Course Philosophy
Clinical interventions made by psychotherapists are usually based, at least to some extent, on the therapist’s theoretical and philosophical beliefs and on the knowledge gained during his/her experience in working with patients. This can sometimes lead to a degree of inflexibility on the part of the psychotherapist, who places faith in a certain therapeutic modality and disregrads the needs of the client. The “map” or “story” of the clinical case is constructed by the therapist based on own training and reading books or journals presenting contemporary research. But what constitutes “good” research in the field of psychotherapy is controversial (Salmon, 1983; Murcott, 2005). Thus, it is very likely that “the map is not identical to the territory”. In other words, there are always alternative ways of constructing clinical reality (Hawkis, 2002).
Based on the research on therapeutic outcomes, Lambert (1992) concludes that 40% of therapeutic success can be attributed to “extraterritorial change” (for example, unforeseen events, social support, self reinforcement, etc.), 30% to “common factors” that are encountered in all therapies regardless of the theoretical orientation of the therapist and 15% to the specific psychotherapeutic “technique” (eg. systematic desensitization, hypnosis, etc.). Although no form of psychotherapy is superior to another, all are superior to lack of treatment (Lambert and Bergin, 1994). The common factors approach (Frank, 1973; Lambert and Bergin, 1994) seeks to determine the central ingredients that different forms of psychotherapy have in common, with the ultimate aim of creating more effective and integrative treatments based on these common points (Hawkins, 2002 ).
However, different schools of psychotherapy do not involve these factors equally. Usually in each school one or two factors (usually one) are considered central, and the other factors are assigned a secondary status. Research shows, however, that one of the most influential factors in the outcome of psychotherapy is the relationship between psychotherapist and patient (Bergin and Lambert, 1978, Luborsky, Crits-Cristoph, Alexander, Margolis and Cohen, 1983, Clarkson, 1998).
For these reasons we consider that the practice of hypnotherapy must be carried out in an integrative framework. In addition, the principles of Ericksonian psychotherapy, most often taught in conjunction with the practice of clinical hypnosis, are integrative principles.
One of the problems of hypnotherapy is that clinical hypnosis is a working tool, a psychotherapeutic technique and not a theoretical model in psychotherapy. On the other hand, learning hypnotic techniques, hypnotic language and how to use trance and suggestion requires time and thorough study. But any hypnotherapist needs a theoretical basis to conceptualize the clinical cases, a map for the psychiatric diagnosis and a treatment strategy. The practice of hypnotherapy means the integration of clinical hypnosis techniques into psychotherapeutic practice. We believe that the theoretical basis of integrative psychotherapy offers a theoretical and contextual framework through which the hypnotic interventions and suggestions find their place in the practice of the clinician specialized in hypnotherapy.
Training Curricula – Hypnotherapy
MODULE 1. INTRODUCTION TO INTEGRATIVE HYPNOTHERAPY.
1. The nature and history of hypnotherapy; 2. Myths and misconceptions regarding hypnosis; 3. Conceptualization of hypnosis (3.1. Hypnosis as a permissive state; 3.2. Hypnosis and role play; 3.3. Hypnosis as a modified state of consciousness; 3.4. Hypnosis and reality testing; 3.5. Hypnosis as a result of interaction; 3.6. Other theories regarding hypnosis); 4. The context of hypnosis (4.1. Stage hypnosis; 4.2. Medical hypnosis; 4.3. Hypnosis in dentistry; 4.4. Hypnosis in legal medicine; 4.5. Hypnosis in education; 4.6. Hypnosis in business; 4.7. Hypnosis and sports; 4.8 Hypnosis in psychotherapy); 5. Human suggestibility (5.1. Expectations; 5.2. Communication styles; 5.3. Direct and indirect suggestions; 5.4. The structure of suggestions); 6. Susceptibility to hypnosis (6.1. Traditional theories regarding susceptibility; 6.2. Age and hypnotic susceptibility; 6.3. Intelligence and hypnotizability; 6.4. Mental state and hypnotizability; 6.5. Relational factors and hypnotizability; 6.8. Hypnotic susceptibility scales); 7. The structure of a hypnotherapeutic intervention (7.1. Trance induction; 7.2. Deepening of the trance; 7.3. Hypnotherapeutic techniques; 7.4. Trance termination).
MODULE 2. THE HYPNOTIC TRANCE (PART I)
1. The experience of the trance (1.1. The psychological characteristics of the trance state; 1.2. The physical characteristics of the trance state); 2. Hypnosis neuropsychology (2.1. EEG differences between high hypnotizable and weakly hypnotizable persons; 2.2. Hemispheric cerebral asymmetry; 2.3. Frontal lobe activity and hypnotizability; 2.4. Cerebral metabolism and hypnotizability; 2.5. Neuropsychology and hypnosis. Psychoneuroimmunology); 3. Selection of clients (3.1. Evaluation and preparation; 3.2. Indications and contraindications); 4. Induction of hypnotic trance (4.1. Traditional induction: 4.1.1. Progressive muscle relaxation techniques, 4.1.2. Experience of a relaxed scene, 4.1.3. Techniques for fixing the gaze, 4.1.4. Counting technique, 4.1.5. The technique “as if” 4.2. Naturalistic induction: 4.2.1. Use of past experiences, 4.2.2. Indoor centering, 4.2.3. Metaphorical inductions with suggestions included, 4.2.4. Induction by negative suggestions, 4.2. .5 Induction by confusing technique).
MODULE 3. THE HYPNOTIC TRANCE (PART II)
1. Techniques for deepening the hypnotic trance (1.1. Gowing downstarirs metaphor; 1.2. Metaphor of the elevator; 1.3. Arm catalepsy; 1.4. The method of “trance in trance”); 2. Phenomena in the hypnotic trance (2.1. Age regression; 2.2. Creation of false memories; 2.3. Age progression; 2.4. Amnesia; 2.5. Analgesia and anesthesia; 2.6. Catalepsy; 2.7. Dissociation; 2.8. Hallucinations and sensory changes ; 2.9. The ideodynamic response; 2.10. Time distortion); 3. Therapeutic use of the trance state.
MODULE 4. INTEGRATIVE PRINCIPLES IN HYPNOTHERAPY. PART I.
1. Common factors in psychotherapy (1.1. Definition of common factors; 1.2. Classification of common factors); 2. The client variable in psychotherapy (2.1. Stages of change and resistance to change; 2.2. Motivation for psychotherapy; 2.3. The presesentation problem and the degree of functional impairment; 2.4. Development of the client’s self; 2.5. Self-esteem, self-efficacy and learned helplessness; 2.6. Coping styles; 2.7. Attachment style; 2.8. Client personality; 2.9. Personality disorders; 2.10. Capacity to assimilate problematic experiences; 2.11. Client values and preferences; 2.12. Demographic and diversity variables); 3. The psychotherapist variable in psychotherapy (3.1. The relational variables; 3.2. The professional variables; 3.3. The developmental variables; 3.4. The demographic and diversity variables).
MODULE 5. INTEGRATIVE PRINCIPLES IN HYPNOTHERAPY. PART II
1. Common relational factors (1.1. The therapeutic alliance; 1.2. The therapeutic relationship; 1.3. Transference and countertransference; 1.4. Psychological games); 2. Common trans-theoretical factors (2.1. Clinical decisions; 2.2. The therapeutic context; 2.3. Placebo, hope, expectations; 2.4. Adaptation of the strategy to the presentation problem; 2.5. Extratherapeutic change); 3. Common strategic factors (3.1. The therapeutic myth; 3.2. The evaluation process; 3.3. Confrontation with the problem; 3.4. Reinforcement of the self; 3.5. Insight; 3.6. Attribution of therapy results; 3.7. Enhancement of acquisitions).
MODULE 6. PSYCHODIAGNOSTICS AND CASE FORMULATION IN PSYCHOTHERAPY
1. The psychotherapeutic diagnosis (1.1. Categorical and dimensional diagnosis; 1.2. Object of psychotherapeutic diagnosis; 1.3. Components of psychotherapeutic diagnosis; 1.4. Relational diagnosis; 1.5. Initial evaluation and case history; 1.6. DSM 5 and ICD 10); 2. The strategic integrative model in psychotherapy (2.1. The 4 domains of the self; 2.2. The biological domain; 2.3. The cognitive axis; 2.4. The emotional axis; 2.5. The psychodynamic axis; 2.6. The social-family domain; 2.7. The existential axis).
MODULE 7. HYPNOTHERAPEUTIC TECHNIQUES
1. Strengthening the ego (1.1. “The force of the ego”; 1.2. Hypnotic suggestibility tests used to strengthen the ego: Chevreul’s pendulum, pencil break test, etc. 1.3. Evoking exceptions; 1.4. The affective bridge; 1.5. Using positive suggestions; 1.6. Metaphors; 1.7. Goal-oriented meditation; 1.8. Activation of some parts of the personality; 1.9. Activation of internal resources); 2. Metaphorical interventions (2.1. Definition and role of therapeutic metaphors; 2.2. Construction of therapeutic metaphors; 2.3. Therapeutic use of metaphors); 3. Specific interventions (3.1. Assertiveness training; 3.2. Critical incident processing; 3.3. Creation of new behaviors; 3.4. Constructing specific interventions).
MODULE 8. HYPNOTIC LANGUAGE
1. Suggestions and their structure (1.1. Direct suggestions; 1.2. Indirect suggestions; 1.3. Positive suggestions; 1.4. Negative suggestions; 1.5. Content suggestions; 1.6. Process suggestions; 1.7. Post-hypnotic suggestions); 2. Elements specific to hypnotic language (2.1. Voice; 2.2. Truisms; 2.3. Implication; 2.4. Open suggestions; 2.5. Suggestions that cover all possibilities of an answer class; 2.6. Compound suggestions; 2.7. Implied suggestions; 2.8. Pressure; 2.9. Wordplay; 2.10. Negative language; 2.11. Juxtaposition of opposing elements; 2.12. Approval series; 2.13. Reading of thoughts; 2.14. Nominations; 2.15. Confusion; 2.16. Surprise).
MODULE 9. INTEGRATIVE HYPNOTHERAPY AND THE BIOLOGICAL DOMAIN
1. Elements of genetics and neurobiology (1.1. Genome and epigenome; 1.2. Vulnerability and genetic resilience; 1.3. Experience-expectant neural maps and neural networks; 1.4. Gene expression and brain plasticity; 1.5. Mirror neurons – pros and cons); 2. Mental illness and health schemes; 3. Psychosomatic mechanisms (3.1. Attachment and the immune system; 3.2. Psychosomatic diseases; 3.3. Pain and perception of pain); 4. Hypnosis in pain management (4.1. Dissociative and placebo components; 4.2. Transition from acute pain to chronic pain; 4.3. Clinical strategies; 4.4. Self-hypnosis); 5. Use of hypnosis in the treatment of the burnt patient; 6. Hypnosis in conversion disorders and psychosomatic diseases; 7. Hypnosis in cancer treatment
MODULE 10. INTEGRATIVE HYPNOTHERAPY ON THE COGNITIVE AXIS
1. Schemes and cognitive maps (1.1. Central beliefs; 1.2. Intermediate beliefs; 1.3. Explanatory style); 2. Perfectionism; 3. Paradoxical interventions; 4. Exposure techniques; 5. Working with automatic thoughts.
MODULE 11. INTEGRATIVE HYPNOTHERAPY ON THE EMOTIONAL AXIS
1. Emotions and emotion regulation (1.1. Basic, primary and complex emotions; 1.2. Emotional regulation; 1.3. Emotional expression); 2. Neurotic guilt and repression of emotions; 3. Conditions of worth; 4. Attachment (4.1. Formation of attachment; 4.2. Attachment styles); 5. Intersubjectivity; 6. Hypnotherapy on the emotional axis (6.1. Changing the emotional state through hypnosis; 6.2. Hypnosis and relaxation; 6.3. Guided imagery; 6.4. Positive suggestions; 6.5. Self-hypnosis; 6.6. Catharsis).
MODULE 12. INTEGRATIVE HYPNOTHERAPY ON THE PSYCHODYNAMIC AXIS. Part I.
1. The self in psychodynamic orientations (1.1. Elements of Freudian psychoanalysis; 1.2. Elements of Jungian psychoanalysis; 1.3. The conscious and the unconscious); 2. Sub-personalities; 3. Therapy of ego parts (3.1. Steps in therapy of ego parts; 3.2. Hypnosis and the empty chair technoque; 3.3. Management of dissociation; 3.4. Therapy of ego parts according to Watkins and Watkins).
MODULE 13. INTEGRATIVE HYPNOTHERAPY ON THE PSYCHODYNAMIC AXIS. Part II.
1. The ego states; 2. Life scripts (2.1. Injunctions and drivers; 2.2. Types of life scripts; 2.3. Psychological games); 3. Transference and counter-transference; 4. Hypnosis and childhood experiences (4.1. The inner child; 4.2. Age regression; 4.3. The theater visualization technique; 4.4. Developmental strategy for meeting the clinet’s needs).
MODULE 14. HYPNO-ANALYSIS AND PSYCHOANALYSIS
1. History of hypnoanalysis; 2. Psychoanalysis and hypnosis (2.1. Psychoanalytic theories and their applicability in hypnosis; 2.2. Differences between psychoanalysis and hypnoanalysis); 3. Projective tests and hypnoanalysis; 4. Principles of dream analysis (4.1. Interpretation of dreams in hypno-analysis; 4.2. Hypnotic dream technique); 5. Age regression (5.1. Techniques for age regression; 5.2. Age regression to birth); 6. The techniques of “reincarnation”; 7. Structure of hypnoanalytical techniques (7.1. Structural elements; 7.2. The corridor metaphor; 7.3. Journey to a rock; 7.4. Alice in the land of mirrors; 7.5. The interior counselor; 7.6. Automatic writing in hypnotic trance).
MODULE 15. INTEGRATIVE HYPNOTHERAPY IN THE SOCIAL AND FAMILY DOMAIN
1. Family roles (1.1. Role of the person in the family; 1.2. Parental dysfunctional roles); 2. Inter-generational and trans-generational patterns; 3. Differentiation of the self within the family; 4. The family structure; 5. Clinical hypnosis as a method of working with the family and the group (5.1. Principles in working with families; 5.2. Principles in working with groups).
MODULE 16. INTEGRATIVE HYPNOTHERAPY ON THE EXISTENTIAL AXIS
1. Identification / differentiation; 2. The 4 fundamental worries (2.1. Anxiety of death; 2.2. Meaning of life; 2.3. Existential isolation; 2.4. Assumption of responsibility); 3. Time and the “psychopathology of time” (3.1. Perception of time; 3.2. Perception of time in hypnotic trance; 3.3. Neuropsychology of time perception; 3.4. Psychophysiology and perception of time); 4. The inclination towards spirituality; 5. Working on the existential axis (5.1. Feeling of loneliness; 5.2. Anxiety of death; 5.3. Individualization; 5.4. Psychological pain).
MODULE 17. HYPNOSIS, STRESS, DISSOCIATION AND TRAUMA
1. Stress (1.1. Definition of stress; 1.2. Stress; 1.3. Effects of stress; 1.4. Diseases related to stress; 1.5. Psycho-immunology); 2. The post-traumatic stress syndrome; 3. Acute stress disorders; 4. Adaptation disorder; 5. Stressful life situations; 6. Hypnotherapeutic treatment of post-traumatic stress syndrome (6.1. Ideodynamic exploration; 6.2. Re-education experiences; 6.3. Imaging techniques; 6.4. Catharsis; 6.5. “Recovery of memories”); 7. Hypnotic interventions in the critical or traumatic incident.
MODULE 18. HYPNOSIS AND CREATIVITY
1. Creativity and research on creativity; 2. The connection between hypnosis and creativity (2.1. The connection at the personality level; 2.2. The connection at the process level; 2.3. The connection at the production level).
MODULE 19. ERICKSONIAN HYPNOTHERAPY AND INTEGRATIVE HYPNOTHERAPY
1. History of Ericksonian hypnotherapy; 2. Classification of Ericksonian hypnotherapeutic techniques; 3. Accessing unconscious processes; 4. Solution-oriented hypnosis; 5. Facilitating “creative moments” in hypnotherapy; 6. Use of metaphors and interpersonal technique; 7. Use of post-hypnotic suggestions; 8. Ericksonian communication patterns; 9. Principles of Ericksonian psychotherapy (9.1. Principle of use; 9.2. Each individual is unique; 9.3. People have the resources necessary to solve problems; 9.4. The answer of the interlocutor is the one that informs us about the meaning of his speech; 9.5. Any behavior responds to an objective; 9.6 There is no failure, there is feed-back; 9.7. The patient is the expert; 9.8. The use of unconscious resources; 9.9. The use of paradoxical approaches).
MODULE 20. HYPNOTHERAPY WITH CHILDREN
1. History of the application of hypnosis in child psychotherapy; 2. Suggestibility and hypnotizability in children and adolescents; 3. Induction methods specific to children and adolescents; 4. Techniques for deepening the trance; 5. Hypnoanalytical techniques in working with children; 6. Self-hypnosis for the child; 7. Indications and contraindications of hypnotherapy with children; 8. The “Wizards’ School” program.
MODULE 21. INTEGRATIVE HYPNOTHERAPY FOR DEPRESSION
1. Diagnosis and symptomatology of depressive disorders (1.1. Disruptive mood disorder; 1.2. Major depressive disorder; 1.3. Persistent depressive disorder (dysthymia); 1.4. Pre-menstrual dysphoric disorder; 1.5. Other depressive disorders. 2. Neuro-psycho-biology of depression; 3. Theories on depression (3.1. Biological theories; 3.2. Psychological theories); 4. Hypnotherapy for depression (4.1. Strengthening the ego; 4.2. Treatment of somatic symptoms and pain; 4.3. Psychotherapy of depression sccording to Yapko; 4.4. Psychotherapy of depression according to Alladin); 5. Integrative psychotherapy for depression.
MODULE 22. INTEGRATIVE HYPNOTHERAPY FOR ANXIETY DISORDERS
1. Diagnosis and symptomatology of anxiety disorders (1.1. Separation anxiety; 1.2. Selective mutism; 1.3. Specific phobias; 1.4. Social anxiety or social phobia; 1.5. Panic disorder; 1.6. Agoraphobia; 1.7. Generalized anxiety disorder. ) 2. Treatment of anxiety disorders (2.1. Short-term strategic model for phobic disorders (Nardone); 2.2. Short-term strategic psychotherapy for agoraphobia (Nardone); 2.3. Hypnotherapy of anxiety – the anxiometer; 2.4. Progressive desensitization.
MODULE 23. INTEGRATIVE HYPNOTHERAPY FOR EATING DISORDERS
1. Diagnosis and symptomatology of eating disorders (1.1. Pica; 1.2. Rumination disorders; 1.3. Avoidant / restrictive eating disorders; 1.4. Anorexia nervosa; 1.5. Bulimia nervosa; 1.6. Compulsive eating); 2. Theoretical models in eating disorders (2.1. Attachment; 2.2. Cognitive-behavioral model; 2.3. Socio-cultural theories; 2.4. Emotional and personality factors; 2.5. Strategic integrative model); 3. Hypnotherapy of eating disorders (3.1. Patient evaluation; 3.2. Self-hypnosis; 3.3. Self-reinforcement; 3.4. Cognitive restructuring and restructuring; 3.5. “Back to the future” technique; 3.6. Metaphorical prescriptions; 3.7. Age regression ; 3.8. Therapy of ego parts; 3.9. Hypnotherapy of obesity).
MODULE 24. INTEGRATIVE HYPNOTHERAPY FOR PSYCHOTIC DISORDERS
1. History of psychotic disorders; 2. Spectrum of schizophrenia (2.1. Schizotypal personality disorder; 2.2. Delusional disorder; 2.3. Short psychotic disorder; 2.4. Schizophreniform disorder; 2.5. Schizophrenia; 2.6. Schizoaffective disorder; 2.7. Catatonia); 3. Neurobiology of schizophrenia; 4. Hypnotherapy of psychotic disorders (4.1. Indications and contraindications of hypnosis in the treatment of psychotic disorders; 4.2. Integrative psychotherapy in the treatment of psychotic disorders; 4.3. Hypnotic techniques for managing developmental deficits; 4.4. Hypnotic techniques for auditive hallucinations; 4.5. The therapeutic alliance and relationship).
MODULE 25. INTEGRATIVE HYPNOTHERAPY FOR PERSONALITY DISORDERS
1. Classification of personality disorders; 2. Group A of personality disorders – diagnosis and symptoms (2.1. Paranoid personality disorder; 2.2. Schizoid personality disorder; 2.3. Schizotypal personality disorder); 3. Group B personality disorders – diagnosis and symptoms (3.1. Antisocial personality disorder; 3.2. Borderline personality disorder; 3.3. Histrionic personality disorder; 3.4. Narcissistic personality disorder); 4. Group C personality disorders – diagnosis and symptoms (4.1. Avoidant personality disorder; 4.2. Dependent personality disorder; 4.3. Obsessive-compulsive personality disorder); 5. Hypnotherapy of personality disorders (5.1. Integrative psychotherapy; 5.2. Ego parts therapy; 5.3. Age regression; 5.4. Behavioral modification techniques; 5.5. Contraindications to hypnosis).
MODULE 26. INTEGRATIVE HYPNOTHERAPY FOR SLEEP DISORDERS
1. Normal sleep; 2. Insomnia; 3. Nightmares; 4. Night terrors; 5. Bruxism during sleep; 6. Hypnotherapy for sleep disorders (6.1. Hypnotherapy for insomnia; 6.2. Hypnotherapy for bruxism; 6.3. Clinical hypnosis and dreams).
MODULE 27. INTEGRATIVE HYPNOTHERAPY FOR ADDICTIVE DISORDERS
1. Psychological models of addiction; 2. Disorders related to a substance (2.1. Alcohol; 2.2. Amphetamine; 2.3. Cannabis; 2.4. Cocaine; 2.5. Hallucinogens; 2.6. Inhalants; 2.7. Opiates; 2.8. Nicotine / Smoking); 3. Pathological gambling; 4. Hypnotherapy for addictive disorders (4.1. Hypnotherapy for smoking addiction; 4.2. Hypnotherapy for drug addiction; 4.3. Hypnotherapy for pathological gambling).
MODULE 28. HYPNOTHERAPY FOR SEXUAL DISORDERS
1. Psychoagnosis and clinical evaluation (1.1. Cycle of human sexual response; 1.2. Diminished sexual desire; 1.3. Disorder of sexual arousal of woman; 1.4. Erection disorder; 1.5. Disorder of orgasm of woman; 1.6. Premature ejaculation); 2. Psychotherapy of sexual dysfunctions (2.1. Integrative psychotherapy; 2.2. Hypnotherapy – 2.2.1. Sexual fantasy; 2.2.2. Paradoxical interventions; 2.2.3. Reframing; 2.2.4. Reduction of anxiety; 2.2.5. Negative cognitions; 2.2.6. Reinterpretation of past experiences; 2.2.7. Use of therapeutic metaphors; 2.2.8. Age regression and progression; 2.2.9. Hypnotherapy for erectile dysfunction; 2.2.10. Hypnotherapy for hypoactive sexual desire; 2.2.11. Hypnotherapy for sexual arousal disorder in women; 2.2.12. Hypnotherapy for premature ejaculation; 2.2.13. Hypnotherapy for female orgasm disorder; 2.2.14. Hypnotherapy for painful sexual disorders).
MODULE 29. HYPNOTHERAPY FOR DISOCIATIVE DISORDERS
1. Trauma and dissociation; 2. Diagnosis and symptomatology of dissociative disorders (2.1. Dissociative identity disorder; 2.2. Dissociative amnesia; 2.3. Depersonalization / derealization disorder); 3. Hypnotherapy of dissociative disorders (3.1. Controversies regarding the use of hypnosis in the treatment of dissociative disorders; 3.2. Tri-phase treatment of trauma; 3.3. Hypnotherapy of dissociative amnesia; 3.4. Hypnotherapy of dissociative disorder; 3.5. Hypnotherapy of dissociative identity disorder; 3.6. Depersonalization disorder).
MODULE 30. HYPNOTHERAPY AND PSYCHODRAMA
1. Principles of psychodrama; 2. Integrative aspects in psychodrama; 3. The use of clinical hypnosis in psychodrama
Personal development program
250 hours of personal development
Personal development focuses, on the one hand, on the development of communication skills, relational skills and self-reflection, and on the other hand on self-discovery, so that trained psychotherapists can discover the ways in which personal history helps or constrains them. regarding professional tasks and their own answers to professional dilemmas.
Supervision
200 hours of supervision
Supervision focuses on strengthening the integration of theory and practice, as well as developing a professional attitude. Supervised psychotherapists have the opportunity to gain insight into their clinical activity, as well as the opportunity to discover what they are already doing well and what they can replace or improve. Supervision implies respect for the supervisee’s knowledge and emphasizes how the supervisee’s experience is relevant in his professional practice.