Any perception that an event is an historic moment is shaped by the contexts we bring to it. eIpnosis has long seen the desire for, and now the reality of state regulation of the psychological therapies as belonging to those traditions of colonization and exploitation that are characteristic of empire. Expressions of a will to dominate and subjugate in which the instigators are blithely unaware of how offensive to their subjects their actions were. And carefully framed objections are seen as ‘needing to be knocked into touch via clear reasons for decisions’.
Such was the tone and actuality of yesterday’s PLG meeting. A more precisely located context might be that of the WW2 invasion of France, and following its capitulation, the installation of the Petain-led Vichy regime of collaboration with the German invaders. More on this in a moment.
Yesterday’s meeting was held in a spacious pale grey room at HPC headquarters that could be home to any corporate or municipal event. Tables in a closed rectangle, with a PC projection screen behind them at one end. Names on labels, eventually seventeen people in chairs around the table. A commonplace group dynamic; everyone could see and hear the chair and see and hear each other. So far so good. At the other end of the room in several rows of fully occupied seats were 20 witnesses to the proceedings, bound to silence. An important influence it seemed to eIpnosis, on the group dynamic of the event as it unfolded.
HPC President, Anna Van der Gaag, a slight, even youthful figure, opened. This was ‘a significant step’ on a ‘long journey’ of the regulation of professional practice. ‘Regulation’, she said, quoting a poet, ‘was a thing of terrible beauty’. She went on to claim that the HPC refused to be dominated by any single agenda, i.e. special interest agenda, and was a bundle of ‘forward looking qualities’ such as transparency, best practice and values. ‘Forward looking’ proved to be an over-used value at this meeting; any obstacles could be overcome if there was enough will to ‘move forward’. As though at this notable point in history we were being invited to accept that the HPC was a modern miracle, an institution so reasonable, so rooted in logic, that its actions and intentions were value-free. (A note on transparency, eIpnosis diligently tried to reach agreement to video the opening of the meeting as a record of a historic moment. It was refused. ‘I am sorry to disappoint but that is how we run meetings’ is how Marc Seale put it).
After a brief round of introductions, the not so hidden agenda of the group unfolded. Niall McDermott, an amiable chap from the Department of Health in Leeds outlined what the group were there to do. The government sought ‘to mitigate the risks to the public posed by malpractice of a minority of practitioners’, it also sought ‘to do this in ways that were proportionate’. The IAPT and SfH initiatives were ‘linked’, and they were expected to ‘feed into’ regulation by the HPC. There followed a useful clarification of what the group task was, or at least how it was seen by the DoH. Regulation under the HP2001 Order was equivalent to a medium sized Act of Parliament that had to be laid before parliament and be open to argument.
The group’s task was to settle policy regarding regulation of psychotherapy and counselling so that their recommendations, channeled via the HPC Council to the Secretary of State could be written as legislation by the present Mr McDiarmid. Getting a ‘clear, light, policy’ was important because ‘this made the legislative process easier’. Implementation? Well it looked like not before 2011. Ahead of this there would be a further consultation or two, even apparently, another Call for Ideas, and as emerged later, a Reference Group meeting in the spring for those people who had not been chosen to sit on the PLG. All very reasonable, not least the response to a questioner on what would happen if the DoH didn’t like the recommendations, McDermott said that this was hypothetical, however ‘if the lawyers didn’t like what they saw they would be likely to push back strongly’.
Michael Guthrie, whose baby this Group clearly is, followed with another presentation that could be summarized in his own words, ‘this is your own group, but…’ He went on to outline how the group task, its ‘workplan’, was defined by the HPC. Some people present didn’t seem to be fully aware of the degree to which they were pawns in an HPC enterprise. More on that anon. His outline of the HPC’s ‘top level principles’ re regulation is worth repeating:
The establishment of standards
Protection of title
The ability to check practitioner’s registration
Taking action when things go wrong.
Guthrie claimed that there were only 0.23 % of complaints last year, leaving out that they were two years behind in processing the complaints they already have, and that week after week there is a continuous parade of public judgments of people accredited by the HPC who are claimed to be in fitness to practise failure. In the last year of press releases announcing these hearings, eIpnosis has yet to see one instigated by a member of the public. They seem overwhelmingly NHS related, as though NHS managers saw the HPC as a way of short circuiting in-house disciplinary proceedings.
Following further exposition of the virtues of the HPC regulatory regime, Guthrie underlined his perspective on the group’s task. This suggested that the Henry Ford statement that customers were free to choose any colour of car they liked as long as it was black, had been a formative influence in his development. The group had to follow the agenda provided and should begin by discussing the Call for Ideas summary paper that had been given to them. In an allusion it seemed, to the inconvenient dissent that this summary contained, he underlined that ‘it would be very difficult’, ‘they would have to make very pragmatic decisions’ and ‘find a way forward’.
After the group had made recommendations to the HPC Council in July 2009 there would be ‘an analysis of ways forward’. ‘A way forward’ was a recurring litany in the meeting, a surface eruption perhaps of hidden expectations that Guthrie’s blatantly parental style could be expected to produce problematic reactions in the PLG children.
I outline these preliminaries as necessary context to appreciate that as it accumulated, the meeting seemed by any standards, appalling. A colleague said she felt poisoned. Other words would include ‘inadequate’, the chairing was very weak, the meeting was packed with loyal HPC acolytes. Ballast in case the ship showed signs of overturning?
But to cut to the chase, and if you can bear the metaphor mix, the meeting's elephant in the room, the fact that the only major item on the agenda was discussion of the Call for Ideas summary paper. And that in Guthrie’s euphemistic style, ‘it presented important avenues needing further work’. Euphemisms such as these commonly hide manipulations directing people to collude with the boss in how to handle the task at hand, and so it proved.
Before coming to the meeting, eIpnosis did a text analysis of the HPC's Call for Ideas Summary. It contains 5,000 words of detailed response to the questions about ‘standards’, ‘title’ and grandparenting etc that the HPC want settled as policy. Before that there are 2500 words of general comments that variously reject, or object to state regulation of the psychological therapies, either in any form or in the form that the HPC embodies.
The group danced around this dissent in a curious circular ballet of non-engagement, to music that Julian Lousada to his credit described as much too reasonable, ‘there are no opponents around the table, where is the engagement?’ he said. It didn’t help. The dance of avoidance continued. The reason for packing the meeting with the loyal acolytes became clear as a series of what were held to be obstacles were met by a matching series of rescuing reassurance from the HPC inmates. I wonder if Eileen Thornton and Professor Turner realized that their chorusing of ‘don’t worry it will be great on the day’, ‘it was very difficult like this for us but we always found a way forward’, demonstrated to this listener the ineptness of the HPC as a regulator of anything more complicated than hamster-rearing.
All very reasonable, as Julian Lausada said a second time, and yet this was a room full of people, many of them practitioners who might be expected to be more savvy to the group dynamic murkiness that was enveloping them and those of us in the ‘Greek chorus’ witnessing it.
Such discussion that there was of the dissent in the Call for Ideas document pirouetted around claims that ‘the group had to move away from left-field views’, that this dissent ‘was based on myths that had to be softened’, or ‘lack of information’, or ‘confusion’ about the benefits of regulation and, an insult to the practitioners they were rescuing from malpractice, ‘fear of the unknown’. One of the notions that was claimed to be a myth was the idea that there was a ‘medical model’ of human functioning.
For eIpnosis much of the discussion amounted to a familiar catalogue of the kinds of things that people who feel secure in their positional power say when faced with objections from the marginalized or excluded. And indeed with two exceptions that I’ll come to, the meeting did succeed in ignoring the 2500 words of the HPC’s collated summary of dissent that the Call for Ideas had produced.
Kathi Murphy, the UKCP delegate, spoke of holding this dissenting/objecting position alongside commitment to regulation. A tough role to try to sustain in this group and ultimately one that must be untenable. However, she found the courage to speak of the sense that people didn’t like what was being imposed on them and were anxious and suspicious, they wondered how far regulation, while ostensibly of ‘title’, would in practice extend to ‘function’, ‘how broad a brush regulation was going to be’.
Peter Bell, of the Relate federation of charities, said that setting standards had important side-effects. There was considerable pressure on practitioners from service commissioners who wanted them to meet statutory targets and they had little control over this. Professor Waller quickly moved in to reassure (and misunderstand him) ‘the HPC protects practitioners from ‘illegal demands’’.
Brian Magee, of COSCA, was the only person who raised the question of whether the group was entitled to decide that regulation was not in service users’ interests.
The spotlight of Reality was turned on him. There was a somewhat perfunctory response of ‘No, that’s not what we are here for’, ‘we will have to manage difference’ from Professor Waller, followed rapidly, much too rapidly, by her announcement as chair that we would now break for lunch.
If there had been any question about whether this group was only here to do the bidding of the HPC, i.e. to make recommendations about how to regulate the psychological therapies, this doubt was overrun by the decision to eat rather than face the discomfort of hearing anything to the contrary. Or that might have been witnessed by the spectators as disagreement.
The effect was the opposite. There were people in the Greek chorus who looked as if they were about to explode with rage at this farrago.
Any expectation that Brian’s Magee’s very relevant question be picked up after lunch was over-run by the chair’s decision to invite the heaviest hitter present, Professor Fonagy, to tell us about his Skills for Health [SfH] work. As if, in a bizarrely inept way, the ‘read across’ or ‘feeding into’ HPC regulation of the SfH National Occupational Standards and the well-known distortions of the power-brokering involved, would be reassuring. We were even re-assured by Professor Fonagy that SfH (let us not forget, an ‘employer-led organization’) was ‘independent’.
But perhaps the very presence of Professor Fonagy was reassuring to the Liaison Group. Whenever he spoke there were smiles and murmurs of pleasure from the meeting. Perhaps it was his upward mobility that they warmed to, Professor Fonagy seemed at one point to expect his audience to be impressed, as he evidently is, that Lord Alderdice had become the (unelected) Chair of the SfH ‘security council’. But then in the Fonagy value universe, unelected leadership of the ‘independent’ SfH that is re-engineering psychotherapy appears to sit well with his practice as a psychoanalyst.
At this point eIpnosis was beginning to lose patience with the event. Its bureaucratic dreariness and dishonesty began to feel soul destroying. I counted at least ten occasions when ‘obstacles’ to the ‘way forward’ were met with reassurance from the HPC ballast in the meeting, Professor Annie Turner and Eileen Thornton and supported by Professor Waller (a weak chair who often seemed to this observer well out of her depth).
There were lots of other professors present, Professor Mick Cooper, who at times looked as if he had bought a seat for the wrong opera. The afore-mentioned Professor Peter Fonagy, a psychoanalyst obsessed with psychopractice manuals for, presumably, practitioners other than himself. Professor Lucas, a ‘lay’ member, so ‘lay’ that he had become a Professor of Health Studies. And then there was Professor Graham Smith. Did I miss anybody?
As anyone with a close relationship to UK academic culture knows, the professorial role may be founded in research and intelligent enquiry but tends to drift towards dealing with staff/student ratio management, too many scripts to read properly in too little time, fund-raising and awaydays to quangos like the HPC. And not least, departmental assessments.
Isn’t it curious that these six HPC professors are so enthusiastic about imposing regulation on the psychological therapies when they themselves are embedded in a very unpopular and discriminatory system of state regulation, the Higher Education Funding Council for England [HCFE] and its Research Assessment Exercise [RAE]. For anyone unfamiliar with this ‘exercise’, the HCFE, a quango that resembles the HPC (it also claims to be at arms length from government), rates Higher Education institutions against each other on the basis of how many research papers they have published (books don’t count at all) and publishes the score in national league tables that determine levels of future funding. The HPC, eIpnosis guesses, presently has a much lower priority in these academic minds than the contents of the envelope the courier will deliver on December 18th carrying their department/universities RAE2008 rating.
Might this subordination to the state’s agendas for education be why, as it seemed to this observer, intelligent enquiry had been left at home as not wanted on the trip? Plus, as I speculate below, diligent exploration had perhaps stalled because so many witnesses were present. Witnesses, the majority of whom know that the PLG is an unelected group. Witnesses who see the PLG tasked with the imposition of a research-free regime of truth about how regulation of psychotherapists and counsellors (no mention all day of psychoanalysts) can be coerced into the protection of clients. Witnesses seeing existing diversities of language, nuance, specificity and theoretical universes, including the existing rich collection of ways of supporting the practitioners civic accountability, being written out of the regulatory agenda. Witnesses experiencing in their face enactment of this.
The PLG is a group of people who claim to be competent enough to decide on behalf of perhaps thirty thousand practitioners what counts as fitness to practise and yet their process as a group looked and felt like that of trainees. In training for subordination to Michael Guthrie?
One frame for their group dynamics, that derives from hypnosis, would see the whole meeting was a well-hidden form of trance induction, with Michael Guthrie as trance-master-in-chief, ably assisted by Professors Turner and Waller plus Eileen Thornton doing reassurance. Trance inductions work through intentionally narrowing perceptions and shutting down discrimination. Was this the lightly concealed HPC agenda for this meeting? The suggestions of inevitability (the PLG workplan is a given) that ‘debate could be defused’, that ‘regulation was non-invasive’, screamed denial to this observer. Denial explicitly of the level of dissent contained in the Call for Ideas summary paper.
My guess is that there was a feeling in the leadership over lunch that the trance wasn’t happening to plan. How so? From a trance perspective might it be that the inductees were outnumbered by the witnesses? Spectators who palpably, were not entranced by the proceedings, and most of whom seemed to be holding an informal role of public/professional conscience.
What to do?
In an almost inaudible whisper (or was it a whimper) and without protest, Professor Waller closed the meeting at 1:30pm, two hours before it was scheduled to end. And only a couple of hours after Mr Guthrie’s urgings about what a lot of work the PLG had to do in the five days left to them.
In what other kinds of context does any of this make sense? One that eIpnosis finds apposite requires a switch of paradigmto the situation in France during 1939 and after, when following the successful German invasion, the invaders looked for an economic way of controlling the whole of France when they occupied only the north of it. As with the UK state’s imposition of regulation on the psychological therapies, there was a need among the French to find an accommodation with the overwhelming German force. In France in 1940, as in our present debacle, there were elements of government who were not that far away politically from the invaders, i.e. whose notion of right government saw dominance as necessary and proper.
As a ‘way forward’ and often for ‘pragmatic reasons’, i.e. what would be the least worst outcome, many French people collaborated with the German forces. Historians distinguish two groups, ‘collaborationnistes’, enthusiasts for the German take-over, and ‘collaborateurs’, people who, often unwillingly, did what had to be done to survive. There was also, we might recall, the Resistance. Yesterday at the HPC all three attitudes to the state’s colonization of the psychological therapies as a values-congruent way of working with the human condition seemed present.