ELIGIBILITY REQUIREMENTS
A candidate for Diplomate stat2s in Clinical Hy6nosis offered by the American Hy6nosis Board for Clinical Social Work (AHBCSW) must meet the following requirements:
1. Possess a Masters or Doctoral degree in
Social Work from a graduate school
accredited by the Council on Social Work
Education;
2. Have clinical course content, clinical field
work or postgraduate internship, and not less
than five (5) years of post masters direct
clinical practice experience, including the
clinical use of hypnosis;
3. Have acceptable training and experience in
clinical hypnosis. Acceptable training
includes those offered by the American
Society of Clinical Hypnosis, the Society for
Clinical and Experimental Hypnosis, the
International Society of Hypnosis, and their
affiliated organizations. Other graduate and
postgraduate courses and workshops offered
by accredited colleges and universities and
organizations, may be accepted at the
discretion of the AHBCSW;
4. Possess a current license, certification, or
registration at the highest level of
independent clinical practice in the state
where they are currently practicing;
5. Be a Diplomate of the National Association
of Social Workers (DCSW) or the American
Board of Examiners in Clinical Social Work
(BCD), or document eligibility for either
examination;
6. Submit an application with documentation
certifying that the required standards have
been met, along with an application fee.
7. Provide three (3) letters of recommendation
from colleagues who can attest to your
character, and experience with hypnosis and
psychotherapy;
(continued)
8. Successfully complete a written or oral
examination covering theory,
conceptualization, research, case
formulation, clinical techniques, and
professional issues and contributions. The
examination will include a discussion and
critique of an audio or video recording,
including a printed transcript, of an actual
clinical session, by the applicant, utilizing
hypnosis.
Examinations are given by scheduled
appointment at national or regional meetings,
workshops, or scientific sessions of the Society
for Clinical and Experimental Hypnosis and the
American Society of Clinical Hypnosis. Detailed
exam information will be provided if the
applicant is found to be eligible for the
examination. Three (3) copies copies of the
recorded session(s) and transcript(s) will be
required prior to the exam.
Send application and other correspondence to:
William Mark Adams, M.S.W., D.A.H.B.
AHBCSW Secretary Treasurer
3103 Bee Cave Rd, Suite 101
Houston, TX 7704
(713) 796-3197...voice
[email protected]
Application fee: $100.00
Examination fee: $175.00
Make checks payable to:
William Mark Adams, AHBCSW Secretary/Treasurer
marked with the appropriate notation of either
‘AHBCSW Application Fee’ or ‘AHBCSW
Examination Fee.’
Revised on 03-20-2014
AMERICAN HYPNOSIS BOARD for
CLINICAL SOCIAL WORK
Board of Directors
President
George P. Glaser, MSW, BCD, DAHB
Austin, Texas/[email protected]
P/F: 512-371-9418
Secretary-Treasurer
William Mark Adams, MSW, DAHB
Houston, Texas / [email protected]
P: 832-6560-437 / F: 281-494-0565
Founding President
Ray W. London, Ph.D, ABPH, DAHB
Tustin, California, P: 714-505-0873
Past Presidents
James A. Deutch, DSW, DAHB
Honolulu, Hawaii, Phone: 808-988-5000
Jordan I. Zarren, MSW, DAHB
West Palm Beach, Florida
P/F: 561-684-6172, Mobile: 561-833-7989
Stephen R. Lankton, MSW, DAHB
Phoenix, Arizona/ [email protected]
P: 602-532-0800, F: 602-532-0801
Jane Parsons-Fein, MSW, BCD, DAHB
New York, New York / [email protected]
P: 212-873-4557 / F: 212-874-3271
Members at Large
Juan Arellano, MSW, DAHB (WI)
Victor Fitterman, MSW, DAHB (MD)
Mary E. Hallowitz, MSW, DAHB (IL)
Randall Leith, MSW, DAHB (NY)
Bette Jean Rosenhagen, MSW, DAHB (NY)
Mitch Smith, MSW, DAHB (PA)
APPLICATION – AMERICAN HYPNOSIS BOARD for CLINICAL SOCIAL WORK
Name _____________________________________________________________________________________________________________
Address ___________________________________________________________________________________________________________
Phone (office)________________ (home)_______________ (fax)_________________ (email) _____________________________________
EDUCATION
University
Major
Degree
Date
__________________________________________________________________________________________________________________
Diplomate in
Clinical Hypnosis
__________________________________________________________________________________________________________________
Field Placement(s) _________________________________________________________________________
Date __________________
Post Graduate Internship(s) __________________________________________________________________
Date __________________
American Hypnosis Board
for Clinical Social Work
Work Experience ___________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
Diplomate, American Board of Examiners in Clinical Social Work (BCD) No___
Diplomate, National Association of Social Workers (DCSW)
No___
Yes ___
Yes___ Date ___________ Certificate # _______
Date _________ Certificate # __________________
Name, Date, Certificate # of other Diplomate, Fellow, or other Board Certifications: __________________________________________
__________________________________________________________________________________________________________________
If you are not a Diplomate in Clinical Social Work (NASW) or a Board Certified Diplomate (ABECSW), greater documentation will be
required to determine eligibility status.
HYPNOSIS ORGANIZATION MEMBERSHIPS
SCEH: Yes _____ No____
If Yes, Year Joined ________
Membership Level
If Yes, Year Joined ________
Membership Level
____________________________
ASCH: Yes _____ No____
____________________________
Other hypnosis societies, including date and membership level and recognitions: ____________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
State Licensed in: _______
&Type
Date Licensed _________________
License Number
Please document on separate pages:
1. The extent and scope of your hypnosis training and experience, including dates, names, and locations;
2. Describe your types of cases, number of patients/clients, treatment lengths, etc.;
3. List of hypnosis courses, workshops attended and taught, sponsorship, subject, kinds of participants;
4. Your professional specialization, orientation in psychotherapy, and in hypnosis;
5. List all of your publications or speeches dealing with hypnosis; send reprints or copies;
d
The Advanced Competency
Certification in Clinical
Hypnosis for Social Workers
d
Endorsed by the
American Society of Clinical Hypnosis
Society for Clinical and Experimental Hypnosis
Constituent Organizations
American Board of Clinical Hypnosis, Inc.
American Board of Hypnosis in Dentistry
American Board of Medical Hypnosis
American Board of Psychological Hypnosis
American Hypnosis Board for Clinical Social Work