Submission to The Minister of Health on Regulation of Psychotherapies: October 2016 (1 of 4)

In the autumn of 2016 the Irish Minister for Health asked for suggestions regarding the best way to design legislation for the psychotherapy professions in Ireland. I made the following submission in October 2016: 


Dear Minister,

You have asked for submissions & suggestions regarding the proposal to legislate for the profession of psychotherapy.

First of all, you need to give some thought to what is the nature of psychotherapy & what is its place in society.

Psychotherapy has become a part of everyday life & there is a tendency to assume we all now know what it is, & what it does, & what it is for. In fact, its nature is not generally understood.

Initially, we are all are drawn to psychotherapy for reasons we grasp only vaguely. A deep understanding of why it is such a compelling part of contemporary life & what we should expect from it only comes later, after much work & learning.

The first thing to underline is that the advent of modern psychotherapy throughout the developed world is a cultural event. This means, in particular, that it is not a scientific event & it is not a medical event. To compare psychotherapy with an innovation in medicine is misleading. The problem of emotional health is different from the problem of physical health. It is different not just in certain details but in fundamentals.

Above all, psychotherapy needs to be seen in the relatively recent historical context of the decline of structured religious faith. In no country has this been more apparent than in Ireland. Here, the rapid expansion of the world of psychotherapy from the 1990s onwards has coincided exactly with the collapse of the authority of the Church in society. Psychotherapy is, in its essence, a new kind of expression of faith, a secular faith that in the rational evolution of the individual lies the best hope for what man is.

One might well ask if psychotherapy is not more usefully considered under the heading of education, rather than health. Good psychotherapy is a deeply educative experience. But whether it makes us more healthy is a different question. Even to ask this question is indicative of a certain naiveté. Good psychotherapy leaves us less sure rather than more sure about what health really means. It challenges the prejudices we all enter therapy with as to what health is, & our sureness as to why we lack it, or, worse, our sureness as to why we possess it.

Although we are generally not conscious of this, these assumptions about health that we all begin with are derived for the most part from religious teaching. Even the most secular of us carry these assumptions around with us, because we are all the children of a culture that was, until very recently, shaped by religion.

In contrast to religion, however, which purports to tell us what health is, psychotherapy is a journey of gradual discovery of how much of what we initially dismiss as illness may actually have rich seams of new life concealed within it. We learn that insisting on how healthy we are, or demanding to be made healthy, are both kinds of delusion, reflecting a lack of insight into the nature of the human condition, & a lack of faith in the life it contains.

Going back to its original derivation in Greek, the term psychotherapy literally means, the care of the soul. This describes its nature well.

We should however carefully distinguish here between care of the soul, & cure of the soul. Cure of the soul is essentially a religious notion, with the implication of coming closer to God through faith & through renouncing sin. Many people expect psychotherapy to give us a secular version of this, on the grounds that religion told us how to live, so psychotherapy should do the same thing. This reflects the unconscious assumption that in a society no longer governed by religious teaching we should still be able to achieve consensus on what a healthy state of the soul is. In fact, in the absence of religion (or some enforced totalitarian substitute for religion) no such consensus is possible. The notion of a cure for the soul therefore has no place in psychotherapy.

Psychotherapy comprises a set of intellectual & emotional disciplines for tending & cultivating the individual, in a context where the dogmas & certainties of religion & morality are pointedly excluded. We are particularly watchful here for the tendency to try to transfer certainties derived from religion into secular dress, in an attempt to disguise their dogmatic intent & conceal them from critical examination.

Psychotherapy is a unique development of modernity & cannot be understood outside of this historical context. It reflects the most recent evolution of Western culture, the culture that emerged in the early Middle Ages out of the confluence of the traditions of ancient Greece & Rome with those of ancient Judaism & Christianity. Contemporary psychotherapy reflects the development of these interwoven historical matrices into the modern world. It contains within it elements of Western science & elements of Western art & elements of Western religion & philosophy. If you wish to be a serious psychotherapist you should know something about all these things. And yet it is not exactly a science, & not exactly an art, & not exactly a religion. It is, in fact, like only itself – & its purpose is to help individuals to develop who are like only themselves.

Modern psychotherapy reflects the fact that for a long time now Western culture has been moving slowly towards the evolution of one overriding ethical imperative: the cultivation of autonomous individuals who live beyond any unconditional morality. This is the new faith of the West. We cannot in any sense “prove” that this is a better or more justified faith than the more dogmatic & less individualist cultures associated with the East. But it is our faith, the modern faith of men & women who belong to the Western tradition. It is in the greatest possible autonomy of the individual that we now place our highest hope for man.  

No other civilisation has evolved in quite this way. To the extent that other cultures have adopted forms of psychotherapy this is because they have also adopted in some measure the ideas & ideals of the West. The emotional & intellectual autonomy of the individual is the supreme ethical imperative of modernity, & the practice of psychotherapy is this modern imperative made manifest.   

Psychotherapy is a development out of modern culture as a whole & it is the property of that culture as a whole. It is practiced by certain people within that culture, but it is not the exclusive possession of any particular profession, or caste, or elected priesthood, or privileged church. If legislation attempts to turn it into such a possession, it will fail.

The philosophy, ideas & practices that underlie modern psychotherapy are accessible to anyone who is receptive to the appropriate authors & texts, who acquires the habit of reflecting carefully on himself & on others, & who, above all, has the emotional capacity continually to shape & reform himself in a way that increases his creative potential in life. If you possess these qualities you may make a good psychotherapist, irrespective of what paper qualifications you may also possess. If you lack these qualities you will not make a good psychotherapist, irrespective of what paper qualifications you may also possess.

If legislation attempts to restrict the practice of psychotherapy to those in possession of particular paper qualifications, the work that characterises it will migrate elsewhere under a new guise (in the same way as a few decades ago it migrated out of medicine). People will seek out & find good psychotherapy, whatever name it bears, & whether or not it is sanctioned by the State.