F 20. Resources are the practical tools or people present in the client's life and available to assist in problem solving.


Grade this Course Please complete this short course evaluation and return to our office by fax or mail.

BLUE SHEET Grade this Course Page 1 of 1

Date: __________________________ Course Title: ___________________________________

Was this course completed: Live Homestudy

On a scale of 1-5 (5 being “highest” and 1 being “lowest”) please answer the following questions:

1. The instruction appeared knowledgeable of the materials: 1 2 3 4 5

2. The course objectives for this class were met: 1 2 3 4 5

3. Appropriate teaching methods were utilized: 1 2 3 4 5

4. The handout materials were useful: 1 2 3 4 5

5. Sound quality was acceptable: 1 2 3 4 5

6. How much of this material was new to you: 1 2 3 4 5

7. The overall quality of this course was: 1 2 3 4 5

8. Please feel free to make any additional comments below:

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

Thank you for your participation!

Please sign or initial here if you give permission for your comments to be used on our website or other advertising materials.

Name/Initial: ______________________ City, State: ___________________________________


Application for Clinical Hypnosis Specialty Certification Recognition

Complete the required information and attach any required supplemental information. Sign and date both pages of this application and return to our office by fax or mail with any additional information requested.

GREEN SHEET Application for Clinical Hypnosis Specialty Certification Recognition Page 1 of 2

Name (as you want it displayed on your CEU Certificate): _________________________________________

Address: _______________________________________________________________________

City: ________________________________ State: ________________ Zip: ______________

Daytime Phone: ________________________ Email: ___________________________________

List your highest academic degree: ___________________________________________________

University Name: ___________________________ Year of Graduation: ___________

List your professional license(s):

Type: _______________________________________________ State: ___________

Type: _______________________________________________ State: ___________

Which Level of Certification are you applying for through the ICBCH?

Certified Hypnotist (C.Ht.) The requirements for associate ICBCH membership and certification include completion of our basic live or homestudy 24-hour certification program. This level of certification is designed for those who are not licensed or certified as mental health professionals.

Certified Professional Hypnotist (C.P.H.) Requirements for this level of certification include completion of our basic 24-hour certification program, plus an additional 30 hours of ICBCH approved training. Members of the ICBCH who are certified by or have completed coursework through another professional organization with substantially similar training requirements may apply for CPH status through reciprocity. Attach documentation of the additional 30 hours of training or certification by another organization.

Certified Clinical Hypnotherapist (C.C.H.) The ICBCH will award status as a Certified Clinical Hypnotherapist only to those who are certified or licensed by a state or recognized national board in healthcare, medical or mental health professions. Must provide licensure/certification documentation.

ICBCH Diplomate Status Diplomate status is reserved for those who are ICBCH certified as Hypnotists (CHt), Professional Hypnotists (CPH), or Clinical Hypnotherapists (CCH) who have completed at least 100 hours of hypnosis instruction through the ICBCH or another recognized provider.

Signature: ____________________________ Date: ___________________________________


Application for Clinical Hypnosis Specialty Certification Recognition

Complete the required information and attach any required supplemental information. Sign and date both pages of this application and return to our office by fax or mail with any additional information requested.

GREEN SHEET Application for Clinical Hypnosis Specialty Certification Recognition Page 2 of 2

Are you a clinical hypnotherapist? Yes No Certified By: __________________________

Have you ever been convicted of a felony? Yes No (If yes, attach full explanation.) (NOTE: Although a prior felony conviction will not automatically disqualify one for certification, any person with a prior felony conviction for moral or sexual crimes against children, or sexual violence against adults, or other felonies as deemed inappropriate for certification by the ICBCH will not be certified by the ICBCH. Failure to disclose criminal history will result in revocation of credentials, and is an act of perjury. If you have questions on this policy, please contact our office prior to completing the course materials.)

Have you ever had a professional license or certification revoked, suspended or denied in any state or by any certification board? Yes No (If yes, attach full explanation.)

Please enclose a legible photocopy of a government issued photo ID (i.e. driver’s license, passport, professional license, military ID).

Please attach documentation of the required continuing education hours completed. If you have completed some of the required coursework prior to now, a photocopy of the CEU certificates for

each course should be attached. If you are returning completed coursework and this application at the same time, please send them all together

in one envelope. You can fax them, but mail is preferable for this process.

Read and Sign Your Acknowledgement:

I certify the information contained above is true and accurate. I am applying to receive recognition as a hypnotist/hypnotherapist. I understand that this certification recognizes specialized training in the required subject matter and does not provide the authority to offer client services apart from the existing licensing requirements or my state of residence. I agree to practice within the scope of my education, licensure and training and provide client services consistent with the ethical standards of ICBCH, my respective professional designation(s), and within the state law. Certification certificates remain the property of the ICBCH and must be surrendered in the even of revocation by the Board.

Signature: ____________________________ Date: ___________________________________

Documents

ICBCH Basic24 EvalQuiz YellowSheet · T F 14. Public demonstrations of hypnotic phenomena are banned by the ICBCH. T F 15. Past-life regression is merely a speculative approach to