The Dynamics of Professionalisation: a personal view on counselling research

Introduction
In the past few years, the field of counselling has been moving towards a more self-confident professional status, and there are many aspects of this process which are to be welcomed - not least because it helps to enhance the credibility of counsellors working in a variety of settings. In this article, however, I want to express some personal reservations about this process, and about the form that moves towards professionalisation are taking in the counselling field.

First, there has been the hasty embracing of the principle and practice of accreditation (see, for example, Dryden, 1994: 194), with at best only lip-service being paid to the unconscious dynamics driving such a process (for a notable exception see Wasdell, 1992). This neglect seems at the very least surprising in a 'profession' in which one of the central leitmotifs is reflexive self-understanding, and mature awareness of what drives our beliefs, feelings and motivations.

More recently, we are seeing another imprudent rush, this time into a concern with research, audit and evaluation - and most notably, empirical research or counselling evaluation; and, in my own professional field, an explosion of concern with the cost-effectiveness of general practice counselling and psychotherapy (see, for example, Fahy and Wessely, 1993).

Counselling Approaches and Market Ideology
Robert May of Amherst College (quoted on a Routledge advertising leaflet) has recently written that 'we see counselling and psychotherapy more and more pushed towards a purely surface-oriented, symptom-focused and cost-driven approach'. In the medical literature, we are increasingly seeing statements like the following: 'All therapies must prove their worth.... The new rigours of the purchaser--provider split mean that all such treatments will now be subject to... cost--benefit analyses' (Fahy and Wessely, 1993: 576). And it comes as no surprise that the logic of controlled scientific evaluation and market rationality leads inexorably to the conclusion that, 'The psychotherapy that has adopted the market approach par excellence is behaviour therapy. The practice of graded exposure to phobic stimuli incorporates the routine measurement of symptoms during treatment and the recording of hours of therapy. Cost--benefit information is thus readily available' (ibid.). Such a claim for the objective scientific validity of behaviour therapy ignores the fact that the theory and practice of behavioural therapy are shot through with unacknowledged and, to say the least, highly questionable epistemological and ontological assumptions, and that as a form of therapy it contains 'very serious limitations in its capacity to address some aspects of the human situation that are basic to the conduct of psychotherapy in the contemporary world' (Woolfolk and Richardson, 1984: 778; see also Spinelli, 1994: 243-254).

Nearly 30 years ago, Anthony Storr wrote that 'the idea that... cure in psychoanalysis is analogous to the cure of physical disease ought to be finally discarded' (Storr, 1968: 60); and that 'the exploration of... symptoms inevitably leads on to a consideration of the whole person.... Abolition of [a] single symptom..., even if this were possible, would not relieve the patient of the bulk of her emotional problems. The same is true of by far the majority of neurotic symptoms' (51, 56, my emphasis). Many counsellors of various orientations would surely view these arguments as being as relevant to counselling practice as they are to psychoanalysis; and to the extent that this is so, then considerable doubt is cast upon the the relevance of the kinds of symptom-orientated 'objective' evaluation studies referred to above, with their extremely limited and limiting conceptions of 'cure' and the therapeutic change process.

Yet in the world of realpolitik, it has been argued that '(NHS purchasers) may need to resist the demand for more counselling services until better evidence of efficacy and safety is available' (Fahy and Wessely, 1993: 577). Thus, as Hicks and Wheeler (1994: 29) write, 'the reality remains that any service, just to survive, must be as cost effective as possible.... a scientific approach may be required if counselling is to optimise its practice and to survive in the current climate of welfare cuts. Indeed, counselling may have to justify its very existence...' (my emphases).

The phrase '(just) to survive' is most telling, for it is revealing of the fear-driven dynamics that are in part, and quite understandably, precipitating the increasing preoccupation with evaluation and audit, just as, according to Wasdell (1992), it is deep unconscious levels of anxiety that are in part driving the often unquestioned embracing of the principles of accreditation and registration (Wasdell, 1992). For if our very survival is at stake, then the pull to embrace what may feel like an alien set of values may be irresistible - notwithstanding the fact that those same values may well be substantially antithetical to our own deepest-held humanistic, person-centred principles and moralities. In their article, Hicks and Wheeler pay no attention to the possible dysfunctional dynamics that may well be driving the trend towards what they term 'research-mindedness' - an omission which I am attempting to rectify in this article.

Dilemmas and Dangers for Humanistic Practitioners
I do not want to minimise the profound dilemmas and difficulties in all this for the person-centred or dynamically inclined practitioner working in health-service settings (I am one such myself): for do we embrace the agenda of undiluted market rationality and risk betraying in the process the foundational principles of our practice and world-view; or do we stand up for and defend humanistic and holistic principles, at the risk of being replaced in the market-place by more mechanistic therapeutic approaches whose values and view of the person are very different from and largely incompatible with our own? There are, alas, no simple answers to these dilemmas, and it is for each practitioner to decide how to respond to such challenges.

I believe that there is a vital need to pause and reflect upon the dynamics of the trend towards audit and evaluation, and also critically to question the values and implicit assumptions that underlie the kinds of empirical methodological approaches which are actively being advocated and taught in increasing areas within the counselling profession. In the remainder of this article I attempt to articulate the reasons for my concerns. I write as a professional counsellor, and, in a previous incarnation, as an academic empirical researcher with a Ph.D. in regional economics. I therefore write from a vantage point that includes both extensive experience of relatively high-powered academic empirical research and also a thorough immersion in the ethos of humanistic counselling, psychotherapy and personal development.

Recent issues of Counselling have contained strongly expressed arguments in favour of the growth of research, audit and evaluation in the field of counselling (Hicks and Wheeler, 1994). Dryden (1994: 194) has also argued for counsellors taking an increasing interest in evaluation and audit. He writes, 'Potential employers will want harder evidence and it is likely that counsellors will be required to provide such evidence in the not too distant future.... counsellor training courses will need to put evaluation and audit on the curricula' (ibid.).

There can be a seductive fascination and excitement with the world of seemingly 'objective' statistical techniques; and so it was of no surprise to read in Hicks and Wheeler's article that trainees who had previously been highly sceptical of, and resistant to, doing counselling research 'became more excited by the empirical methods used' (ibid.: 31).

One of the greatest dangers of predominantly or exclusively quantitative research is that we end up knowing the price (or numerical value) of everything, and the value (or essential quality) of nothing. The desire to quantify, irrespective of the appropriateness of such an approach to the subject matter under consideration, is one which has to be self-consciously and tirelessly guarded against - for the seductive power of quantification, and the appeal that it makes to the scientistic, technocratic mind at this point in the evolution of human consciousness, is such that we can so easily be seduced into entirely inappropriate research procedures without even realising it. We would also do well to bear in mind that 'Attempts to equate scientific knowledge with... some inflexible standard of verification have proven lacking' (Woolfolk and Richardson, 1984: 777); and that 'all knowledge, even scientific knowledge, cannot be isolated from its psycho-social context' (Spinelli 1994: 84).

Anyone of humanistic persuasion who is familiar with the empirical research literature in any of the social sciences (including many branches of the psychology discipline) can only surely wince at the aridity and disembodied irrelevance of a significant proportion of the conventional literature in the academic journals; and I submit that it would surely be a tragedy if our profession, based as it is on person-centred, holistic values, were to go down the same road of sterile and soul-less empiricism.

The Neurotic Psychodynamics of Modernity and Scientism
Modernity and modernism constitute a world view which 'is dominated by science and scientific technology and the modes of thought peculiar to them.... the quest for certitude, and a devaluation of the traditional past.... technique and technical considerations achieve paramount importance.... The aims of prediction and control and a style of planning and decision-making in which emotional and aesthetic considerations are subservient to the rational and pragmatic are essential features (of modernity).... Science becomes the ultimate source of knowledge' (Woolfolk and Richardson, 1984: 778, my emphases).

The psycho-social analyst David Wasdell argues that the dynamics of the global social system are (d)riven by shared, species-wide developmental traumata which are normally repressed from awareness, and the effects of which only tend overtly to manifest themselves dysfunctionally under conditions of high stress and anxiety, and diminishing resources. Although Wasdell focuses exclusively on pre- and peri-natal traumata, his argument can very plausibly be extended to the post-natal world of human experience (House, 1996); and without wishing to be overly reductionistic, it is logically and evidentially compelling to view our dysfunctional ideological belief systems as being in some sense rooted in and driven by species-wide developmental traumata, and the associated 'deformations of mind' which accompany them. To quote Wasdell, 'Where the primary trauma is shared in common, the cyclic psycho-drama is enacted in common. With the common ground [of shared developmental traumata - RH] collusively denied, the dynamic process is corporately constructed. It is supported by symbolism and mythology and socially reified into an unquestionable ideology' (Wasdell, 1991: 1, my emphases).

I am proposing that the objectivist epistemology of empiricist methodology, and its associated zeal for quantification, can be understood in this light; and that it is only through the experiential task of working through and integrating the repressed and unintegrated material of early developmental experience that we will be in a position individually and collectively to heal our individual and collective psychic dis-integration and move towards a wholeness from which it is far more likely that an epistempology and methodology which is truly humanistic in nature will organically emerge.

Thus, Janus (1989: 52) has recently written that 'research in the psycho-social field always entails the involvement of the researcher himself and is a process of consciousness transformation. The actual research process changes the researcher, and is thus also limited by his personal resistance' (my emphasis). As I read it, his point seems to imply that the methodologies that we choose and the research procedures we embrace are not a coincidence or some kind of random event: rather, they closely and faithfully reflect our own personal character structures, defences and the extent (or otherwise) of our own personal psychological integration.

I fear that unless we pause and take careful stock of the dynamics driving the evaluation bandwagon, and the implicit and anti-humanistic assumptions that so often underlie so-called 'objective' empirical methodologies, we could conceivably end up with a plethora of sterile research studies which are sustantially antithetical to the values of person-centred and dynamic counselling - and worse, we might well be doing a kind of violence to the values on which humanistic therapeutic philosophy is based. There are some disturbing signs of the possibility of such 'violence' being done to humanistic principles in the position paper by Hicks and Wheeler (1994). Thus, they write of what sounds suspiciously like a non-democratic imposition of 'research-mindedness' when they write of 'top-down directives... emphasising the role of research as a means by which... resources (can be) used with optimal effect...' (my emphasis). Would these authors normally advocate 'top-down directives' in their professional practice as counsellor trainers? We must all pay close heed to the possibility of an anxiety-driven reaction to the various 'scientific' critiques to which our profession is currently being subjected (Spinelli, 1994: 66-93) if we are not to risk being drawn into potentially dysfunctional and neurotically driven acting-out which might well betray the very values which I believe to be foundational to our profession.

Towards Humanistic Counselling Research?

there are inherent difficulties in any attempt to fashion a meaningful understanding of existence in terms of the moral and epistemological categories provided by scientific culture.(Woolfolk and Richardson 1984: 783)

I agree with Dryden (1994: 195) that 'the increasing attention being given to qualitative research will... help to introduce reluctant counsellors to the world of research as it is... more in keeping with the spirit of counselling than quantitative research'. But what might a thorough-goingly humanistic research methodology look like? Some useful pointers are contained in the paper by Gillian Thomas (1994), in which she describes a qualitative phenomenological approach to researching into counselling for irritable bowel disease. Moustakas has recently made a major contribution to the literature on phenomenological research methodology (Moustakas 1994).

There is, further, a substantial literature on qualitative research philosophy and methodology; and the pioneering volume edited by John Rowan and Peter Reason (1981) on 'new paradigm research' provides an excellent base from which to develop the kinds of sensitive, person-centred research on which a humanistic evaluation practice should surely be based. In addition, there is the journal Collaborative Inquiry (based at Bath University's Centre for Action Research in Professional Practice), which advocates collaborative, self-reflexive research of the kind that will certainly appeal to the humanistically minded practitioner; and last but not least, it is now possible to carry out qualitative Ph.D. research in counselling and psychotherapy at Regent's College, London.

I disagree with Higgs and Wheeler (1994: 30) when they write that 'only quantitative research can lead to predictions concerning best treatment procedures'. Such a view assumes that a quantifying methodology is the appropriate approach for evaluating the efficacy of humanistic-dynamic counselling; yet the kinds of factors that a humanistic perspective holds to be decisive in facilitating therapeutic change (most notably, the healing quality of a relatively non-neurotic loving reparative therapeutic relationship) represent human qualities that are quite beyond the ambit of controlled and 'objective' scientific measurement and mechanistic modes of understanding. Similarly, Castoriadis (1995) has recently argued that positivist scientific practices, which place such emphasis on the principles of falsifiability, replicability, predictability and substitutability, are quite inappropriate for studying the human psyche and the therapeutic change process. And a recent paper by Bromley (1990) has set out a detailed, carefully argued case for a clinical, case-study approach to evaluation, which allows for 'the scientific study of the individual without recourse to experimental and quantitative investigation' (p. 299).

Hollway (1989) has forcefully argued that there has been an almost 'intentional blindness' within the psychology discipline to the conditions of production of psychological knowledge. Any counselling training or degree course which is advocating or insisting upon its trainees or students carrying out research into counselling would do well to leave considerable space for reflection upon the dynamics of the research process itself - focusing on both the researcher's own particular personality dynamics in so far as they resonate with and determine the choice of research methodology, and also the wider cultural dynamics and ideology of modernity which underlie orthodox and received research practice. At the very least, I would advocate a close and critical reading of Carl Rogers's seminal paper, written 40 years ago now (Rogers, 1955), in which he explores the tensions he experienced between his subjective therapist self and his hard-headed, scientific self: for this paper serves as an excellent introduction to the issues raised in the present article. Academic departments in counselling, counselling psychology and psychotherapy should surely pay close and attentive heed to the 'conditions of production' (to use Hollway's phrase) of research knowledge, if the kind of sterile and disembodied empiricism described earlier is to be avoided.

The Post-Modern Turn
There is also a steadily growing body of literature in the psychology field which offers a potentially devastating critique of empirical social-scientific research from the post-modernist standpoint (see, for example, the papers in Kvale, 1992). Anyone who is concerned to promulgate and advocate research-mindedness in the counselling field should at the very least be fully aware of the post-modernist challenge to empiricism, and be prepared and able to offer a coherent and sustainable response to the formidable post-modernist critique.

Some commentators are rightly concerned that a full embracing of the 'anti-epistemology' of post-modernist thinking might lead to a sort of formless relativism in which we end up in a solipsistic position where it is impossible to say anything about the world beyond the subjective and purely private. Smith (1994), for example, has recently attempted to steer a sustainable course between the Scylla of disembodied empiricism and the Charybdis of post-modernist relativism. Thus, he refers to a truly 'human science' as somehow being able to combine 'the usual conception of science as aiming at progressive approximation of truth in regard to causal analysis of conditions and consequences' with 'intrinsic reference to human meanings and values' (Smith 1994: 114). There certainly exist a number of dynamically inclined studies which do attempt to incorporate some kind of quantitative element into their research procedures (e.g. Ryle, 1989; Firth-Cozens, 1992), but I am not at all sure that any of these studies respond adequately to the kinds of anti-empiricism arguments outline in this article.

Perhaps post-modernism is a kind of 'reaction-formation' against the excesses of the soul-less scientism of modernity; and it seems to me that the fields of counselling and psychotherapy are in a unique position to develop an embodied, humanistic approach to research that transcends the ideology of objectivism, and which honours both our need for communicable inter-subjective knowledge about the world and our core humanistic principles, which elevate the values of holism and human meaning above those of mechanism and quantifiability.

Conclusion
Those who are responsible for the funding of counselling and psychotherapy, steeped as they are in the often unquestioned ideology of modernity and technocratic culture, will very likely fail to be impressed by the arguments expressed in this article. Elsewhere (House, 1996), I have discussed at length the preconditions for policy-makers being in a position to question the ideologies that drive their policy-making practices. If recent American experience (Eckert, 1994) is anything to go by, however, where for some years there has been a relentless drive towards ever shorter-term, focused, 'scientifically evaluated' cognitive-behavioural therapeutic approaches, the omens for the future of humanistic person-centred practice are far from encouraging.

I would conclude by saying that as soon as we unquestioningly accept the agenda of the current Zeitgeist of 'cost-effectiveness', audit, 'objective' evaluation, management control systems, and all the other leitmotivs of the market economy and cultural system, we immediately do a (quite possibly terminal) violence to the humanistic principles on which our practice is founded. And the supreme irony would be that we end up destroying the very foundational values of the profession whose status we are actually endeavouring to elevate through our burgeoning preoccupation with research and evaluation. What a tragedy that would be for all of us.

I realise that I have expressed the 'anti-empiricist' position in stark and uncompromising terms, and at some length; but this is in part because the views I have expressed do not seem to be receiving anything like the attention in our profession that I believe they warrant, and that one would expect in a profession whose central concern is with open, reflexive, undefended inquiry and understanding. I would welcome a frank and open debate with the proponents of the 'research and evaluation tendency' in the pages of Counselling: Dryden (1994: 194) refers to the stimulation of some 'lengthy debate for the future good of our field', and the foregoing article should be seen in this light.
To end with a most apt quotation from Carl Rogers (1955: 260): 'For science too, at its inception, is an "I--Thou" relationship with the world of perceived objects, just as therapy at its deepest is an "I--Thou" relationship with a person or persons. And only as a subjective person can I enter either of these relationships'.

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Richard House is a counsellor in general medical, private and voluntary practice in Norwich, a supervisor, course tutor in counselling at the University of East Anglia, and a group supervisor and facilitator with Waveney Counselling Service (affil. WPF).