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STATE REGULATION: ILLUSORY, UNETHICAL, AND HAZARDOUS -
Eleven good reasons to oppose SR
The following arguments are laid out to establish a comprehensive basis for opposing state regulation of psychotherapy and counselling. Not all will speak to everyone but it would be strange if at least 8 out of 11 didn't. If you can adduce further 'good reasons' please publish them and let me know.
SR is currently projected for installation sometime between late 2009 and early 2011. Note SR through the Health Professions Council is intended to be regulation of function, of practice itself, not just title ('psychotherapist', 'counsellor'). Already there are significant currents of both discontent and outright opposition emerging within the umbrella organisations in tension with the party line that SR is both good and inevitable. I am monitoring the UKCP. What is the situation within BACP? It is important to make links with oppositional trends wherever you find them and to agitate/resist in whatever forum you have access to, - in print, online or at meetings, and this can be around the central platform that the status quo is good enough whereas what will ensue from SR is a disaster for the psy field. Heads in the sand bystander time is over. There is a window for derailing the SR project and countering its malignancy NOW. Later may prove too late.
Acknowledgement: With a different preface most of this text has already appeared in the Summer 2008 edition of 'Transformations', the journal of PCSR (Psychotherapists and Counsellors for Social Responsibility).
Eleven Good Reasons To Oppose SR
1) Surveillance Privacy Neutrality
SR undermines civil liberties. The subjection of the psy field to state-managed processes of audit and surveillance jeopardises practitioner neutrality and erodes the client's psychic space. Foucault identified how the panopticon effect operates as a disciplinary instrument because subjects (in this instance therapists as much as clients) never know when they are objects of its observatory or not and so eventually internalise the panopticon and act as if always under observation. Boal's political theatre for exorcising the cop in the head is becoming especially relevant for the psy field and provides a praxis for undoing the panopticon.
2) Diversity or Standardisation
The current diverse, local, voluntary and intuitively responsive ecology of the psy field is superior to and should be valued above the proposed compulsive and centralised control of standards administered by a tickbox bureaucracy. Standardisation will paralyse creativity in developing new forms of practice and will artificially and arbitrarily restrict research. James Scott has contrasted the diverse local 'metis' with the standard centralised 'techne' and chronicled techne's dedication to extinguishing metis.
3) Medical Model Hegemony
SR can only establish effective hegemony by means of distorting psychotherapeutic practice/praxis through bundling it all in under the medical model of mental illness, in the future likely to be glossed or hybridised with a WellBeing ideology imported from the corporate world. This violates the public's right to choose and access practitioners working within other paradigms e.g. personal development, co-operative enquiry, authentic humanistic psychology and unrecuperated psychoanalysis.
4) Output Regulation versus Input Regulation
For training institutes SR is a lifebelt to save them from sinking in the sea of a deregulated market. Obtaining a monopoly on a protected title (however the HPC wont guarantee this) is linked to exaggerating the role of input regulation (control of entry into practice) at the expense of output regulation which is of much less economic value to trainings. Prioritising the latter entails the active fostering of self-regulated integrity at the point of contact between therapist and client by means of ongoing peer review (Independent Practitioner Network), supervision, wider debating of ethics (which will bring the state's behaviour into view) and above all the education of the public in what to reasonably expect from therapists beyond the clichés. This last initiative will often run contrary to government prescription. It has been mostly dodged by the umbrella organisations (BPS, BPC, BABCP, UKCP and BACP perhaps less so) which prefer to focus on cultivating a more prestigious and self-serving culture of highly academised expertise.
5) Misallocation of Risk and Redress
There is no evidence that SR as a licensing procedure can achieve the elimination of risk and pre-emption of abuse that its controls and ideology suggest it can. A quick look at the HPC's publicly viewable stocks and gallows listings might be in order.The umbrella organisations are deeply complicitous with government agendas of 'being seen to be', as though it is fatal not to dance to a public relations tune. Overegging 'protection of the public' is linked to the spread of a professional false self.
The scale of risk is exaggerated (the transposed Shipman effect). There is insufficient evidence that therapists abuse clients on a scale that warrants the costs (financial, political, psychological and cultural) of state intervention in the form of the HPC. The HPC and Skills for Health are between them fostering a dangerous conflation of ethics and competencies under the bundleword of standards.Very very few therapists act unethically, all therapists have issues of competency at one time or another. However as Carl Rogers pointed out there have always been at least as many licensed charlatans and exploiters as unlicensed and the licensed ones are actually more dangerous because of their stronger credentials to be trusted.
If the position taken so far is too laissez faire the Counselling Society has suggested there may be a case for creating a fallback instrument of legal deterrence, that is a new category of criminal offence which would require criminal standards of proof termed 'Professional Abuse'; this being applicable only in cases of financial or sexual abuse or physical assault by a professional acting in a trust-based caring capacity (this charge could apply to other professions beyond the psy field). Proposals like this have the virtue of stealing the HPC's thunder and locating redress in its proper place with the judiciary instead of the executive and its HPC courtroom. Short of these extremes an expansion of independent mediation and resort to existing common law are surely the way forward for redress.
6) Core Values Erosion and Toxification
SR with the requirement to be registered directly with the HPC will subvert the values and varied forms of association that traditionally have held practitioners collectively in what is a consistently demanding work space; namely the values of responsibility, ownership, self-management and mutual care for the quality of colleague's work. The HPC will pull for STASI-style inducements to shop colleagues with corresponding reactive collusions to cover genuine mistakes rather than admit and clear them. Together these components of false compliance will accelerate a spread of fear, shame, cynicism and internalised oppression towards toxic levels. The deal on offer is this: follow NICE guidelines and adhere to NOS stipulations and the government will protect practitioners from the public and the litigation industry. Refuse these and regardless of your skill and experience the HPC will pillory you as a charlatan.
Thus the psy field is to be reconfigured according to the gospel that the government and the Department of Health knows what is best for you and your clients. Actually you are damned if you do and damned if you don't so it makes good sense to reject the whole caboodle of SR. This deal is the next move in the government strategy of breaking in to be followed by performance management of the next sector of the caring professions. After stuffing teachers and then doctors it will be psychological therapists turn next.
7) Delivering Government Agendas
Some sections of the psy field have been seduced by government interest (IAPT) in what they might contribute and don't appear to be overly concerned with the nature of the use government finds for their skills. There are obvious dangers, not least contagious loss of client trust, in being subpoenaed to serve government purposes. Opposition to SR supports the maintenance of a necessary distance from the state, even for those who have always been in NHS employment as the nature of the social contract is shifting. Compliance with SR will collapse the space for critiques that put the government's business in question and this is no doubt intended. The current moves to block further judicial enquiry into BAE style corruption are the writing on the wall.
Closer to home for the psy field is the Layard formula. Crudely it runs so: you are out of work because of your individual pathology which is costing the state too much in unemployment/ disability benefit. Ergo CBT therapy prescribed. Structural changes in society? Global level economic factors? How dare you suggest these are contributing to social misery with associated anxieties and depression! It is just conceivable that beyond the PR value of demonstrating some care rather than boosting the profits for Big Pharma's recently exposed largely ineffectual drug treatments lies a further agenda for IAPT to screen off more troublesome social/ economic analysis of links between distress and deprivation.
8) Corporate Appropriation
SR will install mechanisms of administration paralleling those in health and education which will enable and excite corporate designs upon the field (Virgin Asda and Tesco are already bidding for slices of the NHS) and a corresponding governmental receptivity to takeover. Here 'choice' and 'change' will be buzzwords that echo but actually bear no relation to what therapists might understand from these terms; instead these will be cheatwords that seem to be offering the public something while actually functioning as government signposts for the deregulated corporate drive to incorporate in order to open up new profit sectors in a service 'industry' (some already speak of the psy field in these terms).
Paternalistic government increasingly adopts the corporate promoting their wellbeing. SR is here knotted to appeasement of the fetish of the free market. A captured or training might itself be a loss leader but its transferential potentials will not be lost by the new proprietor who will proceed to sell holidays, mortgages or supermarket loyalty cards off the back of it. Current networks of informal gratis and beneficent referral safeguard the public seeking therapy from such incentivised insults.
9) Bystander Trance
The message generated by the umbrella organisations that SR is inevitable constitutes a powerful trance induction towards a kind of helpless assent to SR that is equivalent to bystanding behaviour. This mantra of inevitability, frequently repeated by psychotherapists and counsellors, is pitched to simultaneously play on fear and relieve guilt and anxiety by legitimising apathy. For practitioners who purport to be in the business of reducing anxiety and helplessness such a stance is massively incongruent with their core assignment.
10) Exhaustion, Despair and The State as Rescuer
Even with making allowance for the hypocrisy of those who, notwithstanding the above reasons for refusing SR, still see personal or institutional advantage in passively acquiescing to it, as indicated by the affecting of a noncommittal detachment or by adopting a position of reasonableness, pseudo amnesia or feigned ignorance as to what is going on, there remains a question about the root cause of the broader acquiescence, this regulationitus. One must ask why so many in the psy field seem to have turned their attention away from these issues, as though exhausted by something. One hypothesis is that after all the years of infighting between organisations much of the psy field is in some underacknowledged despair over its capacity to live and let live, to live with difference and to tolerate diversity of theory and practice without trying to steal a march on the other. This political despair may be the Achilles heel, the reason no organisation can trust the others not to cut a deal with the state to gain advantage and favours (the UKCP rationale for maintaining a so-called 'ringside view').
Furthermore this scenario would suggest a corresponding unconscious fantasy in which the state is configured as the necessary authoritarian parent who restores order, enforces agreement and rescues the feuding children from destroying each other. That it wont and anyway cant actually do this is beside the point. Such infantilism is actually an appalling indictment of a profession that makes extensive claims regarding its capacity to help clients yet cant help itself as a whole field when it comes to ordering internal and external relations at a political level. That said, currently the UKCP, faced with the exclusion of at least half its registrants (not to mention several thousand trainees) from the privilege of entering the HPC compound, on the grounds that Skills for Health can only recognise this remainder,- which includes the largest section of the UKCP (HIPS), as derivative variants of the psychoanalytic/psychodynamic, the cognitive behavioural and the family systemic, has a major identity crisis on its hands. In certain reactionary parts of the psy field this is a very gratifying scenario, one they have waited years for. It remains to be seen whether this late in the day order from above that Sections organise their footsoldiers (sorry registrants) to fire off letters of protest to their MP a) is sufficiently complied with to produce a significant volley and b) whether MPs in turn raise enough questions for the Department of Health to beat a retreat rather than simply ignore it on the principle that regulators regulate, they don't negotiate, especially when policy has already been decided elsewhere.
11) Conjointly Foreclosed Debate
And so in the light of the above the historical conjoint foreclosure of proper debate and full discussion of what is at stake by both the umbrella organisations and the state has to be named. Since both the state and most of the psy field associations are dominator organisations, structured hierarchically to promote power over as opposed to power with, this is hardly surprising. Proper debate however would be extensive and lateral, decentralised, from the bottom up, practitioner and yes, client/user group driven, the discussion itself congruent with the activity it is all about, the results of this discussion pooled by delegates in the true meaning i.e. subject to right of recall by their constituencies should they start to represent other interests. PCSR to its credit is attempting to launch a discussion that will meet some of these criteria.
In the last 10 years three full-length books (see references) and numerous articles have been published that argue the case against state regulation of psychological therapies. No comparable 'case for' has ever been articulated and if it has it has yet to be produced for public scrutiny. Apart from the active rubbishing of Richard Mowbray's seminal work "The Case Against Psychotherapy Registration" by an early UKCP Chair and Fellow of The Royal College of Psychiatrists, Dr Michael Pokorny, who was clearly horrified by the detailed thoroughly researched deconstruction of the UKCP and SR, the case against has simply been ignored as if many wished it would just go away. Which it hasn't and if anything it has become more cogent than ever with recent developments in the governments agenda. The 'case for' doesn't appear to have got much further than "state regulation is a good thing for the protection of the public so repeat that after me".
This asymmetrical phenomenon should alert observers from outside the psy field as well as those within it to the fact that something has been avoided, debate has been refused because one side cant actually muster a sustainable argument or cant come clean or some mixture of the two. Perhaps above all debate is foreclosed because values are at the heart of the matter and there is resistance to full spectrum declaration. Instead we get mystification, typified by the continuing both careless and deliberate muddling of statutory registration (the project of the fortunately failed 2002 Alderdice parliamentary bill) with state regulation, a very different beast.
After round about 85 years in Britain of freedom from state interference it seems the largely bemused or even apathetic psy field in Britain wont know what it will lose until after it has gone. After which that freedom will be far harder to restore. The state and its collaborators from within the psy field lack the wisdom that pertains to knowing when to leave well alone. Those who confront and refuse SR can take heart from the fact that the body, the unconscious, the transpersonal, the awareness of power relations and indeed love and relationship itself, none of these can be computed in Skills for Health's sorry calculus. In other words very large parts of the therapeutic process and its context will necessarily escape the annexation being attempted by the state and it's collaborators and this gives grounds for hope but not quietism.
Mowbray, Richard. The Case Against Psychotherapy Registration. A Conservation Issue for the Human Potential Movement. Trans Marginal Press 1995.
House, Richard and Totton, Nick. Editors. Implausible Professions. Arguments for Pluralism and Autonomy in Psychotherapy and Counselling. PCCS Books 1997.
Postle, Denis. Regulating the Psychological Therapies. From Taxonomy to Taxidermy. PCCS Books 2007.
Foucault, Michel. Discipline and Punish. Translation. Vintage 1977.
Scott, James C. Seeing Like A State: How Certain Schemes to Improve the Human Condition Have Failed. Yale University Press 1998.