The Future of Therapy in Ireland

Malachy Kinnerney talked to Mary Montaut

I was very pessimistic up to a few years ago. My biggest fear ten years ago was
 that therapy would become monolithic, and I’m glad that hasn’t happened. I know
 fragmentation can be very damaging, but I think in Ireland the fragmentation is
 working to good effect, in that it has prevented a monolithic take-over of therapy.
 I was really worried about that and I felt that there was either a conscious or a semi-
unconscious move on the part of the religious establishment to try and get their 
hands on this movement. Now I think that battle has been won, and that they’ll 
never be able to do it now. But having said that, one concern that I do have is that 
quite a lot of what I call ‘ex-religious’ are filtering into the profession and trying to 
use therapy as a route towards evangelisation, conversion and a wishy-washy 
spirituality. One of the things that I would like to see in the future is a sound 
psychology, a sound therapy and a sound spirituality, but not a watered-down 
spirituality or a watered-down therapy that does not do justice to clients. My fear
 would be that we would get a lot of the distortion that we’ve seen in religious life
 filtering through a wishy-washy spirituality. This isn’t really just a battle of
 secularity versus religion, it is really about a wholesome attitude towards human 
beings, that has won out and that institutionalised religion cannot now take over.


Men and Therapy


I’m positive about the outlook because I feel that counselling and therapy together
 have helped the Irish nation to grow up and especially helped women. By and 
large. I am more pessimistic about men in relation to counselling and therapy,
 however. I do feel that, for whatever reason, it has not impacted yet on the male
 section of Irish society. I feel a bit disappointed about that but I’ve seen little or
 no change in the ten or fifteen years I’ve been involved in the world of therapy. But
 then of course, I do believe the future is by and large with women anyway. I think 
they will change the men ultimately, both in politics and social life, and in
 emotional life. It’s around the area of emotions that they will have the largest
 impact, whether it’s in individual relationships or in institutions.

Need for an Ombudsperson


One of the things I would like to see is the provision of counselling and therapy in 
the Health Service. I feel that there should be access within each Health Board to
 a body of counsellors, and that counselling (and I don’t mean Guidance
 Counselling) should be available at primary, secondary and third level schools and
 colleges and in adult education institutes as well. Of course, that means that there 
should be a move to also provide therapy through the VHI. In relation to that, I 
feel therapy and counselling are now affecting so many people’s lives – we’re
 talking about child abuse, divorce, abortion, adoption, etc. – and there is so much 
money involved in it. that if it were in any other area, somebody would have been
 appointed by now to oversee it. And while I wouldn’t like it to be over- institutionalised, I feel that there are now so many people’s lives at stake here. I 
would call for an Ombudsperson to oversee the various bodies at voluntary,
 community and professional level. There should be access to an Ombudsperson
 where clients or organisations feel that they have been abused, or where
 organisations set themselves up without clear and adequate criteria.

Access to Counselling

An example would be Guidance Counsellors in schools, who really do more 
guidance than counselling and actually promote people towards third level and job 
appointments. Now, whether schools have a high academic achievement or not,
 counsellors are needed in the schools. There is a lot of emotional disadvantage, a
 lot of disturbance, a lot of break-down in the families and communities, and so on.
 So I would be asking that counselling should be established on a separate track 
from career guidance in education, for the emotional, social and psychological
 development of pupils, students and trainees. 
Similarly in the Health Service, where people are not in the VHI, local community
 services would be able to provide some counselling and therapy on the medical
 card system, just as with any other illness. I suppose the fact that in Ireland we 
don’t have therapy or counselling on the VHI does suggest a block in the psyche 
somewhere, that it’s OK to break your arm on the VHI, but it’s not OK to have a 
nervous breakdown, emotional or psychological upset. Interestingly enough, you 
may get support if you’re an alcoholic or a drug-addict, but you will not get support 
if you have been severely abused, rape victims are not properly provided with
 support, nor are battered people – a whole range of people are excluded from 
psychological healing. It’s as though we have this split still permeating our 
ideology and social approach, that the physical can be looked after, but we don’t
 want to get involved in the emotional and psychological well-being of people.

Support Teams

Luckily we haven’t had any major disasters here as they have in Britain, but I’ve 
been reading a lot about the team supports established there, and I dread to think
 what would happen here if we had a major disaster. When we have had examples
 of abuse in institutions, there has been no team to deal with this. I am calling for 
a national task force that could go to a disaster, like the fire at the Stardust in the
 early eighties, and certainly within each region there should be a pool of
 counsellors who could go at a moment’s notice, like the fire brigade, if the 
community says it cannot cope, as in Omagh for example. The team would be
 there, so that support can be provided. I think that would be something quite useful
 for the future in the various regions of Ireland.

Need for More Integrative Approach


At the moment, there is an absolute obsession with the
 accreditation/professionalisation of counselling and I think that people are either
 in denial or dismissive or indeed antagonistic towards the massive amount of
 counselling that goes on in the voluntary sector, in the community and in the 
established professions like teaching, nursing and so on. It’s as though these 
voluntary people are being treated almost as subservient to the big, accredited
 individuals, who have paid enormous sums of money for their qualifications and 
who are addressing themselves to a pretty narrow band of society – the YAVIS (the
 Young, Articulate, Verbal, Intelligent and Sophisticated). That’s by and large the 
clientele that they are addressing. Even though the professional counselling 
organisations are in powerful, self-regulating positions and have tremendous 
independence, I am very concerned that they are not promoting counselling at all 
levels of society and at all stages, whether voluntary, community, semi-
professional, clinical, and so on. I feel very strongly that the Samaritans are
 dismissed, the Rape Crisis Centres are dismissed, and the Child-Lines. I think the
 backbone of counselling ultimately is very much with the voluntary community 
sector. Very often front line people who are not ostensibly counsellors, are in a 
tremendous position to help people in all sorts of situations through support groups 
and so forth. I would like to see a more cohesive and integrative approach – we
 have it within therapy, why not on a social, educational and geographical level?

Resistance?

When there is a major issue like child abuse or divorce or abortion, these
 professional organisations lie low. They will never stand up and be counted even 
though they have the resources and the woman power and man power, they have 
the education, qualifications. I feel that there is a discrepancy of some kind. They
 say very little in the national press – for instance, about battered people, or the poor 
service offered to rape victims who have to wait endlessly on waiting lists for
 counselling, support and therapy. In a way the Yuppie mentality seems to have
 filtered through to the counselling and therapeutic community. They do not want 
to be challenged, and would probably resist very strongly the appointment of an
 Ombudsperson. Individualism rules within and outside of the therapy room. I
 wonder whether it is because most accredited practitioners are generally working 
in isolation, that they don’t seem to take part in the political life of society. 
Needless to say, you can’t bring the political into the counselling room, but there
 is no justification for not bringing it up outside of the room. It’s not inappropriate 
for groups of therapists or counsellors to campaign on social, political, moral and
 economic issues affecting them and their clients.


Medicalisation

My other area of concern would be the psychiatric profession. Again the
 counsellors and therapists have not campaigned with outrage at the way that 
patients are still being ‘treated’. To give you an example, a young woman was 
admitted to a psychiatric insitution a few weeks ago. and she was put in a male 
ward with perhaps ten or twelve males in various states of psychiatric disorder and 
alcoholism. Needless to say, she was quite disturbed anyway, but when she was 
put in this ward, she ‘freaked out’. She was taken by four men, pinned on the bed
 and injected. She subsequently ran away from that institution. This is 1999. but
 it’s like a spectre out of One Flew Over the Cuckoo’s Nest! So it would seem that,
 even though we’ve had therapy courses established in places like St Vincent’s and 
available to a lot of medical personnel, they have had little or no impact on the 
medicalisation and chemicalisation of treatment. In a way, again, the therapy 
organisations have been very reticent in challenging this publicly – politically,
 socially, in terms of lobbying and so on. It doesn’t cost a lot to put letters in the
 paper, it doesn’t always have to be Ivor Browne or Michael Corry! A group of
 well-established counsellors could make themselves heard, if they were to say that 
they are very concerned at the way doctors and psychiatrists in general are still
 looking to ‘a pill for every ill’, rather than a skill. I am very worried about that.
They seem to work on the principle or paradigm that it’s either pills or counselling,
 them or us – whereas any enlightened therapist now would take it for granted that 
in some cases people do need medication, but only as an aid to help them talk out
 and tell their story and reach the core. Likewise an enlightened person nowadays
 in the medical-psychiatric establishment ought to realise that once they have taken 
this person to a stage of equilibrium, they should send them to where they can tell
 their story. Most people who are medicalised are actually put on ‘hold’, it’s like a 
tape recorder where the ‘pause’ button is pressed but never released to allow the 
person to rewind, start again and move forward.

Removal of Stigma


I am very pleased about the currency and popularity of counselling. I remember
 when I started training, many people did not even know what the word meant! The
 truth of counselling as a talking, healing procedure has really triumphed – even
 though the psychiatrists are carrying on in their own world! The battle has been
 won in Ireland. If we have anything to thank the religious for, it might be the 
confessional, because the priests placed themselves as ‘doctors of the soul’,
 whereas the others called themselves ‘doctors of the body’. In a weird way, the 
doctors of the soul and doctors of the body have both lost their credibility and by 
and large, the general mainstream of society now does not see a person going for 
counselling as having a stigma of any kind. One of the tutors here at ACCEPT, 
who also works at a university, told me that the people who come in for counselling
 there now feel that it is like asking for a grant or for their rights in housing and 
accommodation – it’s a normal thing, they can just come in to talk – whereas the 
older generation perhaps still feels the stigma and fear around therapy. It makes 
me optimistic to see that young people are in touch with their feelings and have 
been brought up to talk from a different centre than I was allowed to do. They have
 a self-confidence earlier in their lives, that many of us had to fight to get and so 
there is still a defensiveness around even that kind of confidence.

The Irish Approach

I mentioned earlier that I am worried about the way therapy does not seem to have impacted on men in our society, and very few politicians – who are mostly men -
 seem able to address emotional and psychological issues. But that’s where the 
future lies – men are not yet able to speak out. Anonymity is difficult in Ireland, and this may deprive a lot of people from having access to counselling. But there
 is a certain maturity coming about in Irish society, and within the field of 
counselling and therapy the Irish approach is not only mature but it is very 
different. I’m delighted to see that, just as we avoided becoming a British clone or
 slavish follower of the BAC model, neither did we adopt the highly legalistic and 
technological American model, but somehow or another we have achieved an 
easier approach that spans American, British and European trends. Most of the 
therapists in Ireland now, I feel, don’t have the fanatical orthodoxy that we see in 
other countries. There is a fluidity about therapy in Ireland, and somehow our 
genuine tradition of story-telling has come through – therapy is seen as story-telling
 which can tune into this ancient tradition. I think that’s the special Irish
 contribution to counselling and therapy centres around the concept of ‘story’, told,
 heard, understood, believed and responded to with warmth, empathy, humour and
 compassion.

[Malachy Kinnerney is Director of ACCEPT Counselling Association of Ireland.]