000No hierarchy, low bureaucracy.
000There will be no distinction of more or less qualified or 'registered' members, since we recognise that therapeutic ability is not based on hours of training or numbers of essays written. Nor will we be scrutinising each others qualifications... nor will there be a central code of practice.
000The network will not try to define terms like therapy or to distinguish between different styles of work, since we see a richly pluralistic and multi-skilled ecology as the ideal'. (Totton & Edmondson 1994)
000This proposal led to a crowded meeting at the Open Centre in November 1994 and the formation of what later became the Independent Practitioners Network. [IPN]. In the two years since then, IPN has gathered around three hundred supporters spread widely across the UK. About two hundred are presently in member groups in various states of formation.
000Since the initial proposal was first published, the structure has been confirmed as a network of autonomous member groups, each linked to other groups; with no central administration; with no individual membership but accessible in principle to any psycho-practitioner who can meet the network criteria. The defining task of an IPN group is to get to know each other well enough personally and professionally to be able to stand by each other's work. This entails a lengthy process of support, inquiry and challenge,
000Refinement has led to, among other things, two mandatory requirements. One, that to be able to declare itself a Member, each group must have active links to at least two other IPN groups that are prepared to validate the process through which the group reached their agreement to stand by each others work. And secondly, that member groups publish to the network the names of their members plus a statement of their ethical commitment.
000IPN has evolved with numerous centres of influence but no centre of control. In its pursuit of 'power-from-within' for ourselves and our clients it continues to sustain itself exclusively via 'power with' social relations, with varying levels of elegance and certainty.
000For someone like myself whose practice spans facilitation, psychotherapy, counselling, and coaching, I find that, as a model of accountability and validation IPN is amply 'good enough'.
000Some criteria for practitioner accountability.
000IPN is an elegant social innovation. It is ripe for both expansion in the UK and for reproduction in countries that have similar issues of practitioner accountability and the distribution of power. If you wanted to replicate IPN in your community what would be the core learnings about an adequate way of holding the client/practitioner relationship that would be relevant? After consulting with other IPN members, I came up with the following list:
responsibility for competence and accountability is vested in the practitioner, with external support and challenge, rather than centralised 'policing'.
the basis for being able to stand by a practitioners work is extended and ongoing face to face contact and knowledge of their client work and life circumstances.
the accountability culture is small scale, local and self-generating.
the national organisation grows out of the local ones, it is practitioner driven rather than bureaucracy driven.
the wide diversity of models and means that constitute effective psycho-practice is acknowledged.
the power relations in the organisational structure are congruent with the psycho-practice of member groups and individual practitioners.
The organisational structure is horizontal rather than vertical, with the decision making process being based on a 'pluralistic consensus' model rather than one of centralised representative 'democracy'.
the organisational structure is the minimum needed to hold to its original intentions.
the attitude to accountability/quality control seeks to eliminate 'defective practice' through core process design rather than post facto detection of defective practice and the rejection of practitioners.
client access to individual practitioner's group colleagues is open, direct and immediate.
the organisation gives constant attention to how it manages the distribution of power
there is a constitution which sets out the conditions for 'participation' which is open to any practitioner and 'Membership', which is open to any group of practitioners who satisfy the network criteria.
client practitioner disputes are framed in terms of 'conflict resolution' rather 'complaints procedures'
000Is there a downside? What might be IPN's limitations? As with any effective community, participation in IPN takes a considerable commitment of time, energy and attention. As with any truly co-operative venture, it requires developed emotional competence (Heron 1992, Postle 1993) a level of affective education that is not necessarily commensurate with psychotherapy competence (and even less with 'post-graduate' status). Participation also seems to require a measure of developed self-direction and practitioner autonomy. It is a very demanding option and these requirements may set a limit to its growth.
000A consequence of the network structure we have adopted is that no-one is entitled to speak for the network, there is no 'official' IPN policy. Some might consider this a disadvantage. However IPN tends to support individual initiatives and there are well-attended national 'gatherings' every three months or so at which policy issues are debated and decisions taken.
000From this perspective of where I stand as a practitioner, and in the light that IPN sheds on psychotherapy 'professionalisation', I develop at length in the sections that follow, five arguments against current registration approaches to accountability and particularly that of the UKCP.
000THE ARGUMENT FROM EQUIVALENCE
000'The self-regulation of UK media-workers, presently administered by the UK Media Consortium [UKMC] received a boost today when the Heritage Minister outlined legislation to confer statutory status on the UKMC's voluntary registration scheme'. Voluntary registration has already begun to install far-reaching regulation of journalists, TV producers and directors, photographers and advertising executives'.
000 'The Minister welcomed the UKMC initiative, noting that it built on the success of the statutory register of psychotherapists', She claimed that readers and viewers welcomed the government backing for measures 'to protect them from the inaccuracy and intrusiveness of a minority of maverick journalists, intrusive photographers and the trance-inducing quality of some broadcasting.'
000 'The minister added that while the requirements for media-worker registration were stringent, they were also fair, and aimed to balance diversity of editorial opinion with protection of the public.
000'The government believes that, as the media-worker register comes into full operation, it will guarantee that all content provided for public consumption is factually accurate, ethically sound, and has been obtained without intrusion into privacy, and that comment is fair and objective'.
000'The new legal pre-requisite for media-worker registration includes the satisfactory completion of a four year post-graduate training, including 900 hours of supervised practice, adherence to strictly administered codes of ethics, complaints procedures and working practices, breach of which may result in being 'struck off' the media-worker's register'. 'Media observers note that these new requirements have already created an explosion in the demand for training as everyone in the field realises the economic consequences of being unregistered'.
000 'A further announcement is expected soon from the Heritage thinktank that is looking into the possibility of extending statutory registration to artists, painters, sculptors, musicians and singers and composers...'
000Need I go on?
000In comparison to the global culture-setting capacity of TV, newspapers, magazines and advertising, the effect on national life of psychotherapists is peripheral. Yet there is no conceivable way that, say, journalists in the UK, would accept a statutory register with equivalent limitations on access to the media.
000Would not restricting the production of films, or journalism, or fashion photography to a list of accredited practitioners, amount to an oppressive constriction on freedom of speech and action? Is not a similar course of action in attempting to regulate psychotherapy, especially if it involves statutory enforcement, similarly oppressive and limiting? Many psycho-practitioners outside (and some inside) the UKCP think so.
000I have suggested that it amounts to 'a stealing of the flame', asking how a professional 'light' at the centre of UKCP or other 'professional' bodies can avoid casting a 'shadow' that perpetuates deference and ignorance outside the registration domain (Postle 1989). Kalisch described UKSCP, the fore-runner of UKCP, in terms of 'dependencies being created, empires built and nests lavishly lined'. To be followed in their wake by restrictive practices, closed shops, protection and collusion' (Kalisch1990). Heron has pointed out that 'the political argument for professionalisation based on legally accredited competence in handling transference, is a rationalisation of a deep seated transference phenomenon'. He sees this as a paradox. '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' (Heron 1990). Wasdell sees individuals primarily involved professionally in one-to-one relationships as at the mercy of unconscious irrational and often destructive forces being acted out at the corporate dynamic level of psychotherapy, counsellor and analysts' organisations. He couples this with the proposal that the aggregate dynamics of the profession as a whole mirrors the most common societal defence maintenance processes. He sees the psychodynamics of the psychotherapy profession as collusional counter-transference that maintains the pathology of the social system. (Wasdell 1992)
000This line of argument can of course be deconstructed as a 'tyranny of the unconscious' in which in which anything disagreeable, in this instance, to those of us who are dispossessed, is ascribed to pathology on the part those of whom we disapprove. No doubt the reverse could and will be argued. However the extent of scepticism about psychotherapy registration process is considerable. And publicly accessible too (Postle 1997), in contrast to the negligible public defence, or justification of it.
000In what other ways does psychotherapy 'registration' pose a serious threat to freedom of speech and action?
000 Self-Directed Learning
000People in the UK commonly assemble for themselves a career in art, journalism, writing, film, theatre or music through self-directed experiential learning. This may take the form of ad hoc training, casual and short term employment, supplementary courses, coaching, mentoring, apprenticeship and supervision. This often chaotic and uncertain cultural milieu has contributed, in recent decades, to an internationally renowned flourishing of creativity in the UK. I want that to continue to include psycho-practice.
000Many people are inclined, for reason of life experience, inclination and, as I will show below, creative style, to also take a strongly self-directed line in assembling for themselves the elements of psycho-practice competence. I see no reason to suppose that this is an exclusively UK phenomenon. 'Registration' as now constituted presents, and is intended to present, an almost insurmountable obstacle to this.
000I think that before groups of psychotherapists are entitled to ring-fence their view of psychotherapy via registers, they need to show conclusively that this informal self-directed mode of entry to psycho-practice is damaging to clients (rather than damaging to a 'profession' of psychotherapy). In the absence of such a demonstration, registration, and particularly the pursuit of statutory registration, is oppressive and unbecoming in an occupation devoted to relationship. So far as other colleagues and I who take an interest in these matters are aware, no such defence of registration exists.
000Support for this view recently emerged from an unexpected quarter. Anne Richardson Senior Policy Advisor at the UK Department of Health outlined factors that, in the view of the Department, decisively militate against statutory regulation of psychotherapy. After reminding her BCP conference audience 'that there is no agreement here in the UK, or it would appear in Europe, about what exactly does or should constitute the activity of psychotherapists'. She went on:
000There are no plans to regulate what, after all we have to call, an activity, rather than a title. I mean psychotherapy is something that people do. It's something doctors, psychologists, nurses, social workers, lay psychotherapists, do. Lots of different people practise this activity. Many... most... some... with training, some without training... with different kinds of training. Psychotherapy is an activity not a job title.
000...Its important to say it would be extremely difficult to regulate by statute something which is an activity like that. Could you imagine trying to write a law? It would be impossible.
000Another thing that militates against [statutory regulation] is the increasing evidence of the effectiveness of a variety of approaches which some people wouldn't call psychotherapy. Some sorts of stress management... you might not call it psychotherapy... some forms of psycho-educational approaches... you might not call psychotherapy but other would and do. And there is good evidence for the effectiveness of some of these approaches with mental illness groups. So if you were to regulate or legislate you might stop that, prevent that diversity and that would be unwelcome.
000However improbable statutory regulation looks from the admirably well-informed perspective of the UK Department of Health, the glacial political strength of the 'psycho-security' that psychotherapy and counselling registration purport to offer may yet dictate otherwise. Evidence of a unified profession looks like a minimum pre-condition for the notion ever to be taken seriously.
000Certainly the adoption of an industry wide standard which requires that 'everyone get themselves bar-coded', as a psychiatrist I know recently described it, will strongly support the marketing of psychotherapy services. And of course, the UKCP's seventy-three bodies, a diverse and formidable array of principally training interests, with 3500 names in one register-text can be claimed to support the idea that a 'profession' of psychotherapy does exist.
000However, from the wider perspective of psycho-practice, the 'unified profession' will shortly embrace five competing 'registers', BPS, Tavistock, BCP, UKCP and the UKCR, each with very divergent criteria for membership. Of these registrars, UKCP is the largest and has by far the best established public face, which is why I tend to focus on it in this text.
000But is UKCP a wonderful federal expression of diversity, or is it more a territorial non-aggression pact between two at least, fundamentally contradictory worldviews?
000THE ARGUMENT FROM HUMAN NATURE
000Some years ago, in a previous life, so to speak, I made a film about Human Nature with Robert M. Young, a historian of biology and the human sciences and presently a psychoanalytic psychotherapist and Professor of Psychotherapy and Psychoanalytic Studies at the University of Sheffield. The film 'Behaving Ourselves', (Postle & Young 1982) looked at the way models of human nature influenced such human activities as scientific research, animal experimentation and genocide.
000I remember being shocked to discover that my perspective on human nature, informed then and now by Humanistic Psychology theory and practice, was fundamentally different to that of Bob Young, who favoured psychoanalysis.
000From my Humanistic Psychology perspective I saw human beings as being born fundamentally OK. We have innate capacities for giving and receiving love, understanding and being understood and choosing and being chosen, but are vulnerable to primal wounding, deficits of care and nourishment and distorted learning. (Heron 1992, Postle 1989)
000Bob Young's psychoanalytic perspective emphasised Freud's view that:
000People are innately aggressive. 'Man is a wolf to other men' and hence must be tamed by institutions (Gay, 1988, p. 541). The constitutional inclination to aggression is the greatest hindrance or impediment to civilization (S.E. 21, pp. 129, 142) (Young 1992)
000And as he says in recent writings, 'this is a dour doctrine:'
000'life consists of - is - a struggle between love and destructiveness. Civilization consists of renunciation. ....[Freud] says elsewhere that 'love and necessity are the parents of civilization' (p. 101). We live our lives in a space between the two great meta-instincts, and the main forces at work are rapacious sexual and destructive instincts, guilt, renunciation and sublimation. (Young 1992)
000......... 'Social institutions are many things for Freud, but above all they are dams against murder, rape, and incest' (Gay, 1988, p.547).
000In another recent article, Young presents a cogent image of what this means for the psychoanalytic perspective on human nature.
000I want to spend a moment on the image of a veneer. I chose it to emphasize the delicacy, vulnerability and beauty of the more moral, generous and creative dimensions of human nature. A veneer is usually thin, made of a precious material, applied to cover a baser, less presentable one to make it more attractive. A typical example is a thin layer of a precious wood, glued on top of a coarser one. It is easily damaged and needs maintenance, usually cleaning and polishing. We use cloths, mats and other items to prevent it being burned, stained, or scratched. A moment's carelessness can seriously damage it. Characterising human decency as a veneer implies that I see it as an imposed surface phenomenon. (Young 1992)
000He goes on to say that he personally supports the Kleinian approach to our 'nasty' side, 'the idea that destructiveness was as strong as erotic impulses at the basis of our most primitive natures'.
000This image of civility in human nature as a thin and fragile veneer covering a substratum of rage, aggression and sexual rapacity helped me a lot. I began to understand why the coming together of psycho-practitioners to form a psychotherapy profession as UKCP and other bodies could be perceived by some people as desirable, and inevitable and by others and myself, as oppressive and incongruous. In other words, whether you thought it a good thing or not depended, at least in part, on what model of human nature you subscribed to as a psycho-practitioner.
000If you believe that people are innately good but become damaged and so think and behave in distressed ways, then your institutions are likely to favour relatively open, negotiable boundaries, trust, self-direction, and self-reflexive regulation. For example many of the people who have joined the Independent Practitioner's Network have a high level of expectation that they can be trusted to take responsibility for their psycho-practice with external reference but without prescriptive, external, certainly not legal, controls. In this universe, people may make mistakes, or unawarely act out hurts, or behave in inadequate or inappropriate ways, but not because they are 'naturally' aggressive or sexually rapacious.
000By contrast, if you are committed to a belief that people are innately aggressive, with hard-wired instinctual desires to damage, punish and act out sexual desires, and that unless this tendency to 'emotional disorder' is very highly contained, chaos will result, you will expect that all practitioners are quite capable of behaving badly. The only way to minimise this is to create a container with tight boundaries, lots of control, and sanctions, preferably legal, against bad behaviour. Statutory registration would then look like a virtue, because it adds the power of the courts to police these boundaries.
000The more I looked, the more evidence there was to support my intuition that the psychoanalytic view of human nature seemed to be having a profound influence over the professionalisation of psychotherapy. For example, as some of the following material shows, many psychoanalytic practitioners see the UKCP as impossibly liberal and wishy washy about training and standards. Even so, UKCP office holders are strongly weighted towards psychodynamic/ psychoanalytic practice. More on that anon.
000I find it difficult to believe that the twenty-five or so organisations of the UKCP Humanistic and Integrative Section [HIPS] subscribe to the psychoanalytic view of human nature set out earlier. For example one of its members says in a current brochure that:
000There are certain situations and personal capacities towards which we are all more or less consciously attracted: for instance, the ability to have good relationships with others, to enjoy good health, to make free and conscious decisions, to use our mind to its maximum potential, to enjoy all that is beautiful, to be competent in our work and calm even in moments of crisis, to be open to serenity and joy, and finally the ability to love.... Psychosynthesis is a unified conception of human development... (Pyschosynthesis Trust 1996)
000In another recent article, Young argues that:
000if you have a developmental psychology, you have a theory of human nature......I take the view that if you have a psychology, that's equivalent to having a theory of human nature, however much latitude for the role of different experiences and different developmental pathways there may be within the particular theory you espouse. (Young 1995)
000And this view is supported by a former chair of UKCP:
000...the study of psychotherapy is about understanding human nature in all its complexity (Deurzen-Smith 1996)
000The hints of a model of human nature in the Psychosynthesis brochure, its 'unified conception of human development', sound a long way from the psychoanalytic model of human nature:
000 neither Freud nor Klein, nor for that matter Karl Menninger...believed in innocence. All believed that destructiveness was inherent in human nature. On this account, there is no innocence to be lost. Instead, we are initially given to destructiveness, and our task is to become civilised and to remain so as much as we can.
000'...the struggle between Eros and Death, between the instinct of life and the instinct of destruction, as it works itself out in the human species. This struggle is what all life essentially consists of...' (Freud, 1930, p. 122). (Young 1995)
000But insofar as UKCP and their like minded partners are installing a collection of trade-restrictive practices, ring-fencing their psycho-territories and gearing up for a politically timely for the move to statutory registration, they do seem to be behaving collectively as though they subscribe to a view of a human nature that has to be contained and controlled.
000I was left wondering why so many people for instance in the Association of Humanistic Psychology Practitioners [AHPP] and in the rest of the HIPS section of UKCP, who I would suppose shared my perspective on what is 'human' and 'natural', would be so committed to a form of organisation that appears to be so incongruent with their core beliefs.
000The UKCP trade association comprises some 75 member organisations. It is, as Diana Whitmore says in a recent Self and Society article, an 'organisation of organisations'. On the ground this amounts to about 3500 UKCP registered psychotherapists. Overlapping with this are about 2000 psychoanalysts, perhaps half of them with dual membership of UKCP and BCP. Then there are the two outsider groupings, The Institute of Psycho-Analysis and the Independent Practitioners Network with about 200 each.
000Looking at these totals I realised for the first time what a large proportion of the total the psychoanalytic tendency occupies, about half of UKCP, and if we count the 'psychodynamic' organisations as essentially psychoanalytic in their values, more than half. Furthermore psychoanalysis is by far the oldest and most established of the psycho-practices with an extensive international array of trainings and a very extensive body of theory. It has also, I understand, deep roots in the NHS and a lot of influence through occupying many of the senior consultancy posts, with the patronage that flows from positional power. One such person is the current chair of the UKCP.
000As I researched this section of 'The Alchemists Nightmare', I came across another of Bob Young's papers that went some way to explaining how the structural style of UKCP may have come into being. In a long and intricately written paper on the psychodynamics of psychoanalytic organisations, he details the shenanigans that resulted in the departure of the psychoanalysts (as distinguished from the psychoanalytical psychotherapists) from the UKCP. I believe that these events are the tip of an ice-berg. They show how a psychoanalytic perspective on human nature is likely to have had a considerable and lasting influence on the UKCP's organisational style. While the analysts may have left, they have been present throughout the UKCP's formative period.
000Before we come to his narrative, here are some remarks from Bob Young about the culture of British psychoanalysis, including psychoanalytic psychotherapy.
000'...people are mixtures; ... They behave well in some contexts, less well in others, badly in others. In psychoanalytic organisations, as Kenneth Eisold has helpfully shown, dissent is not tolerated. There seems to be no space for genuine and open political debate and uncertainty.
000A situation has been developing in this subculture for some years which has, in my opinion, reached a level which seems to me to pose serious problems under the general heading: 'Physician, heal thyself!'(Young 1996)
000In a talk given to a US audience, he narrates some of the difficulties that the formation of the UKCP posed for the psychoanalysts.
000'the problem which soon became apparent was whether or not the IPA psychoanalysts, i.e., The British Psycho-analytical Society, would get into bed, first with the Jungians and then with the psychoanalytic psychotherapists...
000...there were reasons for optimism until the psychoanalysts said that the price of their staying in [The UKCP] was that their representatives should have a veto over the decisions of the council - not the section, mind you, but the council of the whole organization. No kidding. They claimed to be senior to all other psychotherapeutic practitioners and referred to the device they advocated as 'the Security Council model', after the body in the UN where any one of five countries has a veto and the Security Council can in some circumstances overrule General Assembly decisions. There are about three hundred members of the Institute of Psycho-analysis practising in Britain out of a total of about 2500 reputable and recognisably psychodynamic psychotherapists. (The present chairman tells me that there are about 3400 on the register at present).
000He goes on to describe the turning point.
000a person who was not a psychoanalyst but worked closely with them was not elected to a key committee, [of the UKCP] and the whole house of cards fell down. The representatives of the psychoanalysts and their allies decided that they 'had had enough'. A new and rival organization had been abuilding in the wings, and it was inaugurated. Only certain psychotherapy organizations were invited to join it........ The analysts withdrew, and the positions of several organizations close to them became very unstable because of divided loyalties. Practically all other psychoanalytic psychotherapy organizations which joined the newly-created British Confederation of Psychotherapists (BCP) remained in the UKCP, as well. It now has ten member organizations, with a lot of overlapping membership, e.g., analysts who work at the Tavistock Clinic or people who work there and are also members of the Association of Child Psychotherapists or any of the above who are members of the Association of Psychoanalytic Psychotherapists in the National Health Service.(Young 1996)
000So far as I am aware, this dual membership of the breakaway Confederation and the UKCP is still in place.
000These events lead me to infer that there was, and probably remains, an understandable desire in the rest of UKCP to adjust its standards and/or values to accommodate the analysts, or at least to find some compromise that would keep them on board, or help them return to the fold. Candidates for this would seem likely to include longer courses, more frequent therapy, more supervision, consolidation of the move towards postgraduate entry and an expansion of theory at the expense of experiential work which some students are reporting.
000An internal memorandum to all registrants of the psychoanalytic/psychodynamic Sections of UKCP lists seven reasons why they should not leave. The text ends on an anxious note, urging the reader not to 'stand idly by whilst our profession becomes split even further'. (Tantam 1996)
000Even to someone such as Bob Young inside the psycho-analytic tradition, the actions of the analysts were off the scale in their arrogance. He continues:
000attempts to designate a group of highly-qualified psychoanalytic (or religious or political) practitioners as superior by virtue of having particular qualifications and then place them over the rest of the profession is a breathtaking usurpation. For them to object to people not allowing that they constitute a 'Security Council' and then to set up a breakaway organisation whose main structural features are keeping organisations out which don't kow-tow to them and declaring all other practitioners of an inferior caste (or perhaps even charlatans) is clearly and simply a power play and should be transcended.
000That is, we must find a way of going beyond the present situation. However, in order to achieve this healthy iconoclasm, we have to unscramble the self-infantilisation and deference of the organisations whose members have allowed it to happen. That may be harder. Mandarinates trade on the low self-esteem of ordinary people, even and especially, ordinary people who express their ordinariness in being good and non-self-idealising psychotherapists, priests or politicians. (Young 1996)
000I believe that many of the people whose names the UKCP register carries within its pages are also 'ordinary people who express their ordinariness in being good and non-self-idealising psychotherapists'. But I rather suspect that as UKCP has evolved, the infinite easygoingness of the humanistic/integrative culture has led them into a loss of political will, a failure of nerve and/or courage in relations with the psychoanalytic tradition.
000Unscrambling the 'self-infantilisation and deference of the organisations whose members have allowed it to happen', of which this article is an example, is a task that seems also relevant for the HIPS section of UKCP. As Mowbray so cogently puts it, 'involving a removal of as many heads as possible from the sand before eager register builders add the cement' (Mowbray 1995)
000If this feels unduly critical in tone, I want to say that a considerable tension that is hard to hold, between wanting to tolerate diversity of belief and practice and a determination to resist what I experience as oppression, has shaped this writing. That some people wish to have a registration-based type of organisation I can live with, though I regard it as ill-advised. However, I refuse to be over-run by a psychotherapy trade association/trainers club, that seeks to determine who in the field of psycho-practice are cultivars and who are weeds, or to shift metaphor a little, who seem intent on making a daisy-free lawn out of the UK psycho-meadow.
000The UKCP style may seem decent and civilised and innocuous but it bears a resemblance to the arrogance of the analysts in believing that they should constitute the 'security council' of psycho-practice, that they have a corner on quality in a way that no-none else has. Is not the UKCP a self declared 'security council' that embodies 'power over' domination in exactly the same way as the United Nations version does? Evidence of its agendas (van Deurzern-Smith 1996, Tantam 1996) easily sustains this parallel.
000I'm tempted to leave this argument here but in case you don't yet find it compelling, Bob Young goes on to outline some of the qualities of the organisations who eventually couldn't stomach the plurality of UKCP but with whom about half of the current UKCP membership nonetheless share a bed. And who were there from the early Rugby Conference days. I give the quote at length because this is a rare insight, whistle-blowing done at some risk to the author, as he outlines elsewhere in his text.
000What I want to say about the other organizations which broke away [from the UKCP] is contentious but the simple truth as far as I have been able to discern it. For the most part they kow-tow to the Institute of Psycho-analysis. This is not true of the Jungians, but it is of the others. In particular - and I suggest that this is crucial - they insist that (with vanishingly rare exceptions) the people who are allowed to be training therapists in their psychotherapy trainings should be psychoanalysts. The same is true, although not quite to the same extent, of who can supervise and who gets asked to lecture and run seminars.
000Who can say how much we are looking at insistence on quality versus the maintenance of a patronage network and the hegemony of one organization over a number of others?
000Young goes to detail how, in this 'caste system ', the analysts dominate psychoanalytic psychotherapy.
000The analysts analyse and supervise the psychotherapists. They decide if and when they are ready to see training patients and eventually to qualify. They do or don't make referrals of patients to them. They do or don't appoint them to positions as honorary therapists in the hospitals where the analysts control practically all the consultant posts in psychotherapy...
000As the analysts put it at a recent British conference on the relationship between psychoanalysis and psychotherapy (and as it was put by another in an internal memorandum describing their proposed programme in psychoanalytic studies), they represent 'the gold standard'; the therapists are alloys and baser metals - copper, as I recall one saying. (Young 1996)
000The BCP is quite shameless about its 'seniority'. In their world web site screens (BCP 1997) they outline the reasons why they separated from the fore-runner of the UKCP, an umbrella body that was catholic in it membership and where, in order to recognise difference of titles and function, member institutions were divided into separate sections.
000The momentum by which this was achieved made it difficult for the older more established institutions,....to have their seniority recognised within the structure of UKSCP. (It is difficult to represent with sufficient force the problem this presented. It was as if the United Nations had no permanent members of the Security Council, only nations elected to it from the General Assembly in which each nation had a single vote)
000The institutions of the UKSCP were not equal in their contribution to the field nor in public esteem. Current and historically-based realities of that kind could not be accommodated within the constitutional structure of the UKSCP....and this was a decisive factor which led to the establishment of the BCP as a separate body. (BCP 1997)
000To what extent, after reading this you feel that the IPA, the BCP and UKCP amount to a 'gold standard' in the field of psycho-practice in this country, I suppose depends on what model of human nature you subscribe to.
000The point I seek to make here is not to denigrate the practice of psychoanalysis, undoubtedly one of the flowers in the meadow of psycho-practice. Nor do I intend to demean the objectives of the BCP in pursuing the highest standards of training and practice or their assertion that 'a proper self-definition and self-discipline by institutions intent upon self regulation protects the public'(BCP 1997). I want to keep our attention on how psycho-practice organises itself, to re-iterate that Young's story-telling points to a set of values that have been at the heart of the UKCP since its earliest days, that remains current in about half the member organisations and that have decisively shaped the attitude and structure of that organisation.
000As with persons, UKCP's history is formative of its present behaviour. It sets the perspectives that can be entertained, lays down the comfort zones of what can be tolerated; and determines what can be embraced and what is anathema. I believe that the attitudes to power and human nature that Bob Young has so well delineated have been formative in UKCP's history to such an extent that allegiances, alliances and administrative and constitutional style have been decisively skewed towards those long in place in psychoanalysis, and not least, those of medicine. As Christopher Coulson, until recently Association of Humanistic Psychology Practitioners [AHPP] representative to UKCP, has commented in reviewing this article:
000'the skewing... is not just towards an analytic mode but towards the medical model and particularly the NHS medical model. The chair, general secretary and head of the registration board are all doctors' (Coulson personal communication)
000For our present purposes, what matters about this bias is how it affects the ways in which an organisation handles the distribution of power. One choice is to merely reproduce the societal norm of hierarchical dominance, as UKCP appears to. Here is Coulson again
000The fear culture/battle for market dominance thrives within the UKCP. Pure training organisations are beginning to challenge accrediting organisations...to query whether they are competent to judge therapist competence. The implicit claim is that only training organisations are fit to accredit practitioners and therefore presumably to re-accredit at intervals. Goodbye independent accreditors. Hello total control by the industry. (Coulson personal communication)
000This choice of how to handle the distribution of power appears to match the values of UKCP's psychoanalytic/psychodynamic registrants. But how can it be acceptable to Humanistic and Integrative practitioners?
000THE ARGUMENT FROM INCONGRUITY
000The structure of UKCP appears to be federal as regards training schools and institutions but it is not representative, accessible, or accountable, either to clients, or to those of us outside its range. Nor apparently even to registrants, who have been told in the UKCP house journal that, even though motions from the Executive and Governing Board had been rejected at an annual conference, and the way through from local organisation to Section was far from clear, 'there is no need, however, to camp out in trees. Twice a year (at least) [my italics] you can speak to all fellow registrants in these pages (UKCP 1996)
000Yet through its 'register', UKCP purports to be a body that uniquely represents the whole spectrum of psychotherapies in the United Kingdom and to embody ways of holding and discharging, core ethical and occupational responsibilities between practitioners, trainers, trainees and clients.
000How has this been done? Through a searching, open exploration of the views of existing practitioners inside and outside training schools and accrediting bodies? No, a variety of influences, for example, a defensive preoccupation with hostile attacks from the media and elsewhere, (House 1996) the need to consolidate training businesses in a near saturated market and the desire to build a profession with equivalent status to science and medicine, has led to what is effectively the formation of a trade association of psychotherapy training schools and accrediting bodies. A formulation that has subsequently been partially acknowledged (Tantam 1996)
000Among committed supporters of UKCP and also in the BPS and BCP, there is concern about the 'status' of the psychotherapy 'profession'; its status relative to psychotherapy in other countries but especially Europe and not least, its scientific status.
000In the first paragraph under the banner heading 'Scientific Program' The announcement of the First European Conference on Group Relations and Psychoanalysis comments that the conference will encompass.
000the group phenomenon that in all European countries the situation for long term psychotherapy is problematical specially in the public sector.
000This scientific enterprise would try to answer the question:
000" how can we guarantee a future and space in the public sector and society for our way of helping patients".
000This journal has carried some indications of other aspects of the urge to re-define psychotherapy as an independent scientific discipline, The 'Strasbourg Declaration', of the European Association for Psychotherapy declares that;
0002.Training in psychotherapy takes place at an advanced, qualified and scientific, level (EAP 1996)
000The UKCP person who looks after European matters is on record as believing 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'.(van Deurzen-Smith 1996) There is also a desire to be seen as a profession with equivalent status to medicine, because 'only after the profession [of medicine] had been organised and proper qualifications put in place...funds became available for more research...' (van Deurzen-Smith 1996)
000 Not surprisingly, there have been doubts. One line of argument, that I support, says that because psychotherapy has no autonomous theory-base independent of general psychology and anthropology, it must therefore have an inherent diversity. Following on from this, since no position regarding psychic causality can define the nature of the field, the connectedness of psychotherapies can usefully be expressed only in terms of commonalities of praxis. What kind of organisation does this point to? A trade association? But not, surely, a 'profession'?
000Christopher Hauke concluded a conference introduction to the UKCP Analytical Psychology section by noting that 'a psychological perspective that acknowledges diversity and multiplicity in the psyche also questions the need for either synthesis or hierarchy as the means for resolving the apparent fragmentation of psychotherapy' (Dinwoodie 1996)
000However the UKCP mirrors other political institutions in the UK and elsewhere, in seemingly being rooted in an uncritical acceptance of 'power over' dominance as natural and inevitable:
000Power-over comes from the consciousness I have termed estrangement....It is the consciousness modelled on the God who stands outside the world, outside nature, who must be appeased, placated, feared and above all, obeyed. p9
000The language of power-over is the language of law, of rules, of abstract, generalised formulations enforced on the concrete realities of particular circumstances....in the worldview of power-over...value must be earned or granted....in the secular world, the worth we acquire is constantly rated against that of others... we internalise a primal insecurity about our own right to be, which drives us to compete for tokens of pseudo-value....Power-over motivates through fear. Its systems instill fear and then offer a hope of relief in return for compliance and obedience. p14
000Power-over shapes every institution of our society. p9 (Starhawk 1990)
000'Power-over' shows up in the structural form of the UKCP. Emmy van Deurzen-Smith, a previous UKCP Chair, admitted in an interview (Jones 1992) that as people elbowed for position, 'inevitably a hierarchy will form'. David Kalisch describes it thus....
000UKCP is a dominator hierarchy seeking to borrow power from another dominator hierarchy in order to impose its dominance....' He continues,. It is not possible to canvas for pluralism and diversity whilst voting for statutory registration'. [my italics] (Kalisch 1996)
000That UKCP could get itself into the position of claiming to do both, speaks to me of a deep lack of awareness of how ubiquitous 'power-over' dominance is.
000In my view, despite the no doubt honest and genuinely felt motivations of many of its supporters, UKCP exists at least in part, to express colonial/imperial ambitions. It is imperious in manner, as witness Pokorny's dismissive comments about Mowbray's comprehensive and scholarly book, 'The Case Against Psychotherapy Registration....'. (Mowbray 1995)
000....we are offered a strange collection of analogies, dogmatic statements, and opinions, embedded in a number of facts...All these are arranged in such a way as to be almost unrecognisable...this book far from being embarrassing for the UKCP is nothing other than a collection of opinions and fragmented facts which are stitched together in a particularly idiosyncratic manner and thus purport to be evidence. (The Therapist 1996)
000A letter to the Guardian was open about UKCP's agenda to colonise and dominate the field of psychotherapy. 'While Sigmund, Karl and Melanie indeed simply "set up shop in their back bedroom", Tom Dick and Harriet will discover that since 1989, Jo Public is highly unlikely to come to them unless they are registered with the UK Council for Psychotherapy' (Oakley 1995) The writer was apparently unaware of the irony of publicly declaring as a virtue, the exclusion of present equivalents to innovators such as Freud and Klein!
000Recent supporters of UKCP in the press have claimed that statutory registration is a 'political red herring' (Tricia Scott 1996) yet an internal memorandum to registrants of the analytic and psychodynamic sections who might be considering leaving, claims the pursuit of statutory registration as one of the seven reasons for staying in the UKCP. 'The Council continues to work to achieve statutory regulation of the profession' (Tantam 1996) What else does statutory registration of psychotherapists mean in practice, if not engaging the sanction of state law enforcement to police the boundaries of a psychotherapy 'profession'? Even without legislation, is it not also true that - a 'voluntary' register plus time, equals a 'de facto' 'statutory' register?
000Whether awarely or not, power is expressed through UKCP as 'power over', across the council/others boundary, that is to say between the council and unregistered practitioners (and also between the council and registered practitioners insofar as it holds the sanction of removal from the register for misconduct). Also as I recently witnessed, between the UKCP and other competing organisations. Speaking about European umbrella organisations at a recent BCP conference on registration, (BCP 1997) Anne Casement, representing UKCP, even felt licensed to (erroneously) claim 'that in this instance, UKCP, for the United Kingdom, is the body that actually regulates anything to do with psychotherapy here'.
000But power relations between persons are not inevitably of the power-over variety. The last several decades has seen the emergence of efforts, at least in the Anglo-Saxon culture, to install, (some would say re-install) ways of relating to each other, both interpersonally and through institutions, that do not unawarely reproduce 'power-over' consciousness. I'm thinking of the wide range of self-help communities and initiatives such the ParentLink Network, Alcoholics Anonymous, Hearing Voices Network, United Kingdom Advocacy Network [UKAN] and co-counselling and reciprocal counselling. Because there is also 'power-from-within' and 'power with'.
000Power-from-within ....sees the world itself as a living being made up of dynamic aspects, a world where one thing shape-shifts into another, where there are no solid separations and no simple causes and effects. In such a world, all things have inherent value...We do not have to earn value. Immanent value cannot be rated or compared. No one, nothing can have more of it than another.
000It is language in action, which speaks in the body and to all the senses in ways that can never be completely conveyed in words.
000Power-with sees the world as a pattern of relationships, but its interest is in how that pattern can be shaped, molded, shifted. It values beings, forces and people according to how they affect others and according to a history based on experience. It can recognise inherent worth, but can also rate and compare, valuing some more highly than others. p15 (Starhawk 1990)
000In the co-creation of a psychotherapeutic encounter, are not ethically sound relationships between practitioner and client of the 'power with' variety? Are they not aimed at awakening 'power-from-within' in the client?
000Yet the organisation that seeks to regulate psychotherapy 'expects that the importance of the register will increase until there will come a time when members of the public, or healthcare providers, will only engage the services of registered psychotherapists'. (Tantam 1996) i.e. a time when the register monopolises the market for psychotherapy.
000To me, a competent, ethical, but non-registered psychotherapist, this determination to dominate the market for psychotherapy looks fundamentally incongruent, particularly for the HIPS members. As though a herd of gentle, co-operative psychotherapists had taken flight, through fear, whether of exclusion, or unemployment, or 'Europe', into delegating to willing bureaucratic hierarchs the building of an elaborate 'security' system. To protect clients? Or to protect themselves?
000A recent international report (Travis 1997) shows that England and Wales is the most security conscious country in the industrialised world. The country tops the international league for home security devices, with more than three quarters of homes boasting an alarm, or special door locks, or grilles on windows or doors. What if this style of home-security and the enthusiastic embrace of 'psychotherapy-security' in the form of registration were related? That they both signal the absorption into our unconscious of some of the key prevailing values (and effects) of the recently ended period of ideological experimentation in UK national politics?
000There is a high probability that practitioners whose speciality is one-to-one work will be unaware of the collusive group psychodynamics of their organisations (Wasdell 1992) and it follows that such groups would be likely to have an unnecessarily restricted range of options when seeking a structure for their organisation. It is perhaps unsurprising that they would unawarely reproduce the underlying unconscious norms about power of the society around them, i.e. dominance expressed through stratified hierarchical bureaucracy supported by forms of voting that are likely to privilege majorities. (Pokorny & Fanning 1996)
000Yet is it not so, that many, if not all, clients who come for therapy have some difficulty with exactly these power relations? Not least the degree to which domination (and submission) continues to seem 'natural' or 'second nature'? Do not many of these clients, in their struggles to find a way out of say, a victim orientation, look to the therapist for a model of how relationships can be? One that demonstrates, as they co-create the therapeutic relationship, a lived capacity for 'power with', i.e., co-operation, authenticity, negotiation, clarity of boundaries etc.? My experience of living and working in Belgium has demonstrated that this is not exclusively a UK, or Anglo-Saxon problem.
000For me this is a fundamental element of ethical psycho-practice. If you think so too, yet you are also a UKCP registered psychotherapist, or working towards registration, how do you justify the incongruence between aligning yourself with an institution that embodies 'power over' relations while running your own practice in 'power with' mode, aimed at awakening 'power-from-within' in your clients? And if you are able to justify it, perhaps economically, how do you avoid this incongruence contaminating relations with your clients?
000Since the unaware acting out of dominance appears to be a fundamental flaw in how the UKCP is constituted, I thought it worthwhile to take step back and examine how such an outlook may affect the services to clients that psychotherapy exists to deliver.
000THE ARGUMENT FROM ECOLOGY
000While we in the UK have yet to reach the medicalised, insurance driven, 'managed care' of the US, I am convinced that the incoming tide of professionalisation in the UK will seriously diminish diversity and innovation in psychotherapy.
000For example, UKCP registered psychotherapists 'are required to refrain from any behaviour that may be detrimental to the profession, to colleagues or trainees...' and they 'are required to take action... with regard to the behaviour of a colleague which may be detrimental to the profession, to colleagues, or to trainees' (Mowbray 1995) As Mowbray asks: 'Who decides what is detrimental? The profession of course'. This is exactly the kind of circular collusive dynamic that will create 'no go' areas in psychotherapy content and practice.
000Furthermore, the present Chair of UKCP is on record as hoping that psychotherapy:
000registration will weed out unpromising, ineffective, or downright harmful innovations at a much earlier stage.(Tantam 1996)
000 Notice the phrase 'weed out'. But psychotherapy registration is not some informal evolutionary process, a register creates weeds. Indeed for it to make sense, it has to create weeds to justify the high cost of the education of cultivars.
000This is a cultural and political decision, the conscious creation of privilege. I believe that it damages the interests, both of the psychotherapy client population, and of psychotherapists in general. The former are likely to be denied sufficient choice to find a good match for their issues. And the latter, due to becoming locked into a culture where hierarchical bureaucratic control dominates quality assurance, will gradually drift towards a 'play safe', 'low risk', 'defensive' style of practice. This is especially likely if this control is focused through cascades of supervisory deference (Young 1996) or a desire to end the 'balkanisation' of therapy (Savage 1996). As Kalisch has suggested, at the heart of bureaucratisation that UKCP represents is a desire that the wildness, iconoclasm and potential dangerousness of creative thought and imagination be tamed, anaesthetised and rendered anaemic in order to be safe for human consumption (Kalisch 1990).
000Perhaps anyone who feels that psychotherapy registration does not compromise creativity would outline how they would propose setting up from scratch a new psychotherapy training school and gaining UKCP recognition for it.
000Diversity matters and those who move to damage it generate confrontation and resistance, 'Society is like an amoeba: it moves from the margins, not from the centre. Cut off from its margins it can only sclerotise and shrivel, become ever less responsive to change' (George Monbiot 1996) I return to these matters later in some detail in the next section.
000But before that, in seeking to understand the ecology of psycho-practice, I recommend to you the eloquent testimony of Vandana Shiva, in Monocultures of the Mind, a book about what happens when diversity is damaged or undermined. (Shiva 1993) Shiva is writing about the destruction of forests in India but his observations seem to me to apply very well to the UKCP's annexation of psychotherapy.
000The UKCP may argue that within their structure there is a wide diversity of practice. Local flavours there certainly are, but if we take an ecological perspective of the emergence of the UKCP as a public body, several factors combine to make it 'monoculture of the mind'. These factors include:
000- the requirement that entry and training be at postgraduate level (UKCP 1993).
000- The belief that outside the remit of the UKCP and its participant organisations there is no tradition of psychotherapy of comparable value (Tantam 1996).
000- The conviction that welding together the disparate sects of psychotherapy into a profession that has the same sort of status as science or medicine is an intrinsically worthy project.
000- The belief that the public needs to be protected from psychotherapists. (Tantam 1996).
000- The belief that the public can to be protected from charlatans by the existence of adequate training standards, codes of practice and complaints procedures. (van Deurzen-Smith 1996).
000Monocultures first inhabit the mind.
000Then as a monoculture takes root, they have a characteristic relation to the world around them.
000..monocultures of the mind generate models of production which destroy diversity and legitimise that destruction as progress, growth and improvement....[this leads to] impoverished systems both qualitatively and quantitatively. They are also highly unstable and non-sustainable systems not because they produce more, but because they control more The expansion of monocultures has more to do with politics and power than with enriching and enhancing systems..
000Monocultures identify themselves through their attitude to the distribution of power.
000Uniformity goes hand in hand with centralisation, while diversity demands de-centered control.
000Resisting monocultures he argues, requires active protection of, and promotion of, diversity.
000Diversity as a way of thought and a way of life is what is needed to go beyond the impoverished monocultures of the mind.
000Shiva's ecological overview points to another characteristic of monocultures: the inflation of one local practice into global dominance, so that for example, a local tradition, British public school education, becomes the means by which a whole continent is subjugated-India in the 19th and early twentieth century.
000Power is also built into the perspective which views the dominant system not as a globalised local tradition but as a universal tradition inherently superior to local systems.
000What has been a local tradition is inflated into global dominance. So that 'scientific psychology', 'psychotherapy', and perhaps soon 'counselling' are elevated from being local varieties of psycho-practice, to the globally dominant.
000What people who over-value control in human affairs miss is that the universal will emerge anyway and that the ethical, technical, and theoretical corsets of UKCP will frustrate this evolution. As Shiva reminds us,
000The universal would spread in openness. The globalising local spreads by violence and misrepresentation. The first level of violence unleashed on local systems of knowledge is not to see them as knowledge.
000Knowledge (or practice and experience) that does not fit the criteria of the dominant 'universal' definition of 'psychotherapist', is declared inadequate, wrong or dangerous. A person claiming to practise psychotherapy outside the umbrella of the UKCP is then potentially a 'charlatan'.
000The public needs... to be protected from charlatans by the existence of adequate training standards codes of practice and complaints procedures... we were also disadvantaged by the fact that anybody could set up as a therapist and in some case practise erratically and irresponsibly, tarnishing our reputation. (Van Deurzen-Smith 1996)
000As Shiva goes on
000When local knowledge does appear in the field of the globalising vision, it is made to disappear by denying it the status of a systematic knowledge, and assigning it the adjectives 'primitive' and 'unscientific'.
000An example is the separation of weeds and cultivars. Shiva has this to say about weed-making.
000Declaring a locally useful species a weed is another aspect of the politics of disappearance by which the space of local knowledge shrinks out of existence. The one dimensional field of vision of the dominant system perceives only one value, based on the market, and it generates practices which aim at maximising that value.
000After I had drafted this text I came upon a couple of descriptions of psychotherapy as a garden
000unfortunately everything in a garden is not lovely. Some plants are poisonous. Other become vectors for pests and viruses. Trees are not ideal for every situation, but neither are ground cover plants. Bulbs will mature and flower in a year, but shrubs will take much longer. Some nurseries undercut others by producing poor stock cheaply... and so on. I am sure you can see how this metaphor applies to psychotherapy, and how it could be made to apply further.(Tantam 1996)
000And in the context of counselling registration van Deurzen-Smith argues in a recent talk that:
000when a garden has been very fertile and has been left to itself for a long period of time it is overgrown. Sprawling plants obscure each other's light and deprive each other of nutrients. It is then necessary to cut the plants back, quite drastically and carefully select the ones that one wishes to encourage and make room for, at the same time as uprooting those plants considered to be weeds.
000 'It is then necessary to cut the plants back...' again who is the 'it'? Who decides? Who is it who claims to know what to cut back and what to select and which are weeds to be uprooted? On what criteria? She is undoubtedly aware of the dangers in what she is suggesting. Such pruning...
000If it is done haphazardly and too aggressively the result can be a sparse, unattractive environment in which little growth can be observed for a long time to come.
000However she is confident that, in these times of rapid growth:
000the pruning of registration and standard setting is a welcome and entirely necessary phenomenon. ...as far as I am concerned: it was high time that we began to disentangle this overgrown field, for it had turned into a jungle, where some weird and wonderful creatures were sometimes doing untold damage.
000Here is a professor of psychotherapy and counselling, and former chair of UKCP, using the word jungle to represent a state of appalling and threatening disorder populated with damaging creatures. For me 'jungle' means rainforest, far and away the richest ecological structure on this planet. One on which the whole of its climate and possibly its future depends. And one indeed populated with weird and wonderful creatures. Such as for example the gorilla, along with jungle, notoriously abused as a carrier of negative projection, i.e. King Kong, yet in reality is a gentle vegetarian creature.
000Gardening, along with pet keeping is one of the most ubiquitous pointers to underlying attitudes of domination (Tuan 1985) The gardening metaphors as employed above all imply a 'gardener', a 'controller'. Applied to psychotherapy, the assumption of an intrinsic right to dominate. Exactly the point I seek to make here.
000Shiva goes on to further delineate how colonisers who succeed in inflating their local knowledge into universal dominance, consolidate their gains.
000By elevating itself above society and other knowledge systems and by simultaneously excluding other knowledge systems from the domain of reliable and systematic knowledge, the dominant system creates its exclusive monopoly.
000Attempting to inflate psychotherapy, a local tradition, to that of a dominant universal, a process that will necessarily marginalise the alternatives, requires concealment. An ambitious 'dominant universal' such as UKCP requires a public face, a serviceable political fascia of 'public accountability' and 'ethical responsibility', and 'public protection' in support of its attempt at creating a monopoly. Behind this, it can conceal its inaccessibility to 'outsiders' and most significantly, clients, because individual participation is impossible. Once more, Shiva has a useful perspective on the process.
000Paradoxically, it is the knowledge systems which are considered most open, that are, in reality closed to scrutiny and evaluation.
000Sadly, this is what tends to be typical of existing dominant professions such as law, medicine and science and now it seems that psychotherapists, through some strands of opinion within UKCP, along with BPS and BCP are intent on helping create their own customised stronghold.
000Part of the difficulty of confronting psychotherapy professionalisation is finding adequate ways of grasping it whole, of avoiding being entranced by the apparent solidity and reasonableness of it as an institutions, or unduly privileging the perspective of the beholder. Examining the models of human nature that are explicitly, or as seems to be the case, implicitly in-forming professionalisation, are one way of doing it, the ecology of the field another, the power relations yet another. In addition, there is the historical, legislative, and ethical case against psychotherapy professionalisation and the experience of licensing in other countries such as the US, Canada and Australia that Mowbray has assembled (Mowbray 1995).
000What else could provide an adequate, if necessarily local way of looking at the phenomena of psychotherapy professionalisation as a whole? Considerable anxiety certainly seems to be associated with it and because of this I was tempted to explore in depth the view of deep structures of group cohesion put forward by Kellerman. He points to the way that:
000'the accumulated or collective anxiety or tension of members (that) constitutes the substance which is converted into cohesion energy'(Kellerman 1979)
000He identifies three kinds of groups, intra-punitive, extra-punitive, and impunitive.
000Intra-punitive groups tend to look inward rather than attend to personal behaviour and moral and ethical responsibilities. The members of such groups concern themselves with personal sin and its expiation. Extra punitive groups tend to solve problems through scape-goating. They cast difficulties in the shape of some out group that must be dealt with severely. In the extra-punitive group intra-group relations are inherently hierarchical and antagonistic. This is because the group contains an authoritarian structure that justifies its existence by seeking scapegoats or victims onto whom dissatisfactions are placed. By contrast impunitive groups are those in which members tend to examine their motives, feelings and learning process. They will also generally not insist that any one member unconditionally follow collective instructions or persuasion, they are not inherently hostile towards members who disagree, or towards other groups.
000IPN would appear to be constituted formally as an impunitive group while UKCP and the psychoanalytic communities that Bob Young describes appear to have at least some of the characteristics of extrapunitve groups.
000Though this and Wasdell's lengthy and detailed perspectives on the psychodynamics of professionalisation (Wasdell1992) that I have mentioned earlier are tempting, I found myself drawn to another way of looking at professionalisation.
000THE ARGUMENT FROM CREATIVE STYLE
000The UKCP, an umbrella structure for psychotherapy training and accrediting organisations, claims to honour diversity. However there are other dimensions to diversity apart from models of human functioning and therapeutic practice and some of them have a significant effect on organisational structure and behaviour. One of them is 'creative style'. I argue here that the UKCP's diversity of practice favours a consensus of creative styles and unawarely devalues and/or restricts access to practitioners who favour certain other varieties of creative style.
000Adaption/Innovation Theory [A/I Theory] (Kirton 1989), widely used in Europe, the Far East and the US, is one of the fruits of occupational psychology. It provides a very useful perspective on how creative styles differ and the effects thereof. The theory says nothing about the amount or level of creativity as such, it focuses solely on the style of creativity, i.e., how we approach any task that involves creativity. I believe A/I Theory sheds light on the registration of psychotherapists in the UK, particularly on who might welcome, or resist registration, and why.
000Nomads and Settlers
000Kirton asserts that there is a spectrum of creative styles that range from very adaptive to very innovative in a normal distribution (Kirton 1989, Postle 1991).
000People whose creative style is very adaptive prefer settled, clearly defined boundaries. They prefer to remain within an agreed consensus and tend to perceive change as useful only so far it is expressed as an evolutionary improvement of existing conditions.
Seeks solutions to problems in tried and understood ways.
Liable to make goals of means
Is an authority within given structures
Challenges rules rarely, cautiously, when assured of strong support.
Tends to high self doubt. Reacts to criticisms by closer outward conformity. Vulnerable to social pressure and authority; compliant. (Kirton 1989)
000People whose creative style is very innovative have little respect for boundaries. They tend to range across them, freely entering and leaving settled communities or interest groups. They tend to be impatient with improvement and prefer mould-breaking change.
Queries problem's concomitant assumptions: manipulates problems
Seen as unsound, impractical; often shocks his opposite.
In pursuit of goals treats accepted means with little regard
Tends to take control in unstructured situations.
Often challenges rules, has little respect for past custom.
Appears to have low self-doubt when generating ideas, not needing consensus to maintain certitude in face of opposition. (Kirton 1989)
000Just as people with average size feet, have a lot of choice in shoes, so people around the middle of the range of creative styles have a lot of choice in people with whom they can happily associate. However, because they form a majority, they may tend to feel that their perception of creative style is 'normal' and that other creative styles are 'deviant', 'irrational' or even 'pathological'.
000 A/I Theory makes two other useful suggestions about creative style. Through 'coping' behaviour anyone can learn to function across the range of creative styles. But adopting a style far away from our preferred one, is stressful, and eventually we tend to revert to the 'home' style. Secondly, any of the range of creative styles is intrinsically valuable. As a corollary to this, A/I Theory demonstrates how much of a gross distortion is the white western cultural norm that equates creativity only with innovation. A concomitant distortion is the perception that adaptivity is not creative at all.
000If we bring A/I Theory to bear on the phenomenon of psychotherapy registration in the UK, what does it show us?
000The first thing that comes to mind is that there is likely to be a large consensus to which most people belong, and other much smaller groupings or a number of individuals for whom this 'herding together' is anathema, or brings grave difficulties.
000If we look at the range of British psychotherapy practitioners we see the Independent Practitioners Network; a grouping who prefer a no-hierarchy network structure consisting of self-regulating cells of practitioners.
000 There is also the British Confederation of Psychotherapists who have left UKCP and are trying to detach other organisations from it (Tantam 1996) They appear to prefer formal, settled groupings with strongly and clearly defined boundaries and appear to be intolerant of dissent (Young 1996)
000And then there is the UKCP that claims to represent the 'profession' of psychotherapy. It takes the form of a flattened hierarchy, with several thousand 'registrants' connected to 77 or so training and accrediting bodies. Each of these has representation in the governing body and executive council and all meet annually to discuss/ratify on-going business. The UKCP decision making model was recently described as 'consociational democracy' (Pokorny and Fanning 1996).
000From the perspective of creative style, the IPN grouping looks strikingly 'innovative'. The psychoanalytic grouping looks 'adaptive'. And the UKCP appears to represent the varieties of creative style in between them.
000The Invention of Charlatans.
000Well, you may say, that's all right then, the majority have voted with their feet and formed a weighty consensus that occupies the middle ground. And yes, there is a certain statistical inevitability about that. The difficulty comes from the equally likely myopic tendency of practitioners in this consensus to see outsiders with differing creative styles as anathema or problematic, or worse, as quacks or charlatans.
000Practitioners with an adaptive creative style will tend to see significantly more innovative practitioners (a majority of the population) as, unreliable, casual about quality, and disrespectful of seniority and settled boundaries. They will also be likely to be dismissive of practitioners with a more innovative creative style, as undisciplined and anarchic, and their practice as superficial. This accords well with my modest face to face contact with BCP.
000Practitioners with an innovative creative style will tend to see significantly more adaptive practitioners (again a majority of the population) as collusive, complacent and bureaucratic, and to perceive highly adaptive practitioners as rigid and pedantic and their practice as ineffective or irrelevant. This is a view commonly expressed within IPN.
000Practitioners with creative styles that occupy the central two thirds of the spectrum will also tend to identify the one third of practitioners outside their central consensus as either unreliable and anarchic, or alternatively complacent and pedantic. However, unlike highly adaptive or highly innovative practitioners who are likely to feel marginalised, the practitioners who occupy this central consensus will, through sheer weight of numbers, be inclined to hold a position of tolerance of their diversity while imposing their view of good practice as the view that matters.
000This is because, for any variety of creative style towards the centre of the spectrum, there are large numbers of others whose style is adjacent if not identical. Hence agreement is likely to be easier to reach, even though the divergence of creative style across this central majority is still likely to be considerable and a source of great tension.
000I am not suggesting that these are tight categories, obviously there are innovative psychoanalysts and adaptive human potential practitioners. But the centres of gravity of these groups are likely to be distributed in the way I have outlined. I would suspect that a similar distribution would appear in other countries.
000Why should this perspective on organisation and creative style in the field of psychotherapy matter?
000UKCP, the occupiers of the middle ground, while claiming to honour diversity, have erected a boundary fence around those kinds and levels of psycho-practice that the central consensus majority of creative styles agree constitute 'psychotherapy'. From this perspective, in espousing regulation of psychotherapy, they attempt to institutionalise their consensus creative style.
000Once erected, this boundary, symbolised and enacted initially through registration, with the promise of eventual legal sanctions, is likely to give many practitioners within it a deep sense of security and 'rightness'. For others inside the boundary but not so near the middle of the range of creative styles, it is likely to generate serious tension. Not enough to mean they can't live with it but enough to mean they constantly feel sceptical, unenthusiastic, uncomfortable, compromised, or are simply silent about their doubts and discomfort.
000For practitioners outside this consensus of creative style, there seem to be two kinds of reactions. In those practitioners like myself who are strongly innovative in creative style, the central consensus of UKCP evokes anger at the attempted annexation of a sector of the field, anxiety at the likely economic effects of this action, coupled with a determination to create a form of organisation congruent with my values and to resist any attempt to show that 'psychotherapy' as represented by UKCP or its cohorts is a united profession.
000In my quest to understand the phenomenon of psychotherapy registration, the lens of creative styles has brought into focus another important element. I began to suspect that the majority consensus of creative styles is not symmetrical, i.e. not evenly distributed around the mean. The central consensus is skewed, and I believe it is skewed towards the adaptive style. Since I first drafted this section I have discovered what appears to be evidence in support of this, and of discomfort about it within UKCP.
000One registrant has compared the internal dynamics of the UKCP to the ecumenical movement within the Church (Savage 1996) He equates the Freudian/Jungian Analytic wing with the Orthodox/Catholic tradition within the Church and then goes on to note that the Churches' ecumenical Governing Board has five Orthodox/Catholic out of six officers. Of its four members representing the main body of 'churchgoers', all four are Orthodox/Catholic. He ends this ecclesiastical survey by noting that, 'of an Ecumenical Governing Board totalling twenty-one souls, no fewer than thirteen would belong to the Orthodox/Catholic persuasion'. 'So long as this state of affairs prevails, it is difficult to accept that decisions made are not coloured by the perceptions or prejudices of the dominant group'.
000If you accept my premise that the centre of gravity of the psychoanalytic wing of psychotherapy has an adaptive creative style then here is evidence of a major bias within UKCP towards that style and towards psychoanalytic/psychodynamic agendas.
000Savage concludes: 'When I once asked why the Analytic wing of UKCP had three sections to everyone else's one, I was told, "for historic and pragmatic reasons". To paraphrase the old Irish joke about the response of a local to a stranger seeking directions. "If you are looking for democracy, I wouldn't start from here"'. (Savage 1996)
000If this may seem exceptional, the facing page of the same publication featured a more coded and incomplete article about decision-making in the UKCP (Pokorny & Fanning1996). It observed that 'the greatest danger to us is that we become led by a majority faction who can overrule any awkward minority interests and call the process unity'. After a quite detailed discussion of the dangers of adopting a proposed model of decision making that was 'explicitly based on a model of national government', the article went on to conclude that the health of the Sections is our safeguard against any system that can trample on minorities. And that 'One of the biggest fears at the Rugby Psychotherapy Conference was that one form of therapy would predominate'. We think this danger has reappeared'. Decoded, this appears to refer to the weight that the psychoanalytic tendency has within UKCP.
000How curious that this anxiety about a threat to in-house democracy is coupled with a failure to notice that in promoting a profession with statutory boundaries (rather than a trade association that recommended its members) the UKCP enacts on those of us who don't share the consensus creative style, exactly the same kind of oppression.
000To summarise. There are four points I want to make. One, that from the perspective of creative style, the UKCP does not represent the full spread of psychotherapy practice in the UK. Secondly, that the consensus of styles that it does represent is likely to be skewed towards adaptivity in creative style and towards the psychoanalytic/psychodynamic and, as a reviewer has reminded me, the NHS/medical model of practice. Thirdly, that this, coupled with the dominance of the central consensus, results in an oppressive devaluing and marginalising of practitioners who are strongly innovative in creative style. Fourthly, there is a certain symmetry in the way the organisational situation has unfolded. The 'adaptive' analysts have rejected the UKCP consensus on the grounds of unrecognised 'seniority' and inadequate training standards and the 'innovative' Independent Practitioners Network rejects the consensus on the basis of values incongruence.
000I want to re-iterate that what is at issue here is the preservation and valuing of diversity. It is not a trivial matter. So far as it strongly pursues its present course of mimicking other institutions such as law and medicine and creating a 'profession', with or without state enforcement of its boundaries, the UKCP has the capacity to undermine or destroy the territory outside it's orbit.
000During the recent recession there appears to have been a decisive shift in the UK's collapsing labour market towards over-valuing paper qualifications. This tends to mean that individual, self-directed, experiential learning (which appeals to people with a highly innovative style) is correspondingly de-valued. So that anyone who wants to develop as a psycho-practitioner tends to see the writing on the wall-no paper qualification, no work. Joining the dominant consensus means moving away from ad hoc education no matter how deep or valuable, and joining an 'accredited' or 'recognised' course.
000This brings with it dangers for the consensus too, As Kirton has pointed out very convincingly, (Kirton 1989) over time, the consensus centre tends to shed its innovators as too obstreperous, too divisive, or the innovators quit as they become fed up with the demands for deference. The organisation then drifts towards greater adaptivity, bureaucracy and stasis.
000As many organisations (and nations) have found to their cost, when the consensus creative style feeds back on itself in this way, innovation and renewal become more and more threatening, until maintaining the existing boundaries starts to dominate the life of the organisation. The former East German Republic and the former USSR, along with countless businesses, are examples of this in action.
000Both highly adaptive and highly innovative psycho-practice seems likely to continue, either underground within the registered consensus, or in exile. Though it is likely to remain marginal and under-resourced, that may be better both personally and for clients than the alternatives, extinction or souldeath.
000As this article has gone the rounds of colleagues it has accumulated a variety of feedback and criticism. While some of this has shaped revisions, I want to take the opportunity both to respond to some of the critical comment and to anticipate other likely objections.
000By suggesting that UKCP, and in particular the HIPS section, are in the pockets of the totalitarian pessimism of psychoanalysis, you define the field in terms of one portion of it. Doesn't this amount to a totalitarianism of content which is what you oppose from the dogmatic psychoanalysts? It is important to be scrupulously fair in these matters.
000I doubt that there is a 'scrupulous fairness' that is not shaped by ideology. Nonetheless my intention in deploying Kirton's adaption/innovation model was precisely to contradict an overly myopic, single lens view of the field of psycho-practice that unduly privileged the educational-humanistic-psychology perspective that I bring to it.
000From my 'nomadic' perspective, UKCP represents a massive privileging of psychoanalytic pessimism and the medical model. To name this is not to argue for a reverse privileging of a 'nomadic', i.e. 'innovator' approach to accountability that for example the human potential movement represents but for the maintenance of a valid space for it in the psycho-prairie.
000Isn't your devotion to opposing psychotherapy regulation and resistance to hierarchical authority a displacement of some unresolved personal material, perhaps some compulsive outsiderist complex?
000Projective identification is the glass in the lens of perception. The best any of us can do is recognise this and be diligent in personal therapy and collegial consultation around engaging issues. However, where there is a challenge to institutional power, I am also watchful for dissent of the kind I have assembled here being dismissed as pathology. As I mentioned earlier, I am inclined to deconstruct such a line of criticism as a 'tyranny of the unconscious'.
000Your reduction of the issues to an ideological clash between models of human nature is not only a displacement of the really important issues that are to fight for in the political context, but also reinforces the impotence of those who think as you do because it gives no alternative long-term political pathway.
000The issue for me is not that someone should subscribe to a particular model of human nature but that they are aware of how it shapes political institutions such as psychotherapy registration.
000There are no innocent bystanders in this matter. To have a model of human development is to have a model of human nature. Models of human nature that seem inclined to naturalise dominance as medicine and psychoanalysis profess do, will lead to institutions that install dominance, hierarchical control, gate-keeping and the policing of professional boundaries.
000I don't see that creating an alternative form of accountability, as in IPN, that is congruent with the model of human nature that underlies much of humanistic and human potential psycho-practice, in any way reinforces my impotence. Does not such a suggestion presume a discourse of dominance and subjection? IPN's clusters of emotionally competent practitioners are developing a discourse of co-operation, mutuality, 'power with' and 'power from within', in a network based on affinity and shared values. Is this not a political act of considerable social and political potency?
000The article is unfair. You don't honour the passion of those practitioners within UKCP who seek to establish institutions that support tolerance and diversity.
000I think that this is again to misunderstand the article's origin as an expression of the politics of the dispossessed -'nomads' faced with 'settlers' who have fenced off a very large section of the communal psycho-prairie and are denying access to it (without discussion) to those who previously ranged freely across it. I and many other colleagues find ourselves with our livelihood damaged, our probity demeaned, and described as charlatans. By whom? People, some of whom we know well, who own and staff a collection of training schools and accrediting bodies. These are persons who have decided with such confident certainty that they are in possession of the truth about 'standards' in a psychotherapy they as yet decline to define, that they even seek statutory support for their position.
000Opposing this kind of unaware dominance as I and others intend to do, is likely, as Shiva points out, to attract devaluation of the form of discourse employed to resist it. Like too 'polemical', 'petulant', 'bad faith', 'insufficiently rigorous' and especially, 'unfair'.
000But who is being unfair to whom here? Why should I overly honour the passion of someone who is oppressing and harming me? Should victims of oppression be denied the right to make loud sounds?
000You don't give anything like enough attention to the influence of the medical model and the National Health Service.
000I think that this is undoubtedly correct. The BCP which has a substantial overlapping membership with UKCP, is very transparent about its medical alignment, claiming accountability to an advisory board made up of representatives of mental health professions. This includes the Royal College of General Practitioners, the Royal College of Nurses, and the Royal College of Psychiatrists. (BCP1997)
000As the biggest employer in Europe, the NHS is a massive embodiment of the medical model of human functioning. It is easy to imagine that for those who toil within, or even adjacent to it, relations with the medical model and its values dominate most conversations about pay, status and conditions of employment. Psychotherapy registration and the creation of a matching 'profession' would clearly enhance a career path within the NHS. I imagine it already has for many people. I would find this socio-economic agenda easier to accept if registration was not being sold to the public and practitioners by UKCP and others as a necessary protection for clients from malpractice.
000The article takes insufficient account of the difficulties that training schools have in setting and maintaining standards.
000While I have seen at very close quarters the distortions that entry to UKCP imposes on accrediting bodies (sign up or fade away) it hasn't been part of my intention to take account of training issues except so far as I argue that the institutional modelling of standards comes first, and that is where I have given my attention.
000You should try to straddle the divide, not sharpen it, this is a cut throat situation, loaded with Machiavellian realities, sooner or later we will all have to get into the same tub. We have to work for the best we can get, which means getting access to the levers of political influence and you can't do that from an ideal position.
000I can accept that this 'pragmatic' approach to UK psycho-politics represents a commonly held view from inside the registration approach to accountability. I find it very unappealing.
000I don't see that I am 'sharpening the divide' but staking a claim for the conservation of a valuable tradition. Just because some psychotherapists have created a politics of psychotherapy that is a 'cut throat situation, loaded with Machiavellian realities', doesn't mean I have to join them in their folly. I also don't see that we need to eventually get into the same tub. We were in the same tub until unilateral action delineated a privileged space for the agendas of psychotherapy training.
000'Working for the best we can get', as I hope I have shown, depends on the core values that define our starting points. An uncritical acceptance of dominance/subjection in psychotherapy institutions may provide a starting point that facilitates 'access to the levers of political influence', but in whose interests? And 'you can't (get access to the levers of political influence) from an ideal position'. No? Nelson Mandela did.
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