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11th October 1999
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IPNOSIS attended a late October conference in London to launch Therapy on the Couch Camden Press, editor Susan Greenberg, a well put together and timely contribution to the debate about the regulation of psychotherapy in the UK. The theme for the day 'Does Therapy Hurt?' attracted people from all over the UK and a very diverse list of speakers, the Chief Executive of UKCP failed to turn up, though billed. No excuse given. This absence appeared to be accepted with the unsurprised resignation that colours too much of current psycho-politics. If the organisers, the Association of Independent Psychotherapists, full members of UKCP, knew anything, they didn't tell us. The excellent array of talks left me with an after-reaction, that we had been 'fiddling while Rome burned'. As one of the speakers, Bob Young, pointed out, the people who really counted in this debate were absent. This was a pity because minds, like parachutes, work much better if they are open and there was much to learn here about the regulationist paradigm. The conference opened with Christina Wieland a psychoanalytic psychotherapist whose crisply intelligent review of how therapy can go wrong, drew out, anong others, two useful notions: client resistance should not crushed, and secondly, if they colluded with the client, the practitioner would end up crushed A third space that has no place for winning/losing was essential. I include the notes for Petruska Clarkson's talk. If I understood a low key but impassioned plea that she made in the plenary, Petrushka seemed to be hinting that there was still time, before the statutory apocalypse, to do something more than re-arrange the deck chairs. Frances Blunden of POPAN briefly described the increasing support and funding (Dept of Health and Lottery) for their work with abuse survivors and complainants. Here are some headlines from her talk. Of the abuse reported to them, psychotherapists (24%) counsellors (12%) and psychologists (7%) accounted for 43% of the total. Most abuse was not sexual. The key areas of abuse were: failure to maintain professional boundaries, exploitation of vulnerability, and abuse of trust. Abuse arose: through the therapist using the relationship to meet their own needs, often not intentionally, through a failure of assessment so that the practitioner was out of their depth and not recognising their limitations, through over-lapping, or dual roles e.g. among health professionals. Frances noted that transference relations dispersed very little over time. Practitioners who got in a mess were often in difficulties in their own personal lives. People who were lonely, bereaved, or recently separated were more likely to abuse. 80% of psycho-practice abuse survivors were survivors of child abuse. POPAN recommends: Never bend the rules, no matter what. Hold to an appropriate professional relationship. Hold to appropriate professional boundaries. Vincent Keter, a lawyer and high court advocate outlined three recent cases. He concluded with the view that yes, therapy can be harmful, so severe as to warrant the intervention of the law without any need for mediation by a profession. Secondly that Statutory Regulation was legally irrelevant, as these recent cases had shown, judicial review was an adequate route for legal redress for a complainant. David Mellor of the hosting Association of Independent Psychotherapists, went down the list of questions posed in the conference invitation. Perhaps not surprisingly, his talk felt like a low key, local version of the (missing) UKCP position. Statutory regulation is necessary and inevitable. Psychotherapy does more harm than we think. De-registered psychotherapists continue to practice. Statutory regulation of psychotherapy could go a long way if the registrars and examiners were well funded. However, David noted that so long as training organisations needed students, corners would be cut on standards and that registration would be undermined if, due to this kind of financial consideration, the UKCP sections continued to have changeable standards. Does therapy hurt? Not nearly enough in the wider political context of schools and prisons he argued, due to the hidden agendas of the psychotherapy profession. In the afternoon: Nick Totton insisted that statutory regulation of psychotherapy was not inevitable, that psychotherapy is not what statutory regulation exponents say it is, and while it may need a form of monitoring, it does not need an off-the-peg one. Psychotherapy is not an expert system, it is matter of local knowledge, experience, education, instincts plus the ability to fully enter a personal relationship. Psychotherapy is not a medical practice, it had escaped from medicine but is being pulled back towards medicine for reasons of power and money. Psychotherapy is an enlightenment practice that helps people reach a point where they see that a lot of their aims or shoulds are impossible, unnecessary, or even, shouldn't be pursued. Psychotherapy, Nick argued, is also a political practice through which two people negotiate which view of reality is to prevail. Psychotherapy is full of contradictions, the organising and monitoring of it has to find room for this diversity. Nick asked how, in devising regulation, psychotherapists could forget what they know from their own work about how to relate in groups? How could psychotherapists be so keen on expelling what is 'bad' or 'wicked' i.e. malpractice, and idealising leaders or teachers? We need to take the tendency to criminalise and judge back into ourselves. How did we forget this? Responsible psychotherapy required the toleration of ambivalence and uncertainty and taking the risk of not-knowing. He concluded with the observation that psychotherapy has historically been marginal, transgressive, and challenging of oppressive authority. For psychotherapy to become comfortable, medical, or normative is just what we encourage clients not to do. Bob Young supported Petrushka Clarkson's call for regulation to be based on research. Research showed that psychotherapy helps most people, more training is better, and the more psychotherapy you do the better. Harm he identified as deriving from a failure to maintain boundaries and that some abuse was the result of practitioners being socialised by their training organisation's culture into abusive styles. There was some value in trainings being run by large organisations such as universities that were, he claimed, better at knowing how to hand power on, certainly it was better if key roles rotated. Bob observed that he had found himself challenged by a published piece that claimed that the style of regulation that was preferred was determined by the person's belief's about human nature. If human nature is a veneer over primitive chaos, then restrictive, controlling regulation will seem essential, if human nature is seen to be benign then supportive peer self regulation is more relevant. And, as Bob reminded us, as you are trained, so you practice. Peter Burley, deputy registrar of the Council of Professions Supplementary to Medicine [CPSM], a familiar figure at this kind of event, gave a review of the political position of regulation from the perspective of someone who has been a party to several organisations moving towards regulation. I hope to include the complete text of a related talk on IPNOSIS shortly. Some headlines from Peter's intricate and detailed presentation include the following. The Cabinet Office's 'Regulatory Impact Unit' is one of the centres driving government policy around accountability, it sees regulation as needing to be similar across different professions viz. Accountants, Nurses, Doctors etc. Another important current influence is a circular about nursing, 'Making a Difference'. The government see the recently implemented Order in Council route as the preferred way to deal with professions who request regulation. The preferred definition of what constitutes a profession, is that held by the Privy Council. Regulation of psychotherapy, if it comes, will be several years away, ahead of it in the queue are the CPSM, nurses and clinical psychologists, plus probably the BPS. There is very unlikely to be any government time for a private members bill but work on one will support an application for regulation when the time comes. Under the present system, a profession volunteers for regulation. If it were to be opposed (i.e. no-one volunteered for the regulatory body) then regulation would be impossible. Chairman David Henderson hinted in his introductory remarks at a desire for a day which generated more light than heat. Curious that this signal to regard strong feeling, even passion with such suspicion was directed towards a group of psychotherapists. In the event, his wish was granted, in that there was perhaps too much agreement, or perhaps not enough conflict. The Chair had his prayer for light answered though, since the day closed with an excellent presentation by Dan Hogan, perhaps the most important statement about psychotherapy regulation I have come across since Richard Mowbray's 1995 book the Case against Psychotherapy Registration. Dan Hogan is the US ex-Harvard author of a four volume study of psychotherapy in the early 80's, that sets out many of the arguments for and against licensure as he calls it. Dan's outline of a range of a range of proposals for psychotherapy licensure demonstrated once again how restrictive, and unimaginative current UK proposals for regulation are. Here is the complete published version of his talk taken by permission from Therapy on the Couch(1999) Edited by Susan Greenberg Camden Press.
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| a journal for the Independent Practitioners Network |
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| edited, maintained and © Denis Postle 1999 |