Some Comments on
Proposed Regulation for the Therapy Professions
Presented at City
Colleges in Dublin on March 25th 2018
as part of the conference
on
What is the Future for Counselling &
Psychotherapy in Ireland?
Chaired by Dr
Finian Fallon
Marcus Bowman PhD
I am going to make just a few brief
comments on the question of regulation for the therapy professions. This is a very
complicated subject that needs to be given a lot of thought, but I will keep my
remarks short & hopefully to the point.
I know that my remarks may seem
surprising to some people but I want to stress that my intention in making them
is not to cause upset or to shock anyone. My hope here only is to make a few
points that can be used as an opening for discussion. My concern is that we
have not to date had a proper debate about regulation & that given the
potentially significant & long-term consequences of legislation we need to
remedy this lack.
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I want to preface my remarks by saying
that I am using the terms therapist & therapy here purely in a generic
sense to refer to anyone who uses talk therapy as a way of assisting people
with emotional problems, whether they call themselves counsellors or
psychotherapists or anything else. I am not here concerned to draw any
distinctions within the field of the talk therapies in general.
Also, I need to stress that I am speaking
here only of therapy with adults. I have nothing to say about therapy with
children, who obviously need special safeguards. Adult therapy involves a
dyadic relation between two people, either of whom is free to end the therapy
at any time. Child therapy in contrast involves a triadic relationship, because
a parent or guardian is always included, & consequently the dynamics of the
process are quite different.
Indeed, my essential objection to the
current proposals for regulation of the therapy profession is that they would
turn adult therapy into a variant of child therapy by establishing an external
authority to oversee the patient-therapist relation. In my view this is
incompatible with the practice of therapy in a secular democracy.
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The first thing we need to understand is
that in designing legislation for any profession we confront two fundamentally
distinct options.
Our first option is to erect entry
barriers into that profession. This approach starts from the assumption that a
candidate for entry into the profession is not competent to practice
that profession until he or she has proven otherwise. This proof of competence
is provided by the candidate passing certain prescribed tests &
examinations.
This is how for example medicine is regulated,
& also its ancillary professions like nursing & physiotherapy, & so
on.
By & large this approach to
regulation is the one adopted in the case of any profession that is based on
the practice of the physical sciences. Alongside medicine we could mention professions
like engineering & architecture, & also trades that have traditionally
required apprenticeships like that of the plumber or the electrician.
The reason this approach of setting up entry
barriers is taken in professions like this is that it is easy to establish
tests in the physical sciences that are objective & that will give rise to
results that command a high degree of consensus. There is doubtless an element
of luck in being admitted to any profession, but in general you won’t become a
hospital consultant unless you have been able over many years to demonstrate a
high degree of technical skill in your specialty.
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Now, our second option in regulation is
to start from the opposite assumption, namely to assume de facto that all
candidates – or virtually all candidates – for entry are competent to
practice, unless they clearly prove themselves unfit to do so.
This is the approach that is taken to
most of the professions based on the human sciences, that is to say, the
non-physical sciences. It is taken here because with these sciences it is not
possible to establish objective tests of competence that will command broad
consensus.
This is why anyone is free to practice
as, for example, an historian, or an economist, or a social scientist, or a
journalist, & to describe herself professionally in such terms.
This family of professions based on the
human sciences have certain characteristics in common. For instance, forms of
employment within them tend to be quite diverse. Some practitioners work in
education, some work for government agencies, some are employed in industry,
& some are self-employed. Those who are employed by formal organizations
will of course have to meet the particular requirements stipulated by those
employing organizations. But entry into the profession as such is open to
anyone, irrespective of their formal qualifications.
Another characteristic of these professions
based on the human sciences is that they tend to form within themselves
informal schools of thought, reflecting the fact that influences &
approaches are diverse. There is, in other words, not a high degree of agreement
on what standards, or priorities, or approaches are crucial for inclusion in
the profession as a whole. This again reflects the fact that in the human
sciences, unlike the physical sciences, it is not possible to set up tests of
competence or ability that will give results that command wide consensus.
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My contention is that, with certain
qualifications, it is to this latter family of humanities that our profession belongs,
& not to the former family of professions based on the physical sciences
like medicine.
Like the other professions based on the
human sciences our field is fragmented into multiple schools reflecting the
fact that there is not broad agreement on many significant aspects of the
philosophy underlying the work we do, & therefore on what particular values
& aims we should prioritize.
I contend therefore that an attempt to
treat the talking therapies as if they belonged to the former group
rather than to the latter will not work. What is being made here is what the
philosopher Gilbert Ryle long ago called “a category mistake”.
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The current proposals for legislation for
therapy are explicitly formulated in the first way, not in the second. They
expressly treat therapy as an ancillary discipline to medicine & propose to
provide a legislative framework based on that assumption.
In other words, the assumption is being
made that we have an objective basis for establishing within the profession a
system of hierarchy & authority that will be able to command general
consensus, when in fact this crucial element for the successful functioning of
such a system is absent.
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If we legislate as if we have the basis
for a consensus on such matters, even though we don’t have this, I suggest that
certain undesirable consequences will inevitably ensue.
First of all, the arena will be set for
an intense power struggle between the various associations, groups &
factions that constitute the therapy profession as a whole as each one fights
to acquire authority in the hierarchy that the law will create.
Since we have no objective measure of who
is qualified to exercise authority in our field this will be decided by which
groups are the most effective & ruthless at political lobbying on behalf of
their own members. In the absence of an objective test of the right to exercise
authority, such as we have in medicine for instance, there is no other way the
matter can be settled.
Second, & following on from this, an
arbitrary line will be drawn through everyone who now & in the future is
practicing as a therapist. Those who are lucky enough to fall on the right side
of this line, who have membership of the groups that successfully seize power,
will be legalised. Those who happen to fall on the wrong side of this line will
be criminalised, or at the very least strongly disadvantaged in their work as
therapists. This line won’t make any distinction between good therapists &
bad therapists. On both sides of the line there will be some therapists doing
good work, & some doing mediocre work.
Thirdly, under the proposed system, some
therapists will become wealthy at the expense of others. Privileged groups
within the profession will become enriched, because they will be granted
effective monopolies in the most lucrative aspect of therapy, which is the
training of other therapists. Those dependent on these privileged groups for
legitimation & accreditation will be impoverished at their expense.
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I suggest therefore that the problem of
the design of legislation for our profession needs to be thought through very carefully
– something that clearly did not happen before the current proposals were first
made, over 10 years ago, & so far as I can see, has not happened since.
The aim of legislation in this area
should be not arbitrarily to empower certain groups at the expense of others
within the profession but rather to empower the general public vis-à-vis the
profession as a whole.
The aim should be to make the market for
therapy as efficient & transparent as possible by providing as much
information to the public as we can about therapists & the profession of
therapy.
In my view, we should not place major
restrictions on any adult person who wishes to work as a therapist. Possibly the
minimum qualification of holding a degree & having spent a couple of years as
a client in therapy would be sufficient. I think a minimum age of perhaps 30 or
35 for registering as a therapist would not be inappropriate. I don’t know.
These are things that need to be mulled over & discussed by all of us &
not just by a self-appointed minority.
But I would require anyone who chose to
enter the profession to appear on a register of therapists, which should be
available to the public. On this register each therapist would be free to
outline her education & qualifications, membership of organizations if any,
general background & experience, general philosophy of therapy, & any
other information she wishes to give about herself.
Everyone on the register would be bound
by a general code of ethics. Any therapist found to have infringed that code would
be subject to suspension from the register, either temporarily or permanently,
& the reasons for this suspension would be noted.
Each member of the public would thus have
access to all relevant information about any therapist he or she chose to
attend, & it would be up to each client to decide whether he or she wished
to attend that therapist.
In addition, there should be a concerted attempt
to educate the public in general about what therapy is, what it can
realistically achieve, what it cannot realistically achieve, & what a
member of the public should expect if they choose to enter therapy.
Such a system would not be perfect. No
system of legislation for such a complex field as ours can be perfect. But it
would reflect the reality of the world of therapy as it actually exists now
& as it will continue to exist in the future.
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In conclusion, it needs to be acknowledged
that there are many personal stresses that are unique to the profession of
therapy. We all have to deal with these as best we can, & I think if we are
honest we all manifest symptoms of these stresses to some degree.
For people of a certain temperament however,
this stress manifests itself in the form of a wish to try to control the work
of other therapists & to deny them full legitimacy. From the inception of
our profession a century ago – in Vienna – this exclusionary neurosis, if I may
call it that, has been the main blight on it. It is rooted, of course, in
unconscious fantasies of sibling rivalry & a sense of insecurity about
parental love & approval.
Our focus, I suggest, should be on developing
institutional structures that minimize the scope for this kind of symptomatic
behaviour. My concern is that the current proposals, which were not designed
with any reference at all to the very unusual characteristics of our
profession, will have exactly the opposite effect, causing us to hand on to the
next generation of therapists a damaged profession, lacking in honesty about
its own motives & distorted by its own anxieties.
Thank you for your attention.
