Magdalen Medical Practice, Norwich

Both the frequency and the ferocity of attacks upon the fields of counselling and psychotherapy have been mounting apace in recent years, and the BBC 'Watchdog' programme of 26th February was a particularly virulent and nasty strain of this phenomenon. The programme was so shot through with ignorance, abusive and unethical behaviour, prejudice masquarading as fact, and unarticulated and fundamentally flawed assumptions that it is difficult to know where to start in criticising it. In what follows I will work through the programme as it was presented, exposing as I go the multitude of fallacies, flawed logic and (wilful?) ignorance that were the hallmark of this appalling programme. In so doing, I throw out a challenge to both the 'Watchdog' team and also to their 'expert psychiatrist', Dr Raj Persaud, to respond fully and point by point to the multitude of criticisms that I raise in this paper.

To begin with the programme starts with a patent falsehood about the British Association for Counselling (BAC), serving the purpose of setting up a straw-man which the programme makers then proceed to demolish with a relish which at times seemed to border on self-satisfied and self-congratulatory glee. The falsehood is the presenter's description of the BAC as (and I quote verbatim), 'The organisation which claims to regulate the ever-growing industry of therapists and counsellors' (her emphasis). To my knowledge the BAC has never claimed to regulate qua regulate the counselling field (though of course it may well have future pretensions to do so), and to date the BAC has never claimed that membership somehow confers 'counsellor' status upon ordinary members. Indeed, it has always been scrupulously careful to stress that members should not use their ordinary membership as a means of publicising their status as counsellors.

The Consultant Psychiatrist, Dr Raj Persaud ('our expert psychiatrist', as he is reassuringly [?] referred to several times) then takes centre stage, and proceeds to make several quite outrageous comments. Dr Persaud (whose credentials to pronounce upon the nature of counselling qua counselling are never, incidentally, explained by 'Watchdog') believes that 'two main things can go wrong' (with counselling) (only two?; I wonder 'how many things can go wrong' with psychiatry?...): first, 'because very many counsellors aren't properly trained they could miss serious or psychiatric conditions which don't receive proper treatment'. Note the use of medical-model terminology - 'psychiatric conditions', 'treatment'. Note also the totally unsubstantiated claim that 'very many' counsellors aren't properly trained. Where is Dr Persaud's evidence for this?; and even more fundamentally, is Dr Persaud setting himself up as someone who knows what an 'adequate' training in counselling would be? Judging by the medical-model approach in which everything he says is steeped, I cringe to think of the kind of counsellor training programme that Dr Persaud would deem to be 'adequate'. The other thing that can go wrong, according to Dr Persaud, is that 'there could be nothing seriously wrong with the clients that they see and they may be taking money off them for problems that don't exist'. This statement displays a staggering ignorance about the nature of counselling (an undertaking which Dr Persaud is probably viewing as some kind of inferior third-rate psychiatric consultation). For clearly Persaud is making an assumption of infantilised patients who do not have sufficient self-awareness to decide for themselves whether they need help or not (no doubt this is how Persaud 'treats' his own patients, but he has no right to extrapolate his own infantilising medical-model assumptions into the realms of person-centred counselling). It will become clear later that one of Persaud's central defining assumptions is that the practitioner knows better than the client/patient whether the latter needs help. From the standpoint of counselling principles, such a view is totally antithetical to the theory and practice of counselling, and reveals a complete lack of comprehension of what counselling is really about.

The presenter goes on to say that, according to 'our expert psychiatrist', 'the sort of advice I should be getting is that these emotions are perfectly normal...' (my emphasis). Again, therefore, for Persaud, it is the counsellor's role not only to give advice, but also to tell the client whether they should be worrying about something! It seems clear that Persaud doesn't even know some of the most well-known and fundamental principles of counselling theory and practice. I now go on to examine the extraordinary way in which the 'Watchdog' team attempted to prove its presumption that unregulated counsellors are potentially dangerous. In essence, they got one of their reporters to pretend that he had a minor emotional problem (viz. that he was feeling low because his girlfriend was away); and the reporter went to three different counsellors and secretly tape- and video-recorded the sessions with each of them. Dr Persaud was then set loose on the recordings to pronounce upon the relative merits of the three counsellors' 'advice' (more of this later).

Now there are enormous difficulties with this as a piece of research, both ethical and methodological. (I won't dwell on the possibility that, from the counsellors' standpoint, the client could well have been someone with delusions that he was pretending to have an emotional problem which was then going to be given nation-wide TV exposure.) First, the very fact that the 'pretend-client' was lying itself became a central part of the presenting problem, and a crucial part of the dynamics of each initial consultation. This fact alone makes the kind of conclusions later reached by Persaud totally invalid methodologically speaking, for in making the kinds of judgements he makes Persaud has to assume that which is patently not the case - i.e. that this is a genuine client being responded to by a counsellor. He is making judgements on the assumption of a 'normal' counselling session when in reality the relationship is extremely abnormal. In other words, all this 'research' shows is what happened when a lying client presented to three different counsellors; it is totally invalid for Persaud to generalise from this to make pronouncements about genuine counselling. Second and relatedly, the very fact that the client was lying and secretly recording the session will have introduced an incongruence into the situation, which in the case of a counsellor who was tuned in and emotionally literate would almost certainly lead to counter-transference feelings of unease - that something was amiss here... and of course, in the situation it would be entirely understandable for the counsellor to put this down to the client's difficulties (yet to be discovered). This view is the complete opposite of that favoured by Persaud: for I am arguing that a good, competent counsellor would in such a situation pick up that something WAS amiss with this client; whereas Persaud is claiming that a competent counsellor should have reached the conclusion that the client didn't have a problem!

Third, it is again extraordinary that Persaud seems to be assuming that on the basis of just one session of counselling, an accurate 'diagnosis' of the client's difficulties can be made. Anyone who has worked with clients long-term will have had the experience not only of the initial presenting problem sometimes seeming quite trivial and inconsequential, but also of clients often taking many sessions before they can begin to trust sufficiently to share their deepest and most shaming emotional pain. And it is therefore quite simply a nonsense to assume, as Persaud does, that a counsellor can with any confidence make a full and accurate assessment of a client in just one session.

Fourth, let us accept for a moment Persaud's argument that this client does not have a problem. From this it follows logically that the client does, in fact, have a problem - which is that he seeks professional help for a self-perceived problem which in fact does not exist. So on this view, such a client would in fact benefit from counselling, in terms of helping him to explore and heal his incapacity to recognise in his own experience whether he has a problem or not.

Fifth, person-centred, humanistic counsellors typically assume that the client possesses sufficient 'Adult' in order to know in their own experience whether they need help or not; whereas the implicit assumption of this shoddy piece of 'research' is that clients need to be told by someone else who knows them better than they do themselves (after just 50 minutes?!) whether they need help and have a problem or not!

I turn now to Persaud's extraordinary comments on each of the three counsellors' performance. It is a massive irony that the counsellor that Persaud felt to be the most competent didn't pick up that anything was amiss in this extraordinary situation (i.e. she took everything that the lying client said at face value; cf. above), and actually told the client that 'it sounds like you've got nothing to worry about'! (Incidentally, this is no doubt very revealing of Persaud's own clinical practice, where in his psychiatric consultations he probably assumes that he knows the 'patients' and their needs better than they know them themselves.) Following my earlier argument, the reality is that this counsellor apparently failed to pick up in any way that this was in fact a lying client. Even more extraordinarily, Persaud then goes on to criticise the second counsellor in these terms: 'this counsellor was a bit worrying. He was rather dithering and couldn't seem to make up his mind as to whether there was actually anything wrong with you'. Err... perhaps you've forgotten, Dr Persaud, that the client was not only lying, but was secretly and surreptitiously (not to mention unethically) recording the session as a set-up for a sensationalising media story! Any sensitive counsellor worth her or his salt would, in such extraordinary circumstances, pick up that something was fishy and incongruent; so in fact, and quite contrary to Persaud's view, this counsellor's 'dithering' and uncertain response was actually entirely fitting and understandable, given the situation he was inadvertently placed in. Not even seeming to be capable of retaining an internal consistency within his own position, Persaud then goes on to accuse the counsellor of 'jumping to conclusions...' (so according to Persaud, we seem to have a dithering counsellor who can't make his mind up what's wrong with you, jumping to conclusions? Hmmm...). Persaud even says that the counsellor encouraged the client to return (and I quote) 'for yet another appointment' (my emphasis)... err, you mean a second appointment, Dr Persaud.

In general, Persaud states that 'What is important about this is that you went to three different counsellors and got three different responses which shows that there is a huge variability in the counselling industry'. Again, Persaud inadvertently reveals his impeccable medical-model assumptive ontology of the therapeutic process: thus, he seems to have no understanding of the view common in counselling theory that all therapeutic relationships are the unique result of two co-creating subjectivities rather than a controlled, scientific, mechanistic meeting of a bundle of objectified symptoms and an 'expert' clinician who will hand down a cure to the unfortunate patient. Only if such a latter view is adhered to (whether explicitly or implicitly) can someone then expect there to be a uniform, programmatic response from a range of practitioners to a given client's presenting problems. (Note also that again, there is yet another fundamental methodological flaw here, in that the second and third initial consultations would have been influenced by, and could never be identical with, the first consultation; so it then becomes methodologically invalid to compare the consultations as if they were identical.)

Overall, I was left with the impression that at least as much light might have been cast on the counselling process by listening to the thoughts of Bernard Manning as was thrown on it by Dr Persaud.

A more general point, finally, is that the case of Bernard Manning joining the BAC and setting up as a counsellor was actually a very poor example to pick in order to make their regulatory case - for in reality, someone with Bernard Manning's personality would most certainly not be drawn to being a counsellor anyway. So again, 'Watchdog' completely missed its target in trying to set up a sensational headline-catching story that in reality does nothing whatsoever to support their simplistic, fear- and ignorance-driven sloganising about the need for regulation of the field.In sum, then, the 'Watchdog' feature was an absolutely appalling piece of 'journalism' for a whole host of reasons, not least its perpetration of highly unethical and abusive treatment of counsellors; and in the process the makers of this programme betrayed a total lack of comprehension of what a counselling relationship really consists in. In recent years counselling and psychotherapy have been exposed to quite unjustified attacks, driven more by a deep fear of the emotional world and a fundamental ignorance of the nature of intersubjective human relationship. It is surely vital that those of us who care passionately about the value of our work respond robustly and unapologetically to these outrageous slurs; and I hope that this paper has served such a function in the case of the Bernard Manning horror-show shown by the BBC in February 1996.


Norwich, March 1996

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