Mental health is an objective that each of us can set only for himself. No one else can give us instructions on how to achieve a good life, & no one else can make the journey to a better life on our behalf. A builder can make me a house, a plumber can repair my domestic pipes when they break, an electrician can install lighting in my study, an engineer can design for me an environmentally friendly motor car, a surgeon can heal me when I fracture a bone. All these things can be done for me. And this is why the professions of builder, plumber, electrician, engineer & surgeon can all be regulated by statute with success. If I feel any of them has not done a proper job for me I can appeal to what society has formally stipulated they should be able to do for me, & I can seek redress under the law.
But no one, no father or mother, no church, no priest, no government, no government minister, no psychotherapist, can make me well in an emotional sense. That journey is one I must make myself. And if I decide to make it then it will be a unique journey, for me alone, & it won’t resemble the journey to health for anyone else. And if I further decide to enlist the help of a psychotherapist, by employing her to challenge me & get me to see in myself what I cannot see by myself, & encourage me & support me when the anxiety of confronting myself is hard to handle, if I do that then only I can judge whether she has given me the help I need. Because only I can know where I need to get to & only I can know when I am there. I cannot resort to some societally sanctioned criteria of what she is supposed to do for me, because no such criteria are possible, because society cannot decide for me how to be healthy.
In short, we cannot “regulate” psychotherapy without damaging it in a fundamental way, because we cannot specify beforehand what constitutes success, or failure, in psychotherapy. No one else but I can decide whether my therapist has been successful, or helpful, or worthwhile. The suggestion that a third party should step in & decide this for me, by vetting beforehand whom I may call on for psychotherapeutic help, is misconceived in the most profound way. It is an attempt to infantilize a process that exists precisely to assist in the enriching & deepening of adult responsibility.
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The proposal to “regulate” psychotherapy leads to an incoherent result because it is not what it purports to be. Like a neurotic symptom, which in essence it is, it is lying to itself, & to us, about what it is trying to achieve.
The wish to see psychotherapy “regulated” is motivated
by an unacknowledged shame & an unacknowledged resentment. The shame
reflects an anxiety about not being able to regulate one’s own life & a
fear that the signs of this weakness may become visible. The resentment is of
those who are strong enough to discover what health means for them & to
decide how they are going to live, of those, that is, who are strong enough to
regulate themselves.
There is much occasion for shame in modern Ireland. In
recent times a spirit of greater emotional honesty than has characterised most
of our history has forced us to look into what is an unflattering mirror. Psychotherapy
has become a target for “regulation” because it represents & symbolizes this
mirror.
Things have been brought to light that for generations
we have tried to keep hidden. For instance, the fact that the emotional &
physical abuse of children has been an intrinsic part of our culture,
sanctioned by the highest authorities; that we have for long been supine in the
face of religious doctrine & prejudice; that we are timid when it comes to confronting
authority in general; that alcoholism & private violence are a routine part
of our lives; that incest is common in our families; that we make daily use of
illegal drugs; that we make daily use of pornography; that the delight we take in
the misfortune of our neighbour is equalled only by our fear of his disapproval;
that we resent anyone who we think has got something we don’t have; that we are
deeply suspicious of the stranger in our midst; that we are deeply suspicious
of each other.
This is not the Ireland we promote abroad but it is
the real Ireland we all know. This is the foul rag & bone shop of the heart
where we all start, every day, again.
Our relative honesty about these things is very newly acquired.
Only a few years ago we still enjoyed one of the lowest suicide rates in Europe.
We achieved this because we lied about the true figures. We lied, because at
the time suicide was “regulated”, it was a criminal offence.
The spirit of this old “official” Ireland, where “regulation”
ensured that messy unpleasant things were not talked about, is not yet dead. It
is this Ireland that is calling now for the “regulation” of psychotherapy &
for a new culture of hypocrisy about mental health.
In psychotherapy we refer to this kind of self-deception
as resistance. Resistance is a response to the challenges of psychotherapy that
is rooted in an anxiety that one will not be strong enough to govern oneself.
In the relative privacy of the consulting room
resistance tends to show itself in the form of anger or moral outrage. In
public discourse it is usually more careful to dress itself in the respectable
tones of concern for the public good. In this arena, it generally involves an
appeal to some authority that it hopes people will be too frightened to
question. In days gone past this might have been the Church. In totalitarian
societies it is the Party. In more liberal open societies it tends to be more
vague, abstract notions like Science, or Public Safety. But in every period
& context it betrays its true nature by the attempt to place in question
either the validity or the possibility of the emotional & intellectual
autonomy of the individual self. It is regressive, because it refuses to accept
the only authority which in the present age now has final legitimacy: the
exercise of personal autonomous adult judgement.
*
It is not only those outside the immediate world of
psychotherapy who suffer the pressure of all this revelation. Those of us who
work within that world suffer it too. Exploring the unconscious is a fascinating
& rewarding discipline. But it is also, at times, stressful, & it needs
strong nerves. Often it can result in a kind of emotional vertigo, when the
ground under one’s feet seems to sway, & when one wishes dearly for greater
stability & firmer points of guidance.
There are moments when all of us working as
psychotherapists wish we had some assurance from authority that all this
uncovering of its nakedness were not going to leave us without a guide. As much
as we all wish to be free of the old gods, there are moments of confusion &
fatigue when we wish back again the reassurance they seemed to provide. This
anxiety, this fear of paralysis & retribution for challenging ancient
authority within ourselves, is scarcely acknowledged even to ourselves,
because we are ashamed of it; it is incompatible with our image of ourselves as
toughened explorers of the unconscious. But it too is an important source of the
appeal of “regulation” & it is why calls for it can be heard within
psychotherapy also.
Sometimes, too, this moral anxiety on the part of
psychotherapists mixes with other, less noble motives.
Within the profession of therapy there are some older
& better established practitioners who feel it is in their interest to try
to establish a greater control of entry into it. This is less about diminishing
competition from new entrants than it is about establishing a monopoly on
training, which, because it can last so long, can be very lucrative.
Training therapy always involves some compromises with
the principles of therapy. This is unavoidable. A client who is attending a
therapist purely for personal reasons can terminate the therapy any time she
feels she is not getting value for her money. In contrast, trainee therapists are
often required to attend for thousands of hours of educational therapy
extending over several years, irrespective of whether they genuinely need this
in any personal sense. When a therapist is working in a training capacity
therefore she has significantly more power than she has with other clients. As
everyone in the profession is aware, courses of training therapy are often
unsatisfactory from a purely therapeutic point of view for this reason.
A monopoly authority for “regulation”, however, would
deepen these known problems rather than alleviating them because it would give
even more power to the training therapist than she enjoys under the present comparatively
open system.
The method of therapy hinges upon the freedom of the
client to challenge & to criticise the therapist, including in personal
terms. Emotional honesty is not possible if the client is not assured he has
this freedom. But how many new candidates would have the confidence to
challenge a training therapist who potentially, through the submission of a
negative report on the candidate’s progress, had the power at the least to
delay his acquisition of a licence to practice, which in practical terms might
mean denying it altogether?
The essentially corrupt system proposed by the
“regulators” would gradually squeeze out from the profession the maverick &
the outsider, those who have the greatest capacity for independence of mind,
& who constitute the life & soul of psychotherapy. They would be replaced
by the timid, the conforming, & the politically ambitious.
*
Grandiose schemes to “regulate” psychotherapy reflect,
among other things, out-dated & superficial analogies between psychotherapy
& medicine.
In the past, the practice of medicine relied significantly
on the personal relation between the physician & his patient. Over time however
this aspect has been transferred out of medicine into psychotherapy, &
medicine has changed as a result. Modern medicine relies now as far as possible
purely on the disciplines of the physical sciences & on the principle of
what is “evidence based”, which means the assumption that what works in one
case will probably work in another. The ideal now in medicine is to minimise
the divergence that patients with the same condition receive from different
doctors. The aim is to minimise the personal element as much as possible.
In psychotherapy such an approach is quite useless.
In psychotherapy, we start from the assumption that
what works in one case will certainly not work in another, because what we are
treating here is precisely what makes the patient different from everyone else.
The notion of “regulating” such a process externally is a contradiction in
terms.
The purpose of psychotherapy is to educate the
individual in her own nature, so that she can then continue her life in a way
that is more creative, in whatever way she has potential to be creative.
Whether other people in society then approve or disapprove of the life she goes
on to live can never be a legitimate concern of psychotherapy.
Any legislation for psychotherapy therefore, if it is
to be of genuine value & not merely a pretext for undermining the challenge
it represents, can never concern itself with the attempt to make the outcome of
therapy more acceptable from the point of view of society as a whole.
What legislation for psychotherapy should aim for is an
objective that is honest, modest & realistic.
The aim should be to make the market for psychotherapy
as efficient & transparent as it can be & to see that the public has as
much information as possible about particular psychotherapists & about
psychotherapy in general. The profession should be made not more closed, as the
“regulators” would like, but more open.
It should not be made more difficult than it now is to
enter the profession. A multiplicity of schools & viewpoints should be
cultivated & protected. No school of therapy should be given legal
privileges over others, & no therapist should be obliged to join a school.
Information about therapists should be made readily available to the public. A
register of therapists, outlining educational qualifications, contact details
& any other biographical information each therapist wished to give, would
be useful.
Also useful would be more general education for the
public, outlining what they should expect from psychotherapy & what they
should not expect from it. Rather than being encouraged to complain when they
find psychotherapy is not what they anticipated, the nature of psychotherapy
should be better explained to them.
People should be taught that psychotherapy is a
process of learning & discovery about the self. Like all genuine learning it
involves hard work & sometimes it will be stressful. In psychotherapy you
must expect to be challenged, it is not the task of the therapist always to
agree with you. It won’t always be plain sailing. There will be times when you will
feel confused, & there will be times when you will feel angry. This is what
you must expect in psychotherapy. It is not easy. It is not comfortable. However,
your therapist should also be supportive of you through this process, &
should be sensitive to how much confrontation you can handle. If after a
reasonable time with a therapist you feel you are not being properly supported,
then you should discontinue, & possibly consider an alternative therapist. But
the decision either to stay with a therapist or to leave is ultimately your
responsibility alone.
Psychotherapy is not for children. It does not offer a
sugar-coated world of easy alternatives & peace & love & happy
endings. It is an engagement with real grown-up life, with all its tragedies
& terrible dilemmas & conflict & responsibilities & unfairness
& uncertainties & mistakes & imperfections. If you feel you cannot
handle such an engagement, then don’t enter psychotherapy, this is not something
for you.
*
The essence of modernity is the recognition that we
don’t know what man is in a spiritual sense. We cannot say where man is going. Modern
psychotherapy is one reflection of a new phase of human culture, one in which
we acknowledge that we do not in fact have the answers to life that religion
told us we did have. We now understand that trying dogmatically to impose
solutions on ourselves, where there is in fact only ignorance, diminishes our
humanity & diminishes our faith in man.
In a culture that has given up religious dogma, man
has become an experiment again. Each of us is an experiment to see what health
for the animal man might mean. And each course of psychotherapy is an experiment,
to explore, very tentatively, what health for one particular individual might
mean.
This requires courage. It requires faith in ourselves
& faith in the future that we are creating.
Calls for the “regulation” of psychotherapy spring
from a lack of this essential faith. They arise from an anxiety that we do not
have within us the resources to deal with an unpredictable future, one that may
not be like the past.
Good psychotherapy is premised on the faith that we do
in fact have the resources within us to deal with this future. We are creative,
we can meet the uncertainties of the future, we are not just passive dependent
children at the mercy of events. Tomorrow does not have to be the prisoner of
yesterday.
Essentially, we have to decide what it is we as a
society wish from psychotherapy. Nothing would be easier, of course, than to turn
the profession into just another form-filling adjunct of the swollen bureaucracy
of health. This would be a great shame, & a great opportunity lost.
Alternatively, however, we could work to make psychotherapy
a vital & challenging part of the cultural & spiritual education of the
people, helping us to question our prejudices & comfortable assumptions,
& helping to re-open those deeper springs of our creativity which we have,
for the moment, in our timidity, shut down.
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