From Here to Eternity

by Sarah Kay

In  response to Ed Boyne’s article on ‘Government policy on the role of psychotherapy’ (Inside Out Autumn 2006), I would like to thank Ed, who was invited to be part of an Expert Group, for giving us the background to the formation of the group, for sharing extracts from the report entitled A Vision for Change and for including the names of the people involved. As I read over the list at least twice I wondered if there had been an error of omission or whether my eyesight was in fact deteriorating.

There was no mention of IAHIP or IACP or ICP within this expert group. Strange. Then I read on to some of the policy conclusions. The Vision for Change proposed ‘an ‘holistic’ view of mental illness and recommended an integrated multidisciplinary approach’ etc… Buzzwords like ‘person-centred’, ‘maximizing recovery’ and ‘meaningful integration’ sprung from the page. Promising. Then things started to go downhill. Psychotherapists it appeared were the group lagging behind. Like naughty schoolchildren we were described as ‘fragmented’ and squabbling amongst ourselves and presenting a poor image to the public. We were also greedy and demanding expecting statutory recognition to be ‘gifted’ to us. Unless we pulled up our socks and improved our social skills we didn’t have a hope of being part of the mental health care system.

So I went along to our AGM to see if I could find out more and asked why our professional bodies weren’t included in the Vision for Change report. Our IAHIP executive responded that neither they nor ICP were invited to join. Ed Boyne who was at the AGM said the Minister didn’t want to deal with groups. Wow. With an election coming up I would think the Minister would welcome speaking to as many groups as possible. What also surprised me at the meeting was that nobody seemed shocked by this omission. Maybe they were and were just too stunned to speak, maybe they were tired (at the end of a long day) or maybe they felt the Minister was right and we really are a fragmented and greedy bunch.

In his article, Ed described the ‘Vision for Change’ report as ‘wide-ranging and representative.’ I would have to disagree. I would have thought and hoped that before an Expert Group was put together there would have been a much broader consultative process than the one conducted. This could have been a golden opportunity for government to have conducted a detailed research into psychotherapy practices and other related social issues in the form of a questionnaire to those of us working at the coalface, which would have been a) an inclusive gesture towards practicing psychotherapists, and b) provided data from which to formulate policies for the future. Psychotherapists are in the unique position of having also been clients so we can offer insights into the variety of problems that continue to surface in our workplaces.

I would have expected that the Expert Group, which espouses a ‘multidisciplinary’ approach to mental health care, would at very least have included elected psychotherapists who represent their membership in an official capacity on the professional bodies such as IAHIP, ICP and IACP. These are the bodies that have worked for years in a voluntary capacity to put together all the necessary components that make us a professional, viable and independent concern and their exclusion from this process is both discourteous and undemocratic.

I would also take issue with Ed’s description of psychotherapists as ‘inward looking’. I think in fact we have got our house in order relatively quickly (constitution, by-laws, codes of ethics, accreditation, supervision, training standards, etc…), certainly by government department standards. We have always been part of the wider community in voicing our concerns that therapy needs to be available to everyone who needs it and funded where necessary (just read all the articles in Inside Out over the years) and we continue to work at the coalface, many of us at reduced rates of pay. (The Rape Crisis Centre, Community Centres around the country, Irish Cancer Society to name but a few.) Some of us would say we were too ‘outward’ looking in pursuing Europe and the European certificates. As a consequence we may have kept our eye off the ball in our own backyard. Perhaps there was a naïve hope that the nation state would  automatically include us in their health care plans.

Ed states in his article that psychotherapists expect to be ‘gifted’ statutory recognition. ‘Gifted’ is not a word I would use in relation to the investment a psychotherapy student  makes into their training. I am told that a four-year training costs a trainee around 26,000 euros. Ed is himself a trainer and I’m sure when he set up his programme and advertised it he was confident in so doing that his graduates would find satisfying employment in the mental health services. So yes, I do have an expectation that on completion of my training and having met the required standards for accreditation, I have a well-earned (but not gifted) right to practice psychotherapy and to statutory recognition.

As to our ‘fragmentation’. I don’t believe we are as ‘fragmented’ as has been suggested. On the contrary I think we have managed to integrate many different modalities under two large umbrellas, IAHIP along with ICP and IACP. Many of us belong to more than one modality within these groupings. We talk to each other, read each other’s publications and go to each other’s meetings. Yes some of us do feel there is a difference between counselling and psychotherapy and that amalgam could have been avoided if we had held informed debates on the issue at the time of the consolidation. Difference has never stopped us from working towards the same end, which is to do the best for our clients and to be recognized in the health care system. The fact that we tolerate dissonance and difference is a healthy sign.

I’m afraid I just don’t buy ‘the harsh reality….that the fragmented nature of our field is a major problem where Government or statutory recognition is concerned.’ This sounds to me like a flimsy excuse for stalling and a subtle form of scapegoating.

If the Government were really serious about psychotherapy being part of a Vision for Change and had the political will to do it, they would have invited our elected representatives in at the beginning of this process. So why didn’t they?

Here is my take on what might have happened.

NO MINISTER

(The scene takes place in a large room in Leinster House where newly elected TD  and Minister for Health, Tom Small is sitting at his desk surrounded by papers feeling very buoyant after his first meeting with the Expert Group for A Vision for Change. Opposite him sits senior and well-seasoned civil servant, Denis Foley)

TOM (florid and energetic)

Well sure now Denis wasn’t that a great meeting. We need to get Carmel in here quickly and organize a press conference and strike while the iron is hot. I am determined to have every mental health care professional recognized and brought inside the system. I think I may have finally found the solutions that have bedeviled every health minister in the history of the state.

DENIS

Really Minister. Perhaps you would enlighten me?

TOM

Well now haven’t those psychotherapists really come up with a great game plan? Just think of it. Their talking cures could save us millions of euros. They could halve the amount of people going to doctors, being prescribed drugs, and reduce drug and alcohol addictions through therapeutic interventions. I mean we could actually become a healthier nation. Every dog in the street knows what needs to be done to improve our quality of life and Denis I intend to do that. That’s why I was elected because I’m the man to meet these challenges. (Stands up and starts walking up and down the room, his chest puffed out.) Now what am I going to say at the press conference? Something like…People of Ireland, I have a dream…. (Pregnant pause) um I think that’s been said before…

DENIS

Martin Luther King, Minister. l968. He got shot for his troubles.

TOM

Yes, yes, but that was way back in the 60’s when there was racism. Anyway it was in the States where we all know guns are out control and crime is rampant, not like here…well not as…(coughs) well anyway crime isn’t my problem. It’s health that’s my concern and I want to introduce an integrated health care system that is all about prevention, Denis, as well as cure. A system where people will be treated in a holistic way by teams of professionals and where the patient has access to a range of treatments including alternative and complementary medicines. You know Denis that I’ve been for acupuncture myself and found it very useful for stress and tension. You should try it. My wife swears by aromatherapy and all my children have been for counseling. I’m not sure why they went…but there you go. One of my brothers even went to a therapist and then gave up the drink. So we have to give the people what they want.

DENIS

Very dangerous Minister, if I may say so.

TOM

Dangerous? Come on Denis. This is the 2lst Century and we live in a democracy don’t we?

DENIS

Precisely why we have to be very careful Minister. Think about it. If we give the people everything they want too quickly they’ll become complacent and they won’t be bothered with elections… or governments….

TOM

…or politicians. Umm. I see what you’re getting at. Well I made election promises and I’m going to deliver them. Now I want Carmel in here to discuss the press conference.

DENIS

As you wish, but before you do that Minister I feel it is my duty to bring your attention to something… you are perhaps not aware of. Something important.

TOM (annoyed)

Now what. Denis I really find all this stalling…

DENIS

With respect Minister without the VIs on side you haven’t a hope in hell of getting your policies implemented.

TOM (surprised)

The VIs? Who, what are the VIs?

DENIS

The VIs. I beg your pardon Minister. Departmental parlance for ‘vested interests.’

TOM

Vested interests. Aha. You mean lobby groups. Now Denis, look here, I’m not getting into that one. I wasn’t elected on a landslide victory to cave in under pressure from bishops, property developers, builders, publicans, multi-nationals, farmers, taxi drivers, big business, and pharmaceutical companies. No, the days of brown envelopes and nudges and winks are over Denis. Transparency and accountability. That’s my motto.

DENIS

May I remind the Minister that in a democracy it is the majority of the people who vote in the politicians and…

TOM

Damn right. And if I don’t serve the people and deliver on my promises I will be out on my ear in the next election.

DENIS

As I was saying, Minister. The majority may vote a politician in but it is usually a minority that throw him out.

TOM

Well I’m not going to get bullied out of office by any powerful minority Denis and that’s the end of it.

DENIS (clearing his throat and adjusting his tie)

If I could return to your dream for a moment Minister. Let’s suppose, hypothetically speaking, that you implement your new integrated health system, your Utopia, where everyone is accommodated and health care is efficient and everyone becomes, hypothetically, healthy. Services are drastically cut back. Fewer services mean fewer prisons, less crime, less drugs, less anti-social behaviour, fewer hospitals. Fewer hospitals mean fewer doctors, fewer nurses and so on.

TOM

Fantastic isn’t it? A real health care system instead of a sick one.

DENIS

Not really Minister. You see fewer hospitals mean fewer buildings. No building and property devalues. Then the property market collapses. Less crime puts the gardai, social services and media out of work. A reduction in prescription drugs means pharmaceutical companies will go to Eastern Europe. Then the doctors will pack up and go to the States, the nurses to Saudi Arabia. Serious reduction in alcohol consumption will affect our tourist industry. All those stag and hen nights will move to somewhere like Greenland. Drug barons will move to Spain. Unemployment will skyrocket. Next you’ll see civil unrest and marching on the streets. Finally our economy will collapse. And then we get kicked out of the EU.

TOM (shocked and slumps into a chair)

Oh Jesus, Mary and Joseph. That can’t possibly happen. I would have to resign.

DENIS

Nonsense Minister. No one ever resigns even if the country is on its knees. This requires some strategic thinking that’s all.

TOM (in a panic)

But what am I going to do Denis. I promised these psychotherapists that I would go ahead and regulate them and implement the recommendations in their report. What am I going to tell them?  Why their spokesperson is a friend of my wife’s. This is terrible.

DENIS

Calm down Minister. It’s very simple. You go ahead and announce your planned health care system and then say that you are surprised to discover the professional bodies involved have requested more time to debate the issues. Its very regrettable but its democracy at work. It gives you all the time in the world, at least until the next election.

TOM

But my promises go up in smoke and nothing gets done.

DENIS

Minister, that’s infinitely better than you going up in smoke. Think of the next election. You get the credit for a brilliant idea and the professionals will get the blame. They will be seen to be squabbling ad infinitum and the country carries on as normal.

TOM

But all the professionals at the meeting were in agreement as to the way forward.

DENIS

Leave it to me Minister. Squabbles can easily be arranged. It’s standard department procedure. When things get sticky we just pit the VIs against each other and you get on with things like….well finding another idea. That’s the beauty of vested interests. It’s so easy to throw the cat in among the pigeons. Machiavelli was indeed a prince…

TOM (desperate)

Denis please! How am I going to….?

DENIS

You have nothing more to do Minister. Take some time off. Go and play golf.

TOM

Well what is my function Denis? What on earth are politicians elected for?

DENIS

I’ve often wondered Minister. Which is why I’m in the civil service. Now I’ll need Carmel to organize the media, release some contentious information and announce immediate cuts in health spending.

TOM

But that’s misinformation Denis.

DENIS

Come, come Minister. It’s merely spin. May I remind you that we are in the 2lst century? Information in the hands of the few is bad enough. In the hands of the masses it’s a disaster. This is why we employ spin-doctors to combat the Internet and blogging and all these subversive forms of communication. How else are we going to divert attention away from the Minister and protect and further vested interests?

TOM

But I promised these health care people they would be part of the new system. I’m going to look like a right eejit and they’ll want my head on a platter.

DENIS

But Minister, this is no longer anything to do with you. These fragmented groups are now at each other’s throats. The doctors and psychiatrists never wanted psychologists and psychotherapists invading their territory, taking away their status and their power. The psychologists didn’t want psychotherapists taking over their jobs in the Health Boards. Everyone ends up fighting for a piece of the pie and you are just the Minister standing by patiently waiting for them to reach a consensus.

TOM

But there is enough money for everyone and plenty of jobs to go round.

DENIS

Minister we don’t tell them that. That is a turkey voting for Christmas. No we tell them that the money needs to go on… research. We don’t say what research but imply that it is something groundbreaking. Then we sow the seeds of doubt. Sprinkle in a bit of fear. Something like ‘The public deserve protection. We need more science-based evidence. More investigation is needed into the health and safety aspects of….A further report is to be conducted into…’ Departments do this all the time. Where do you think the actual money goes Minister?

TOM

What am I going to tell these people when I meet them tomorrow? That their organizations are going to have to wait to be officially recognized in order to save our necks and further vested interests. Denis, it’s nothing less than scapegoating.

DENIS

Sacrifice sounds more esoteric Minister. We all have to make sacrifices in the national interest. Now are you ready to see Carmel?

TOM (hysterical)

What am I going to say at the press conference?

DENIS

‘On mature reflection I’m afraid… Between the jigs and the reels. In the heel of the hunt. After much consideration. In the fullness of time. In the interests of democracy. More debate is needed.’ Here Minister, let me give you the department booklet on Useful Phrases, I think you may find it invaluable. (Places large book on desk)

TOM (slumped in his chair)

Thank you. (Pause) Denis, is my health care plan entirely scuppered?

DENIS

No Minister, not entirely.

To conclude on a more serious note, I believe we need to adopt a more confident and positive mindset, which really believes in the good service, we provide. I agree with Ed when he says we should focus on dialogue with the medics, psychiatrists, psychologists and other related professionals and we need to be there on equal terms in Leinster House, not standing outside the gates. We have just as much to contribute to the process as any other profession. And we need to be seen, heard and read. We should be contributing to the Irish Times Head to Head for example. We need to get involved in informed debates. We need to approach government and media with the mindset that they need us as much as we need them. We need to get very clear and strategic in our thinking and planning. We need to choose carefully and wisely where we position ourselves in relation to the media.

How long will it be before we are recognized? Well I’m not holding my breath on this one. I’ve been involved with IAHIP for about fourteen years and watched it grow. We started as a very small marginalized organization. It wasn’t so long ago that Anthony Clare referred to us as a semi-religious sect! So things have changed and in the grand scheme of things quite rapidly. We’ve weathered many a storm, people worked themselves into the ground and there was a time when we thought we might fold because we couldn’t get enough people to join committees.

I was delighted to see at this year’s AGM loads of people, many of whom I didn’t know and was told that so many people came forward to go on committees they had to hold elections! There is a lot of energy and new blood, good will, talent to burn, solid leadership down through the years and a great improvement in communication. Inside Out has been resurrected and a regular newsletter keeps members informed.

I believe that psychotherapy will eventually become part of a mental health care system of multidisciplinary professionals because sensible people will demand it of their government. And if its any consolation architects having been trying to register their profession for one hundred and twenty years and they are not short of work!

So have faith. Trust the process. Our time will come.

Sarah Kay is gestalt therapist who welcomes the fact that there is a Conference in Florence in June on Therapy and Humour.