Psychotherapy as an emerging profession.
Friday 4 September 1992
As I arrived at the conference and looked in vain for somewhere to park, the man who was directing the traffic said very poignantly, “We were only expecting about twenty and we have got two hundred!” Although this was an exaggeration, I feel that basically there was considerable surprise, even among the organisers, at the degree of interest which the profession immediately demonstrated in its own affairs. There had been no previous public meeting of the Irish Standing Conference of Psychotherapy, and there was a palpable feeling of excitement and involvement among the listeners to the conference speakers. This was no passive gathering of people who would allow the direction of their profession to be decided for them.
The Opening address was from Michael Walsh, a Hospital Manager, who expressed a somewhat guarded interest in the subject of psychotherapy, and he was followed immediately by Dr Michael Fitzgerald, who spoke about ”The Practice and Training of Psychotherapy in Ireland”. He emphasised the value of psychotherapy as a non-medical speciality and said that he would be in favour of the Health Boards employing non-medical personnel as therapists. He pointed out that many psychiatrists are poorly informed as to what psychotherapy is and have no training in its disciplines. Their ideas tend to be biological and, in the words of Denis Hill, “would regress to the early twentieth century” model of brain pathology. The assumption in psychiatry, he noted, was from logical positivism, that “only the observable exists”, and he aptly described this as rather a male (or even macho) model, compared with the practice of psychotherapy which might be seen as more feminine. He informed us of recent research in Germany and the States which left no room for doubt that therapy could be cost-effective within health services. It showed that those who received therapy improved much more quickly than those who did not; in some areas, a mere fifteen sessions with a therapist could produce the kind of improvement which would probably take two years for the patient to achieve if he had to wait for a spontaneous remission. It was also shown that people who received more therapy did better than those who received less. In fact, the studies suggested that medical expenses could be cut by 20% if therapy was used in conjunction with medical treatment. He cited the fact that some German insurance companies will pay for therapy for this reason. At the end of this stimulating paper, he delivered the clear message that “therapy has powerful outcomes” and cannot be ignored.
Mary Banotti, MEP, spoke next, and I couldn’t help thinking that it was a sign of the growing acknowledgement of the work of the profession that such a busy and popular speaker could be persuaded to come. She gave various practical warnings about the workings of the EC and told us in no uncertain terms to “get our act together” as a profession, citing the nurses as an example. She warned us about the forthcoming Liability For Services Directive, due to come into operation before the end of the year, by which a consumer will no longer be required to prove negligence against a professional. Rather, the professional will be required to prove that he/she was not negligent. She summarised her message under the following heads: the profession must decide who/what it is; get its act together (no schisms); work with co-professionals from other EC states and especially in Brussels; and set up a register of psychotherapists for Ireland.
The questions which followed this submission reflected some dismay at the prospect of the Liability for Services Directive. The question of who, in Europe, is presently entitled to receive money from insurance companies brought out the fact that psychiatrists on the whole qualify. There was a general feeling of uneasiness after Mary Banotti’s speech, I thought, as if some threat was being held over us – yet the threat was never made fully clear. The next two speakers, who had come from Holland to tell us about the European Association for Psychotherapy (EAP), reinforced this feeling. First Professor Dijhuis (“My name is not difficult – it is a dyke and a house”) gave us the history of the Dutch Association of Psychotherapy, The NVP. This was founded 60 years ago, consists of 60% psychologists, 30% psychiatrists and 10% “others” (typically social workers) and it operates as a ”master society” to “specialist” organisations. He told us that the NVP feared the EC regulation might damage it, but was reassured to learn that the EC will not interfere with national organisations which are regarded as adequate. It seemed that these anxieties nonetheless gave rise to the NVP initiative to create the EAP, to which they have already devoted £90,000.
Dr Van Dijk now took up the story and gave us an outline of the EAP. It was set up on 3rd July of this year in Brussels and consists of “an outstanding group of psychotherapists for the 12 Member States of the EC” (I quote from their press release). “EAP membership is only open to organisations whose members meet EAP’s standards of education and training and belong to one or more of the following streams of psychotherapy – psychoanalysis, psychoanalytic psychotherapy, behaviour therapy, experiential therapy, cognitive therapy and systemic therapy. A university level of 4 years study plus a training in psychotherapy are obligatory.”
When the session opened for questions, it soon became apparent that many people in the audience felt that the submission was less than perfectly clear. Even after persistent questioning, it was not obvious whether accreditation by the ISCP would be sufficient for membership of the EAP, and there was no clear answer about who EAP represents. In fact, it only emerged much later in the day, in a different session, that the EAP has in fact only the fifteen signing “private person members” so far, which leaves one open to guess that, since the NVP is paying, they are probably calling the tune too. I was somewhat surprised that, when I requested a copy of their constitution and any other information about the organisation, there was nothing available. The questions ranged widely, but I think that a lot of people present would have shared the feeling expressed by Derry Mohally (IAHIP) that there was little evidence of either democracy or the idea of subsidiarity in the presentation, and indeed it seemed as if the EAP was “coming down” to us.
The afternoon session felt considerably more grounded. Speakers for each of the sections of the ISCP spoke to us about their work and their ideas for the organisation. Nessa Childers described the work of the Irish Forum for Psychoanalytical Psychotherapy, Philip Carney told us about the Family Therapy Network of Ireland, Ger Murphy outlined the concerns of the Irish Association for Humanistic and Integrative Psychotherapy, Brian Sweeney gave us a personal account of Constructivist Psychotherapy and finally Tony Bates and Aidan Lawlor described the work (much of it within the health services) of Cognitive/Behavioural Psychotherapy. There was a feeling that at last some real meeting was beginning – the different groups needed to talk, and this was the start of a dialogue which would certainly be vital to psychotherapy in Ireland. The audience was plainly interested and involved in each of the brief submissions and at the end it seemed as if the ISCP had begun to have a body.
Perhaps predictably, the last session of the day, for questions, reverted to the issues raised by the attendance of EAP at the meeting. People asked about other European organisations, and expressed the worry that the EAP seems to view psychotherapy as an “annexe” of the medical/health establishment and would be reluctant to relinquish the medical model. It became plain that the reception had been far from passive and people were very seriously questioning the real motives behind the EAP initiative. On the whole, I did not feel that Dr Van Dijk’s answers allayed the anxieties of the meeting.
It was undoubtedly a most stimulating day, full of questions and unresolved issues which must have given the profession here in Ireland a great deal to think about, and for this we must indeed be grateful. Even more, it was the first public meeting for the ISCP, which is likely to prove the most significant organisation for Irish psychotherapy within the EC. It is indeed vital that the whole profession should speak to Brussels with one voice, but quite what that voice should be is far from resolved. Towards the end of the day, many demands were made that there should be more meetings of the ISCP members like this so that the sections can talk, interact, get properly acquainted. In response, Michael Fitzgerald, suggested that another meeting should be arranged in a couple of months’ time – it will surely be an occasion not to be missed.
Report by Mary Montaut