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AUGUST 13 2006 EDITORIAL: The Regulation Journey - From Taxonomy to Taxidermy

Two strands of psychotherapy and counselling regulationism converged in July 2006. In mid-July the Foster report on non medical regulation 2006 was posted on the Internet. I’ll come to that in a moment, but first, let’s look at the letter that in common with a hundred-plus UK organizations, IPN received from Professor Louis Appleby, National Director for Mental Health.

Professor Appleby wrote to outline the next steps in the DoH’s Next Steps process of codifying and regulating psychotherapy and counselling. As was promised at the end of 2005, the accumulated knowhow of psychopractice is to be subject to a formidable array of technical experts whose declared field is taxonomy, i.e. to treat the subtle, often ineffable skills of human interaction, as though they were trays of butterflies to be catalogued. If this seems unduly dismissive, take a look at the links in this paragraph from Professor Appleby:

Skills for Health will co-ordinate the production of an initial framework which will identify the scope of practice involved in psychotherapy and counselling, and will be based in the first instance on existing relevant competences held by four sectors skills councils and a national training organisation, and training standards where these are known. The four sector skills councils include: Skills for Health, Skills for Justice, Skills for Care and Development, and SEMTA. ENTO is the national training organisation also involved…

Curiously, NDAH, the National Development Agency for Hubris is not mentioned, though it would seem have an important perspective to contribute. Not least their staff might remind us that the expertise hidden behind the taxonomy expertise of such organizations is, as James Scott outlines, (see below) taxidermy, preserving outward appearances after the living organism has been removed.

Is this an exaggeration? Professor Appleby goes on:

…all other professional bodies in the field known to us to have an interest, [will be invited] to contribute to the population of the framework by demonstrating to Skills for Health where your standards fit within it, and where there may be gaps.

Therapists and counsellors, many of them brimming over with mêtis about interpersonal and group dynamics, will be invited to demonstrate to the DoH how their standards fit into the taxonomy which is being prepared for them in the next few months.

It may be recoverable but this feels like an inflection point, a critical moment, the point at which psychotherapy and counselling practitioner power came under the thumb of the DoH. Arguably this was already apparent at the so-called reference group meeting last November which Ipnosis attended and which is reported on here.

The letter from the National Director of Mental Health also tells us about that meeting:

At a meeting in November 2005 of all training organisations known to BACP and UKCP, the Government's objective was reiterated, and agreed by the majority of those present, that statutory** regulation was accepted as being necessary for protection of the public by setting standards of practice, conduct and training for these professions.

Contrary to Professor Appleby’s text, the meeting was declared as a presentation of a DoH/UKCP/BACP mapping exercise. This presentation was followed by an unannounced set of power point slides from Ros Mead, Manager of New Regulation projects at the DoH outlining the Next Steps in the DoH regulatory plan. This appeared to be news to everyone at the meeting; there was next to no opportunity to discuss either the mapping exercise results, or Ms Mead’s presentation. There was certainly no vote, or show of hands on whether those present agreed with statutory regulation as ‘necessary for protection of the public by setting standards of practice, conduct and training for these professions’. At  conference on regulation a few months later, those of us from IPN who at this meeting had declared regulation to be 'a mistake', were congratulated by other attendees who hadn’t felt able to declare their dissent.

But back to Professor Appleby:

The way forward proposed at that meeting was to hold a preliminary planning meeting of sector skills councils, qualifications authorities and others with expertise in competence development for these bodies to plan setting up a competence framework covering the practice of psychotherapists and counsellors.

As the first paragraph above from his letter makes clear, ‘the way forward’ heard at the November 2005 Reference Group meeting was not a proposition but an announcement. As the DoH picks up the regulation agenda so diligently polished for them by the UKCP and BACP and others, Professor Appleby’s looseness with language betrays the highly unethical tendency towards abusive power relations which the DoH and their trade association collaborators have demonstrated in recent years. These are people who aspire to install exemplary standards of ethical behaviour but they often seem not to have brought any with them. (BTW I would not include Ros Mead of the DoH in this critique, in her relations with IPN she has been direct, accessible and scrupulous.)

Professor Appleby ends by hoping that practitioners ‘will contribute to this exercise (ipnosis emphasis) which marks a significant step forward in ensuring safe and effective services provided to patients and clients of psychotherapists and counsellors.’

Again the language betrays the technocratic lens though which psychopractice is being viewed—as an exercise in fitting in—‘demonstrating to Skills for Health where your standards fit within it, and where there may be gaps’. Tragically this approach to accountability is for practitioners not only an exercise in ‘self mutilation’, as this recent conference paper about the regulation of psychoanalysis by Chris Oakley called it, but one that if accepted, will terminally compromise the quality of psychopractice working alliances with clients. And yet in this upside down, techno universe of the DoH and its collaborators, (free also, it sometimes seems, of the core knowledge that therapists might be expected to have about human relating), regulation is claimed to be for the benefit of clients.

**Evidently not yet up to speed in these matters, Professor Appleby doesn’t seem to realize that if the Foster Report is to be believed, what he is planning is state regulation, not statutory regulation. (For a note on the difference and why it matters, see this letter to the UKCP from Guy Gladstone).

Mêtis and Techne
Before I come to look at the Foster Report’s policy pointers to our regulated future, I want to mention a very helpful resource in understanding why psychopractice regulation is destined to be a disaster for clients and practitioners. In Seeing Like A State, James C. Scott traces the emergence of the state’s need to first map and then regulate and bring onto its books, aspects of society that had otherwise escaped the reach of its administrative and legal grasp.

In the 17th and 18th centuries the definition of property rights via surveying and cadastral maps enabled the state to better enforce taxation (and conscription). Contemporary practices of inheritance and ownership were legible locally, but because of their vernacular language and diversity of incompatible measurements, tended to be invisible to the state. Through unified measurements, notably the metre, kilograms, and hectare, plus uniform map scaling and standardized legal language used in its documentation, and registration of property, the state grasped previously local knowledge, for instance about who owned what, and made it global, i.e. legible to the state.

Scott shows how, from these beginnings, through the globalizing of local vernacular knowledge, the infrastructure of the modern state grew, in a sense became the state. While we benefit from many such developments, Scott lists numerous state initiatives entered into with the best of intentions that due to hubris ended in tragedy or failure.

One of his contentions is that states often feel driven to colonize areas of daily life that are perceived as wild or which elude their jurisdiction. The mapping and measuring this entails generates categories of territory that can be manipulated centrally.

So far as the state believes that any reality is ultimately reducible to administrable components, a tendency strongly apparent in recent government circles, this can be very damaging. Some people would see the continuing crises in UK schooling and the NHS as examples of this, see also the list of skills councils earlier in this text. For our present psychopractice regulation context, there is an equally problematic kind of damage, a tendency for a procrustean transformation in the field being colonized, in which reality is stretched, or alters itself, to fit what the state can administer.

In Seeing Like A State, Scott introduces the notion of Mêtis, local practical knowledge, in contradistinction to Techne, technocratic, or scientific knowledge. Mêtis is the sort of practical ability needed to fly a kite, or a glider, ride a bicycle, drive a card, fly a glider, make love, care for a baby, or sustain a working alliance with a client. Mêtis is experiential knowledge and it is almost always local. Mêtis is that subtle, intuitive perception that there is something significant being left out a client’s story. It is ‘the ability and experience necessary to influence the outcome—to improve the odds in a particular instance’. (p318) as for example in navigation, which to be successful requires responsiveness and improvisation and skillfully judged iterations of trial and error.

...the context of mêtis is characteristically “situations which are transient, shifting disconcerting and ambiguous, situations that do not lend themselves to precise measurement, exact calculation or rigorous logic.

Only by grasping the potential achievement and range of mêtis is it possible to appreciate the valuable knowledge that high-modernist schemes deprive themselves of when they simply impose their plans. One reason mêtis is denigrated, particularly in the hegemonic imperium of scientific knowledge, is that its findings are practical, opportune, and contextual rather than integrated into the general conventions of scientific discourse.’

‘Mêtis ‘is the mode of reasoning most appropriate to complex material and social tasks where the uncertainties are so daunting that we must trust our experienced intuition and feel our way.’

Mêtis knowledge is often so implicit and automatic that its bearer is at a loss to explain it.

Mêtis far from being rigid and monolithic, is plastic local and divergent. It is in fact the idiosyncrasies of mêtis, its contextualness and its fragmentation that make it so permeable, so open to new ideas. Mêtis has no doctrine or centralized training; each practitioner has his or her own angle. In economic terms the market for mêtis is often one of nearly perfect competition, and local monopolies are likely to be broken from below and outside. If a new technique works it is likely to find a clientele.

However despite its intrinsic value, as Scott reminds us throughout Seeing Like A State, mêtis is constantly being eroded or denigrated or destroyed. The diffusion of modernity over the last 200 or more years has seen progress overwhelmingly shaped and driven by the antithesis of Mêtis, Techne.

Techne, as Scott argues, is a ’characteristic of self-contained systems of reasoning in which findings may be logically derived from the initial assumptions. To the degree that the form of knowledge satisfies these conditions, to that degree is it impersonal, uniform and completely impervious to context’.

‘It would be a serious error to believe that the destruction of mêtis was merely the inadvertent and necessary by-product of economic progress. The destruction of mêtis and its replacement by standardized formulas legible only from the center is virtually inscribed in the activities of both the state and large-scale bureaucratic capitalism’.

Mêtis is exactly the kind of unpredictable, intuitively perceived, inexactly expressed and dare we admit it, emotionally rooted knowhow of psychotherapy and counselling that the technocratic sieve of the Foster Report, posted on the Internet in mid July 2006, seeks to colonise and pacify. The report sets the context for the Blair government’s policy for the regulation of psychotherapy and counselling, and yet fails to mention them by name.

The Foster report on non medical regulation 2006 is a lengthy text, 72pp with a 14pp summary, here, courtesy of ipnosis, are some selected quotes. Despite being on the list of psychopractice organizations that engaged with the 2005 DoH funded mapping 'exercise' (I’ll come back to that word) IPN was not invited to contribute to the Foster report and only after the intervention of my MP, and very grudgingly too, were IPN participants able to make a submission.

You might think, looking at the topic and title of the Foster Report, ‘Non-medical regulation’, that this is an even-handed look at the myriad forms of working with the human condition apart from medicine and how they could be regulated. Not so, outside perhaps of hospital consultants’ pay negotiations, a more concrete example of medical model hegemony would be hard to find.

Neither ‘counselling’ nor ‘psychotherapy’ appear in the document, all the examples given are intrinsically medical, and overall the report can be seen as a primer for how the NHS might absorb/capture/accommodate any appetizing technical roles that are as yet unincorporated. Examples that repeat and that indicate the narrowed vision of the Foster team are: Anaesthesia Practitioner, Emergency Care Practitioner, Endoscopy Practitioner, Medical Care Practitioner and Surgical Care Practitioner

So that’s OK then nothing here to concern psychotherapists and counsellors? Not so, on p46, the report endorses the DoH status quo on who should do what:

A regulator like the Health Professions Council, dealing with a range of disparate professional groups, can deliver the functions which public protection requires.

And then, despite the omission of any discussion or context, further down the page is the announcement:

It follows that any new profession coming into statutory regulation should be regulated by one of the existing regulatory bodies, probably the HPC.

Not only that but:

Some aspirant groups have argued that new bodies should be set up to regulate their professions. The preceding discussion has led to the rejection of that approach.

I can imagine that this announcement hasn’t been that well received by some accrediting organizations such as the UKCP or BACP with large numbers of members who see themselves as outside a mental health discourse. The Foster report seems to offer clear evidence that for the DoH, medical is all there is.

The downside of this is that the core knowledge of the last hundred years of psychology, however much it is contested, matters such are projection, denial, displacement, etc appear to be entirely beneath the DoH radar. How else can we explain the report’s devotion to the notion that:

All regulators should adopt a single definition of “good character”, one of the legal requirements for getting registration. This should be based on objective tests.
Page: 10

Let’s ask a few questions. What else does “good character” mean other than the application of Foster and his assistants’ (socially constructed) model of human nature?’ And isn’t this exactly the kind of issue that any capable psychopractitioner will find emerging in their working alliances i.e. what counts as human and natural? And doesn’t it sound like the headmaster of a minor public school instructing his heads of school on its hiring policy? That’s what socially constructed means.

Let’s go on a bit further. Doesn’t “good character” imply that there is also “bad character”, implicitly creating a false dichotomy, as between 'weed' and 'cultivar'?

Doesn’t the use of ‘objective’ show that Foster, and the great and good on the list of people who signed off his report are ignorant of, or more likely in institutional denial of the hard won understanding that claims of objectivity are instruments of coercion and subordination; power words that are intended to enforce compliance and conformity?

If, as seems certain, this report, regardless of its omission of any mention of counselling and psychotherapy, is set to define government policy, this catalogue of ignorance reinforces what has been intuitively obvious to many people in the field over a decade, that taking part in the state regulation of psychopractice is a form of digging your own grave. If this seems like ipnosis riding a familiar hobby horse, read these extracts from the Foster report for yourself. Better still, take the time and get up to speed with the future that is being written for you, read the whole Foster rep

Seeing Like a State: How Certain Schemes to Improve the Human Condition have Failed James C. Scott 1998 Yale University Press

Ipnosis is edited, maintained and © Denis Postle 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006
October 15 2006

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