Consider for a
moment what would be the result of such an arrangement.
Those
candidates who were able to cultivate favourable connections with the governing
cadres within the profession & who were able to meet their demands in terms
of fees & training would be granted the right to practice. Those who were not
able to do so would be denied the right to practice. The final result would be
the drawing of an arbitrary line between those psychotherapists who were
favoured by the hierarchy, & thus legally allowed to practice, & those
who were not so favoured, who would be criminalised.
The
“regulators” defend these proposals on the grounds that the monopoly authority they
want to see set up would be able to process complaints from the general public
about particular psychotherapists. Again, this claim betrays a lack of acquaintance
with the most elementary aspects of psychotherapy.
Any assessment of the technique & general
abilities of a psychotherapist requires making a retrospective judgement about
private conversations, conversations that dealt with very intimate &
emotive subjects, between two people, the therapist & her client, of which
no verbatim record exists, & at which no witnesses were present. Under the most
favourable of circumstances this is an exercise fraught with difficulty. No
matter how carefully you conduct such an assessment you can never be sure you
have not made mistakes. In fact you can be sure you have made mistakes, because
you are forced to re-create in your imagination a series of events at which you
were not present. You can never reach more than a tentative, subjective &
problematic judgement.
Furthermore, at some point every serious course of
psychotherapy must involve challenge & disagreement between therapist &
client. There will, at times, be upset & anger on the part of the client,
& some degree of emotional stress also on the part of the therapist. It is
a part of the responsibility of the therapist to ensure this happens.
Now let us put ourselves in the place of the Committee
of Wise Men & Women proposed by the “regulators” who are to ensure that
only “qualified” psychotherapists are to practice. Suppose we have to consider
a complaint from a therapist’s client & are now faced with the task of
assessing the course of psychotherapy in question. What objective basis do we, necessarily
excluded from that course of therapy, have for distinguishing between justified
challenges made by the therapist to the client, that the client will, inevitably,
have found in some degree upsetting, & criticisms or verbal attacks that
reflect only the therapist's own insecurities or technical failings?
The answer is: we have none.
If a client makes a formal complaint to us, how then are
we to judge to what extent the complaint is justified?
How are we to know, for instance, to what extent we
are simply looking at a poor match between therapist & client, a clash of
incompatible personalities, in fact?
How are we to know to what extent the therapist was just
tired or stressed & doing poor work at the time?
How are we to know to what extent the client was
simply too lacking in self-critical abilities to respond to what were in fact good
& insightful interventions on the therapist’s part?
On the other hand, how are we to know to what extent the
problems that the client was bringing to the therapy were particularly upsetting
to the therapist’s personal insecurities & anxieties, & caused her to
react to them too much from a personal point of view & with not enough professional
detachment?
From yet another point of view, how are we to know to
what extent the freedom the client experienced to express his anger with the
therapist acted in fact in a liberating way for him from things that were
holding him back?
What grounds do we have for assuming the conclusion of
good psychotherapy should be mutual congratulation between therapist &
client, rather than, for instance, a deepened mutual scepticism?
The short answer is, we don’t have any. A therapist
who is producing disciples & converts is a therapist who is failing in her
job.
We cannot answer questions of this nature in any other
than the most tentative & uncertain way. They remain always a matter of
subjective judgement, & every good psychotherapist is perfectly aware of
this.
Yet it is on the basis of such unreliable answers that
the “regulators” propose either to allow candidates to practice as therapists,
or, it might be, to disbar them.
How things
would work in practice, of course, is that complaints against well-established
& well-connected therapists would, in the main, be set aside. No one is
going to cause professional embarrassment to a friend, still less vote her of a
job. But, in order to reassure the Minister that the authority was energetic in
fulfilling its responsibilities, complaints made against those therapists less
established, more distant from, & less favoured by, the ruling elite would,
in the main, be acted upon. Such an outcome as this is inevitable because, to
repeat once again, we have no objective basis for assessing the competence of a
psychotherapist as a psychotherapist.
Other problems
would be created too. Given such an authority as the “regulators” propose, the
internal politics of the profession would come under the sway of the larger
politics of the State itself. An authority that relied for its mandate on the
Minister for Health, who is elected by the public, would not be in a particular
hurry to endorse candidates for psychotherapy who were known to hold unorthodox
views on mental health, or views that might not run well if reported in the
tabloid newspapers. The discussion of mental health by professionals in general
would start to be compromised by what was politically acceptable in the larger
sense. Psychotherapists & candidates for psychotherapy would learn to
self-censor their views to stay politically correct. The very spirit of
psychotherapy, which depends on the courage to speak uncomfortable truth to
complacent power, would weaken & fade.
The
establishment of such an authority would in short make the profession of
psychotherapy as a whole more corrupt, more bureaucratic, & less responsive
to the needs of the public.
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