I spent this afternoon watching an excellent You Tube discussion hosted by Caz Binstead and Peter Blundell of Therapists Connect with five panellists (Rima Sidhpara, Dr Emma Radway-Bright, Erin Stevens, Andy Rogers, and Jay Beichman) focusing on the current iteration of the SCoPEd framework for counselling and psychotherapy.
The British Association for Counselling and Psychotherapy (BACP), the membership body to which I belong, calls SCoPEd ‘a ground-breaking project to map professional competencies for the counselling and psychotherapy professions’. Some beg to differ, and it's safe to say that #SCoPEd has created much controversy and continues to raise concerns.
As I listened I was reminded of my involvement with the campaign against state regulation 11 years ago, as a soon to be member of the organising group of the Alliance for Counselling and Psychotherapy. When this afternoon’s discussion ended I re-read a personal account of going to the Alliance’s (very memorable) inaugural conference on 5th April, 2009.
I’m re-publishing that account here, today. Personally, to remind myself to stay engaged with what’s going on with the current #SCoPEd project, particularly given that I can ‘ostrich’ like the best of us (see article!) I’d encourage other therapists to stay engaged, too. I’m not sure how detrimental #SCoPEd would be to me and my work. I’m BACP-accredited, have been practising for 17 years and have six years of post-qualifying training. I’m not saying that to infer that I’m a more ‘advanced therapist’, or necessarily any more effective than someone who’s newly-qualified, and I hope I’m not being complacent (even after studying the BACP case studies I honestly can’t tell if I’m a ‘B’ or ‘C’!) I think, individually, if #SCoPEd were implemented I would still be able to practice, even if not using the ‘title’ I would prefer. But that’s not the point. Therapy is a community activity, a systemic one, not an individual one. Therapy is about the health of clients, of fellow therapist, based on how well we’re listening to clients (let alone how much attention we pay to those we fail to reach because of therapy’s often inaccessibility). Therapy is not only about the health of our societies, it’s about the health of the planet we live on, and how we relate to other-than-human and more-than-human life, too. What are the implications of #SCoPEd for the therapy trade, what will our trade look like by the time I retire, less than 20 years from now? What am I prepared to stand by and witness – or not?
I found it heartening re-reading this article – it was a fabulous, enlivening day, with so much care for clients – and disheartening, in that so little has changed in the forces for regulation. Back then we were opposing statutory regulation, which was successfully opposed – with much cause for celebration. Now I’m opposing #SCoPEd in its current form. It is not state regulation (although some argue it’s paving the way for that) but it is overwhelmingly reminiscent it. I find it useful reminding myself of the neo-liberal roots and drivers of what’s happening, and of my own conditioning (again, see article.) In reading, please bear in mind that this is a personal account, it’s not a referenced article, it was never meant for publication, as such - I simply wrote and sent it to the organising group in appreciation of them hosting the day (and surprisingly, I still agree with most - not all - of what I’ve written). And it’s appreciation I feel again, today, for Peter, Caz and all the other panellists and those campaigning for a dialogue about and change to #SCoPEd.
Reflecting on the inaugural conference of the Alliance for Counselling and Psychotherapy
5 April 2009
What a brilliant day. To be frank, I wasn’t expecting brilliance, I was simply going along to stay informed and to deepen my understanding of the debates around regulation. I also went to widen my experience of counselling and psychotherapy beyond practising here in my little corner of Bristol. I also wanted to learn from people whose work and understanding in the field I already respect: Nick Totton, with whom I’m currently undertaking further training, my supervisor, Arthur Musgrave, and others. It feels important to educate myself, given that I work in private practice and want to understand how the proposed regulation might affect the work I do; work I care about more passionately and humanely than any other work I’ve done to date.
I nearly didn’t go, to be honest. I partly feared I might encounter lots of people who were anti-regulation for the sake of being anti-regulation, an over-simplified ‘them’ (the government/Health Professions Council [now known as the Health and Care Professions Council] versus ‘us’ (counsellors and psychotherapists) sort of attitude. Happily, I didn’t encounter either.
What I did encounter was an atmosphere of genuine engagement with, and care for, and intelligent understanding of the themes of the day. More strikingly and immediately, I sensed that those who were there knew why they were there and cared considerably about the present and future of the therapeutic work they do. That was evident from my arrival; the pre-conference small talk was different. For a start, it wasn’t small! There was a tangible buzz of anticipation, engaged interest, and apprehension and uncertainty about the future of our trade. My sense - in the far south east corner of the room, at least - was people immediately engaging with one another. Lots of different reasons for coming, with people of varying backgrounds and orientations, from all over the UK - an interesting and interested starting point.
I’ve many thoughts, feelings and impressions arising from the day; too many to talk about in detail. My strongest impression is one of feeling deeply heartened by the sense of care in the room. Care for the work we do, care for the clients with whom we work and care/concern for the challenges of the zeitgeist. That was evident from all of the speakers and from the way everyone I heard talk, whether one to one, or in the wider audience. I was impressed (in the best sense of the word) and slightly in awe of the experience, expertise, skill and care around me. I heard people who had clearly spent hours and hours and hours thinking through and discussing these themes, the potential affect of regulation upon their client work and practice, and their wider working field with colleagues, peers, the Health Professions Council [now known as the Health and Care Professions Council], the Alliance for Counselling & Psychotherapy, etc. I was struck by the diversity of the speakers and the audience. I always feel more confident when I sense diversity in the room. I’m pretty careful – possibly too careful! - about what I join and who I align with, but am always heartened when I see a wide cross section of people in terms of training, orientation, and activities coming together on a strong enough basis of shared values.
Finally, at the conference I was reminded of why I do the work I do and why I had made the effort to rise at 5am to catch a train to London. I tangibly sensed that whether I or like it or not, by the virtue of the fact that I work as a therapist, I’m part of this whole regulation/anti-regulation process/momentum. Being present that day and finding out more for myself felt empowering. I’m not a big fan of that word, but I can’t think of a better one for now. The events, speakers and people got me to think about my own relationship with the work I do, the field in which I work and the current state of play in terms of the implications of statutory regulation for wider humanity, in an immediate, embodied way.
Stepping back from my experience of the conference itself, I also want to reflect upon a reason I nearly didn’t make it to the conference. My personal process - which I’m sure isn’t personal to me - part of that reason, is how I’ve kept myself busy ‘ostriching’ about state regulation to date. Thoughts like “oh well, I’m sure it’ll be alright in the end…state regulation’s inevitable isn’t it, so why bother engaging with it…it’s a waste of time and there’s lots of good people involved in the anti-regulation thing so I don’t need to be…I’ll just get my head down and get on with my work, I can’t make a difference” etc. I recognise this ostriching as a wider attitude and, as I see it, malaise in the cultural conditioning of my generation (us late 30 to mid-40 somethings – I’m 38). I’ve been thinking about the effects of this conditioning quite a bit.
The 1980s and early 90s – my formative teenage and young adult years - were not a time well-known for encouraging political and civil engagement, community consciousness and collective action, the things I was most interested in. The mainstream emphasis (in retrospect, lie, actually) was upon free choice, individuality, ‘greed is good’, and get rich whilst you can. The mainstream emphasis was not about encouraging each of us to look around and see the wider culture and social, economic, political and ecological system of which we were, and are, all a part; a more systemic, interconnected recognition and belonging. It was about un-ashamed “I’m all right Jack” success, with that success measured in material and status-driven terms, with the conscious erosion of community and collective values.
Of course, that wasn’t all that was going on in the 1980s (fortunately), but those messages did have a huge effect upon my generation, with the danger of getting distracted by getting rich quick, or more subtly, let the magic of the free market do it’s work (hasn’t that worked out well) whilst we each go out and realise our individual dreams. The American dream mixed with laissez-faire free market economics, “me first-ness” and the paradox of decentralising governments needing a strong centralising force; the antecedents of an ever increasing litigious and deepening regulatory culture, atmosphere and ‘normality’ of which we are now in the full throes.
Anyway, I deviate and I’m acutely aware I’m drawing sweeping generalisations which need unpacking, although they are critically important cultural generalisations in my mind, in terms of what’s going on in this sector alone, at the current time. The switch in understanding more fully for myself why I needed to engage with anti-regulation came a couple of months ago. In fact, there were a couple of switches. The first was imagining myself working as a therapist in a few years time, perhaps in a position where I wouldn’t be free or as free to practice the work I have been trained in, in the way I currently work, knowing that the work offers positive, therapeutic conditions. I imagined how I would feel, knowing damned well that I hadn’t done anything for the work and clients I care about and stood for what I believed in. The second switch was reading the ‘statement of intent’ of the Alliance, notably the following parts:
“..Although many counsellors and psychotherapists work in medical settings, their work is not a branch of medicine nor an activity ancillary to medicine. Most forms of therapy do not focus exclusively on the relief of symptoms, but emphasise creating and exploring a relationship….
…A majority of practitioners work in private practice. Their clients make decisions as responsible adults to come to them and to continue in therapy or to leave, and are able to seek advice or redress from a number of self-regulating professional bodies or from the legal system; they are in effect the practitioner’s employer. State regulation is clearly inappropriate for an activity contracted voluntarily between adults. We support extending the private client's autonomy and freedom of choice to NHS and voluntary sector clients, rather than the reverse…
…Many practitioners see their work as more an art than a science: a series of skilled improvisations in a relational context, where each client, and indeed each session, offers unique issues and demands unique responses. Such an activity cannot be captured by a list of ‘competences’, however elaborate; at best, such a list can offer only a parody of therapeutic practice…
…The initiative to regulate psychotherapy and counselling is itself a symptom of our tick-box society: of an obsession with ‘safety’, a compulsion to monitor every activity, an illusory belief that everything can be brought under control…
…Like many important activities, psychotherapy and counselling, though usually helpful, are inherently ‘risky’; they cannot be made to conform to safety-first culture…”
The following parts of the statement above ‘jumped out’ at me:
· The work I do is nothing to do with medicine, it’s about working in a reparative, relational way. My work is all about providing the conditions for healing or alchemy, and not about ‘making better’. That’s the very important job of doctors and nurses. Making better in a therapeutic sense implies an ‘I’m okay, you’re not okay’ relationship, which is most definitely not my starting point in the therapeutic relationship. It also implies that I’m an expert and the client is a patient, which is an anathema in terms of the way I work.
· The work I do in private practice is work contracted voluntarily between two adults. Why would or should the government intervene in this voluntary arrangement, provided that I continue to practice effectively, continue to be a member of BACP, have regular and effective supervision, engage with ongoing training and am part of a community of peers with whom I actively meet and share my work experience? A broader question - what is the world coming to if the government is free to regulate meetings between two adults?
· The work I do is most definitely an art not a science. In fact, if I signed up for regulation which is aligned with the medical model I would feel duplicitous, given that I have no training, interest or competence in ‘making people better’ in terms of diagnosis, prescription, medication etc. I have seen other areas I have worked in (particularly training and development in the management development/ HE field) going through the ‘competency’ process. I am at a loss to understand how the nature of a reparative, therapeutic relationship could be captured in a list of competences. And if it is straightforward to capture relational factors in core competencies, if we had cracked that one, we would all have perfect marriages, friendships and working relationships and live in a Truman show utopia. Human relationships are and life is, of course, messier, more complex and much richer than that. Thankfully life in the 21st century is not reducible to a set of competencies, although it sometimes feels as though there is a desire for our society to move in that dubious and unreal direction.
· In my experience, monitoring activities particularly of the core competency, tick box variety, doesn’t necessarily make those activities more effective. Looking around at some friends and colleagues in a number of different sectors, it seems to me that people (teachers, charity workers, lecturers, social workers, entrepreneurs, many others) become disillusioned with meaningless paperwork which doesn’t add anything to the quality of the work at their particular coalface. I’ve seen too many good folk lose confidence in the powers that impose the system, their bodies responding by becoming depressed and ill and spiraling into burnout. It’s often the most skilled, talented and innovative people who seem to fall foul of this system, because their creativity and life force is so severely hampered – a saddening phenomenon.
· In my mind, therapy often works because it’s a risky business, because life itself is a risky business, that’s kind of the whole point. Change, even healthy change, entails a degree of risk and denying the truth of that is dicing with our clients. Personally, speaking from my experience as a client rather than a therapist, picking up the phone to a new therapist feels risky; developing a relationship with a therapist (or any other meaningful human relationship, for that matter) feels risky. One of the most important themes for me in growing and learning and becoming more aware is learning to recognise, live with and grow from life’s ongoing dance between safety and risk. In saying this, I am all for risks that can be assessed, risks which can be managed, and never taking unnecessary risks, either ourselves or with clients.
So, in summary, I found the statement of intent thought-provoking, well written, timely and challenging. Thank you, Alliance people, and in particular given that your statement helped me to wake up to the regulation debates and to get involved.
In essence, I’m still not sure I’m anti statutory regulation per se. Or more accurately, to term the terribly reductive and simplistic economists’ term, if we lived in an ‘other things equal’ world, I wouldn’t be anti-regulation. But the key flaw here is that we don’t live in an ‘other things equal’ world (and given the nature of humanness, probably never will, and perhaps, how dull if we did?)
What I’m trying to say is that if I thought that state regulation would help prospective clients in terms of informing them about: choice of therapists, therapy itself, accessibility of therapy, what therapy might be most useful and helpful amidst the vast, lively and vibrant rainbow of therapies on offer, providing vouchers for clients to choose a therapy of their choice even (perish the thought!) etc. etc, I would be all for it. But as far as I can see - and I stand to be corrected if I don’t understand - state regulation isn’t about that. It seems to be about professionalising a trade and a craft under the false pretenses of making it properly measured and accounted for e.g. how many bums on BACP-accredited counsellor training programmes, how many accredited counsellors, how happy our clients are from a scale of 1 to 5 - tick the relevant box etc. And of course, the big, emotionally loaded pro-regulation gun: regulation of therapy will be ‘safer’ for the general public. What drives that professionalisation, as it has in all the rounds of professionalisation in other sectors, is the promise of greater revenue and relieving the status anxiety of those of us who want to be ‘professionals’ in a professionally-run association, with, in fact, scant attention often paid to clients and asking them what’s in their best interests.
Thinking more widely, I’m dubious about the state regulating anything at the moment, given the events of the past 18 months. The obvious thing that comes to mind is the Financial Services Authority being set up in 1985 (by the then Chancellor of the Exchequer) to regulate the financial services with two of the key aims being protection of consumers and promoting public awareness of financial systems. Aside from all the arguments linked specifically to the field of counselling and psychotherapy, I feel a moral obligation to object to regulation of our field, in principle, if that regulation is going to leave anything like a similar trail of corruption, misery and suffering created by what’s happened, happening and will likely continue to happen in the wake of the turmoil in the financial sector. And if that’s not enough, how about the lack of positive government action in terms of the current environment/climate situation? Who regulates the regulators?
So personally, as a human being in the 21st century, and given that I’m regulated by virtue of my long-standing membership of the BACP (British Association for Counselling and Psychotherapy). I feel dismayed at the needless bureaucracy that is driven by the fear of litigation, protectionism, corruption, the need to measure (even though there’s generally little consensus as to what’s being measured and how it’s relevant) status-anxiety, free-market-ness and power struggles in our world. I feel sad and troubled by what’s happening in the light of the proposed state regulation of counselling and psychotherapy. More encouragingly - and a welcome development for me - since the conference, I also feel more galvanised and know that now is the time to engage with and be more consciously aware of what’s going on more widely in this field and know that I can make a useful contribution in the company of other like-minded allies.