Having attended several of these meetings, at the 'High Table' of the professional institutions pursuing the regulation of the psychological-therapies field, I feel moved after the latest such meeting to write a short piece of the 'where we are now' variety, as the professionalizing psychodrama continues to unfold towards some kind of long-anticipated dénoument. Like my friend and IPN colleague Denis Postle, I, too, am weary of revisiting yet again the arguments against the statutory (and state) regulation of our work. Those arguments have been exhaustively developed in many different published forums; and those of us responsible for that literature probably share the view that if rational argument were to have been given due weight in this debate, the argument for the statutory regulation of the psychological therapies would have been lost, sunk without trace a long time ago. So something different is clearly needed in addition to rational argumentation - and I'm inclined to think it's something akin to ideological and political critique, together with a relentless exposing of the (power) dynamics often less-than-consciously driving the psychodrama.
Denis Postle thankfully does a lot of this in his new book (see his 'Ipnosis' website for full details)'; and it is painful and extraordinary in about equal measure to witness therapy practitioners abjectly failing to use the precepts of their own assumptive worldview to interrogate the assumptions and unconscious dimensions of their own political and institutional behaviour.
It would also be all too easy for those of us who have opposed state involvement in regulation from the outset to take up a kind of triumphalist, 'told you so' position - but I'm too weary of the issue even to do that! How could the field, and its institutional officials, have been so naïve as to believe that a government that duplicitously misled its populace into an appalling war in the Middle East, and which is presiding over quite unprecedented curtailments of civil liberties on the one hand, and escalations in 'audit' and society-wide 'surveillance' on the other, was remotely capable of, first, listening to, then understanding, and finally responding maturely to rational arguments that the therapy institutions have, far too late in the day, been putting about how the Skills for Health agenda, the NHS 'NICE' guidelines and the HPC route to regulation entail values and assumptions that the vast swathe of the therapy modalities simply reject outright?
But back to the meeting - at which I spoke up in favour of what I call a stance of 'Principled Non-Cooperation' (or PNC) with the government's White Paper proposals. I also posed this poignant question to the assembled notables at the meeting: at what point would the institutions who have been pressing for regulation decide that the state regulation that was on offer (currently, via the Health Professions Council) was worse and more harmful from the standpoint of therapy values than no statutory regulation at all. Nicola Barden of the BACP did seem to concede that the option of 'taking our ball home' was, indeed, one - albeit last-ditch - option; and I commend her courage in suggesting that at the meeting. But there certainly wasn't any kind of stampede to join Nicola: nobody else from the main players even began to address the substance of my question - after all, this is the age of 'spin' and appearance being all, and the therapy institutions seem to have been very adept at taking on the 'ways of being' of the modern political Zeitgeist, not least in their implicit collusion with the 'audit and surveillance culture', of which the White Paper's proposals are but the latest development.
In my view, the role of the therapist, and her/his institutions, should be to preserve a space of critique of prevailing cultural values - for as David Smail and others have cogently pointed out, it is precisely such values and ideologies that have so often damaged the clients who seek help and support for that damage and its sequelae when they come to us for assistance. Just how authentic can any help I might offer to such clients be if I have colluded with pernicious cultural forces which it should surely be the place of critically minded psycho-cultural commentators and therapists fearlessly to deconstruct and problematise? Perhaps we need to start speaking about a new kind of therapy practice - at the risk of overblown pretentiousness, I'll call it ATP or Authentic Therapy Practice. Perhaps a practitioner can only claim to be offering ATP if they quite explicitly and self-reflexively undertake to strive for a deep congruence between their face-to-face work with clients and/or groups, and the approach they take to, and the relationship they have with, the cultural Zeitgeist and all its psycho-social machinations and vicissitudes. Of course, as an IPN participant I would argue that the IPN peer-group process is a most effective way to enable such a congruence - not that it can ever be guaranteed, of course, for to claim that would be merely to mimic the worst modernist excesses of didactic professionalization. But explicitly to aspire to 'Authentic Therapy Practice' and all that that striving entails seems to me to be a useful starting-point for driving a clear taxonomic wedge between those practitioners who really take a congruent self-society dialectic seriously as a core aspect of their work, and those who play fast and loose with the politics of the profession, as if engaging in the black arts of spin, power-driven manipulation and political inauthenticity had no relation whatsoever with, and could be neatly separated off from, the actual coal-face work they do with their clients.
I could say much more both about the meeting, and White Paper more generally. I made the point that while the rhetoric of the institutions is one of 'standards', the White Paper is clearly shot through like a stick of rock with the ideology of standardization - and all the violence that such a mentality perpetrates on the rich diversity of therapy practice across the field. For example, on page 85, para 7.17 of the White Paper, we read the following extraordinary assertion: "the Government believes that all professionals undertaking the same activity should be subject to the same standards of training and practice so that those who use their services can be assured that there is no difference in quality". You really couldn't make this up… - I could almost write a book on this sentence, and the multiple misunderstandings grafted upon multiple misunderstandings that it betrays. Yet make no mistake; this is the ideology and worldview that is informing those who are planning to state-regulate our activity - and the prospect is terrifying and depressing in about equal measure. (Better line up some off-the-shelf CBT for me, quick!... - and for all the other traumatized therapy practitioners that will be littering doctors' surgeries before long, if this madness continues to play through to its threatened dénoument.)
It is the post-modern subtleties and nuances of our activity, then, that the policy-makers and state regulators seem either quite unable to grasp, or else determined willfully to ignore - and it seems more a case of the latter than the former. There is also a great need for the therapy world to deconstruct and lay bear the erroneous assumptions of the 'roles and competencies' ideology, and how, again, its imposition upon therapy practice will do our work a peculiarly excruciating kind of violence. And the same goes for the 'NICE' guidelines, and their ignorant and quite unwarranted promulgation of CBT as the favoured, 'empirically validated' 'treatment' in so many realms (for a trenchant and often devastating challenge to CBT's clinical and cultural hegemony, see House and Loewenthal, 2008).
What is perhaps most fascinating to witness is the way in which the psycho-institutions are (understandably) wringing their hands and complaining about what's being done to them by the state (with its abuse of political power), not seeming to realize that the only difference between themselves and the government power-wielders is that the latter have come out on top; while the nature and the dynamics of the power game that each is playing are essentially indistinguishable. That's one reason why it's rather hard to muster much sympathy for the plight that the institutional professionalizers have got us into; for it's at least plausible that had the psycho-institutions not relentlessly pursued regulation with government over many years, that the government wouldn't have shown anything like this degree of interest in regulating the psychological therapies, and we wouldn't then be in the mess we're in now.
So… long live ATP and PNC! And if Denis Postle's welcome new book has the impact that it deserves to have across the field, then we can be assured that ATP will be alive and well in the land, notwithstanding the countervailing effects that the statutory regulators (in a hole and furiously continuing to dig) will no doubt continue to have on therapy practice.
Richard House, Independent Practitioners Network, Roehampton University, London
House, R. and Loewenthal, D. (eds) (2008; in preparation) Against and For CBT: Assumpions, Beliefs, Challenges, Open University Press
Postle, D. (2007) Regulating the Psychological Therapies: From Taxonomy to Taxidermy, PCCS Books, Ross-on-Wye