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|10th August 1999|
The 1990s may well be remembered as "the professionalisation years"
in counselling. Setting ourselves up as a profession and installing compulsory
registration has been a major concern. So much has been written about the
subject that some people seem tired of hearing about it. In a letter to the
editor of "Counselling" in February 1999, Graham Wilson asks:
"Do you think we could stop publishing the whingeing and drawn out
criticism about the BAC's approach to improving standards. This stuff is really
getting tedious....Outside I know of no one who would dispute the need and many
ridicule the minimal standards required."
Even ignoring the spectre of the E.U., many counsellors (e.g. Feltham, 1995 and Lefebure, 1996) feel that the professionalisation process is inevitable and that we should just surrender to it despite our reservations. Counselling has been widely adopted in the public sector and by general practitioners, and so is being seen more as a medical instrument. Counsellors are thus subject to demands for cost-justification (via scientific research) and cost-effectiveness (via the adoption of short-term models) by these major employers. As the professionalisation process gathers pace, counsellor training is incorporated more and more into university curricula which renders it more academic and encourages the scientific and research elements being demanded by employers. This is compounded by the fact that academics find it easier to get books and articles published, and so have kudos and credibility, have the opportunity to persuade, occupy prominent positions in the professional organisations, and have a vested interest (Postle & Anderson, 1990) in fostering the professionalisation, 'scientification' and 'academicisation' of counselling. A former chair of the UKCP, Emmy Van Deurzen-Smith (cited in Postle, 1998) said in a keynote address to the UKCP in 1996 that "We have to transform what used to be a craft or an art based on moral or religious principles into a scientifically based accountable professional expertise", and states that this is necessary in order to secure more research funding.
Another major influence on the process has been a seemingly constant flow of media criticism of counselling, the most prominent of which was BBC TV's "Watchdog" programme on 26th February 1996. Such criticism seems to have provoked a rather defensive response which seems to have fuelled the push towards professionalisation and licensing. (Thorne, 1997, House, 1996c).
So, given the apparent inevitability of professionalisation and licensing, the power behind it and the idea that it is in the client's best interests, we might ask why the whingeing, as Dr Wilson puts it, continues. Some (e.g. Frankland, 1997, p56) implore the whingers to view accreditation as "a suitable challenge, a step in professional development and a learning opportunity in its own right". Some would argue that the "whingers" are counsellors who are simply not prepared to put in the work required to get accredited. It will be contested here that far from this, the "whingers" represent a substantial rapidly growing but relatively voiceless proportion of Britain's counsellors who are concerned that where we are going is not in the client's best interests, and fear that in fact it will be quite harmful to the client.
As this new era of professional counselling dawns, it may be useful to project the current trends into the future in order to predict what the client will get from counselling.
First, the client will get the illusion of security . By introducing a register of approved counsellors who have all been trained in a certain way to a certain "standard", we may be offering the client false reassurances that this will reduce the likelihood that she will be damaged by the counsellor. As Wasdell (1992) points out, such confidence would be misplaced. It may encourage her to drop her natural guard, in the same way that someone might let a police officer through their front door late at night but would not do so for someone without credentials. There is simply no evidence to suggest that a registered counsellor will be any less damaging than a non-registered one (Postle, 1998, House, 1996a, Pilgrim, 1997). As Rogers (cited in Mowbray (1995) p113) states "There are as many certified charlatans and exploiters of people as there are uncertified." Moreover, the increasing number of statistics (via scientific research) which seem to vouch for its effectiveness also reassure the client that counselling is a scientifically proven discipline practised by carefully screened professionals. It appears to be a treatment which promises to "cure" clients.
There are several problems with sending out messages like this. First, as Heron (1990, pp unknown) points out, it "legitimises psychotherapists taking money under the pretence of offering a service that did some good." Research has not demonstrated unequivocally that counselling works and it certainly has not demonstrated how or why it works, or what aspects of it work and in what ways (Erwin, 1997, Thorne, 1997, Feltham, 1995). Our fear of ridicule or accusations of quackery lead us to clutch at straws, claiming "research proves it works" when it does no such thing. "Self-interest impels therapists to pretend to knowledge they do not possess" (Masson, 1993, pp285). It is even debatable that scientific research can ever give the answers to what is an essentially non-scientific question (Szasz, 1995, House, 1996a & 1996b). Counselling is not a thing, out there, to be measured, it is a word used to describe a relationship, and as such we might just as well ask questions like "do relationships work", "which types of relationships work better than others" etc.
Another issue around accepting a medicalised, scientific status is that the client will get the message that counselling is for people who are not functioning properly . Szasz (1995, address) notes that "the degeneration of psychoanalysis - and of psychotherapy in general - is an exorable consequence of the medicalisation of life, that is, of the tendency to regard despair and deviance as diseases and talking as treatment." The use of counselling as a tool for personal growth will become more and more marginalised. It is also possible that as medical research throws out statistics which claim that counselling is a cure that works in, say, 80% of cases , the client will believe either that his own investment is irrelevant or conversely that if he does not feel better, it is his own fault since 80% of people do improve. Statistics such as those currently being demanded are dangerous weapons for authorities, convenient defences for counsellors, and of no apparent use to clients.
We live in an extremely materialistic society where people are under both temporal and financial pressure. A huge part of what counselling is about is to help the client to not lose sight of what is important and meaningful to his innermost self. To do this we need to acknowledge the constraining effects of our materialistic, cost-efficiency-driven society, rather than collude with and conform to it (Thorne, 1997, O'Hara, 1997). Sadly, the purse strings for counsellors who are not in private practice are often held by bureaucrats and civil servants who demand the very materialism and cost-efficiency that counselling seeks to shelter us against. The result is that the client will get a materialistically driven package from the materialistic world she may want or need to distance herself from . Kalisch (1990, pp unknown.) notes that humanistic psychology plays the role of a "social sanctuary" and warns that "by surrendering the historical rebel role ... we project the rebel elsewhere, tighten ranks against him/her, and alienate him/her to other, perhaps more dubious causes."
The drive towards high-efficiency is encouraging the use of brief, time-limited counselling solutions (House, 1996) and therapeutic approaches which lend themselves to both easier research and cost justification (O'Hara, 1997, House, 1996b). In practice this means predominantly, if not exclusively, cognitive-behavioural approaches (Thorne, 1999). Some would argue that this is the emergence of "conveyor-belt counselling" where clients' thinking is quickly reprogrammed as the perpetual waiting lists are fed through the system. The popularity of cognitive-behavioural therapy with the "powers that be" can be seen clearly in the USA, where of the first 20 clinical treatments to be endorsed by the APA task force on "practical guidelines", 19 were cognitive-behavioural (O'Hara, 1997). In short, the client will get a ration of six sessions or less - and will get a much narrower choice of approaches - predominantly cognitive-behavioural . The choice of approaches even in private practice will diminish, since private practitioners will have to go through the same registration/licensing procedures, which will involve more and more university-run, homogenised training courses focused on the market demands of the public sector. As Phillips (1996, cited in House, unpublished) says, people are "being funnelled towards qualifications which mask their vocational deficiencies by increased social status." Therefore the client will get a counsellor who has been blinkered in her professional development and whose innovation has been stifled . Feltham (1995) observes that many claim that scientifically trained practitioners are "handicapped" as counsellors because they have too narrow a focus and are over-mechanical.
Such restrictions will act as a deterrent to innovative and creative people who are considering a career as a counsellor. Postle and Anderson (1990, pp 27) ask "Isn't the professionalisation of psychotherapy denying one of the lessons of its own history, that the trapping of expertise in professions leads to defensive monopolies that legislate against innovation and change?" The client will get counsellors who tend towards conformity and who may not really believe in what they are doing . Masson (1993, pp296) warns that "professional loyalty means subordinating human impulses to what is considered most advantageous to the profession." Thorne (1997, p158) believes this is a fundamental incongruity for a person-centred counsellor, and that "the harsh truth is that person-centred therapists who fall victim to conditions of worth which alienate them from their own essential wisdom are no longer capable of being therapists." For the client, working with a counsellor in this position will feel incongruent at best, and at worst, he might be encouraged into collusive conformity or even be encouraged to rebellion either through projection or (counter-)transference on the part of the counsellor-in-denial (Wasdell,1992). Heron (1990, pp unknown) states "One can scarcely have much confidence in psychotherapists whose need to have their management of transference government approved is itself a sign of unresolved transference material."
At present it is just about possible for a counsellor to develop her own learning scheme rather than follow a formalised training programme, since counsellors are eligible for accreditation with little or no formal training as long as they have 7 years supervised experience. It seems unlikely that this will continue to be a viable route to accreditation (and therefore registration) for very long. Once compulsory registration is introduced it will become extremely difficult to gain 7 years' experience without being on the register in the first place. The likelihood is that trainee counsellors will only be allowed to gain experience in a registered practice/organisation, and these, as discussed above, are most likely to offer time-limited cognitive-behavioural counselling and expect their counsellors to train in that approach. The result will be that in order to become a counsellor, it will be necessary to undergo an extensive 3-5 year academic training programme, predominantly through a university, whilst working for minimal (or no) wages on a placement, possibly whilst incurring regular supervision and personal counselling fees (depending on the generosity of the employer). One would have to have substantial financial backing and confidence in one's academic ability to undertake such a venture. Many potentially excellent counsellors will be prevented from being able to fulfil their potential, as the former chair of the BAC Judith Baron concedes (Baron, 1996). The client will have fewer counsellors from which to choose .
"The often fearful forces that would "tighten up" and professionalise the art, above all the craft, of listening, might, if we are not careful, endanger the work of the common counsellor, who has the expertise, the sense of knowing and feeling how to be with a client, but not necessarily the academic ability or compliance to pass tests successfully and thus become, in the eyes of others and even self, an expert." Sivyer (1995, pp 276)
The client will have access only to privileged, affluent and academically gifted counsellors . Not all clients would choose a counsellor with that general background. The cost of training and the tilting of the balance towards demand exceeding supply will drive counselling prices up - the client will have to pay more for counselling and it will become even less accessible to those on low incomes (House, 1995). The increase in counselling fees will be reflected in increased supervision fees and the combined effect of these increases may be cumulative in successive generations of practice.
It does not require a great leap in imagination to predict that the development of such an elite, narrowly focused set of "professionals" will give rise to some of the problems observed in other professions - the traditional medical profession, for example. Few would argue that there is an imbalance of power between patients and doctors, that the profession tends to "protect its own" when dealing with complaints and that too many of its members have a dogmatic certainty that their own views represent the "right way" or truth. This may be in part (or wholly) due to the elitist structure of the profession, its prescriptive and academic route to registration, and to its hierarchical and patriarchal nature, all of which can be seen developing in counselling (House, 1996a), and all of which mitigate against egalitarian ideals and philosophical freedom. Pilgrim (1997, p114) notes that "psychotherapists can be found making statements implying expert certainty, which are unfounded and can border on the ridiculous." Clients will be treated less as equal humans and more as objects; and as Laing says, "one has to be able to orientate oneself as a person in the other's scheme of things rather than only to see the other as an object in one's own world ... one must be able to effect this orientation without prejudging who is right and who is wrong." (Laing, 1969, p26). In short, the client will encounter more closed-minded, dogmatic counsellors claiming to be experts (Postle, 1998, Thorne, 1997) and ironically , the client will have less access to protection and justice when ranks are closed.
The professionalisation process seems also to be giving rise to practices which seem humiliating and punitive. It is not obvious whose benefit such practices are serving. One example is the ghoulish pillorying of complainees in the pages of Counselling and its supplements. One could be forgiven for thinking of Stalin's show trials when seeing these pages. O'Hara (1997) also points to examples of out-group discrimination in the USA. It is hard to believe that this is the best that can be offered by a professional body of an occupation whose role is to promote self-esteem and to empower people.
A friend of one of my clients said that I was not really his friend because he has to pay for my time. He replied that we all pay for friendship in different ways. Chambers' definition of friendship is "attachment from mutual esteem; friendly assistance", and these seem to be words which could also describe counselling. Rogers (1967, pp201) notes "I enter the relationship not as a scientist, not as a physician who can accurately diagnose and care, but as a person, entering into a personal relationship. " There are special boundaries to the friendship, and part of the counsellor's commitment to it is to learn as much as she can about effective ways of helping, theories of human development and potential, what she brings to relationships and ways in which she can work most effectively within this particular relationship. Whilst she might use skills training, theory training, personal counselling and supervision (respectively) to meet those objectives, there are many other ways in which she could meet them. It seems extremely disempowering to foist a particular set of rules on someone as to how they should learn to conduct relationships. This is all in the name of protecting the client from dubious, ineffective or unscrupulous counsellors, but in practice it will have the opposite effect, for many of the reasons discussed above. Still, the professionalisation bandwagon rolls on, colluding with the public's fear of being hurt, and claiming to be able to protect the client from the risks involved in entering a relationship. As Szasz (1972, pp173) says, "We must scrutinize .. all therapeutic attitudes traditionally ascribed to benevolence, keeping always in mind that such manoeuvres on the part of the therapist may serve only to depreciate and subjugate the patient" or as Heron (1990, pp unknown) puts it, " In the guise of protecting their clients from the unqualified, they will oppress them."
Perhaps the response to Bernard Manning's membership of the BAC should have been "Yes, of course he can call himself a counsellor, but who would choose to employ him as one?" As Mowbray (1995b) points out, the client is being insulted that she cannot judge for herself whom to take a risk in trusting, and she is being given insufficient and inappropriate information on which to base her choice . We should not attempt to choose relationships for other people, which is effectively what we are doing. Masson (1993, pp288) points out that "if anyone ever developed the ability to make the "match" [of client to counsellor] .. there would be no divorce." If the client is given a portfolio containing details of the counsellor's relevant developmental/learning processes of a theoretical, practical and personal nature, together with a statement of professional philosophy and some indication of practice (in other words, what Schultz (cited in Postle, 1998) calls "full disclosure"), he would then be able to make an informed, adult choice about whether he feels that this particular counsellor would suit him.
Counsellors who feel that papers such as this are merely scaremongering or the result of the author's unresolved unconscious conflicts, or simply over-pessimistic, need only look to the emerging pattern in the USA to observe the decay of the profession there (O'Hara, 1997, Mowbray, 1995). Most of the counsellors with whom I have discussed the professionalisation issue have serious concerns about it. There is also a feeling amongst most of them that there is nothing that can be done about it; it is a bandwagon that cannot be stopped. The bandwagon is pushed along by those with a vested interest in the professionalisation of counselling. They occupy positions of power within our professional bodies and through their ability to get work published relatively easily. I believe there is a silent majority who do not feel they have the power to compete with the academics. Frankland (1996) suggested that the debate has now moved on to one of which system of professionalisation is best. Perhaps to his surprise, and to the further irritation of Graham Wilson, there are many "whingers" like myself who are determined to keep this debate alive, and who are committed to protecting the interests of the client, not by elevating their own status, but by climbing down from their ivory towers and entering into a genuine human encounter with an equal human being.
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