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Tony Hughes on You've Got What It Takes: Become a Biofeedback Mentor



I have been teaching biofeedback to licensed clinicians for a long time. I have always encouraged my biofeedback therapists-in-training to become nationally certified through the Biofeedback Certification International Alliance (BCIA). Educationally, certification helps define and structure a plan of action for clinical training. Professionally, certification helps to ensure that clinicians meet recognized and agreed upon minimal level of competency for biofeedback theory and application. There is just one problem. There is a growing need for more biofeedback mentors at the national and international levels. And that's where you come in. Could you become a biofeedback mentor?



Tony Hughes


Dr. Hughes teaches the BCIA-accredited Stens Academy Biofeedback didactic course. He is in private practice in Berkeley, CA. He is nationally known as a professional trainer in applied psychophysiology and biofeedback and is one of the most skilled and interesting lecturers in biofeedback and self-autonomic control today.



Tony is a licensed Marriage and Family Therapist and certified in biofeedback as a BCIA Senior Fellow. His seminars are geared toward preparing students and professionals to use biofeedback, autogenic training, and other techniques of self-control for the treatment of a variety of stress-related and pain disorders. He also serves as a consultant to several hospitals and clinics.



What exactly is a mentor?


The historical roots of mentoring go way back. While putting this piece together, I found a mentoring reference in the epic poem, The Odyssey, by the Greek poet Homer. Now, as then, a mentor is a teacher/trainer guiding others towards mastery of a particular set of skills.

Professionally, the mentor is different from a clinical supervisor, who has legal oversight and responsibility for the work of their supervisee. The biofeedback mentor focuses on the technical and professional development of their "mentee," as well as encouraging attitudes that inspire the commitment to lifelong learning.



Where does mentoring fit?


In biofeedback, mentoring usually begins after a clinician has completed the didactic phase of professional training set by BCIA. With an introductory understanding of the biofeedback equipment and clinical applications, the "mentee" seeks assistance starting biofeedback training with clients. That's where the mentor steps in as a guide, coach, or facilitator. Biofeedback mentors are state-licensed clinicians who themselves are BCIA-certified and have provided biofeedback as a significant part of their practice for 2 or more years.


Participants within the mentoring relationship seek to match clinical interest areas in general, but at other times align more specifically with each other's interests. For example, when my mentees ask to include EEG biofeedback as part of their training, I cannot, as that is outside my area of expertise. On the other hand, I can be very helpful with mentees whose client work has a specific focus on heart rate variability biofeedback.



How long does the mentoring relationship last?


Assuming the mentee has contracted with a single mentor, mentoring is for 20 sessions. I typically Zoom-meet with mentees twice a month for approximately 50 minutes. The number of sessions per month and their lengths can vary from mentor to mentor, but the mentee must complete 20 sessions. Therefore, it is common for my mentees to work with me for 9 or 10 months. BCIA allows mentees to work with several mentors.



What is the focus between the mentor and mentee?


So as not to duplicate information readily available to you as a potential mentor, check out the following link that provides specifics on what mentors need to cover with mentees over time. I'll summarize it here, along with additional thoughts based on my experiences with mentees. As outlined by BCIA, the biofeedback mentor will focus on the following:


1. Structure the mentee's biofeedback training for themselves


There is a saying in the biofeedback field that the biofeedback therapist must be self-trained. In other words, they must be able to do what they ask clients to do in biofeedback. One of my mentees described her work with an elementary school-age client. After she introduced some concepts of hand warming, the child asked the trainer: "Can you do it?" followed by, "Show me."

I encourage my mentees to spend time training on each biofeedback modality. As a result, they discover their unique techniques that lead to physiological control and mastery over that modality. For example, I found temperature biofeedback to be easy - meditate on the sensory event around the hands and fingers. EMG biofeedback, on the other hand, was a challenge. Clients will find training with some biofeedback modalities easy and others more complex. The more difficult modalities for the client often result in the most clinician gain, once mastered.



2. Review their client sessions, results, and progress


Even when there is a well-thought-out treatment plan for a client, sometimes that plan does not work, requiring a change in direction. The limits of HRV biofeedback come to mind when working with some clients. I currently see biofeedback clients at an addiction treatment center. Some are older, long-term addicts that present with poor HRV. As I am limited to seeing clients for only 4-5 sessions, that is not enough time for more complicated cases. Therefore, a shift in training focus is required.



3. The mentor presents case studies relevant to the mentee's caseload


This case review by the mentor may be formal and detailed, but most often, it is not. A less formal, more spontaneous sharing by the mentor of a client experience illustrating a relative point or two to the mentee is more common. When I present the "Five-Session Protocol" to mentees, it starts as a more formal presentation over a couple of meetings. More often, however, a mentee's question will remind me of one of my clients, and I will share what worked or not in that case. However, when a person has previous biofeedback experience, they could present a case to the mentor for discussion about why this happened or what could have been done differently. Also, the mentee can attend BCIA mentoring webinars.



The five-session protocol


Most of us doing biofeedback for a while begin with a plan that works for most people. It is not a rigid plan. It must be flexible enough to meet the exceptional client's training needs. Still, there is a general outline we follow at the start. For teaching purposes, I named my plan "The Five-Session Protocol." Simply put, I sketch out the first five sessions with any client. My mentees start seeing clients using this outline and amend it over time to fit their clinical situation. That is fine and actually recommended. The benefit of having the initial sessions outlined makes for an organized and beneficial start to training with clients.


Biofeedback training begins with teaching clients diaphragmatic breathing and respiration biofeedback. Clients often report achieving the most clinical gain due to respiration training, followed by heart rate variability biofeedback. When these two training modalities, respiration, and HRV, are combined and mastered, self-regulatory skills leading to symptom management improve.


This outline applies to the client's training and also structures the mentee's self-biofeedback training. As mentioned earlier, the biofeedback mentee must complete their self-regulation training under the mentor's distant but watchful eye. This same outline then structures the mentee's practice. Start with respiration and move on to HRV. Add temperature, EMG, or SC training as required.


What is essential is that the mentee master the same training objectives as the client. In the process, they collect their physiological data, organize and present it for discussion in a manner consistent with the model they will ultimately use with clients. "What's good for the goose is good for the gander" rules of learning in the mentee-mentor relationship.


For an excellent discussion and presentation of a short-term model for biofeedback training, find and read "Resonant Frequency Biofeedback Training to Increase Cardiac Variability: Rationale and Manual for Training" by Paul M. Lehrer, Evgeny Vaschillo, and Bronya Vaschillo.



The business side of biofeedback mentoring


Ah, yes, money. Mentoring is a fee-for-service activity contributing to the growing field of clinical biofeedback. Regarding fees, it varies. I have a sliding hourly fee determined by the number of sessions negotiated. Sometimes, I have had a clinician call and ask for a single consultation session. In that case, my hourly fee is what one would typically charge for a professional hour of service. However, many of my mentees need more than a single session, and most plan to pursue international certification through the BCIA, which requires 20 contact hours of mentoring sessions. In those cases, I have found it helpful to discount my fee depending on the number of hours negotiated. Beyond a single hour of consultation, I also offer 5, 10, and 20-session consultation packages. In each session package, the fee lessens as a function of the number of hours chosen.


Other business and professional issues like client contracts, record forms, fees, and professional ethics are covered in a BCIA seminar that mentors must complete.

Conclusion


The professional and personal satisfaction that comes with sharing what one has learned with the next generation of biofeedback providers has been one of the highlights of my professional career. If you choose to become a biofeedback mentor, I hope you find that true for yourself as well.








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