A red herring

My argument against the state regulation of psychotherapy is still under construction so to speak; several more steps are needed. You could perhaps look at previous posts to get an idea.

But while I am at it, the world has not stood still.

It is already September; gone are already half of the three months set aside as consultation period for the regulation of psychotherapy through the Health Professions Council.

I am very well aware that any last minute arguments will not suffice to stop what has started many years ago –namely the move towards state regulation of the so called Health Professions.

But I need to make my position clear. For the record, if for nothing else. Urgently.

So, let me attempt to summarize my point of view.

Here we go.

I am against the state regulation of psychotherapy in general, and psychoanalysis in particular, because I believe that the HPC, in its attempt to create an umbrella of standards applicable (with minor adjustments) to all Health Professions, has created a Procrustean bed that works by eliminating differences and homogenizing approaches in the name of “protection of the public”, “scientific evidence” and “measurable outcomes”. This can only be to the detriment of a discipline like psychoanalysis which as we have seen, and very clearly, does not fit on that Procrustean bed.

Indeed. In previous posts I have tried to outline an argument against the tendency to discredit psychoanalysis and other deep, open ended psychological interventions, on the basis of lack of “scientific” evidence for their effectiveness. I have shown, I trust, that the main tool we have in order to quantify the effectiveness of a therapeutic approach, namely Randomised Control Trials, is not suitable when it comes to psychotherapy and psychoanalysis. I have also pointed out that in our quest for scientific evidence we tend to take for granted an implicit theory of “science” which, in my opinion, is not relevant to psychoanalysis, and which, strictly speaking, is not even relevant to “hard sciences” such as Cosmology.

Let’s go back to the basics.

• Regulation of a profession is not a bad thing in itself. In fact it is a very good thing.
• There are two main ways to regulate a profession. One is to let professionals self regulate. The other is to let the state do the regulating.
• Psychotherapies were traditionally self regulated.
• Apparently, the systems that were in place have been deemed insufficient and the state decided that the public needs more effective protection.

Nothing exceedingly bad up to here, really; one could perhaps comment upon the nanny-state etc but this is a societal trend –not something limited to the so called health professions, and even less to psychotherapy.

My problem as a practitioner is that with all the talk about respect for one’s chosen theoretical approach, the HPC’s draft regulations exhibit very clear signs of implicit disrespect for certain theoretical approaches.

Take, for example, a standard out of the latest HPC draft such as 2c1, regarding the ability “to monitor and review the ongoing effectiveness of planned activity [within the therapeutic setting] and modify it accordingly”.

Very good, I can hear you saying. What’s wrong with that?

Nothing really, this is what any professional does, psychoanalysts included.

But how do they do it? The HPC has an opinion and offers some guidelines.

The practitioner must

• be able to gather information, including qualitative and quantitative data, that helps to evaluate the responses of service users to their care
• be able to evaluate intervention plans using recognised outcome measures and revise the plans as necessary in conjunction with the service user
• recognise the need to monitor and evaluate the quality of practice and the value of contributing to the generation of data for quality assurance and improvement programmes
• be able to make reasoned decisions to initiate, continue, modify or cease treatment or the use of techniques or procedures, and record the decisions and reasoning appropriate

Suddenly, it all changes. We are now talking about “information gathering”, “evaluation of responses”, “recognised outcome measures”, “quality assurance” and “improvement programmes”.

You see what I mean? This standard –which, incidentally, is common to all professions that the HPC is regulating, and not specific to psychotherapy– is worded in a way not applicable for psychoanalysis.

He have a problem here.

Let me spell it out:

I do not believe or argue that a psychoanalyst should be allowed to be indifferent to his or her clients' well being; I only say that in the work they do together, the analyst is required to question even “self evident” concepts such as well being, or evaluation of responses and recognized outcomes for that matter.

This is what psychoanalysts do. They even question your desire to get better. Not because they don’t want you to get better –that would be too ridiculous to allege– but because they are investigating what “getting better” means to you.

In short, the whole issue is a red herring really.

Now I will be the first to agree that not all psychotherapies do the same. There are many which are intensely focused to measurable outcomes. No problem. The “problem” is that there are those which do not.

If sorting out the landscape of psychotherapy was not in the HPC’s set objectives –and it was not– why does the HPC act as if it was?

In other words: The HPS professes itself as being neutral, but it acts in a non neutral way.

This contradiction cannot be left unchallenged.

This is why we oppose current schemes for the state regulation of our profession. Because they are conceived in such a way, that they cancel out our profession.