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SHRINK-WRAPPING PSYCHOTHERAPY
Denis Postle

this is shortened, version of an article based on a talk given at the British Confederation of Psychotherapists Conference 'Statutory Regulation - for or against', June 1999. It appears in the British Journal of Psychotherapy, 16 (3) Spring 2000
my thanks to Nick Totton for his editorial contribution to this article
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ABSTRACT This paper offers a series of propositions about how power has been deployed in the field of UK psycho-practice and draws conclusions about the value of statutory regulation of psychotherapy. The failure by organizations pursuing statutory regulation to engage with dissent is examined and some of the elements of this dissent are outlined. The coercive nature of the power relations intrinsic to statutory regulation are evaluated with regard to their effects on client welfare.



Chaos combines order and irregularity in a subtle way... Too much order is bad for you!... Living on the edge of chaos is the best place to be if you want to live a creative life. (Goodwin 1997)


This article is primarily about power. The statutory regulation of psychotherapy means engaging the power of the state to endorse the values, practices and world-view of the organizations that seek it. As the current Chair of UKCP, Ann Casement, recently put it in a radio broadcast:

At the moment, we're a voluntary register but we are now in the process of moving to registration by law, to statutory registration, we're actually in the process of doing that... We're seeking to protect the title of 'psychotherapist', so after that, once we've registered by law, anyone who calls themselves a 'psychotherapist' will have us to deal with. (Casement 1999)

In what follows, I offer a series of propositions about the way power has been deployed in the field of UK psycho-practice, and draw conclusions about the value of statutory regulation of psychotherapy.


Positional Power
I begin by outlining my notion of 'positional power'. The power of the proprietor, the occupier, the owner, inherited privilege, or the licensed professional. Whether positional power constitutes a bulwark against disorder, a form of imprisonment, a refuge, or an enduring and valued form of social enhancement depends on how it is deployed. However, to suppose that accumulated positional power confers some intrinsic virtue would be naive. The proprietors of UK psychotherapy training schools have been accumulating positional power for a couple of decades by forming what I regard as trade associations: the UKCP, more recently, the BCP, and also the BPS, a trade association for the more scientifically inclined.


In the last 10 years the psycho-practice training market has seen an explosive growth in counselling training. This is exactly the period during which the UK psychotherapy trade associations have worked hardest to consolidate their positional power - notably through attempting to inflate their status to that of a 'profession'. As though this body of psychotherapists had no historical or political sense of the tendency of such bodies to gravitate towards the self-serving clubs (Kendel 1998). Plentiful evidence of this evolutionary tendency of professions is all around us, in medicine (Boseley 1999a), law (Dyer 1998,1999), psychiatry (Kendel 1998; Cassidy 1999), and biomedical research (Boseley 1999b).

Trade associations, whether of psychotherapy trainers or cement manufacturers, have intrinsic legitimacy. However, to inflate an understandable business agenda into ring-fencing a sector of the psycho-practice prairie seems to me indefensible - on ethical grounds, because it is contrary to the interest of clients; and because it arbitrarily imposes oppressive and damaging conditions on the occupation of psychotherapy that I and others practise, with neither representation nor consultation which will constitute a form of imprisonment.

How trade associations such as the UKCP, BCP and BPS deploy positional power and, especially, how they deal with dissent, indicate the ideology around power that they have adopted. And there has been considerable dissent during (at least) the last 10 years as UK psychotherapy professionalization and the prospect of statutory regulation have emerged. Since many practitioners seem not to be aware of the extent and depth of this dissent, here are a few items from it, the tip of an iceberg.

Dissenting Voices

First, and certainly the most influential, is The Case Against Psychotherapy Registration: A Conservation issue for the Human Potential Movement by Richard Mowbray (1995): a substantial, thoroughly researched book, well supported by evidence from a wide variety of sources, with an 18-page bibliography. Mowbray asks, 'Is psychotherapy a suitable case for statutory treatment?' His book responds with a resounding 'No!'

Mowbray shows that registration in all its various forms restricts the supply of practitioners, inflates the costs of services, stifles innovation and discriminates against minorities by raising market entry requirements (p.86). At the same time, he demonstrates that the supposed benefits of regulation are illusory - for example, psychotherapy does not have a clearly defined scope of practice capable of clear legal I definition (pp.92-3), nor is there consensus as to values, goals and means (pp.96-7); it cannot be shown that practitioner incompetence is the source of harm to clients (pp 106-8); licensing laws do not necessarily prevent such harm (pp. 112-14); existing laws offer simpler and better ways to achieve the goals of regulation (pp.215-16); and, overall, it is hard to avoid the conclusion that the negative effects of regulation far outweigh the positive benefits. (This summary draws on House 1995.)

In another substantial text, Implausible Professions: Arguments for Pluralism and Autonomy in Psychotherapy and Counselling edited by Richard House and Nick Totton (1997), 24 authors, many well-known in the field, examine the dynamics of professionalization from a variety of viewpoints. The challenge to the whole basis of professionalization is comprehensivc and sweeping. Can psychotherapy and counselling be reduced to a set of objective expert skills? Is a core theoretical model necessary or possible? What model of accountability is truly congruent with the values of therapeutic work? Are there viable practical alternatives to current models of professionalization?

The book begins with critiques of the professionalization campaigners, who:

promulgate the idea that psychotherapy is a profession: that this profession needs regulation; and that they are the pe9ple to do it - preferably with the help of government. In our view, and that of many other practitioners and supporters, this would be a disaster. (House & Totton 1997, p.1)

Several authors then take up the theme of 're-foundation', seeking to re-establish some values that have always been at the centre of the craft of psychotherapy. These chapters point to the 'normalization' of psychotherapy and counselling which we aim to throw into question: returning to the clear perception of many of its founders that what they had created was 'wild', extraordinary and unsuitable for domestication. (House & Totton 1997, p.5)


The book concludes with several chapters which move from re-foundation to new foundation, alternative ways forward.

What is new, we feel, is the argument that there is an inherent relationship between psychotherapy and counselling on the one hand and pluralism and autonomy on the other. (House & Totton 1997, p.5)

This implies, the editors argue:

ways of thinking and organizing which we have referred to in our subtitle 'pluralism and autonomy'. Many other terms are relevant here - 'self-regulation', 'horizontal organization', 'networking', even 'mutual aid'. (House & Totton 1997, p.5)

In his forthcoming book, Limits to Professionalised Therapy, Richard House uses a de-construction strategy to generate a long and scholarly critique of psychotherapy professionalization. He identifies what he calls:

the culturally legitimated 'Professionalized Therapy Form' (hereafter, PTF), which, I will argue, can routinely not only of itself be intrinsically abusive, but which actively sets up a milieu in which abuse (be it emotional, sexual or professional/financial) may be a typical byproduct, irrespective of the conscious intentions of the therapist. (House, in press)

Reading the chapters of this book interleaved between client sessions, as I happened to do, was initially a shocking, and then a highly rewarding experience.
My own contributions to the professionalization debate began with 'Stealing the Flame' (Postle & Anderson 1989), followed by 'The Glacier Reaches Edge of Town' (Postle 1994) and 'How Does Your Garden Grow?' (Postle 1997). The titles of these papers and the present one reflect my view of the value of metaphor in enquiries of this kind.

The main task of research is to find images and metaphors which arrest the flow of automatic
thoughts and actions and make taken for granted metaphors more obvious. (Rukonen & Smith
1997)


More recently, 'The Alchemist's Nightmare: Gold into Lead - The Annexation of Psychotherapy in the UK' (Postle 1998) employs a metaphor that conveys my settled perspective that psychotherapy professionalization in the UK constitutes a form of theft. The article contains a series of arguments that support and extend this perspective.

I was surprised and pleased that a major journal in the field was prepared to air these contentions, especially since the editors of Implausible Professions found that several obvious mainstream publishers were unable or unwilling to take that text:

An editor for one of the leading firms in the field wrote: '1 am sure your book will be an interesting and thought provoking collection. I'm afraid, though that ______ would not be able to pursue the idea to publication. We... have close links with the UKCP and BAC and other regulatory bodies who are co-publishing or planning to co-publish with us and it would not therefore be appropriate for us to take on this title.' (House & Totton 1997)

Some of the dissent has found a home on the internet. The G.O.R.I.L.L.A. Internet site that I edit, motto 'facilitate the power of love, confront the love of power' (Postle 1996) contains a large and growing archive of critical articles on professionalization that might otherwise sink from view. The thousands of visitors to the site in the last year appear to demonstrate that these issues resonate with psycho-practitioners in countries other than the UK.

I will conclude this catalogue of dissent by introducing very briefly one of its concrete outcomes, the Independent Practitioners Network (IPN), founded in 1995, which currently has several hundred participants fairly evenly spread across the UK. IPN is:

a network of autonomous member groups, each linked to other groups; with no central administration; with no individual membership but accessible in principle to any psych~~ practitioner who can meet the network criteria. The defining task of an IPN group is to get to know each other well enough personally and professionally to be able to stand by each other's work. This entails a lengthy process of support, inquiry and challenge.
Refinement has led to, among other things, two mandatory requirements. One, that to be able to declare itself a Member, each group must have active links to at least two other IPN groups that are prepared to validate the process through which the group reached their agreement to stand by each other's work. And, secondly, that member groups publish to the network the names of their members plus a statement of their ethical cornmitment.
IPN has evolved with numerous centres of influence but no centre of control. In its pursuit of 'power-from-within' for ourselves and our clients it continues to sustain itself exclusively via power with' social relations, with varying levels of elegance and certainty. (Postle 1998)


I will return to these notions of 'power with' and 'power-from-within' shortly.
This accumulated critique of psychotherapy professionalization/statutory regulation amounts to a formidable body of research/inquiry/practice. Almost all of it expresses disapproval yet this dissent has met with a very clear response from the register-builders and promoters of statutory regulation: silence. Or, rather, a special form of silence that Germans call Totschweigen, ignoring something to death (Totton 1999). What is it that the promoters of professionalization and statutory regulation don't want to hear? Principally that the move towards professionalization/statutory regulation of psychotherapy is driven by considerations of economics, status, and territory.


Economics

One of the fundamental economic drivers of professionalization/statutory regulation has been the explosive growth in counselling training, up from 76 training organizations in 1990 to 545 in 1997 (Lawrence 1997). This means that, increasingly, psychotherapy is part of a saturated psycho-practice market. Seen from this perspective several of the key features of professionalization make good economic/business sense.

Raising the threshold of entry to psychotherapy training, i.e. to graduates only (UKCP 1993), along with academically aligned, theoretical course extensions, contributes to the added value that psychotherapy might be supposed to embody compared with, say, counselling, despite there being little or no evidence that either this academic threshold or the longer courses contribute to better client outcomes (Riikonen & Vataja 1999).

While promoting practitioner registration may enhance training school product differentiation vis-a'-vis other supposedly less valuable modes of engagement with clients, it is also likely to stifle innovation (Postle 1998), through imprisoning practitioners who sign up in professionalized therapy forms that, along with the accreditation structures, glaciate psychotherapy practice (Postle 1998). Plus, as I have seen at first hand, psychotherapy registration forces training schools to either get into the register system, regardless of the profound values incongruence this can entail, or go out of business.

Lastly, professionalization requires the creation of 'charlatans', a chronic tendency of some of the professorial inhabitants of the UK psychotherapy universe that I have gone to some trouble to confront (Postle 1997, 1998).

Status

In response to earlier articles, I have been reminded by several people that, for some sectors of the UK psychotherapy training world, the status of psychotherapy within the NHS is a prime consideration and thus shapes and energizes professionalization registration, statutory or otherwise. If you are training people who, after spending, say, £15-20K on their training/therapy, are denied access to work that, for example, less able psychiatrists control, then clearly the status of psychotherapy is a major business consideration. I was also told that, in looking at what drives psychotherapy professionalization, 'don't underestimate the importance of envy and jealousy of psychoanalytic "seniority"/patronage in the NHS' (Coulson, personal communication).

Will this understandable desire for parity with psychiatry and clinical psychology in the NHS eventually constitute a debasement of the psychotherapy currency? In my experience, few UK practitioners know much about the managed 'care situation' in the US (O'Hara 1997). Were they to be better informed, they might realize that, even in the more public service UK environment, the result of these concerns with status will very likely be a compromised, 'tamed', 'domesticated' and probably 'manualized' form of practice that drives out 'wildness' and, with it, innovation.

Territory

Satisfying the status concerns I have touched on above tends to require that there be a 'unified profession', so that psychotherapists are able to 'speak with one voice' to government and the other professions. There is currently a tremendous struggle for control of this 'one 'voice'. Onc of thc groups in danger of being marginalized, the BCP, issued an 'us' or 'them' ultimatum on dual membership which expired earlier this year (1999). Elsewhere in the psycho-practice landscape, UKCP enthusiasts are busy trying to create/lead/manage/control a 'European psychotherapy profession' with 'science' as a badge of merit (Tantam & van Deurzen 1999).

I can appreciate that, along with the proprietors of training schools, people in or seeking to work in this sector may even applaud these kinds of market-dominance business agendas. But what about the benefits to clients that are supposed to be the prime focus of professionalization?


Client Benefits

'Protecting clients' continues to be the sound-bite of choice of the regulationists. The populist quality of this argument contributes one component to the arguably authoritarian equation some inhabitants seem to ascribe to parts of the UK professionalization of social relations (Wilkinson 1999). Clients' interests as a way of justifying professionalization of psychotherapy have become separated from actual benefits to clients of either professionalization or the proposed statutory regulation. Are there going to be any benefits for clients?

As a result of psychotherapy professionalization and statutory regulation, clients seem certain to be faced with increased costs. Someone will have to pay for the increased levels of training, supervision and administration. Who else but clients?

There will be reduced choice for clients. The already strident insistence that only registered psychotherapists are any good and, above all, 'safe' relies on the spurious definition of 'psychotherapy' in this market as being only what the training schools say it is. This denies and avoids the untidy reality that many other modes of delivery of personal development overlap or mirror what the psychotherapy training schools teach (Riikonen & Vataja 1999; Richardson 1997)

There will be no increase in safety. For example, about 10% of all professionals sexually abuse their clients (Pokorny 1998). So far as I can tell, the UKCP and other registration strategies intend to deal with this 10% mainly by dealing with abuse when someone complains, i.e. the quality control inspector, unpaid, is the client. Might not such a client ask why an institution that claims such privileged, indeed 'expert' knowledge about the human psyche has not revised its trainings to eliminate this abuse? And if they can't eliminate it, how 'ethically sound' are their 'qualifications'?

Power

I hope I have given some sense of the flavours and extent of the critique that has been mounted of psychotherapy professionalization in general, and of the statutory regulation of psychotherapy in particular. Yet, as I have pointed out, in the face of this critique there has been almost total silence from the psychotherapy trade associations. What does this refusal to engage with dissent tell us about their approach to power?

My notion of positional power accounts for much of it. If dissent is experienced as peas bouncing off the battlements rather than as the valid and even vital expression of difference, then it can be ignored. This is not a minor matter, because this is not the manufacture of cement but psychotherapy, in which sophistication about power in human relations might be supposed to be a feature. Many of those promoting psychotherapy professionalization seem deaf, or blind to, or ignorant of the value of dissent.

What other notions of power are there that might help us with this silence or deafness? Bachrach and Baratz's typology of power:

embraces coercion, influence, authority, force and manipulation. Coercion, as we have seen, exists where A secures B's compliance by the threat of deprivation where there is 'a conflict over values or course of action between A and B'. Influence exists where A, 'without resorting to either a tacit or an overt threat of severe deprivation, causes (B] to change his course of action'. In a situation involving authority, 'B complies because he recognizes that [A's] command is reasonable in terms of his own values' - either because its content is legitimate and reasonable or because it has been arrived at through a legitimate and reasonable procedure. In the case of force, A achieves his objectives in the face of B's noncompliance by stripping him of the choice between compliance and noncompliance. And manipulation is, thus, an 'aspect' or subconcept of force and distinct from coercion, power influence and authority since here 'compliance is forthcoming in the absence of recognition on the complier's part either of the source or the exact nature of the demand upon him'. (Bachrach and Baratz, in Lukes
1976)


Pursuit of psychotherapy professionalization has by these definitions involved 'coercion', 'influence' and 'manipulation'; statutory regulation extends the list through adding 'force'. It is perhaps noteworthy that, because of this, for those of us outside the trainers' clubs, 'authority' as defined here has required the creation of a dissenting form of accountability - IPN.

And yet why the silence in the face of dissent? Not only from the professionalization institutions but also apparently from their registrants? Is it because, for many people, 'power' and thus dissent are strongly associated with 'conflict' so that many of us, because of our distaste, or our lack of skill around conflict, don't want to touch it or be touched by it? And indeed, might the power relations of psychotherapy be one of the strategies that we deploy to avoid conflict?

At this point, it may be relevant to make the reminder that observable conflict is not a precondition for, or an indicator of, the exercise of power:

The crucial point is that the most effective and insidious use of power is to prevent... conflict from arising in the first place. (Lukes 1976)

And Lukes claims that this is particularly true if organizations give a lot of value to pluralism in their ways of constituting themselves:

A polity... that is pluralistic in its decision-making can be unified in its non-decision-making. (Lukes 1976)

In these days of 'spin', if power is being exercised within the system to limit decision-making to acceptable issues:

Individuals and elites may act separately in making acceptable decisions but they may act in concert - or even fail to act at all - in such a way as to keep unacceptable issues out of politics... (Lukes 1976)

Following this we might even ask, is the 'umbrella' of psychotherapy regulation really grounded in the personal preferences of the individual registrants? Or is it an example of what Lukes calls 'the supreme and most insidious exercise of power':

… to prevent people, to whatever degree, from having grievances by shaping their perceptions cognitions and preferences in such a way that they accept their role in the existing order of things. either because they can see or imagine no alternative to it, or because they see it as natural and unchangeable. Or because they value it as divinely ordained and beneficial... To assume that the absence of grievance equals genuine consensus is simply to rule out the possibility of false or manipulated consensus by definitional fiat. (Lukes 1976)

If this brief discussion of power comes as a surprise, or seems disagreeable, or in poor taste, that may be because as a topic it is under-represented-to-invisible in psychotherapy journals:

with a few notable exceptions (Guggenbuhl-Craig 1971; Embleton, Tudor and Tudor 1994;Parker 1999) the issue of power seems hardly ever discussed in the therapy field. (House 1999a)

...there is vast literature on the topic of power but, interestingly, most of it is to be found within disciplines such as sociology, politics or philosophy and very little within psychology, psychotherapy and counselling;... Clarkson (1997) describes the lack of literature on power in counselling psychology as a blind spot... the discipline as a whole is deeply implicated in the maintenance and reproduction of power relations which it persistently refuses to make explicit - indeed actively obscures... (Kitzinger 1991, in Hart 1999)

This being so, as psychotherapists we may be somewhat disabled when a major issue entailing the exercise of state power arises such as the statutory regulation of psychotherapy. However, the inconvenience or distaste may be unavoidable.

...until psychotherapists address the issue of the abuse of power within their own ranks, they have not given any reassuring evidence that they care about the issue at all. .. Why, for example, did the evidence of Bruno Beuelheim's abuse ofclients have to come from the clients themselves, though analysts in Chicago knew about it for years? (Masson 1994)

We should endorse the sentiment expressed by family therapist Lynn Hoffman: 'therapists of all kinds must now investigate how relations of domination and submission are built into the very assumptions on which their practices are based'. (Hart 1999)

In seeking to follow this injunction I have found American psychotherapist and political activist, Starhawk, a rich source of nourishment. She offers a model of power that bridges both the personal and the political while honouring the spiritual. She proposes three varieties of power, 'power from within', 'power with' and 'power over' (Starhawk 1990).

Power-From- Within

When working with clients, most psychotherapists seek to evoke, enhance, or awaken the 'power-from-within' of the client. The 'power-from-within' is the power to survive, to recover, to flourish, to heal, to belong, to love and be loved, to become self-directing, or responsible, and so on.


Power With

In relations with colleagues, family, friends and many clients psychotherapists are likely to adopt 'power with'. 'Power with' refers to cooperation, negotiation, debate, parity, mutuality, consensus-building,. power-sharing.

Power Over

However. in pursuing professionalization and the statutory regulation of psychotherapy, it seems to me that UKCP, BCP, BPS and, 10 a lesser extent, BAC have adopted a 'power over' approach to each other, to their registrants, to dissenting psycho-practitioners and, ultimately, to clients. 'Power over' refers to bullying, coercion and domination - the use, or threat, of force/sanctions to ensure compliance, deference, obedience, discrimination, or subjugation.
Engaging the force of the state, through statutory regulation, to consolidate the power of a psychotherapy 'profession' is a 'power over' approach to social organization. It poses a special problem for psychotherapy because:

Power over motivates through tear. Its Systems instil fear and then offer a hope of relief in return for compliancc and obedience. (Starhawk 1990)

Thus, for example, a semi-official UKCP handbook (Palmer Barnes 1998) attempts to bring order and reasonableness to complaints procedures. Between the lines, perhaps unintentionally, the book oozes threat. Palmer Barnes delineates a huge, cumbersome edifice of complaints committees, adjudication panels, investigations and appeals boards. According to Palmer Barnes, the people who serve on such boards and panels 'need to be people of stature within the organization'. Why? The answer is that what is being described amounts to a bureaucratically layered, top-down, seniority-driven, 'big stick'. The message to registrants is highly parental, 'be good and everything will be OK, otherwise look what awaits you'. In other words 'power over'. For an account of one such enquiry see Owen (1999).

At the time of writing, October 1999, a private members bill is being prepared to regulate psychotherapy; it is presently out for 'consultation' to BCP and UKCP and probably BPS and BAC. As a significant feature of the psychotherapy accountability landscape, IPN voices sought to be included in this consultation process. Formal access was denied, however informal access revealed a document that supports in almost every line the perspective I outline here.

In its first draft, the Psychotherapy Bill (Alderdice 1999) leaves almost everything of importance about regulation to be decided after it becomes law. Such unspecified elements include what will constitute a 'recognized training', a 'recognized qualification', or a 'prescribed test of competence'. There is no attempt to define the psychotherapy that is to be regulated. How is this regulation to be achieved? The Bill details a multi-tier hierarchy of authority, with the Privy Council and the Health Minister at one end and registered psychotherapists at the other. Navigation in the area between them is controlled by a General Council, a Registrar, an Education Committee, a Professional Conduct Committee and a Health Committee. Curiously, considering its title, all persons referred to in the Bill, including psychotherapists, are male.

Who is the progenitor of this Bill? And what is its provenance? Its promoter declares his 'interests' as the British Medical Association, he's a Doctor; the Royal College of Psychiatrists, he's a Psychiatrist; and a psychoanalytic psychotherapist, though unregistered so far as I can discover. Lord Alderdice is also a member of the House of Lords. If origins matter, a value I would suppose many psychotherapists share, here again is the unaware assumption that the existing 'power over' constitutional status quo, the House of Lords, even the Privy Council, is a tolerable, or even the only way, to structure the working life of thousands of psychopractitioners whether or not they have chosen to assent to the process, and many of us, probably the majority have not.

Again, 'power over'. How could what I outline somehow pass without notice as involving dominance and subordination? My presumption is that, perhaps, because, as practitioners, psychotherapists are one-on-one orientated, there is a tendency for power/political social relations to be out of awareness, so that when choosing aconstitutional form there was never any consideration of alternatives to the 'power over' status quo.

While it could be argued that these are unimportant local shenanigans, they have value because of the way the 'micro' is often an indicator of the 'macro'. Nevertheless I don't want to get lost in them, because there is a deeper form of bad news in all this. Especially for clients. Why does this ubiquity of 'power over' matter? It matters because domination and the long list of 'power over' correlates - threat, coercion,subjection, subjugation, victimization, discrimination, exploitation, manipulation, bullying, deference, exclusion, dependency, normalization, obedience and collusion - are fundamental factors in most client abuse.

Many, if not most, clients seek to survive or recover from some form of 'power over' social relations; grown-up children whose parents manipulate/control themthrough giving/withholding family wealth; women who seek to survive the dual violence of being beaten by partners and being threatened with worse if they leave; employees whose employer removes out of office lunch breaks and hints that to object would be interpreted as 'lack of commitment'; employees promised bonuses in return for unpaid overtime who find the offer withdrawn later for trivial reasons; women terrorized by casual acquaintances who repeatedly make heavy-breathing phone calls. All are struggling with how power, both personal and institutional, is deployed in their lives. If the psychotherapist they hire, whether willingly or not, and my guess is it is often very unwillingly, structures his/her 'professional' life around, or tolerates,a 'power over' form of constitutionality (as exemplified by BCP, UKCP, BPS), how can the practitioner fail to remain uncontaminated by this incongruence?


Conclusion

That proponents of psychotherapy professionalization deny, avoid, side-step, absorb, ignore, but do not generally engage with the body of argument against their project that I have outlined here, eloquently delineates the approach to power that they have chosen. And this 'ignoring to death' has increasingly reinforced my settled sense that there are two over-arching arguments against the statutory regulation of psychotherapy, either of which should be enough to ensure that it is dropped.

One, there is a massive incongruity between 'power from with in'/'power with' practitioner/client relations and 'power over' occupational politics. This generates a lot of fear in practitioners that will inevitably contaminate work with clients, if it hasn't already done so. As Wilkinson asks, in an important and authoritative critique of professionalization:

If the power structures of psychotherapy are totalitarian, how can our practice fail to be contaminated in significant measure by them? (Wilkinson 1999)



Two, statutory regulation is intrinsically a 'power over' constitutional form. Installing it at the heart of psychotherapy will cement in place the very factor common to both the presenting experience of many clients and the abuse by practitioners that it claims to minimize or eliminate - the societal norm that dominance is OK.


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