SR

[Guest guest]

Dear all,

The following article by Guy Gladstone recently appeared in Ipnosis

psychotherapy journal (June 12th., 2008). Guy is happy to see a wide

dissemination of his article.

Although primarily this article relates to the psychotherapy/counselling fields,

it is entirely pertinent to herbal medicine. Points 9, 10 and 11 are

particularly interesting.

Best regards,

Tim Lane.

STATE REGULATION: ILLUSORY, UNETHICAL, AND HAZARDOUS -

Eleven good reasons to oppose SR

Guy Gladstone

Preface

The following arguments are laid out to establish a comprehensive basis for

opposing state regulation of psychotherapy and counselling. Not all will speak

to everyone but it would be strange if at least 8 out of 11 didn't. If you can

adduce further 'good reasons' please publish them and let me know.

SR is currently projected for installation sometime between late 2009 and early

2011. Note SR through the Health Professions Council is intended to be

regulation of function, of practice itself, not just title ('psychotherapist',

'counsellor'). Already there are significant currents of both discontent and

outright opposition emerging within the umbrella organisations in tension with

the party line that SR is both good and inevitable. I am monitoring the UKCP.

What is the situation within BACP? It is important to make links with

oppositional trends wherever you find them and to agitate/resist in whatever

forum you have access to, - in print, online or at meetings, and this can be

around the central platform that the status quo is good enough whereas what will

ensue from SR is a disaster for the psy field. Heads in the sand bystander time

is over. There is a window for derailing the SR project and countering its

malignancy NOW. Later may prove too late.

Acknowledgement: With a different preface most of this text has already appeared

in the Summer 2008 edition of 'Transformations', the journal of PCSR

(Psychotherapists and Counsellors for Social Responsibility).

Eleven Good Reasons To Oppose SR

1) Surveillance Privacy Neutrality

SR undermines civil liberties. The subjection of the psy field to state-managed

processes of audit and surveillance jeopardises practitioner neutrality and

erodes the client's psychic space. Foucault identified how the panopticon effect

operates as a disciplinary instrument because subjects (in this instance

therapists as much as clients) never know when they are objects of its

observatory or not and so eventually internalise the panopticon and act as if

always under observation. Boal's political theatre for exorcising the cop in the

head is becoming especially relevant for the psy field and provides a praxis for

undoing the panopticon.

2) Diversity or Standardisation

The current diverse, local, voluntary and intuitively responsive ecology of the

psy field is superior to and should be valued above the proposed compulsive and

centralised control of standards administered by a tickbox bureaucracy.

Standardisation will paralyse creativity in developing new forms of practice and

will artificially and arbitrarily restrict research. has contrasted

the diverse local 'metis' with the standard centralised 'techne' and chronicled

techne's dedication to extinguishing metis.

3) Medical Model Hegemony

SR can only establish effective hegemony by means of distorting

psychotherapeutic practice/praxis through bundling it all in under the medical

model of mental illness, in the future likely to be glossed or hybridised with a

WellBeing ideology imported from the corporate world. This violates the public's

right to choose and access practitioners working within other paradigms e.g.

personal development, co-operative enquiry, authentic humanistic psychology and

unrecuperated psychoanalysis.

4) Output Regulation versus Input Regulation

For training institutes SR is a lifebelt to save them from sinking in the sea of

a deregulated market. Obtaining a monopoly on a protected title (however the HPC

wont guarantee this) is linked to exaggerating the role of input regulation

(control of entry into practice) at the expense of output regulation which is of

much less economic value to trainings. Prioritising the latter entails the

active fostering of self-regulated integrity at the point of contact between

therapist and client by means of ongoing peer review (Independent Practitioner

Network), supervision, wider debating of ethics (which will bring the state's

behaviour into view) and above all the education of the public in what to

reasonably expect from therapists beyond the clichés. This last initiative will

often run contrary to government prescription. It has been mostly dodged by the

umbrella organisations (BPS, BPC, BABCP, UKCP and BACP perhaps less so) which

prefer to focus on cultivating a more prestigious and self-serving culture of

highly academised expertise.

5) Misallocation of Risk and Redress

There is no evidence that SR as a licensing procedure can achieve the

elimination of risk and pre-emption of abuse that its controls and ideology

suggest it can. A quick look at the HPC's publicly viewable stocks and gallows

listings might be in order.The umbrella organisations are deeply complicitous

with government agendas of 'being seen to be', as though it is fatal not to

dance to a public relations tune. Overegging 'protection of the public' is

linked to the spread of a professional false self.

The scale of risk is exaggerated (the transposed Shipman effect). There is

insufficient evidence that therapists abuse clients on a scale that warrants the

costs (financial, political, psychological and cultural) of state intervention

in the form of the HPC. The HPC and Skills for Health are between them fostering

a dangerous conflation of ethics and competencies under the bundleword of

standards.Very very few therapists act unethically, all therapists have issues

of competency at one time or another. However as Carl pointed out there

have always been at least as many licensed charlatans and exploiters as

unlicensed and the licensed ones are actually more dangerous because of their

stronger credentials to be trusted.

If the position taken so far is too laissez faire the Counselling Society has

suggested there may be a case for creating a fallback instrument of legal

deterrence, that is a new category of criminal offence which would require

criminal standards of proof termed 'Professional Abuse'; this being applicable

only in cases of financial or sexual abuse or physical assault by a professional

acting in a trust-based caring capacity (this charge could apply to other

professions beyond the psy field). Proposals like this have the virtue of

stealing the HPC's thunder and locating redress in its proper place with the

judiciary instead of the executive and its HPC courtroom. Short of these

extremes an expansion of independent mediation and resort to existing common law

are surely the way forward for redress.

6) Core Values Erosion and Toxification

SR with the requirement to be registered directly with the HPC will subvert the

values and varied forms of association that traditionally have held

practitioners collectively in what is a consistently demanding work space;

namely the values of responsibility, ownership, self-management and mutual care

for the quality of colleague's work. The HPC will pull for STASI-style

inducements to shop colleagues with corresponding reactive collusions to cover

genuine mistakes rather than admit and clear them. Together these components of

false compliance will accelerate a spread of fear, shame, cynicism and

internalised oppression towards toxic levels. The deal on offer is this: follow

NICE guidelines and adhere to NOS stipulations and the government will protect

practitioners from the public and the litigation industry. Refuse these and

regardless of your skill and experience the HPC will pillory you as a charlatan.

Thus the psy field is to be reconfigured according to the gospel that the

government and the Department of Health knows what is best for you and your

clients. Actually you are damned if you do and damned if you don't so it makes

good sense to reject the whole caboodle of SR. This deal is the next move in the

government strategy of breaking in to be followed by performance management of

the next sector of the caring professions. After stuffing teachers and then

doctors it will be psychological therapists turn next.

7) Delivering Government Agendas

Some sections of the psy field have been seduced by government interest (IAPT)

in what they might contribute and don't appear to be overly concerned with the

nature of the use government finds for their skills. There are obvious dangers,

not least contagious loss of client trust, in being subpoenaed to serve

government purposes. Opposition to SR supports the maintenance of a necessary

distance from the state, even for those who have always been in NHS employment

as the nature of the social contract is shifting. Compliance with SR will

collapse the space for critiques that put the government's business in question

and this is no doubt intended. The current moves to block further judicial

enquiry into BAE style corruption are the writing on the wall.

Closer to home for the psy field is the Layard formula. Crudely it runs so: you

are out of work because of your individual pathology which is costing the state

too much in unemployment/ disability benefit. Ergo CBT therapy prescribed.

Structural changes in society? Global level economic factors? How dare you

suggest these are contributing to social misery with associated anxieties and

depression! It is just conceivable that beyond the PR value of demonstrating

some care rather than boosting the profits for Big Pharma's recently exposed

largely ineffectual drug treatments lies a further agenda for IAPT to screen off

more troublesome social/ economic analysis of links between distress and

deprivation.

8) Corporate Appropriation

SR will install mechanisms of administration paralleling those in health and

education which will enable and excite corporate designs upon the field (Virgin

Asda and Tesco are already bidding for slices of the NHS) and a corresponding

governmental receptivity to takeover. Here 'choice' and 'change' will be

buzzwords that echo but actually bear no relation to what therapists might

understand from these terms; instead these will be cheatwords that seem to be

offering the public something while actually functioning as government signposts

for the deregulated corporate drive to incorporate in order to open up new

profit sectors in a service 'industry' (some already speak of the psy field in

these terms).

Paternalistic government increasingly adopts the corporate promoting their

wellbeing. SR is here knotted to appeasement of the fetish of the free market. A

captured or training might itself be a loss leader but its transferential

potentials will not be lost by the new proprietor who will proceed to sell

holidays, mortgages or supermarket loyalty cards off the back of it. Current

networks of informal gratis and beneficent referral safeguard the public seeking

therapy from such incentivised insults.

9) Bystander Trance

The message generated by the umbrella organisations that SR is inevitable

constitutes a powerful trance induction towards a kind of helpless assent to SR

that is equivalent to bystanding behaviour. This mantra of inevitability,

frequently repeated by psychotherapists and counsellors, is pitched to

simultaneously play on fear and relieve guilt and anxiety by legitimising

apathy. For practitioners who purport to be in the business of reducing anxiety

and helplessness such a stance is massively incongruent with their core

assignment.

10) Exhaustion, Despair and The State as Rescuer

Even with making allowance for the hypocrisy of those who, notwithstanding the

above reasons for refusing SR, still see personal or institutional advantage in

passively acquiescing to it, as indicated by the affecting of a noncommittal

detachment or by adopting a position of reasonableness, pseudo amnesia or

feigned ignorance as to what is going on, there remains a question about the

root cause of the broader acquiescence, this regulationitus. One must ask why so

many in the psy field seem to have turned their attention away from these

issues, as though exhausted by something. One hypothesis is that after all the

years of infighting between organisations much of the psy field is in some

underacknowledged despair over its capacity to live and let live, to live with

difference and to tolerate diversity of theory and practice without trying to

steal a march on the other. This political despair may be the Achilles heel, the

reason no organisation can trust the others not to cut a deal with the state to

gain advantage and favours (the UKCP rationale for maintaining a so-called

'ringside view').

Furthermore this scenario would suggest a corresponding unconscious fantasy in

which the state is configured as the necessary authoritarian parent who restores

order, enforces agreement and rescues the feuding children from destroying each

other. That it wont and anyway cant actually do this is beside the point. Such

infantilism is actually an appalling indictment of a profession that makes

extensive claims regarding its capacity to help clients yet cant help itself as

a whole field when it comes to ordering internal and external relations at a

political level. That said, currently the UKCP, faced with the exclusion of at

least half its registrants (not to mention several thousand trainees) from the

privilege of entering the HPC compound, on the grounds that Skills for Health

can only recognise this remainder,- which includes the largest section of the

UKCP (HIPS), as derivative variants of the psychoanalytic/psychodynamic, the

cognitive behavioural and the family systemic, has a major identity crisis on

its hands. In certain reactionary parts of the psy field this is a very

gratifying scenario, one they have waited years for. It remains to be seen

whether this late in the day order from above that Sections organise their

footsoldiers (sorry registrants) to fire off letters of protest to their MP a)

is sufficiently complied with to produce a significant volley and whether MPs

in turn raise enough questions for the Department of Health to beat a retreat

rather than simply ignore it on the principle that regulators regulate, they

don't negotiate, especially when policy has already been decided elsewhere.

11) Conjointly Foreclosed Debate

And so in the light of the above the historical conjoint foreclosure of proper

debate and full discussion of what is at stake by both the umbrella

organisations and the state has to be named. Since both the state and most of

the psy field associations are dominator organisations, structured

hierarchically to promote power over as opposed to power with, this is hardly

surprising. Proper debate however would be extensive and lateral, decentralised,

from the bottom up, practitioner and yes, client/user group driven, the

discussion itself congruent with the activity it is all about, the results of

this discussion pooled by delegates in the true meaning i.e. subject to right of

recall by their constituencies should they start to represent other interests.

PCSR to its credit is attempting to launch a discussion that will meet some of

these criteria.

In the last 10 years three full-length books (see references) and numerous

articles have been published that argue the case against state regulation of

psychological therapies. No comparable 'case for' has ever been articulated and

if it has it has yet to be produced for public scrutiny. Apart from the active

rubbishing of Mowbray's seminal work " The Case Against Psychotherapy

Registration " by an early UKCP Chair and Fellow of The Royal College of

Psychiatrists, Dr Pokorny, who was clearly horrified by the detailed

thoroughly researched deconstruction of the UKCP and SR, the case against has

simply been ignored as if many wished it would just go away. Which it hasn't and

if anything it has become more cogent than ever with recent developments in the

governments agenda. The 'case for' doesn't appear to have got much further than

" state regulation is a good thing for the protection of the public so repeat

that after me " .

This asymmetrical phenomenon should alert observers from outside the psy field

as well as those within it to the fact that something has been avoided, debate

has been refused because one side cant actually muster a sustainable argument or

cant come clean or some mixture of the two. Perhaps above all debate is

foreclosed because values are at the heart of the matter and there is resistance

to full spectrum declaration. Instead we get mystification, typified by the

continuing both careless and deliberate muddling of statutory registration (the

project of the fortunately failed 2002 Alderdice parliamentary bill) with state

regulation, a very different beast.

Conclusion

After round about 85 years in Britain of freedom from state interference it

seems the largely bemused or even apathetic psy field in Britain wont know what

it will lose until after it has gone. After which that freedom will be far

harder to restore. The state and its collaborators from within the psy field

lack the wisdom that pertains to knowing when to leave well alone. Those who

confront and refuse SR can take heart from the fact that the body, the

unconscious, the transpersonal, the awareness of power relations and indeed love

and relationship itself, none of these can be computed in Skills for Health's

sorry calculus. In other words very large parts of the therapeutic process and

its context will necessarily escape the annexation being attempted by the state

and it's collaborators and this gives grounds for hope but not quietism.

References

Mowbray, . The Case Against Psychotherapy Registration. A Conservation

Issue for the Human Potential Movement. Trans Marginal Press 1995.

House, and Totton, Nick. Editors. Implausible Professions. Arguments for

Pluralism and Autonomy in Psychotherapy and Counselling. PCCS Books 1997.

Postle, Denis. Regulating the Psychological Therapies. From Taxonomy to

Taxidermy. PCCS Books 2007.

Foucault, Michel. Discipline and Punish. Translation. Vintage 1977.

, C. Seeing Like A State: How Certain Schemes to Improve the Human

Condition Have Failed. Yale University Press 1998.