The baby and the bathwater:

'professionalisation' in
psychotherapy and counselling

by Nick Totton

The current rush to professionalisation in the field of counselling
  and psychotherapy, and some of its deleterious effects, are examined. The
  parallels between this process and the experience of psychoanalysis in the
  USA in the 1940s and early 1950s are demonstrated, quoting from contemporary
  critics; and comparisons are drawn with the American phenomenon of managed
  care. An account is offered of what is happening in terms of the sociology of
  professions, suggesting that 'expert systems' are being substituted for
  'local knowledges '-skills and wisdoms which cannot be fully systematised.
  The argument that this process is for 'the good of the client' is considered
  and rejected. Finally, some thoughts are presented about the likely future
  for counselling and psychotherapy, arguing that the victory of professionalisation
  and expertise is unlikely to be complete.

  'I have slowly come to the conclusion that if we did away with ‘the expert’, ‘the
  certified professional’, ‘the licensed psychologist’, we might
  open our profession to a breeze of fresh air, a surge of creativity, such as
  has not been known for years. In every area - medicine, nursing, teaching, bricklaying, or carpentry - certification has tended to freeze and narrow the profession, has tied it to the past, has discouraged innovation.... The question I am humbly raising, in the face of what I am sure will be great shock and antagonism, is simply this: Can psychology find  new and better way?'

The rush to professionalisation 
'Good morning , lemmings' (railway graffiti near Paddington station, London).
The unfortunate truth is that the primary response to Car Rogers' question, then and now, is not so much 'shock and antagonism' as a deafening silence. Rogers (who developed the term counselling because he was himself unable to get certified as a psychotherapist is by no means the first significant figure in the field to oppose aspects of professionalisation. For
  example, Freud (1926/1962) vehemently objected to the medical model of
  psychoanalysis, which was intimately tied to professionalisation (Jacoby,
  1986, p.145); while Jung said of psychotherapy that 'holding lectures, giving
  instruction, pumping in knowledge, all these ....... procedures are of no use here'
  (Adler, 1976, p.534). 

  Many eminent and well-respected contemporary figures have also expressed
  reactions ranging from horror to despair at what is happening to counselling
  and psychotherapy, both in the UK and in the USA (e.g. Heron, 1997; Lomas,
  1997; O'Hara, 1997; Thorne, 1997). The opponents of headlong
  professionalisation have largely dominated the argument; but its proponents'
  strategy of what in German is called Totschweigen (deathly silence), combined
  with remorseless organisational advance, meets with continued success. 
  What is 'headlong professionalisation'? This question can readily be
  answered by scanning the pages of just about any recent issue of a trade
  journal in the field. For example, the August 1998 issue of Counselling,
  the journal of the British Association for Counselling (BAC), includes a
  letter from David Buckingham which says:

  'Counsellor training is still expanding. There are ten times as many
  diploma courses as there were a few years ago. The cart appears to be before
  the horse. Courses are offered, places are filled, and there is a hope that
  there will be enough available clients to provide the practice the students
  require.... How long will it be before placements and clients realise that
  they are onto a good thing, and begin to charge for the privilege of
  counselling them?' (Buckingham, 1998, p.175) 

  There are also several letters both for and against the new BAC
  accreditation requirement of 40 hours of personal therapy or counselling.
  Those in favour mainly focus on what Richards et al (1998, p.173) call
  'the need for practitioners to be engaged in a constant process of self
  examination, especially in the way they relate to others'. The arguments
  against are mainly either that research has not demonstrated the value of
  personal therapy in training effective practitioners; or simply that personal
  therapy is too hard, too unpredictable and too expensive! Two other pieces
  from the same issue stand out as relevant. In the Point of View section,
  Sally Saunders argues that: 

  'If counselling trainings are financially directed, they will be
  consumer-led. The consumers ... may understandably choose a course that does
  not have the demand for personal therapy because it is cheaper to train....
  If counselling training was seen more as an apprenticeship allowing students
  to develop at their own pace, it might stop the rush for hasty qualification
  and the pressure to know it all now.... It is surely time to re-evaluate what
  counselling is and who should be doing it' (Saunders, 1998, pp.179-180) 
  And in an interview entitled 'Counselling and the abuse of power', Ernesto
  Spinelli, Academic Dean of the School of Psychotherapy and Counselling at
  Regent's College, London, questions the introduction of new standards of
  professionalisation through endless working parties, committees and guidelines:
  
  'All of these things give an illusion of professional bodies. We say:
  ‘Look, if we go to all of these meetings, if we have all these
  standards, if we have these codes of ethics, we must be professionals and we
  can hide our questions, about what we are professionals of or in,
  or about, by having all these bodies to protect us' (Spinelli, 1998,
  p.182) 

  I am quoting these various viewpoints not in order to make a particular
  case, but so as to establish the ferment of confusion, doubt and disagreement
  which currently pervades the field, and through which the professionalisers
  continue to carve their determined single track. To speak bluntly,
  counselling and psychotherapy training in the UK is close to being a bubble:
  a pyramid selling scheme, in which individuals or organisations near the top
  of the food chain skim off large profits, and those near the bottom starve or
  eat each other. Far more practitioners are being trained than there are
  clients available for them; and a series of emergency measures are being used
  to stave off the collapse of the system by lengthening the food chain
  further, inserting more roles and jobs. As well as client and therapist, we
  now have trainer, supervisor, trainer's supervisor, supervisor's trainer,
  supervisor's trainer’s supervisor. As Spinelli 'sometimes jokingly' says to
  students and trainees, we’ll eventually reach a point where we'll no longer
  need clients, because we can just close the circle, we can counsel each
  other, supervise each other, and train each other ad infinitum' (Spinelli,
  1998, p.183).

  If only this were the case! But unfortunately a supply of clients must be
  generated, at approximately 15 or 20 times the rate at which practitioners
  are being turned out (assuming that a hill practice has 15 or 20 slots). The
  best hope for achieving this is to colonise the public sphere of
  free-to-the-client therapy. But as with pyramid schemes, collapse is
  inevitable—far sooner, usually, than the participants anticipate. Perhaps we
  should go back to Sally Saunders' questions quoted above: what are
  counselling and psychotherapy, and who should be doing them? 
  
  Deep background
  'Slowly but surely psychoanalysis was cleansed of all Freud's
  achievements. Bringing psychoanalysis into line with the world, which shortly
  before had threatened to annihilate it, took place inconspicuously at first
  ... Form eclipsed content; the organisation became more important than its
  task' (Reich, 1942/1973, p.125). 
  All this has happened before. In his 1954 paper 'Therapeutic problems in
  the analysis of the ‘normal’ candidate', the American psychoanalyst
  Gitelson reports that some analysts 'have begun to despair of the suitability
  of ‘normal’ candidates for a career in psycho-analysis' (Gitelson,
  1954/1989, p.413). He quotes Hans Eissler who, after working with someone who
  wanted therapy 'only for professional reasons', decided that he 'would never
  again try the analysis of a ‘normal’ person' (ibid., p.414).

  Gitelson also quotes the then President of the American Psycho-analytic
  Association, Robert Knight, on how 'the great increase in numbers of trainees
  ... and... the more structured training of institutes' had changed the sort
  of people coming for training. In the 1920s and early 1930s, Knight says, 
  '... many gifted individuals with definite neuroses or character disorders
  were trained. They were primarily introspective individuals, inclined to be
  studious and thoughtful, and tended to be highly individualistic ... read
  prodigiously and knew the psycho-analytic literature thoroughly. 
  In contrast, perhaps the majority of students of the past decade or so
  have been ‘normal’ characters, or perhaps one should say had
  ‘normal character disorders’. They are not introspective, are
  inclined to read only the literature that is assigned in institute courses,
  and wish to get through with the training requirements as rapidly as
  possible... Their motivation for being analysed is more to get through this
  requirement of training rather than to... explore introspectively and with
  curiosity their own inner selves... The partial capitulation of some
  institutes arising from numbers of students, from their ambitious haste, and
  from their tendency to be satisfied with a more superficial grasp of theory,
  has created some of the training problems we now face' (Knight, 1952, quoted
  in Gitelson, 1953/1989, p.414) 

  There is an uncanny parallel here with some of the passages from Counselling.
  The same complaint is being made that people are training for the wrong
  reasons, coming from the wrong place internally; that they are concerned with
  the job rather than the work, and with looking into others rather than into
  themselves; and for the same underlying reasons. Like American psychoanalysis
  in the 1950s, the occupation of psychotherapy and counselling has shifted to
  a more central and acceptable cultural position.

  The rise of the 'normal' practitioner dovetails very neatly with the
  remedicalisation of therapy. People have struggled for decades to establish
  that psychotherapy is, as Freud said of psychoanalysis, 'not a specialised
  branch of medicine' (Freud, 1926/1962); that those wanting therapy are not sick,
  since unhappiness or a desire to change are not illnesses. The drive to
  professionalisation, the enormous expansion of training, demands a huge
  increase in clients. The only way to get enough therapy and counselling paid
  for, it appears, is to get the state and other institutions to pay for it.
  For this to happen, psychotherapy and counselling must present themselves as
  somehow medical.

  In the United States, the dominant issue has been getting therapy paid for
  by medical insurance. Reasonably enough from their point of view, the
  insurers have required that the treatment they are paying for is medical
  treatment: in other words, that the client is defined as ill. A whole
  profession of 'managed care' has arisen to administer this process demanding
  that each client is assigned a 'DSM number' a psychiatric definition, based
  on the Diagnostic and Statistical Manual of the American Psychiatric
  Association, Fourth Edition, of the supposed disease entity from which
  they are suffering. The diagnostic categories of DSM IV are a
  masterpiece of circularity and vacuity for example, '312.9: Disruptive
  Behavior Disorder'. Each DSM number is allotted a fixed number of
  authorisable sessions, irrespective of the individual client's needs.
  Internet users will be familiar with expressions of outrage from American
  practitioners over the distortions of therapeutic relationship and process
  entailed (for a print account, see e.g. O'Hara, 1997, pp. 24-28; also Totton,
  1997a, pp. 113-114). We in the UK may congratulate ourselves on having
  escaped. But we have our own mild-mannered version of managed care: the
  presence of counselling and psychotherapy in the National Health Service,
  which, although it lets therapy reach large numbers of people who would not
  otherwise get it (although they may not always want it or be suitable for
  it), also means that the concept of audited, cost-effective, time-limited therapy
  and counselling becomes central (House, 1996; Totton, 1 997a). And, of
  course, the NHS benefits in turn from the training bubble by being able
  frequently to pay GP practice counsellors a pittance - it is a buyer's
  market. 

  Expert systems/local knowledges 
  'I have felt for some years now like a man who is in danger because he has
  become imprisoned in the profession of therapy' Thorne, 1997, p.141) 
  The sociology of professions emphasises two defining features of a profession:
  the possession of 'expert knowledge' (Giddens, 1991; Stehr, 1994), and the
  use of political strategies to establish a small elite group in control of
  its own boundaries. These strategies include 'social closure' (Parkin, 1974),
  'occupational imperialism' (Larkin, 1983), state support and market control
  (Larson, 1977). The medical profession can serve as a template of such
  processes, and a number of authors have described its use of such strategies
  to establish a uniquely powerful role for itself (e.g. Cant & Sharma,
  1996; Griggs, 1982; Larkin, 1983; Stacey, 1992). 

  Psychotherapy and counselling - or rather, powerful groups within these
  occupations - are trying in many ways to repeat the success of medicine. This
  is partly in resistance to medicine's 'occupational imperialism': one of the
  powerful forces in the development of the Rugby Conference, which ultimately
  became the United Kingdom Council for Psychotherapy (UKCP), was the fear that
  psychiatry would attempt to 'own' the activity of psychotherapy, as it does
  in many European countries (Heron, 1997; Wasdell, 1997). 
  Psychotherapy and counselling have responded to the political need for a
  body of 'expert knowledge' by generating one-radically lengthening and
  widening trainings, 'technicalising' every aspect of the work, inserting new
  levels and meta-levels of expertise and qualification. All this in a field
  where research shows repeatedly that technique and outcome cannot be shown
  to be connected: that

  'there are ... hundreds of different versions of psychotherapy, and many
  of them seem to work equally well' (Mair, 1992, p.146). 

  This verdict (backed up by, for instance, Orlinsky & Howard, 1986;
  Frank, 1973) seems to, but does not, support the notion of generic
  therapy, which is vital to any notion of expert knowledge: the idea that
  everyone is in some sense doing the same thing. There are hundreds of
  different forms of marriage, many of which seem to work equally well; but
  they are not all the same thing. And what do we mean, anyway, by 'work', in
  the context of a complex relationship like marriage or therapy? The UKCP,
  especially, finds itself in the position of gathering together under one roof
  people whose activities have virtually no point of similarity with one
  another (Stacey, 1994, p. 110, sees a parallel situation in medicine). The
  rationale is the creation of a generic profession; but it appears that any
  non-empty definition of what that profession does leaves out half of
  its supposed practitioners. 

  Many people have expressed unease on every level at this process, but it
  has often been difficult to produce a clear critique of the notion of
  expertise. A helpful concept here is that of local knowledge (Geertz,
  1983): a term developed in anthropology and the new field of science studies
  to describe the opposite pole from generalised expertise, which is
  '... formulated on a global level, that is, within the abstract
  ‘synthetic nature’ constructed by science. And the terms it is
  built on are to be highly standardized, quantifiable and not subject to
  subjective interpretations. It is through such a model, its language and its
  terms that the necessary control, manipulation and supervision ... is
  established' (van der Ploeg, 1993, p.219).

  Van der Ploeg's seminal paper 'Potatoes and knowledge' (1993) studies the
  interplay between agrarian science and local farmers in the Andes. It
  describes how, from the scientists' point of view, it is 'only logical' to
  model the needs and procedures of agriculture in a standardised way, with so
  much nitrogen required equalling such and such a dose of chemical fertiliser,
  and so on. The practical reality of farming, for someone who knows the
  intricacies of their environment and works by what van der Ploeg calls 'art
  de la localite, is very different. 'However, the outcome of such methods
  cannot be exactly predicted. Nor can the necessary methods ... be prescribed
  in detail... . Local knowledge ... is, under these conditions, rapidly
  becoming not just a marginal, but more than anything, a superfluous or even a
  counter-productive element' (pp.219-220). 

  A closely similar struggle between expert systems and local knowledge is
  being played out within the field of psychotherapy and counselling. Wynne
  (1995) characterises local knowledges which are always necessarily plural as

  '... interwoven with practices ... highly dynamic systems of
  knowledge involving continuous negotiation between ‘mental’ and
  ‘manual’ [for our purposes, practical] labour, and continual
  interpretation of production expenences ... However because it is so
  multidimensional and adaptive, experience is rarely expressed in a univocal,
  clear form. This is frequently mistaken for lack of theoretical content ...
  [But] there is indeed systematic theory, even though this is in a syntax
  linked to the local labour process and does not presuppose a universal and
  impersonal world' (p. 67, my italics). 

  Is this not an excellent description of the 'knowledge system' of
  psychotherapy and counselling-'multidimensional and adaptive', 'interwoven
  with practices'? The concept of local knowledge helps to clarify and support
  the repeated protests of figures like Lomas (e.g. 1987, 1994) that
  psychotherapy is a matter of experience, intuition and human
  sensitivity-wisdom, in fact-rather than of technique and expertise; or Jung's
  statement that 'any organisation that proposes collective methods seems to me
  unsuitable, because it would be sawing off the branch on which the
  psychotherapist sits' (Adler, 1976, p.534). It underlines the crucial role of
  self-knowledge (the self being a large part of the localite for this
  particular art), and the real appropriateness of the apprenticeship model. 
  We can now clarify the quite straightforward socio-politico-economic
  reasons why counselling and psychotherapy appear to be turning their backs on
  their own hard-won local knowledges. A profession must have its expertise
  — which must articulate with the hegemonic expertise of its society. This
  expertise .... 

  would have key characteristics: it would be taught in an organized way,
  most usually in a university (or at least in an institution that collects,
  transmits and eventually reproduces knowledge); and it would be standardized
  and accredited and often have scientific anchorage ... Expert knowledge gives
  some the privilege to speak, to act as arbiters' (Cant & Sharma, 1996,
  p.6). 

  It is no accident that the expert systems/local knowledges dichotomy is
  explicitly linked with themes of colonialism and imperialism. Generic
  psychotherapy and counselling have used a specious version of expert
  knowledge to colonise and weld into an empire many diverse local craft
  knowledges—hence distorting them, much as medical chemistry isolates a
  supposed 'active ingredient' from a medicinal plant (Griggs, 1982). The
  political impetus is so strong that it has managed to ignore how 'scientific
  research' itself-the system's own borrowed expertise-finds repeatedly that,
  although therapy and counselling seem generally beneficial, neither
  technique nor training significantly affect the benefits reported. House
  (1997), Mair (1992) and Mowbray (1995) all offer surveys of relevant
  research; for a particularly interesting example, see Seligman (1995)). What does
  make therapy effective is precisely 'local knowledge' - the 'therapeutic
  bond' and all the imponderables on which it depends. 

  Another closely related metaphor has been used by Postle (1997, 1998),
  drawing on Shiva's (1993) concept of 'monocultures of the mind'. Like the
  multinational companies, generic psychotherapy and counselling extinguish
  local ecosystems in the interest of economies of uniformity, 'weeding out'
  the unique and nonconformist. As Postle (1998) points out, 'a register [of
  acceptable practitioners] creates weeds. Indeed for it to make sense,
  it has to create weeds, to justify the high cost of the education of
  cultivars' (p.154).

  The close parallel between what is happening in psychotherapy and
  counselling, and the historical, global effect of Western science and
  capitalism on local knowledge systems, is made eloquently clear in O'Hara's
  (1997) account of the current American situation: 
  'Managed care spokespeople openly describe their revolution as the
  industrialization of health care and, with unconcealed enthusiasm and
  frequently contempt, declare that the days of ‘therapy as a cottage
  industry’ are over. What is happening to therapists in the 1990s is
  equated with what happened to butchers, bakers and candlestick-makers in the
  1800s' (p.24). 
  
  The good of the client
  'The opinion of the United Kingdom Council for Psychotherapy seems to be
  that a recognised training is required in order for psychotherapists to be
  effective. There does not appear to be much evidence to support this opinion'
  (Mair, 1992, p.150). 

  Professionalisation has its own self-motivating dynamic: once a group
  decides to carve out a niche as a profession, it inevitably seeks to make
  boundaries around itself and to control admission. Perhaps the only way to
  achieve this is by laying claim to a body of expert knowledge. The
  fundamental motivation involved is quite simply one of self-interest. However,
  like many social phenomena (Levi-Strauss, 1967), the drive to
  professionalisation is not conscious of its own dynamic: it holds false
  beliefs about its own motivations. The primary conscious belief is that
  professionalisation is for the good of the client: that it will
  protect the public from being preyed upon by dangerous, incompetent and
  unscrupulous quacks. 

  Unfortunately, there is practically no evidence in support of this belief,
  and a good deal against it. Mowbray (1995) has extensively documented the
  practical, philosophical and technical reasons for doubting that registration
  or licensing protects the client; he draws on a wide range of sources,
  including Hogan's (1979) magisterial four-volume work. We can conclude the
  same thing from the everyday evidence of abusive behaviour in the
  long-regulated medical and legal professions (Stacey, 1992, 1994). What is
  more, every experienced practitioner knows that practitioner abuse occurs in
  the most respectable and senior areas of the field, not just on the wild
  fringes. One well-documented example is the past-president of the American
  Psychiatric Association and the American Psychoanalytic Association, and
  honorary life president of the World Association for Social Psychiatry, who
  was found to have raped patients whom he injected with amytal (Noel &
  Watterson, 1992). 

  At least as bad as the false reassurance of expertise, wisdom and
  unimpeachability is the standardised 'complaints procedure', based upon an
  adversarial, quasilegal structure quite inappropriate to the sorts of
  situations which arise in psychotherapy and counselling (Totton, 1997b).
  Grinding on for month after month, fitting the client to the structure rather
  than the structure to the client, and finally producing at best a largely
  irrelevant verdict of 'guilty' or 'not guilty', complaints procedures are
  often disastrous for all involved. Most differences between practitioner and
  client are far better suited to a conflict-resolution model than to a legal
  one. What unhappy clients often want more than anything is an apology, an
  acknowledgement of hurt; and, of course, this is the one thing that the
  professionalised complaints procedure prevents them from having. In what
  Thorne (1997) has called 'this death-dealing culture of accountability and
  appraisal where the basic assumption is that nobody is really trustworthy'
  (p.147), few practitioners will dare acknowledge error, for fear of being
  hung, drawn and quartered pour encourager les autres.

  The most striking aspect of all this is the extraordinary way in which
  practitioners have amputated their own understanding of human psychological
  processes. We know about the projection of shadow figures; yet we go on
  talking about all these dangerous abusive therapists 'out there', and setting
  up ways to hound and expel scapegoats - as if this will somehow resolve our
  own feelings of resentment and even hatred towards our clients, for stirring
  us up in so many painful ways (Winnicott, 1947/1987). And accompanying this
  hatred, there is perhaps a profound fear of our clients and how they may
  treat us.

  The professionalisation process can be understood as one of expulsion.
  Something is being got rid - for overdetermined motivations, including the
  formation of boundaries towards 'social closure', and the inculcation of
  public anxiety about who is a 'safe' therapist. But the motivations also
  include, it seems, a fantasy that we can get rid of all the messy, dirty,
  chaotic aspects of therapy and counselling - 'cut back' the weeds, the
  'sprawling plants that 'obscure each other's light and deprive each other of
  nutrients' (van Deurzen, 1996; see Postle, 1998). This powerful and alarming
  metaphor, in an address by a former chair of UKCP, raises Kleinian spectres
  of infantile envy and hatred, closely parallel to the suggestion that we may
  be throwing out the baby with the dirty bathwater which we would so much like
  to deny. But the dirtiness is intrinsic to the baby; and the baby is what we
  will, as therapists and counsellors, always be left holding. 
  
  'There is no alternative'
  'Where, I ask, is the soul in all this? Could it be that all the energy I
  have devoted over the years to schemes for accreditation and recognition, all
  the many hours spent in committees and in working parties ... instead of
  improving the quality of therapy and enhancing the well-being of both
  therapists and clients has led instead to the creation of an exclusive
  professionalism and added anxiety, competitiveness and the fear of judgement
  to the lives of those who were previously lovingly and conscientiously
  responding to the needs of their clients?' (Thorne, 1997, p.147).
  The proponents of professionalisation have so far lost the argument -
  partly because they have chosen not to join it. Unfortunately, though,
  arguments are not everything; tremendously powerful forces are involved. At
  bottom, psychotherapy and counselling are reflecting the values of capitalist
  society at the end of the 20th century: standardisation, form over content,
  'give the customer what they want (and never tell them about other
  possibilities)'. The one argument to which professionalisers return again and
  again is a sad but effective one: it is bound to happen. There is no
  alternative. 

  This is not wholly the case. Certainly there is and will continue to be
  'professionalised' psychotherapy and counselling: hierarchical,
  consumer-driven and shored up by an easy scientistic posture of expertise. It
  seems likely, though, that other forms of practice and organisation will in
  fact survive, and even flourish. As Foucault (1992) tells us, power and
  resistance are inseparable: every form of control and centralisation
  immediately creates an uncontrollable margin. Many practitioners from all
  schools have revolted against professionalisation, because it so directly
  flouts all their 'local knowledge'-what they have learnt in practice about
  the interactions which are central to their craft; and because it means
  organising collectively in a way which actively contradicts their skilled
  understanding of human nature and human groups. Some are already grouping
  together to do something else: at least one organisation, the Independent
  Practitioners Network, is striving to create forms of accreditation and
  validation which emerge from, rather than flout, therapeutic practice - in
  this case, based on a network of peer groups (Totton, 1998).

  It is inappropriate to take some sort of Luddite stance, mourning the loss
  of the Good Old Days: they were never that good, in our field or any other.
  Local knowledges have traditionally been hamstrung by lack of
  meta-perspective, of the understanding that they are in fact local
  knowledges; without this awareness, they become dogmas and rituals,
  preventing the development of new and better ways. The professionalisation
  debate has, not always intentionally, cast a great deal of light on hitherto
  'unconscious' aspects of our work-including aspects, like lack of
  accountability, that urgently need changing. We cannot go back to the past.
  The issue is about the future; and the future of psychotherapy and
  counselling, just like the future of our society in general, is still in
  contest. 
  
  References 
  ADLER, G. (Ed.) (1976). C.G Jung: Letters, VoL II, 19S1-61. London:
  Routledge & Kegan Paul. 
  BUCKINGHAM, D. (1998). Letter. Counselling: the Journal of the British
  Association for Counselling, 9(3), 175. 
  CANT, S. & SHARMA, U. (1996). Complementary and Alternative
  Medicines: Knowledge in Practice. London: Free Association Books.
  FRANK, J.D. (1973). Persuasion and Healing. Baltimore, MD: Johns
  Hopkins University Press. 
  FOUCAULT, M. (1992). Sex, power, and the politics of identity. In M.
  FOUCAULT, Ethics: Subjectivity and Truth (pp.163-173). London: Allen
  Lane.
  FREUD, S. (1926/1962). The question of lay analysis. In S. FREUD, Two Short Accounts of Psycho-Analysis. Harrnondsworth: Penguin.
  GEERTZ, C. (1983). Local Knowledge: Further Essays in Interpretive
  Anthropology. New York: Basic Books. 
  GIDDENS, A. (1991). Modernity and Self Identity. Oxford: Polity
  Press.
  GITELSON, M. (1954/1989). Theoretical problems in the analysis of normal
  candidates. In R.F. LAX (Ed.), Essential Papers on Character Neurosis and
  Treatment (pp. 409A27). New York: New York University Press.
  GRIGGS, B. (1982). Green Pharmacy: a History of Herbal Medicine.
  London: Jill Norman & Hobhouse.
  HERON, J. (1987). The politics of transference. In R. HOUSE & N.
  TOTTON (Eds), Implausible Professions: Arguments for Pluralism and
  Autonomy in Psychotherapy and Counselling pp. 11-18. Manchester: PCCS.
  HOGAN, D.B. (1979). The Regulation of Psychotherapists (4 vols).
  Cambridge, MA: Ballinger.
  HOUSE, R. (1996). 'Audit-mindedness' in counselling: some underlying
  dynamics. British Journal of Guidance and Counselling, 24(2), 277-283.
  HOUSE, R. (1997). Training: a guarantee of competence? In R. HOUSE &
  N. TOTTON (Eds), Implausible Professions: Arguments for Pluralism and
  Autonomy in Psychotherapy and Counselling (pp.99-108). Manchester: PCCS. 
  JACOBY, R. (1986). The Repression of Psychoanalysis: Otto Fenichel and
  the Political Freudians. Chicago: University of Chicago Press. 
  KNIGHT, R. (1953). The present status of organised psychoanalysis in the
  United States. Journal of the American Psychoanalytic Association, 21,
  197-221.
  LARKIN, G. (1983). Occupational Monopoly and Modern Medicine. London:
  Tavistock.
  LARSON, M. (1977). The Rise of Professionalism. Berkeley, CA:
  University of California Press. 
  LEVI-STRAUSS, C. (1967). Structural Anthropology. New York: Anchor
  Books. 
  LOMAS, P. (1987). The Limits of Interpretation. Harmondsworth:
  Penguin.
  LOMAS, P. (1994). Cultivating Intuition. Harmondsworth: Penguin.
  LOMAS, P. (1997). The teaching of psychotherapy. In R. HOUSE & N.
  TOTTON (Eds), Implausible Professions: Arguments for Pluralism and Autonomy
  in Psychotherapy and Counselling (pp. 215-224). Manchester: PCCS. 
  MAIR, K. (1992). The myth of therapist expertise. In W. DRYDEN & C.
  FELTHAM (Eds), Psychotherapy and its Discontents (pp. 135-168).
  Buckingham: Open University Press.
  MOWBRAY, R. (1995). The Case Against Psychotherapy Registration: a
  Conservation issue for the Human Potential Movement. London: Trans
  Marginal Press. 
  NOEL, B. & WATTERSON, K. (1992). You Must Be Dreaming. New
  York: Poseidon Press. 
  O'HARA, M. (1997). Emancipatory therapeutic practice in a turbulent
  transmodern era: a work of retrieval. Journal of Humanistic Psychology,
  37(3), 7-33. 
  ORLINSKY, D.E. & HOWARD, K.I. (1986). Process and outcome in
  psychotherapy. In S.L. GARFELD & A.E. BERGIN (Eds), Handbook of
  Psychotherapy and Behavior Change. New York: Wiley.
  PARKIN, F. (1974). Strategies of social closure in class formation. In F.
  PARKIN (Ed.), The Social Analysis of Class Structure. London:
  Tavistock.
  POSTLE, D. (1997). Counselling in the UK: jungle, garden or monoculture?
  In R. HOUSE & N. TOTTON (Eds), Implausible Professions: Arguments for
  Pluralism and Autonomy in Psychotherapy and Counselling (pp.151-158).
  Manchester: PCCS. 
  POSTLE, D. (1998). The alchemist's nightmare: gold into lead-the
  annexation of psychotherapy in the UK. International Journal of Psychotherapy,
  3(1), 53-83. 
  REICH, W. (1942/1973). The Function of the Orgasm. London: Souvenir
  Press. 
  RICHARDS, S., HARGADEN, H. & BEAZLEY RICHARDS, J. (1998). Letter. Counselling:
  the Journal of the British Association for Counselling, 9(3), 173. 
  ROGERS, C. (1980). Some new challenges to the helping professions. In C.
  ROGERS Ed., A Way of Being (pp.235-239). Boston, MA: Houghton Mifflin.
  
  SAUNDERS, 5. (1998). Envy, elitism and egoism: whose interests are
  counsellors meeting? Counselling: the Journal of the British Association
  for Counselling, 9(3), 179-180. 
  SELIGMAN, M.E.P. (1995). The effectiveness of psychotherapy: the consumer
  reports study. American Psychologist, 50(12), 965-974.
  SHIVA, V. (1993). Monocultures of the Mind: Perspectives on
  Biodiversity and Biotechnology. London: Zed Books. 
  SPINELLI, E. (1998). Interview: counselling and the abuse of power. Counselling:
  the Journal of the British Association for Counselling, 9(3), 181-184. 
  STACEY, M. (1992). Regulating Medicine: the General Medical Council.
  London: Wiley. 
  STACEY, M. (1994). Collective therapeutic responsibility: lessons from the
  GMC. In S. BUDD & U. SHARMA Eds), The Healing Bond: the
  Patient-Practitioner Relationship and Therapeutic Responsibility
  (pp.107-133). London: Routledge.
  STEHR, N. (1994). Knowledge Societies. London: Sage. 
  THORNE, B. (1997). The accountable therapist: standards, experts and
  poisoning the well. In R. HOUSE & N. TOTTON (Eds), Implausible
  Professions: Arguments for Pluralism and Autonomy in Psychotherapy and Counselling
  (pp. 141-150). Manchester: PCCS.
  TOTTON, N. (1997a). Inputs and outcomes: the medical model and
  professionalisation. In R. HOUSE & N. TOTTON (Eds), Implausible
  Professions: Arguments for Pluralism and Autonomy in Psychotherapy and
  Counselling (pp.109-116). Manchester: PCCS.
  TOTTON, N. (1997b). Learning by mistake: client-practitioner conflicts in
  a self-regulated work. In R. HOUSE & N. TOTTON (Eds), Implausible
  Professions: Arguments for Pluralism and Autonomy in Psychotherapy and
  Counselling (pp.315-320). Manchester: PCCS.
  TOTTON, N. (1998). The Independent Practitioners Network: a new model of
  accountability. Dialogue, 1(1), 30-33. 
  VAN DER PLOEG, J.D. (1 993). Potatoes and knowledge. In M. HOBART (Ed.), An
  Anthropological Critique of Development: the Growth of Ignorance (pp.209-227).
  London: Routledge. 
  VAN DEURZEN, E. (1996). Registration: what it will mean to you as a
  counsellor. Keynote Address, 5th St George's Counselling in Primary Care
  Conference.
  WASDELL, D. (1997). In the shadow of accreditation. In R. HOUSE & N.
  TOTTON (Eds), Implausible Professions: Arguments for Pluralism and Autonomy
  in Psychotherapy and Counselling (pp. 19-32). Manchester: PCCS. 
  WINNICOTT, D.W. (1947/1987). Hate in the countertransference. In Through
  Paediatrics to Psychoanalysis. London: Hogarth Press. 
  WYNNE, B. (1995). May the sheep safely graze?: a reflexive view of the
  expert-lay knowledge divide. In S. LASH, B. SZERZYNSKI & B. WYNNE (Eds), Risk,
  Environment and Modernity: Towards a New Ecology (pp.44-83). London: Sage.
  
This article first appeared in the British Journal of Guidance and Counselling Vol. 27, No3, 1999