Presentation to What is the Future for Counselling & Psychotherapy in Ireland?, City Colleges, Dublin, March 25th 2018

Some Comments on Proposed Regulation for the Therapy Professions

Presented at City Colleges in Dublin on March 25^th 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.

The Freud Wars Revisited: A Response to Louis Menand’s “Why Freud Survives” in The New Yorker

Nietzsche once remarked that there is a joke concealed within Kant’s philosophy: that he set out to prove what the man in the street already believes, but in a language so obscure that the man in the street would find it completely dumbfounding.

One might say that there is a joke concealed in Freud’s work too, though it is roughly the opposite of this: that he set out to show how little the average educated man actually understands himself, but in a language so clear that the average educated man is convinced he now really does understand himself, but is convinced at the same time that Freud was deluded.

I exaggerate, of course. But perhaps not greatly.

It came to my mind while reading Louis Menand’s recent essay on Freud & his critics in The New Yorker magazine (28^th August 2017). Although boldly titled “Why Freud Survives”, it is not at all clear why Menand thinks he does survive. There is no accusation that has been levelled against Freud in the last fifty years against which Menand shows the slightest inclination to defend him in even the most qualified degree.

The specific occasion of the essay is a new book by long-time Freud critic Frederick Crews helpfully reminding us again in case we had forgotten what a monster the founder of psychoanalysis really was.

Menand raises an urbane question mark over the intensity of Crews’ personal obsession with Freud & he is ironically aware that Crews ends up trying to debunk the founder of psychoanalysis by subjecting him to a version of psychoanalysis of his own. But it is clear nevertheless he largely agrees with him that Freud was in essence a fake.

Menand records again much of the criticism Freud has been subject to in past decades, though most of this is now over 30 years old. At the same time he signally fails to note how much of this criticism has been shown to be unjust & misconceived. Evidently the assumption is that if you go on repeating a charge long enough eventually you will persuade yourself it is true.

According to Menand, for instance, “historians like Henri Ellenberger & Frank Sulloway pointed out that most of Freud’s ideas about the unconscious were not original, & that his theories relied on outmoded concepts from nineteenth-century biology.” This is simple nonsense & reveals Menand to understand nothing about psychoanalysis. In focusing specifically on conflict within the unconscious, which is the key innovation that makes psychoanalysis  what it is & distinguishes it from everything else, Freud had no predecessors in the clinical study of the unconscious, & among the philosophers only Nietzsche anticipates him in this regard. As to biology, Freud uses this always as a general backdrop for his thinking & as a source of metaphor but his characteristic ideas in no way depend on abandoned biological theory.

Menand goes on to repeat without any caveats the assertion by Peter Medawar, described as is now traditional in this kind of literature as “the Nobel Prize-winning medical biologist” so that he can serve as a kind of all-purpose genius, that psychoanalysis is “the most stupendous intellectual confidence trick of the twentieth century.” As for Adolf Grünbaum’s often cited The Foundations of Psychoanalysis, Menand judges this to be “a dauntingly thorough exposition designed to show that, whatever the foundations of psychoanalysis were, they were not scientific.” And so on.

Menand either does not know or does not care that all these attacks have long ago been subject to penetrating criticism. Anyone seriously interested in studying the problems with these writers & many other of the Freud critics could do worse than to start with Walter Kaufmann’s Discovering The Mind: Freud,Adler & Jung, Paul Robinson’s Freud & His Critics, & my own The Last Resistance.

For Menand however the notion that Freud brought about a genuine revolution in the way we understand ourselves was always an illusion. “For many years,” he remarks, “even as writers were discarding the more patently absurd elements of his theory – penis envy, or the death drive – they continued to pay homage to Freud’s unblinking insight into the human condition.” To which the obvious response is: which writers does he mean? Apparently for Menand anyone who has found Freud’s ideas to be fruitful can only be the bamboozled member of a mindless cult, incapable of looking for anything other than confirmation of the master’s pronouncements.

I first began to read Freud when I was a teenager & Penguin Books began to publish most of the Standard Edition in paperback form, starting with the Introductory Lectures. I remember at this time, in the mid 1970s, wise adults gravely explaining to me that Freud had now been superseded by more recent advances in scientific psychology & that his theories were being abandoned by serious scholars & thinkers. I made little protest at this, because I did not believe it. The extraordinary clarity of thought in Freud’s writing & the clear applicability of the ideas to everyday experience seemed to me then the work of genius. More than forty years later they still do.

Over those years I have continued to study & reflect on Freud, first informally for my own interest, later as a doctoral student & in several years of personal analysis, &, for the last twenty years or so, as a psychotherapist doing what I can to help my own clients.

After all these years I am not sure, by any means, that Menand’s examples of penis envy & the death drive are not mistaken hypotheses. But I know for sure they are not “patently absurd”. Anyone who imagines these ideas are not profoundly compatible with a great deal of what we observe in human psychological life is simply unaware of the evidence, or doesn’t want to look at it.

What is so revealing is that such a supposedly sophisticated commentator as Menand should experience not the slightest need even to attempt to justify dismissing these complex & difficult notions. Menand, because he regards himself as a literate man, assumes therefore he must also know enough to know these things are not worth taking seriously.

The great bulk of writing on Freud in our culture is of this nature. The clarity of Freud’s words &, above all, the fact that he writes on things that touch us all most intimately – childhood, parents, siblings, the sexual life, anxiety, envy, death – persuades almost every educated man & woman who approaches this work that he or she must in some inherent way, & without the need for much careful reflection, be in a position to know on what matters Freud was right & on what he was wrong. On the validity of quantum mechanics, or even on the validity of the theory of evolution, most of us are conscious enough of our ignorance of the evidence to maintain an agnostic silence. But on the validity of the Oedipus Complex we are all born experts. Or so we assume.

Menand goes on to write, with a further display of psychological expertise: “It can be useful to be made to realize that your feelings about people are actually ambivalent, or that you were being aggressive when you thought you were only being extremely polite. Of course, you shouldn’t have to work your way through your castration anxiety to get there.”

Menand knows that “of course” we shouldn’t have to do this because – well, because he is a literate & scholarly man.  

But in truth, there is no “of course” about it. Castration anxiety is a symbolic expression for the fear of parental, & later societal, punishment for trying to be true to one’s own nature. None of us can start to come to terms with our ambivalence & none of us can contain it until we have addressed & tried to be honest about this most basic of all human fears that lies at the root of it.

Freud has been very controversial from the beginning. But what are now referred to as the “Freud wars” began in the late 70s & early 80s around the time Jeffrey Masson, who had been given the task of editing the definitive version of Freud’s letters to Fliess, claimed that Freud had deliberately concealed sexual abuse among his patients, & with Frank Sulloway’s bizarre charge that he had concealed the biological basis of his psychological theories.

At the time both were sensations, in the book review sections at least, because they satisfied a craving for evidence that Freud must have “concealed” something. We accept as a matter of course that genius by its nature is never transparent. But we find this very hard to accept in the case of Freud who seems so skilled at uncovering our own secrets. We resent this. And this is why the literature revealing all the ways Freud was a moral monster has flowered so vigorously. We want his secrets out, just as he has forced our secrets out.

Despite some cooling down in recent years the wars have continued on & off in this vein pretty much ever since: eccentric & ambiguous accusations are made, framed in sensational terms, relating to Freud’s abuse of the evidence, or his abuse of his patients, or his abuse of his colleagues, or his misunderstanding of science, or his personal sexual life, that turn out always to have no relevance to his substantive ideas. And this is why the Freud critics – by which I mean here those who have turned attacking Freud into a career or vocation in itself – have had no impact on the development of psychotherapy. Their work is animated not by a serious engagement with Freud’s thought but reflects rather an intense emotional transference to his figure that they cannot overcome in themselves. The ironical thing is that nothing has done more to keep Freud alive in the mind of the educated public than the extraordinary love, we cannot call it anything else, these critics have for Freud.

A case in point is Adolf Grünbaum’s The Foundations of Psychoanalysis from the 80s. Though described by Menand as designed to show that the foundations were not in fact scientific, a closer reading of the work shows that it is much more ambiguous than this. Supposedly questioning Freud’s scientific credentials, Grünbaum in fact fiercely defends him against any other philosophers, like Karl Popper for instance, who have questioned his understanding of science. The true story of the book is Grünbaum’s intense possessiveness of Freud, who he sees in a father & son rivalry with himself alone for the deeper understanding of science.

Subscribing to what is now the conventional wisdom on this subject Menand writes in his casually dismissive way that “from the beginning, Freud was a lousy scientist.” Poor old Freud, bottom of the class again. 

At the same time however Menand is too canny not to realize that there is throughout the critical literature of psychoanalysis an idealization of what science is & what it does. Here, for once, he identifies something genuinely significant.

The ultimate origin for this idealization is the philosophy of Kant, where it serves the purpose of leaving a space free in the universe in which moral dogma can live unchallenged by scientific questioning. What we have learnt from Freud is that when science finally invades that formerly sacrosanct moral space it no longer looks the way classical mechanics suggests it should look. Things get messy, & they get emotional.

At the deepest level, this is what the Freud wars have always been about.

They are not about whether Freud was sometimes economical with the truth, or whether has was having an affair with his sister-in-law, or whether he made a hash of understanding scientific method. They are about the fact that Freud showed us how to criticize our moral presuppositions. They are about the question of how we are going to live, & how we are going to organize the often conflicting inclinations within us in a world in which moral certainties have given way to ethical dilemmas. The Freud wars are just one expression of the crisis that has been brought about in modern life as a result of the disappearance of that ethical space in which motivation seemed certain & transparent, & right & wrong seemed absolute.

The deepest artists & philosophers before Freud could see that this ethical space would not survive the end of Christianity. But it was Freud who did the demolition work in public view when the time finally came. Some people have been able to adapt to this fundamental change in cultural life but some have found it very difficult, & among these are the Freud critics. They cannot make peace with the man who has become the symbol for the coming of the age of moral ambiguity.

The argument therefore is not an intellectual one that will be resolved eventually through some new piece of evidence about Freud or about psychoanalysis.

It is on the contrary a debate between two different kinds of human temperament. It is between those for whom the most important & rewarding thing in life is now the challenge of mastering the self in a world that has become essentially uncertain, of acquiring ever deeper insight & access to ourselves & to whatever resources Nature has given us, and, on the other hand, those for whom such a challenge is alarming & repugnant, who, in our post-Christian world, cannot come to terms with being morally orphaned & who, in spite of themselves & to their own distress, cannot stop looking for a formula that will tell them how to live – whether this be in religion, or in some idealized notion of Science, or in Marxism, or in Feminism, or indeed as many of them previously did, in Freudianism itself, and who cannot live without someone to blame for the fact that life forever leaves them dissatisfied with their fate because it now refuses to give them certain answers.

But for those of us who now believe that moral uncertainty & ambiguity are the price of emotional maturity Freud was a genuinely great man & he is one of the great provocations & inspirations to personal autonomy. We are perfectly aware of his flaws as a man, & we are very clear on which aspects of his theorizing we think doubtful or certainly mistaken. But because we do not need him to be a god, we are not in a perpetual state of rage because he fails to be one.

Those who have made careers out of attacking Freud have missed the message Freud leaves our whole culture, because they are unable to respond to it. And that message is this:

“I have tried to be as honest as I can about the disturbing emotions I have discovered in the depths of my own mind & in the minds of others. In spite of the mistakes I have made, as every human being who has the courage to attempt something new will inevitably make, I have tried to be as honest as I can with myself without losing control of myself & without ceasing to work to form myself into the kind of human being I think Nature wants me to be. - Now, can you show me that you are strong enough to try to do something similar with your own life …?”