THE PROFESSION OF PSYCHOTHERAPY IN BRITAIN
Robert M. Young
A quarterly periodical is not the best forum for writing about rapidly developing situations. I have for years wanted to publish articles about the development of what was formerly known as the Rugby Conference, was then designated as the United Kingdom Standing Conference on Psychotherapy (UKSCP), and is now called the UK Council for Psychotherapy (UKCP). I asked many people, and each declined. Their reasons varied, but here is a sample: 'I could not say in print what's really happening without libelling people, losing my credibility, or being seen as destructive.' 'Mine is only a partial perspective; it's too complicated to explain.' 'It will be possible to write about it in X months, when certain decisions have been taken.' In the meantime, what one could glean depended on how assiduous one's representative to the conference was about reporting back. Many people just want to get on with it and eschew gossip and what they see as endless bureaucratic wrangles.
I dare say that our international readership will already be wondering if this topic is of interest to them. I think it is. It touches on the criteria for being designated a psychotherapist, since the setting up of a register is one aim the Conference has achieved. At present, anyone in Britain can call himself or herself a psychotherapist, and this is to change, partly because of internal developments, partly as a result of entering Europe. A related topic is one of bedfellows. The history of the Conference has had its risible moments about who is prepared to be in the same grouping as whom. There are two very obvious potential cleavage planes the psychoanalysts versus the rest; the psychotherapists from highly-regarded trainings versus those from 'fringe' trainings. (Who decides which is which?) Then there is a related question about Jungians. Are they as elite as the psychoanalysts? How does their parallel pecking order relate to the psychoanalytic and the psychoanalytic psychotherapy ones?
There are many other forms of psychotherapy and therapy, humanistic ones being the most obvious, and there has evolved a list of eight categories: analytical psychotherapy, behavioural psychotherapy, humanistic and integrative psychotherapy, hypnotherapy, analytical psychology (Jungians), psychoanalytically based therapy with children, experiential constructivist therapies. These are not my concern in this introduction to the talks we are reprinting. My aim is to provide a limited context for them. In doing so, I want to make a small number of points only and to provide some more up-to-date information (which may itself be out of date by the time this issue of the journal appears). These talks represent the first public debate on the issues. The event was staged by THERIP, The Higher Education Network for Research and Information in Psychoanalysis. It is remarkable that there had been no previous public event. Most who attended it found it worth while, and there have been a number since then.
Next, it is far from easy to specify the main issues, so l can only say what I think they are. I think that the main axis is experienced by many as standards versus democracy. It is not obvious to me why these need be in competition, but lots of people think they are. There is a strong faction which says that to become a psychotherapist, your training therapy should be at least three times per week and you should see your training cases at least three times per week over, say, two years. Then there is the question of who is an appropriate training therapist and supervisor. Some training organizations allow only psychoanalysts (with a few individual exceptions) to be training therapists. This has the bizarre result that their own graduates are unlikely ever to be thought sufficiently competent and senior to act as training therapists in their own organization. The people who hold these views most strongly do not wish to be in a grouping where people who have what they consider to be lower standards have an equal say.
At present, every organization which is a member of the Conference has a single vote in the governing body. Indeed, some organizations interested in psychoanalysis and psychotherapy who neither train therapists nor practise psychotherapy have an equal say. This is unacceptable to those who link standards to 'times per week' and tough criteria for trainers.
Others maintain that 'times per week' is significant, but is only one of many criteria, including, for example, the need to have a wide experience of cases (once or twice or groups are mentioned). What about infant observation? What about teaching standards? What about peer review? But, as I see it, the crunch is the role of the psychoanalysts. They have their own British Psycho-Analytical Society, with about 400 members, of whom a quarter are abroad or inactive. There are about 2,000 psychotherapists. There are a small number of psychotherapy training organizations where only psychoanalysts can be training therapists or supervisors. The representatives of these organizations most of whom are themselves psychoanalysts have been restive about what they consider to be excessive democracy in the Conference. They took the line that there should be an equivalent of a UN Security Council, with certain powers, including powers of veto over decisions made by other bodies. They did not get their way, and they have withdrawn. Others are thinking about it. The Jungians have stayed in. A new organization has been formed, the British Confederation of Psychotherapists. At the time of writing it consists of the British Psycho-Analytical Society, the Lincoln Clinic, the Association of Child Psychotherapists, the Association of Psychoanalytic Psychotherapy in the National Health Service, the British Association of Psychotherapists, the Scottish Association of Psychoanalytical Psychotherapists, the Scottish Institute of Human Relations, the Society of Analytical Psychology, the Society of Psychoanalytical Psychotherapists at the Tavistock Clinic.
At first glance this looks like an impressive list. In some ways it is, but there are some interesting things to be said about it. First, some organizations have joined the new confederation (BCP) but have not withdrawn from the UKCP. In fact, only one organization offering training in adult psychotherapy has withdrawn: the Lincoln Clinic (formally known as the Lincoln Centre and Institute for Psychotherapy). My impression is that others were expected to withdraw but, after due deliberation, did not do so. Second, there has been a lot of debate about the processes by which various institutions have decided to stay in, withdraw or join the BCP (instead or as well). What constitutes democratic decision-making in this area? Is it sufficient for the duly-constituted Professional Committee to decide in the light of its own deliberations, or is a widespread debate within the organization more appropriate? Should there be a referendum, and, if so, how can the electorate get itself properly informed about complex issues which have evolved over more than a decade? This is especially problematic in institu tions where the leading figures have become committed to particular positions, e.g., withdraw from UKCP and join BCP. Their idea of a democratic decision-making process and adequate debate will be likely to differ considerably from others who feel that the UKCP stands for democracy while the BCP stands for elitism. My impression is that widespread debate has tended to lead to staying in the UKCP, while decision-making by Professional Committees without such debate has led to bad feeling about the process and the decision, and in one case has led to a grass-roots movement to consider rejoining the UKCP. There is also considerable disquiet about the process by which some institutions are becoming members of the BCP. Many people feel that these are not as fully democratic as they could be. There is also the odd situation where organizations representing graduates of trainings have withdrawn from the UKCP and have joined the BCP, while the actual trainings have stayed in the UKCP. I suspect that here, too, there may be a gap between the committees who make the decisions and the wider membership, as well as problems about the electorate getting itself properly informed.
There was another funny thing that happened. Some people in the British Psycho-Analytical Society pointed out that the withdrawal by that institution, which had been duly ratified by the Council, had been done unconstitutionally. Indeed, and very ironically, they had failed to consult the entire membership the very privilege the representatives sought in the UKSCP. So a meeting of the psychoanalysts and trainees was called, their representatives had their knuckles rapped, and there followed a vote to withdraw by an overwhelming majority. There was a small number of psychoanalysts who spoke in favour of staying in, but they never had a chance, I'm told. Since their number included some of the most public-spirited psychoanalysts, I was particularly sad to hear this. I was told that one said that the ratification of the decision to withdraw would be perceived as 'a declaration of war' by the rest of the profession.
I happen to suport the 'three times a week' criterion, though I know much else needs to be made part of the training criteria for a psychotherapist. But I think the way to achieve it or something equivalent or better is to work inside the UKCP. I also think there is scope for tiers or levels of training and competence and believe that this should not be read off from institutional affiliations. Heaven knows, with their multiple representations, the psychoanalysts had plenty of power. The Chairman of the Conference during these ructions has been a psychoanalyst, Michael Pokorny, and psychoanalysts turned up in the guise of psychiatrists, child psychotherapists, representatives of several trainings, and so on. Their representation was all out of proportion to their numbers. But it wasn't enough, it appears.
Here is an example of the sort of issue that arises: a training organization which insists that only psychoanalysts can be training therapists is training people whom it will never value highly enough to be training therapists or even, in some cases, supervisors or teachers. This is masochistic, I think. The analogy is with a college with no graduate school, or a hospital with no postgraduate faculty, but these are not good analogies. A very good therapist does not get that way primarily by taking more courses or studying at a particular institution. It is not easy to measure how they get that way or who has 'it'. This is a socially and philosophlcally deep issue, but in a subculture there is often a large measure of agreement about who is good, e.g., a sought-after therapist or supervisor. Now because of my work with psychoanalysts and psychotherapists as authors, I happen to know that this is not an infallible rule, but it's better, in my view, than automatic validation via a qualification from a particular institution. Once again, it is an issue which the UKCP can and should debate.
It is often said that the UKSCP simply did not get on wlth things fast enough, because it was too rigid to the point of fetishism about democratic procedure. This makes me laugh, when you consider that the Institute of Psycho-Analysis has its own 'historic compromise, whereby every important committee has to have representatives of the Contemporary Freudians, the Independents and the Kleinians, while major posts have to rotate Thls is so sclerotic that the Freudians are having an awful time finding the bodies to fill their reserved slots. Indeed, the eminent consultant on group relations, Isabel Menzies L.yth (who is also a psychoanalyst) was called in to advise about the possibility of dismantlmg thls structure. And these people offer themselves as mandarins or Platonic Guardians.
It seems obvious to many that the debate between standards and democracy is also (if not fundamentally) about hegemony which Gramsci defined as the organization of consent without the overt use of physical power and without the actual relations of power becoming apparent. There may be only 400 psychoanalysts as compared with a couple of thousand psychotherapists, but if the therapists are in analysis with the analysts and are being supervised and (largely) taught by them and if they also rely on them for referrals. that's power: ideological, psychological and economic.
Reprinted from Free Associations (1993) Volume 4, Part 1 (No. 29): 79-84
Copyright: The Author
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The Human Nature Review © Ian Pitchford and Robert M. Young - Last updated: 28 May, 2005 02:29 PM