The Dogs That Didn't Bark* ........Play sound track Part 1, Part 2
A Report on the Psychological Therapies Reference Group Meeting 18th September 2007
In reporting on this Reference Group meeting I've found it very difficult to stay with the actual event. And the several narratives here are the result of this somewhat divided attention. Had I been entranced by the fascinating, if low key tone of the meeting? Was it the several instances of 'dogs that didn't bark' (including questions Ipnosis forgot to raise) that have led me off in unexpected directions? Was it some sense that what really mattered was going on elsewhere that morning? Or was it the gradual emergence of a clearer image of the landscape of UK psychopractice as the fog slowly lifted during the meeting?
Lets stay with the dogs.
Non-barking dog one. While the meeting was held in the BPS City offices, no one from the BPS showed up. Nor did anyone from COSCA. The absence of the BPS was perhaps explained by a pre-meeting item of news that the Section 60 order, which will capture the psychologists and take them into custody has been delayed for a year, thus enabling, Ipnosis supposes, further plea bargaining by the BPS.
The meeting began with a review of where we were with SR of the psychological therapies, a very helpful mélange of news and views.
The nine bodies who had a year earlier concocted the Psychological Professions Council [PPC] were now being spoken of as Five, still Ipnosis supposed, including the BPS. The Five had had a meeting with Philip Hunt, Nick Clark, and Ros Mead of the DoH to discuss the PPC and their concerns about the HPC. They had used the meeting to try to find out if the DoH understood and appreciated their concerns about the way regulation was moving but they had come away from it with confirmation of the HPC as the likely regulator, plus an offer by the DoH to broker conversations between the Five and the HPC. The extent to which the Five were 'sticking together' does appear to have been impressed the DoH. However, later in the summer they delivered a critique of the PPC proposal which was described pretty much in passing in the meeting as 'pedantic' and 'damning'. Not a view that Ipnosis shares.
The rebuttal of the PPC as an initiative, see eIpnosis review, can be taken as a definitive statement of the government's mind, not least because it runs to 18 pages of text. If we needed confirmation, the Regulator name chiseled into the tablet that has come down from the DoH mountain is 'HPC'. That such a long and informative document was quietly passed by in this meeting (it hadn't been distributed) counts as non-barking dog two.
However hope springs eternal in the hearts and minds of convinced regulationists and comfort was drawn from two observations: one, the re-structuring of the cabinet with Alan Johnson as Minister for Health and Dawn Primarola as minister responsible for aspirant professions. New faces=new opportunities for persuasion and U-turns. Except, as someone pointed out, two of the new ministers came from the Treasury, (Primarola was previously Paymaster-General) which might be taken to suggest that the Layard/IAPT tendency could continue to find favour.
Secondly, due to being entirely self-financing, the HPC would appear to be in considerable financial and resource trouble, this was seen by some at the meeting as a motivation that will drive minimum demands of registrants by the HPC so as to suck in business. A highly plausible coda to this claim suggested that, having captured and digested the psychological therapies, HPC would, through its control of training curricula, reverse-engineer the key elements of them (and thus create a new, generation of compliant, employer-led technocratic psychological therapies promoting the Government's view that happiness=health=being at work?).
Among other confluence that was noted, the author of What Works For Who, Tony Roth, who has 'written' the CBT competencies for Skills for Health, is now apparently charged with developing the competencies for the rest of the psychological therapies. (A couple of asides here: 1. as Ipnosis wearily repeats, SfH is a sector of Skills for Business, and 2. at a recent seminar on the topic of regulation at the BAPCA annual conference, none of the 12 participants had heard of Skills for Health)
A brief account of a Stakeholder Conference held on June 5 2007 (IPN was not invited) to discuss the implementation of state regulation, revealed that there were no less than 32 aspirant professions.
Discussion of the government's policy initiative Increasing Access to Psychological Therapies [IAPT] took up a lot of space at this meeting. IAPT was felt by some people at the meeting to be the biggest threat to the current ways of making available psychological help because it took relationship out of the psychological therapies. A view with which Ipnosis is inclined to agree. Nevertheless, as I outline in the Ipnosis landscape of psychopractice pages, some version of IAPT, with a mix of employer/HPC regulation, promises to become the future public face of the psychological therapies.
If we needed to be reminded of the level of interest in IAPT and its technocratic versions of the psychological therapies, someone at the meeting complained that the conference on Upcoming Business Opportunities in the NHS Market Sector, a conference featuring no less than twenty professors, thirteen PhD's plus the Minister of Health and Melvyn Bragg, was full. I'm joking, humour is the only way to approach such a farrago. The conference is actually entitled The Psychological Therapies in the NHS Science, Practice and Policy and two months before the event, it is indeed full.
But this gathering of the great and good, already pre-reviewed some weeks ago on eIpnosis, does indeed seem to promise a fulsome portrait of the social insanity that the mainstream accrediting bodies have unleased through their desire to be state regulated. A feature of this conference, a third dog that didn't bark at the Reference Group meeting, is a promised 'Savoy Declaration', presumably some form of definition of the psychological therapies. A copy of this potentially highly charged statement is to be circulated to the Reference Group but note, it doesn't appear to have been up for discussion with practitioners outside the big Five.
Who knows… perhaps it will echo two previous declarations about righeousness and the moral order - The Strasbourg Declaration of 19xx that 'psychotherapy is an independent scientific discipline', or even more remarkably, a much earlier Savoy Declaration, The Savoy Declaration of Faith and Order 1658 'a modification of the Westminster Confession to suit the Congregational polity', also made at Savoy P[a]lace.
Such a ludicrous echo seems beyond belief, as a colleague of mine is apt to say, 'you couldn't make it up'. Can it be that the hubris fountain of the promoters of this event, which include BACP, UKCP and such supporting luminaries as Richard Evans, the ex-industrialist who re-engineered Metanoia, are in such state of economic overdrive that they are indeed actually offering us an update to the 17thC declaration? Perhaps even 'A Declaration of Faith and Order 2007 'a modification of the psychopractice profession to suit the present government's polity?'
A brief quotation from the 17th C document gives its flavour and shows that it may indeed still have considerable potential relevance to current state desires for the hierarchical regulation of subjectivity:
Of the Fall of Man, of Sin, and of the Punishment Thereof
God having made a covenant of works and life, thereupon, with our first parents and all their posterity in them, they being seduced by the subtlety and temptation of Satan did wilfully transgress the law of their creation, and break the covenant in eating the forbidden fruit.
By this sin they, and we in them, fell from original righteousness and communion with God, and so became dead in sin, and wholly defiled in all the faculties and parts of soul and body.
They being the root, and by God's appointment standing in the room and stead of all mankind, the guilt of this sin was imputed, and corrupted nature conveyed to all their posterity descending from them by ordinary generation.
From this original corruption, whereby we are utterly indisposed, disabled and made opposite to all good, and wholly inclined to all evil, do proceed all actual transgressions.
This corruption of nature during this life, doth remain in those that are regenerated; and although it be through Christ pardoned and mortified, yet both itself and all the motions thereof are truly and properly sin.
Every sin, both original and actual, being a transgression of the righteous law of God, and contrary thereunto, doth in its own nature bring guilt upon the sinner, whereby he is bound over to the wrath of God, and curse of the law, and so made subject to death, with all miseries, spiritual, temporal and eternal.
But let us move on from this remarkable resonance between Christian turf wars and the rollout of IAPT. Running counter to this apparent NHS university/trainers feeding frenzy came the information from someone around the table that the Treasury has not accepted the IABT Business Plan (Ipnosis emphasis). IABT features on other pages here. If you are in close touch with any of the pilot projects and especially the rollout of IAPT in Scotland, Ipnosis would be delighted to hear news about it, good or bad.
This enthusiastic embrace of SR contrasted with an expression of alarm by Christian counsellors at the meeting that SR of the variety being constructed did not take account of the value and scope of voluntary counselling in the UKand paradoxically, the extent to which the NHS heavily relies on it. As the BACP pointed out, 38% of their membership works in the voluntary sector.
However as several observations at the meeting confirmed, the DoH continues to be obdurate around these shortcomings and those of the HPC. For example, as someone asked, where is the evidence that the HPC protects clients? Ipnosis has seen a considerable body of evidence that show that the rigidities of the HPC complaints process have a capacity to harm clients. More on this in coming weeks. And as someone pointed out, how does the HPC's practice of holding all hearings of complaints in public encourage clients with grievances to pursue them? Hearing this I was reminded of my experience of jury service on a rape trial. I came to appreciate very well why, faced with the aversive public exposure of the intimate details of their life experience, many women don't seek prosecution of their attackers. How come the HPC reproduces this?
Very unexpectedly there is currently an alignment between the interests of Ipnosis and IPN members and the mainstream accrediting bodies in preventing the HPC becoming regulator of the psychological therapies. However Ipnosis needed to be mindful that at this meeting everyone around the table, except perhaps some of the psychoanalytic organizations, were still seeking state regulation.
Early in the meeting there had been an injunction to 'stick together', and that the DoH had been impressed by the continued cooperation between the big five. The difficulties of bridging between 'no sayers' and SR enthusiasts was apparent when later, the prospect of moving into action was discussed. There was a proposal from the psychoanalytic end of the table to say to government 'we don't want regulation in this form', this was supported by the argument that 'if we say this now, a new page is created in which we can jointly look at what would work'. The psychoanalytic proposal, reminiscent of an Ipnosis proposal where I invited the members of an earlier meeting to stand by their authority and say to the DoH 'No, Unless', fell like its predecessor without trace into what increasingly felt like a pool of anxious despondency around the table.
Sticking together maybe all that is left for the Five mainstream accrediting bodies, however Ipnosis was more inclined to hold onto to a thread that emerged here and there in the meetingthat the DoH, SfH and the HPC simply did not understand the psychological therapiesespecially the complexity of them. The British Association for Sexual and Relationship Therapy put forward a cogent example of psychopractice complexity. BASRT have 750 members who between them operate under 276 titles.
Ipnosis has just about learned to hold to the paradox that on the one hand, technocrats in the HPC, DoH and SfH are full of good intentions while on the other, they don't simply don't care about the complexities of subjectivity, they have a righteous faith that their taxonomy processes are capable of capturing any human interaction. Undoubtedly, a recipe for grief and harm.
And the last dog that didn't bark at this meeting. There was no mention of the four UKCP member organizations, the Philadelphia Association, the Guild of Psychotherapists, plus SITE and CFAR, who appear to be on the way to quitting in order to form an alternative consortium. At the time of posting of this text Ipnosis had not been able to confirm either the composition of the group, or the reasons for their departure. Might it be to do with seeing the ICO as not something they can live with?
Ah yes, the ICO, surely an enterprise whose sellby date can't be far away.
* the 'dogs that didn't bark' is a feature of a Sherlock Holmes novel, The Adventure of Silver Blaze