Derval Ryan, Chair of ICP in Conversation with Sarah Kay

Sarah: Thank you very much Derval for agreeing to an interview and I just want to start by congratulating you on your new job and wondering how you feel about coming in as Chair of ICP?

Derval: Thank you. Well the short answer to that is terrified when it was put to me first, but with time and experience, I began to think that, yes, perhaps I could do it. Somewhere I was able to find inside myself a response that this was something I was able to do.

Sarah: Now that you are in to the role, what do you feel that you can bring to it that would be different, say, from the previous chair?

Derval: Well, every Chair is different. I’ve been on the Executive for two Chairs’ terms, for Barbara Fitzgerald and Brion Sweeney and both of them have tremendous expertise and did a huge amount of work. I think what I bring to ICP is my group analytic training. My focus is around communication and bringing ICP together as a cohesive group and to working with differences. With Statutory Regulation coming up, whether it happens or not, we have to present a united front at the Training and the Standards level while holding our differences as modalities.

Sarah: Do you see the Department of Health taking on board the idea of psychotherapy as an independent profession with all its differences?

Derval: It’s hard to say. I think like many of the public, the people in the Department are not actually sure what psychotherapy is or what the difference is between psychotherapy and counselling.

Sarah: Do you see that as part of your role to clarify?

Derval: We are very clear in ICP that we represent psychotherapy. We are not in the business of figuring out any other profession. The process of getting ourselves aligned for statutory regulation has been fascinating because there are twenty-two organizations (of which 10 are ICP section organizations) involved in this process and what has emerged is a very clear qualitative difference between psychotherapy and counselling. We know there is a qualitative difference in the work, and that became clear in the forum. Now as to whether that clarity will hold I don’t know. What emerged was that, at the present time, the level of training for a counselling qualification is at the undergraduate primary degree level and the level of training for psychotherapy is at a post-graduate level or master’s level. It’s almost as if psychotherapy is a long apprenticeship.

Sarah: Now one of the pieces with humanistic and integrative psychotherapy is that it is not just about having a degree. There is this ‘equivalence’ of life skills that you can bring to the work and this is something that we hold dear as humanistic and integrative psychotherapists. Is that in danger of being swallowed up by Government or is that something that is being taken on board?

Derval: I have no idea. How the Forum’s submission to the Department will be received is not clear. Psychologists for example are deeply unhappy with the result of their process because their grandparenting standard has been set at primary degree level, which is nonsense in terms of their professional qualification, and it would be even more of a nonsense for us. We are going to try to be clear on the difference between graduation and accreditation. You can graduate with lots of academic degrees but you can’t be accredited to work professionally unless you have that other important personal development piece, which includes personal therapy and supervised practice.

Sarah: Like an applied psychotherapy.

Derval: What do you mean by that?

Sarah: Well you’d have your degree in theory and then apply the psychotherapy by working at the coalface.

Derval: I hadn’t looked at it like that. I’ve always made a difference between the academic and the professional. Psychotherapy training needs to be an integrated training comprising academic, personal therapy and supervised practice.

Sarah: I suppose I am using that term because the universities seem to be coming in on this more and I’m using that term to make a separation between the head stuff and the experiential.

Derval: It is the responsibility of the trainings, including university training programmes and also the responsibility of the modality organizations who are the accrediting bodies to maintain the required standard of training. ICP organizations are very clear that people cannot be accredited until they have completed their personal therapeutic experience and supervised practice. It’s not enough just to have a degree. What we are trying to put in place, and to a large extent they already are in place, are the European standards, which is seven years training, with a primary degree or equivalent, and four years of a modality specific psychotherapy training with all that that entails.

Sarah: Now there have been criticisms in the past that ICP, and to some extent IAHIP, have been focused on Europe to the detriment of not keeping their eye on the ball at home and missing out on putting a stamp on psychotherapy in Ireland.

Derval: There is a certain truth to that but there is a very good reason for it. With a lot of the energy going towards the European piece, the Irish piece may have got left behind. It was not deliberate neglect but with a voluntary committee, even with everyone working as hard as they know how, with meetings every six weeks we can’t do everything. Our meetings run for three hours and we barely cover our agenda. Barbara Fitzgerald and Brion Sweeney have put tremendous work in place and we have achieved everything we set out to do. We put the Conference on and we got the website up and running. So a huge amount has been achieved although it may appear terribly slow from the point of view of the onlooker. The connection to Europe is crucial to our credibility with our Government at home. We are a National Awarding Organization for the European Association of Psychotherapy and working hard to ensure we measure up to the standards of European psychotherapy. The EAP is working towards a common platform throughout Europe so that therapists can move around once they have their European certificate.

Sarah: So you feel confident that someone from here could go and say work in Germany?

Derval: That is being worked on at the European level at the moment.

Sarah: Is it slow because of bureaucracy or do you think there is some resistance in some areas to change?

Derval: I think there is another piece. I’m not sure that psychotherapy in Ireland has been ready to get out there and say ‘this is who we are.’

Sarah: Can you say a bit more about that?

Derval: This is a personal piece, but as a nation, Ireland is beginning to find its confidence and I think psychotherapy in Ireland is also beginning to find its confidence. People are going to conferences around the world and saying ‘hey, I can do that.’  ‘I am as good as they are.’ But that takes time. And that kind of confidence doesn’t come in a week or a month. So I could be wrong but I do think there is a time for these things. We are actually quite highly respected in the European Association and we had a chair of the EAP (Ed Mc Hale).  Barbara Fitzgerald has just stepped down as Chair of one of the committees. We have a voice in Europe.

Sarah: The challenge now is to find the voice here.

Derval: The challenge now is to find the voice here and in a sense this is my role because the European work is ongoing – there are four two-day meetings a year in Europe still.

Sarah: So you are still taking a two-pronged approach?

Derval: Yes, eight days of meeting in Europe and then every six weeks the Irish meetings.

What came out of our Strategy Day is a lot about communication: communication to the media and to the public, communication to our membership and other professionals. How do we tell GPs and other health professionals who we are and what we do? How do we get out there and persuade GPs to refer on to us and which modality is appropriate for the problem?

Sarah: It seems it is up to us to sell ourselves. Am I right in thinking you have employed a Communications person?

Derval: Yes, we have. Maureen Browne.

Sarah: And what has she done to date?

Derval: Maureen has been on board for about six to eight months and she helped us with publicity and organizing for the conference and we find now that if we write a letter to the papers for example, it gets there, whereas in the past it went nowhere. We are finding Maureen’s help invaluable.

Sarah: Yes. I noticed you were very quick out of the traps with a letter to the Irish Times.

Derval: Well there were some people saying it wasn’t quick enough. Even though the issue was nothing to do with us it needed clarification. It is sometimes hugely tempting to react quickly without thinking through the issue. Fortunately we were given good advice and the letter ended up exactly where it was supposed to and we were delighted.

Sarah: I suppose in our money-oriented society it is about informing government and the general public that psychotherapy can save the state a lot of money in the long term.

Derval: Yes, the Alan Carr document outlines that very clearly, and that is another argument for statutory regulation. If you have read the Vision for Change document, recommendations for psychotherapy services appear throughout that document, at primary, secondary and tertiary care levels. There should be psychotherapists employed at the GP level, at the community level and they should also be employed in an inpatient medical setting.

Sarah: Were you as shocked as I was that ICP and IAHIP were excluded from the Vision for Change committee in the early stages?

Derval: Yes and we did send a delegation along to deal with that. But you know I’ve learned over the years when I worked for a semi-state company that you have to teach the managers what you do. They might pay your salary and put you in place but not have a clue what you actually do. And I’m pretty sure with all the vested interests in the health service, a lot of people don’t have the concepts as to what psychotherapy really is and even if they did, they might well feel threatened by it. I hope that there will be a growing realization that psychotherapy might actually help people solve problems.

Sarah: So there is still fear out there, and is mental illness still seen as a taboo?

Derval: Yes, and there are still a lot of vested interests. With any group work it is very slow and we are talking here about a very, very large group, the health system and we are talking about a profession that should have an integral part in that health system which has been resisted out of fear and out of a not-knowing. I mean the Minister two years ago was asking ‘well what is the difference between counselling and psychotherapy?’ Just like a manager, years back, looked at my colleague and myself and said ‘I don’t know what you do here, can you justify it?’ That is the question, which the Alan Carr document, is answering. Yes, psychotherapy works. Yes, we can justify it. Yes, it is cost-effective. These questions have been asked by managers since time began.

Sarah: So we just have to keep on pushing?

Derval: Yes, and I don’t think there is any point in getting upset that they are not understanding. It is part of our job to explain, and to explain and to explain, and to tell them what we do and to prove that it actually works.

Sarah: Do you think we perhaps should have been doing more research to back up our work?

Derval: Yes, and this is also a confidence issue. Even people who are very good and very talented are reluctant to write up their work. I think we need to get confidence and know that we are as good as any other profession and we need to write about our work and believe people will be interested in it. There is already a body of research by Cognitive Behavioural Therapy, which is probably why it is popular with scientific professions. The other modalities need to follow suit. The ICP feels that Alan Carr’s document places the emphasis on research in psychotherapy.

Sarah: Speaking to you as an ordinary member of IAHIP (and I think I speak for quite a few members on this one) I’m wondering how can we bring people in who have worked at the coalface for a long time? They bring a lot of experience and have anecdotal research at their fingertips.

Derval: Well, I have to say we are wondering that too.

Sarah: Do you see a way forward? Is there a way to bring all the umbrella groups together to dialogue more?

Derval: We are already trying to do that with the Chair’s Day. The Chairs of the organizations have been coming together and that has been really useful. The day scheduled in February was interesting and energetic, and we plan to continue that.  Future Conferences will be another opportunity for us all to get together, but since that won’t be happening in the very near future, we are planning several Seminars on topics that will be of interest to and open to all modalities. We recognize that internal communication between ICP and its members can sometimes be problematic, but we are trying to rectify this.

Sarah: I suppose that is the problem with hierarchical structures. It seems strange that we still operate out of this kind of culture.

Derval: Yes, the hierarchical bit is there whether we like it or not. Strictly speaking the sections are our members rather than the individuals in them. So there is that disconnect. We struggle to bridge that gap so that members from different sections know what ICP is about. Our membership is very important. We need to get that across and we are hoping that the newsletter and the website will do some of that. So we have work to do on that. I know that people did feel very minded and cared for at the conference. It was actually a very good experience. So we are getting there.

Ann Daly has put out a request for everyone’s email addresses because we can communicate much more effectively by email rather than through snail mail and I think that virtual highway piece might be quite important, so that ICP can communicate directly with all the membership where appropriate, rather than having to go through the sections. We are also trying to put pieces up on the website for people. We would hope eventually to have a member’s section where there can be some interchanges and activity between members. There is also our newsletter, which is coming out shortly with reports from sections as to their concerns for this year. We really are focusing on internal communication, as it is crucial to our work, and the section organizations want better communication.

Sarah: For example one of the big questions that comes up every year particularly at our AGM when the treasurer’s report comes out is this enormous levy that IAHIP pays to ICP (this year it is 61,000 euros) and members saying where does that money go and how do I benefit from it?

Derval: A lot of our work takes time to come to fruition, and so it is not always immediately obvious how the individual member benefits. Some of the money goes on maintaining the European connection, which as I have said is crucial to our identity as a profession. There have also been years of groundwork by Barbara and Brion to put structures in place for the EAP connection and for statutory regulation. The commission of the Alan Carr Review of Research in Psychotherapy was a cost, and our recent appeal against the imposition of Vat Charges in Psychotherapy required the services of a Tax Consultant. There was a considerable investment in making the Conference the success it became.  There was also the problem with the website, when the organization we chose went into receivership and we had to start again.

Sarah: That must have been a blow?

Derval: It was a huge blow.

Sarah: Unfortunately I was away at the time but I gather the Conference was a great success.

Derval: It was a wonderful success and we hope to do it again.

Sarah: I was just about to ask you if you would do it again?

Derval: We are hoping to do it again. My tenure is about three years and we might do it around year two or three but that would be up to the conference committee. It is a huge amount of work.

Sarah: I am sure it is. It would also seem like a good forum for pushing psychotherapy forward and involving people from the health services who are interested.

Derval: Absolutely. We had hoped to make the last one a showcase for psychotherapy for other Health Professionals but it didn’t quite end up like that. It was hugely interesting and the different modalities were well represented but again this is all new to us, we are learning how to do it.

Sarah: Is your Communications person experienced in organizing conferences?

Derval: Yes, very much so. Maureen has an HSE background so she has the contacts. She knows the systems and we are very happy to have her on board.

Sarah: It sounds like you really have made a lot of headway with Europe, now it seems like the Irish bit is the next challenge.

Derval: It is actually time now for the Irish piece. The structures are in place, and a huge amount is going on at the moment around the training standards. The ICP training sub-committee is working with training organizations to see where people fall short of the standards and how they can catch up or shift things. We’ve had meetings since October with the training institutes of the different modalities and we are making progress.

Sarah: With the HSE in such disarray, are you hopeful that there is going to be a place in there for psychotherapy?

Derval: That may depend on statutory regulation. If we can establish our standards as those of Europe, and as regulation happens in other countries, then hopefully public pressure will push for some sort of regulation here. And even if we don’t get statutory regulation then at least we will have agreement on proper self-regulation – a lot of the professional bodies are self-regulated. But there needs to be clarity around the common standard. For example, there are many people working in the HSE who have psychotherapy training who are not officially recognized as such.

Sarah: So naming it would seem important. Talking of names can you tell me more about this Talking Therapies forum?

Derval: That was the name the Minister used. One of the first questions to be addressed in the forum was what do you call a forum of counsellor and psychotherapy bodies? The department told us not to get too hung up on the name of the board because the name of the board doesn’t matter. What matters is that the separate titles of Counsellor and Psychotherapist be protected under Psychological Therapies because their trainings have a qualitative difference. If we are regulated there will be one registration board, which would cover the group of Health Professionals calling themselves counsellors and psychotherapists. However, as you can’t use more than one name it has been agreed that the Registration Board would be called Psychological Therapies. There were obviously some disagreements around it but that is the document coming out of the Talking Therapies. There has been a bit of hiatus in the process recently, but it is hoped to finalize the process by the end of April and the final document will be submitted to the department at that time. I would hope that the forum would authorize groups to release the document to membership after that.

Sarah: Are relationships within the ICP umbrella groups good and standing firm behind psychotherapy being seen as an independent profession even though we have our different ways of practicing?

Derval: Absolutely. The differences are important, but we are all psychotherapists, we are all professionals and I think it is up to the different organizations to work with the scope of practice piece. The government will not legislate for scope of practice.

Sarah: So that will be left to the accrediting bodies?

Derval: Yes, the government will not legislate for scope of practice and I think that is wise. I gather in Britain there is an attempt to legislate for every specialization and it’s a nightmare. Several of our groupings were anxious for their specialization to be legislated for, but it was held that it was better to have the generic terms and then the scope of practice piece gets held by the different modalities.

Sarah: So there will be a certain amount of autonomy within the groups?

Derval: Yes, it means that training and accreditation standards will need to be agreed across the board, with accreditation resting with the professional organization. In the legislation it says that the minister will take into account the views of the professional organizations.

Sarah: So will the accrediting body for humanistic and integrative therapy be IAHIP or ICP?

Derval: For trainings, it would be ICP, with IAHIP very much alive within that structure.  For individuals, IAHIP accredit individual members in line with ICP standards. I would see myself as representing ICP first and then IGAS and IFPP second (two organizations of which I am a member). Once you are on the Executive you need to see ICP and psychotherapy first and your modality second. Of course we have to hold the distinctions of the modalities that is very important. The people on the executive are representing their modalities but when it comes to statutory regulation of the psychotherapy profession then it’s about all of us as psychotherapists and we are very clear on that.

Sarah: It sounds from what you are saying that if government isn’t meddling then our autonomy can be maintained?

Derval: That is the hope. A lot of the work will go on as before. But then I don’t know. I really don’t have a crystal ball on this one.

Sarah: You sound pretty clear and confident as to where we are going? You’ve outlined the difficulties but you sound quite upbeat and not too daunted by the struggles ahead.

Derval: No I’m not. Of course I struggle but one of the fundamentals of group analysis is that it’s not what happens but it’s what you do with it. I’m not reacting, I’m listening and the group training stands to me from that point of view. And I’m keeping the group as a whole in mind all the time which is what I was trained to do. If we lose the group as a whole piece whether it is a large group like ICP or a smaller group then the individual suffers. So my training holds me and contains me and gives me optimism.

All the modalities are working for the best outcome for their membership and everybody means well. Of course there is going to be conflict but if we can hold those and contain them and work with them then it will be fine. It is difficult and it can be painful in spots but our objectives are very clear. We want to be recognized as a competent profession and we want to be able to communicate with the world and other psychotherapists. It’s not going be easy but if we can keep our mission clear I think we’ll be all right.

Sarah: I was a bit vague as to where ICP was standing so you have clarified a lot and there seems to be a real move forward.

Derval: Yes, and I would have to also give a huge amount of credit to Brion Sweeney and Barbara Fitzgerald the two Chairs I’ve worked with and before that of course there was Ellen O’Malley Dunlop and others. The groundwork that has been put in place, week after week, month after month, on a voluntary basis, not to mention the work that gets done at section level, has been monumental. The underpinnings are there, the documents are in place and the research is published. Everything is in place to move forward.

Sarah: Now it seems like it is a sales and marketing job that needs to be done?

Derval: It’s time to put up our periscope and see who we need to talk to and communicate with. It doesn’t mean the European work stops; it doesn’t, but it is less groundbreaking. I’m very clear that the whole is greater than the sum of its parts and we can do this if we hold together. It doesn’t mean we won’t have differences and that we won’t fight.

Sarah: That’s healthy energy.

Derval: Yes, absolutely. I mean people who are fighting actually want something to happen so I need to persuade them to come on in – we need your energy. I think we can move it forward now.

Sarah: Thank you very much for the interview and the best of luck in your new position as Chair.

Derval: Thank you.