REPORT

Roles, Competencies and Complacency
- mapping the territory of psychotherapy and counselling with the Department of Health
Denis Postle

At a presentation on Friday, 18th November 2005, James Pollard of UKCP and Sally Aldridge of BACP introduced the findings of the BACP/UKCP run, Department of Health [DoH] funded, research project to map UK counselling and psychotherapy. Further up the agenda was a presentation by Rosalind Mead of the DoH's take on all this.

The meeting had a notably low key, polite, amiable, and it seemed to Ipnosis, complacent, tone. This complacency was a sharp reminder of the extent to which we can inhabit tremendously divergent cultural universes, and the pair of us from IPN left the meeting in a state of culture shock. So let's say a few things that the meeting format appeared designed to suppress, or to be attended to in less public gatherings.

First, that in its 'classroom' format, a panel behind a table (albeit all of them women) and people in rows facing forward with minimal contact with each other, it reproduced the top-down, 'power-over', old paradigm model of human community. Not even the more face to face 'horseshoe' of so many management trainings. Despite the opportunities for comment, there were none for interaction with the rest of the group. Why not?

Ipnosis felt that the top down dynamic of the meeting mirrored that of the mapping exercise which was research on people, not research with people, old paradigm research of a kind that is deprecated by the numerous institutions such as Centre for Action Research in Professional Practice, University of Bath, that look at such matters, as fundamentally unethical.

This research, which was being conducted by a team of people seeking to identify and instal the ethical standards that clients need from psychotherapy and counselling practitioners, had a logo that read 'Towards the statutory regulation of counselling', this was coupled with explicit claims to one IPN participant, that in the conduct of the research

'...The question of any bias in favour of BACP's regulatory processes, or the processes of any other professional body in the field of counselling and psychotherapy does not arise...' (Ipnosis emphasis)

Why was the mapping research, and the meeting to present it so top-down, so unidirectional, so from-us-to-you? Might not a psychotherapy and counselling community be supposed to have some awareness of how power is expressed in client work and client lives and thus in professional institutions and research agendas?

Is it because, as I have pointed out elsewhere here, research with people is unpredictable, it often comes up with off-message findings? For example one that contradicts the claim that counselling or psychotherapy clients and practitioners want or need State Regulation? One the other hand, training institutions certainly do need it, and so research methods that at least would not contradict that foregone conclusion were deployed. And here we were listening to the findings.

Some of the details of the bean-counting aspects of the mapping research were intriguing— around 5000 people a year are joining the psychopractice field, there are at least 570 training/accrediting organizations in the UK and about a third of the courses are part of, or under the wing, of higher education/universities. A reminder, were one needed, for those of us watching the psychoplitics field for 15 or more years, that the desire for regulation continues to be training-driven. In a notable bit of leakage of this agenda, the report claims:

There are a large number of titles for both training courses and individual counsellors and psychotherapists. This can only cause confusion to the public. (Ipnosis emphasis)

But only to a public that is held to be naive or inadequate by 'professions' claiming unique knowledge of the human condition.

Unsurprisingly, this proliferation of counsellings and psychotherapies was one of the things the government did not want to see, and James Pollard floated the idea that perhaps they could be reduced to five: HIPS, CBT, Psychoanalytic psychotherapy, Systemic Family Therapy, and Hypnopsychotherapy. Plus, perhaps because the research showed that a quarter of practitioners worked with children, (and not all were trained for it), Child Psychotherapy. Around this point, a voice from the floor said, 'yes we are all going to have to compromise'.

It sounded to me like this was the kind of compromise, i.e. a decision to close down or relocate, that small businesses find themselves making when a national hypermarket opens in their area and actively seeks to eliminate local competition.

I did at times have the feeling that I could indeed be present at a national managers meeting of a large supermarket chain, where the upfront task was improving service to the consumer, while the unspoken agenda was rigging the market. Yes, I know that people attending this meeting really believe in what they are doing but this doesn't mean that, to someone from a groupwork tradition, they didn't seem to be in some kind of consensus trance, not least I guess, due to being in the presence of a potentially powerful government official, i.e. entranced by the expectation that 'at last they were getting somewhere'. As one of the presenters put it, 'the task is to get into a place where the government would like to see us, we are not there yet'.

The politeness of the surface dynamics of this meeting reminded me of an anecdote attributed to Henry Ford, who announced to a board meeting: 'gentlemen I'm leaving, there is too much agreement here'. As though, in the five months since the report was delivered to the DoH, the behind the scenes wrangling between the two lead institutions, the reshuffling of attitudes as evidenced by the BACP evidence to the Foster Review; the organisations who had refused to cooperate in the research; the are-they-in-or-are-they-out matter of the hypnotists; not to mention the psychoanalytic tendency, and the dissent expressed about the whole project* had all evaporated. Very reminiscent of swans gliding effortlessy on the river where I live, the furious paddling of their feet hidden beneath the surface.

Hidden perhaps because of the presence of Rosalind Mead, New Projects Regulation Manager, Department of Health. As though psychotherapy or counselling had, could, or should be matter of 'health' rather than whatever it finds happening in the clients who show up. Sadly there isn't yet a Department of Abuse of Power, in my experience that would be more appropriate.

Ms Mead outlined her civil service, DoH approach to the government's 'wishes', as she described them, around psychotherapy and counselling. What was being looked for were 'standards', 'public protection', and 'discipline'. She also mentioned that the government was committed to 'improving access to talking therapies', adding that there had never been an intention to regulate psychotherapy and counselling together.

Ms Mead eloquently re-iterated her department's position that, because they had to be written into law in a way that didn't contravene human rights legislation, state regulation required clearly identified 'Roles', 'Competencies' and 'Training'. This notion, and its double underlining by Ms Mead, seemed to be received by the meeting as 'The Problem'. For Ipnosis it seemed more like a solution, i.e., while the Roles and Competencies, let alone Training of counselling and psychotherapy were being defined, we could go away and tend our window boxes and forget about psychopolitics for the next couple of decades!

Ms Mead then outlined how the DoH proposed to progress matters. Perhaps, Ipnosis guessed, because of their impatience with the unruly, tedious dynamics of the psychopractice institutions they had hitherto been dealing with, the DoH planned to 'involve UK-wide external facilitators with expertise in competence mapping and development'. Under this proposal, national training organisations such as Skills for Health, and the Qualifications Authorities, would coordinate the production of a competence map for counselling and psychotherapy, using existing competence frameworks. These would be used to compare existing roles, to see how they fitted against the map and then to use this study as a basis for agreeing standards.

In 'Next Steps', Ms Mead spoke of taking this agenda forward by convening a planning meeting. This would engage the national training organisations, the Qualifications Authorities, representation of the four countries' health departments (since devolution, the government does not have reserved powers in these matters, Scotland, Northern Ireland, or Wales could decline to support state regulation of psychotherapy and counselling) and some representatives of professional organizations.

Ms Mead followed this by listing issues to consider:

• 'Statutory Regulation must reflect roles at the point of first qualification not later career specialization'.
  
• 'Standards must reflect what is needed now, not what may be in process of development, they can be reviewed over time'.
  
• 'Roles must reflect what service users and providers need, not just what professions provide, or aspire to'.
  

Around this point she tentatively listed what the latter might amount to, 'general mental health counsellor', plus 'bereavement', 'relationship', school/student', 'drug and alcohol abuse' and 'trauma counselling'. This is what service users want to see, she claimed. Reactions from the audience indicated that some organisations might see this as several bridges too far. There also seemed to be a medical model presumption here; that first you qualified, then specialized, in my experience the reverse is true for many psychopractitioners.

Do you see what I mean about divergent cultural preferences? On the one hand there are those of us who inhabit IPN's self-generating, power-with, cultures of accountability, who see core psychopractice education as including the capacity, with peer support, to assess our own competence, who see face to face contact and external validation of how we run our processes as essential.

On the other hand here was what felt like a supermarket management team discussing its place in the high street, what was to be the brand name that would match, Dixons, HSBC, Mothercare and M&S? There was talk of 'water tight public protection' while the reality, as the quotation from the report above suggested, felt like the infantilisation of service users. There was also talk of 'a register of professional membership being a selling point' and of how Statutory Regulation would help with 'damage limitation to professions'.

As I have outlined in Gold into Lead - The Alchemists Nightmare, and Registering Human Nature there seems to be an ideology, a model of human nature, running through statutory regulation proponents that still sees persons as 'fallen', even persons such as psychopractitioners, who might be supposed to be free of, or at least aware of, such entrancement. The model of human nature driving Statutory Regulation assumes the necessity and dominance of a 'power over' rather than 'power with' approach to community. And yet was this not a meeting mostly of psychopractitioners, many, even most of whose clients, as I have indicated in Shrinkwrapping Psychotherapy, come with some form of victimization – the harm or damage that results from a 'power-over' upbringing and life experience? Not to see the disconnect between that client victimization and the hierarchical, top-down, power-over bureaucratic state regulation that is being sought, continues to seem massively incongruent.

Later in the meeting, points of dissent from the IPN participants seemed defensively met. Question: is it likely that state regulation of psychotherapy and counselling will be more successful in eliminating abuse than medical regulation? Response from Ms Mead: you can't compare medical regulation with psychotherapy and counselling regulation (as though, with the attempt to regulate psychotherapy via the HPC, they had not tried to do just that).

After Ms Mead had very reasonably admitted that mistakes had been, and could still be made, my IPN colleague asked her: 'might you not be making a huge mistake with statutory regulation?' This was rebutted, quickly, defensively, it seemed to Ipnosis, by James Pollard, 'might you, i.e. IPN, not be making a mistake?' Principled dissent, and a corresponding positive programme, the creation of IPN, a lived alternative, a 'mistake'? Really? And if a client doesn't agree with what is being suggested, is this 'resistance', not dissent? James was supported by a Lacanian voice that 'refused to allow the meeting to end on such a complacent note'. How curious for a person with what might be supposed to be a developed competence around projection, denial and counter-transference, to see our dissent as complacency.

*Some months ago, my IPN colleague Richard House, mailed Rosalind Mead copies of two books which he had written, or co-edited, that outlined in some detail the arguments against the Statutory Regulation of psychopractice.

• Therapy Beyond Modernity, Richard House
• Ethically Challenged Professions: Enabling Innovation and Diversity in Psychotherapy and Counselling (co-edited with Yvonne Bates)

Scholarly, referenced, with a rich spread of authors, they elicited neither acknowledgement nor response.

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