Formalization and First Voluntary Register of Psychotherapists
Friday 24th November 1995, Killiney Court Hotel, Co. Dublin.
The launch of the voluntary register of the Irish Council for Psychotherapy was certainly an extremely important event for psychotherapy in Ireland, notwithstanding the small number of people who gathered and the quietness with which the launch was carried out. The ICP chose a conference format, with papers by the External Relations Officer of the United Kingdom Council for Psychotherapy, Professor Emmy Van Deurzen-Smith; by Mary Banotti MEP (who also spoke at the inaugural meeting of the ICP, then the Irish Standing Conference on Psychotherapy, reported in Inside Out No.10, Autumn 1992); and by the incoming Chairman of ICP, Ger Murphy. The work of the ICP since its inception as ISCP in autumn of 1992 has been steady, intense and very little reported.
The meeting was opened by the retiring Chairman of ICP, Dr Michael Fitzgerald, who gave us a brief history of the organization with amusing insights which only the founder and chief instigator could have known. The cups of tea at the Burlington Hotel which began it all – the immense work of organizing everybody which fell on the shoulders of the Secretary, Ruth O’Donnell (who is also retiring now) – the “fizzling out” of the first attempts to form a European Association – the continued resistance of the VHI to acknowledging a role for psychotherapy – Michael lightly touched in the history of the Conference for us, before expressing his hopes that it would remain flexible and inclusive in style. For example, he considered it was a pity that there is a decline in the number of members who are also doctors. This, he felt, was impoverishing – perhaps literally, since doctors are often in control of funding. He expressed the hope that people would not, on becoming psychotherapists, forget their old professions. The rich variety of “core” professions from which therapists come, he pointed out, makes for a broadly based and dynamic Council. Lastly he introduced the members of the Council from the different sections, Psychoanalytic Psychotherapy; Family Therapy; Humanistic and Integrative Psychotherapy; Constructivist Psychotherapy; and Cognitive/Behavioural Psychotherapy. There was a brief presentation to Michael and Ruth in appreciation of their service to the Council before the meeting broke for coffee.
After the break, the new Chairman, Ger Murphy (IAHIP) welcomed everyone to the first formal meeting of the ICP. Godfrey O’Donnell then introduced Professor Emmy Van Deurzen-Smith who spoke about “The European Dimensions of Psychotherapy and Some Thoughts on the Direction of Psychotherapy.” She offered the ICP the congratulations of the UK Council for Psychotherapy, of which she was Chairman for two years. She commented on the fact that it has taken psychotherapy one hundred and fifty years to “take itself seriously as a profession” – the first World Conference of Psychotherapy will be held in Vienna in July 1996, thus marking a century and a half after the birth of Sigmund Freud in 1856. She asked, “Why has it taken us so long?”
Perhaps, she suggested, there is a tendency for psychotherapists to focus solely on individual, internal process and to forget the wider social context in which they work. She admitted that it was strange that the well-being of “souls” is not particularly high on the agenda of social improvement, perhaps because psychotherapy has not taken its place alongside religion in this specific area. She told us that psychotherapists are not yet doing enough to alleviate the distress in society. The launch of the Register, she viewed as a sign of professional seriousness, raising the profile of psychotherapy in the public awareness. After the launch of the Register in the UK, there had been a great increase in public interest in psychotherapy and a corresponding increase in criticism as well. In some quarters, the growth of psychotherapy was even seen as; a threat. She emphasised that, once in the public eye, it is important for the profession to show it can regulate itself, since the media, for example, are likely to become preoccupied with the harm that therapy may do. She explained that the formation of the UKCP was begun more than twenty years ago, following the Scientology scandal in Britain. The UK Register, launched a few days before the ICP Register, had taken twenty-two years to achieve. She congratulated the ICP on launching its Register after less than five years.
Professor Van Duerzen-Smith then explained the links of the UK Standing Conference on Psychotherapy with the British Association for Counselling. In fact, the BAC had facilitated the Standing Conference greatly, even making their HQ at Rugby available (hence the title which most people would know it by, the Rugby Standing Conference). In fact those early meetings of psychotherapists had been rather reminiscent of rugby football, she thought: a lot of dogmatic people coming together to contest issues rather than to agree. The parallel with religion, where training would be seen more as a form of indoctrination, was also apt. She reminded the meeting that the evolution into a profession would require a moving away from dogma, and acceptance of the need for scientific research and standards to apply. The profession needs to become more centrally governed if it wants to have statutory regulation, particularly since the threat of European legislation has been apparent for some time. She stressed the real need for the profession to be seen to provide a good service to the public, to increase public access to psychotherapy, to acquire posts in the public services such as health, since the level of distress in society is increasing so markedly (family break-up; substance abuse; homelessness; depression, all increasing). A recent survey among GPs in Britain showed that the doctors themselves considered that one out of six of the patients they see would be better served by a counsellor/psychotherapist than in the surgery.
Speaking with impassioned sincerity, Professor Van Deurzen-Smith pointed out that Counselling and Psychotherapy is the only profession which gives insight into the human condition. There are, she reminded us, fewer and fewer safe places for distressed people to go and look at their lives and at life. Indeed, it is a very unpopular thing to do – people are continually told to stick in there, not to think “too much”. As a profession, therapists must speak up and let others know the resource which is available for them. Of course, this is not a “miracle cure” for social ills, but as a profession, she stressed, therapists must not underestimate themselves. At present they seem to identify too much with their clients, they stay on the margins, working almost secretly in their private practices. This is no way to redress the public confusion between “psychiatry”, “psychology” and “psychotherapy”; indeed, she pointed out, there are so many strands within psychotherapy itself that the profession has still not arrived at a satisfactory definition of its work.
The clear antidote to this confusion would be a professional body which would speak out in public, and a commitment to research which would prove (even to politicians) that therapy can cut the costs to society of ill-health, crime, etc. Unless complex and long-term research projects are undertaken, therapists will not be listened to by governments. The profession must also prove itsetf to be accountable. It is only when you have a professional body that money for research becomes available, and gaps to be filled in the social structure become apparent.
The major threat to the development of psychotherapy as an independent profession in Europe is posed by the established psychologists, who wish to see psychotherapy designated a “secondary” qualification (ie, added on to a basic psychological one). Germany and the Netherlands seem to be heading this way. On the other hand, Austria, Belgium and the UK would oppose this direction. Professor Van Deurzen-Smith emphasised how important it will be for the future legislation in Europe that there is a unified voice. The European Association for Psychotherapy (EAP) has been formed to look after the interests of the profession in Europe, with Professor Van Deurzen-Smith appointed to look after Brussels (DG15). She has been promised a meeting for psychotherapy representatives alone, next year; it is vital that the independence of the profession of psychotherapy is defended in Europe. In principle it would seem that Brussels is not in favour of the “add-on” model of training which the psychologists are pressing for. It would be in any case extremely elitist, because it would entail more years of training after the basic five years to train in psychology, making it difficult to regulate. She stressed how important it will be now for psychotherapists in Ireland to make their views known, to establish their independence and to get adequate representation in Europe. At present, the EAP is working on a European Certificate in Psychotherapy and it would appreciate input from Ireland. From the UK point of view, she noted that there is a tendency in Europe to go for more elitist standards and she expressed the hope that the ICP and Irish psychotherapists would make their voices heard in EAP. The danger of fragmentation and a proliferation of bodies in this field is very real, especially since it would obscure the real threat to psychotherapy as a profession, which is the aims of some psychologists in Europe to subsume it. She looked forward to co-operation between the UKCP and the ICP in the future.
After this very impassioned and, in its way, political speech, there was a “buzz session” where the members of the audience (by this time, about fifty people) were invited to talk among themselves and especially to talk with people from different sections. The idea of this “buzz” was evidently to bring the different sections together and increase the sense of common purpose within the ICP, but in succeeding in these objectives, I felt this session had the unfortunate side-effect of distracting people from the vital points of Professor Van Deurzen-Smith’s presentation. The questions which followed were about the relationship of counselling and psychotherapy, more information about the proposed European Certificate, “grandparent Clauses” for membership, admission of new sections in future, all of which the Professor answered in some detail. But it was only then, as the session was nearly at an end, that unease about the “strong central body” and its powers began to show itself. Anxiety about the bureaucracy began to surface – how would the European Certificate include the social dimensions, or the “soul”, which the Professor had mentioned earlier? If the organization became completely centralized, how would its power be controlled? The Professor candidly admitted that these are real problems, and that she herself had felt, when she was Chairman of the UKCP, that she had somewhat lost touch with the grass roots. Dialogue and debate, she hoped, would help to lessen this divide. But the most pained question followed a point which the Professor had made in passing, about the UK arrangements. She had told us that a lead body is in place to set up a National Vocational Qualification in Counselling/Therapy. These NVQs would be at four levels: i. Advice, ii. Guidance, iii. Counselling and iv. Psychotherapy. They would be based, not on courses and numbers of hours (like the present qualifications) but on “competency testing”, which apparently means that candidates would be assessed simply on the level of skills they could demonstrate to the examiners. The questioner professed to be “terrified” at this kind of proposal for psychotherapy, and the “buzz” around the audience meant, I thought, that she was not alone in this. However, it does seem likely that some form of “competency testing” may ultimately be favoured by Europe and hence that some conformity will be required. Professor Van Deurzen-Smith stressed that she believes it will be twenty years away – another generation, as she put it. But she clearly believed that this would be the likely direction in the long term.[On this point, the information I have received from Mr Malachy Kinnerney of ACCEPT (Irish Representative on EAP Board) is that the NVQs will be in place from 1996 in Britain, through the Open University and the City & Guilds examinations among other providers, and that the structure is actively being considered here in Ireland under the aegis of the National Council for Vocational Awards (NCVA). The EAP is in the process of developing criteria to meet EC Education Directives on this subject.]
Just before the audience at the conference thanked Professor Van Deurzen-Smith for her extremely stimulating and informative paper, there was one last “observation” from the floor which I cannot resist reporting. Why, mused the observer, are there so many women in this audience? Quick as a flash, the Professor replied with an observation of her own. “Women make up nearly 80% of the profession, and yet 80% of the representatives of the profession are men. What do you make of that?” Amidst laughter and applause, one of the most important and unspoken issues of psychotherapy was consigned for future discussion – as usual!
Later in the day, the new Chairman of the ICP, Ger Murphy, read a paper which clarified and defined the role of the ICP. He pointed out that it differs in several important ways from the role taken by the UKCP, and in particular that it is less centralized, but acts as an umbrella organization for the five member sections. Thus, for example, accreditation, ethics, training, complaints and appeals procedures are not centralized but are left to the management of the individual sections. On the other hand, the ICP will take on those functions which concern all the sections, such as negotiations with government agencies, representation of the profession at European level and general overseeing of the five member sections in accordance with the federated structure agreed by all of them.
In February of this year, Ger told us, he represented the ICP in Brussels at an EU Commission meeting about the Mutual Recognition of Diplomas, in the capacity of expert adviser to the Irish Government representative (currently a senior executive from the Dept. of Education). The chief concern of the Commission seems to be the free movement of labour within the EU, and they are not seeking to regulate the profession centrally. Their concern is to establish equivalence between countries (presently governed by European Directive 89/48 which deals with professions where a minimum of three years third level study is required). Eventually the Irish Government will be asked to designate a competent authority to judge equivalence for psychotherapists wishing to enter from other countries, and this will also entail decisions about the payment of psychotherapists from Government funds, such as insurance. The ICP is holding regular meetings with the Dept. of Health in order to achieve the following objectives:
1. To have the ICP designated the competent authority on psychotherapy in Ireland with a view to assessing equivalence for psychotherapists coming into Ireland from other member states;
2. To have the grade of psychotherapist established within the Health Service;
3. To have the ICP established as an advisory body to the Dept. of Health about psychotherapy in the meantime.
The Chairman was evidently pleased to report the progress on two of these fronts – that twice-yearly meetings with Dept. of Health representatives have been agreed, and perhaps even more significantly, that a post has been advertised for the new grade of “psychotherapist” in one of the Dublin hospitals.
As the full scope and volume of the work undertaken by the ICP became apparent, it also became clear why this launch, important though it was, might seem a rather quiet occasion. There is still work to be done within the five sections themselves to complete the regulation of their individual organizations with constitutions, codes of ethics, complaints procedures, etc. The Chairman reminded the sections that the date of January 1997 has been set for completion of these tasks. Only then will the ICP be in a position to make a full, public launch of the Register, supplying copies to public libraries and making it available for everyone. Even so, the presentation of copies of the voluntary register to the representatives of each section marked a most important step on the way towards full recognition for the profession of psychotherapy in Ireland.