Hosted by The Irish Standing Conference of Psychotherapy
Friday October 8,1993.
The conference was held in All Hallows College, Drumcondra, Dublin and was attended by about 100 people. This number was made up of therapists from the five constituent organisations of ISCP: Humanistic and Integrative; Family and Systems therapy; Psychoanalytic Psychotherapy; Constructivist therapy and Behavioural/Cognitive therapy. It also included people from the Irish Association of Counselling and other interested individuals.
The question was whether the ISCP should have a generic training course that would be common to and agreed by all the member organisations. This course, should it come to pass, would include elements considered by all to be essential to the training of all psychotherapists.
Philip Kearney who works as a family therapist and is a director of training with the Clanwilliam Institute introduced the day. He explained that some of the main aims of the ISCP were:
To promote a wider vision of psychotherapy. To develop and monitor high standards in the profession. To promote the exchange of theory and practice among members. To provide education and resources. To represent ISCP to other organisations and statutory bodies.
He also explained that ISCP was still “embryonic”. This was so, both for the member organisations and for the conference itself. The idea of the ISCP was more “conceptual than formal” at this point. Therefore, there was no sense in which the ISCP was dictating to members or to others.
Phil explained that the purpose of the day was to begin a “ritual of defining a constituency”. He emphasised that the role of ISCP was in the “distribution of available resources.”
Phil was clear that ISCP is in an interim stage of development and it was “critical that we remain fluid”. He also said it was important for member organisations to supply a list of accredited members so ISCP could begin to form a register of professional psychotherapists.
Later in the morning there were to be small groups to discuss the issue of training and to start with Phil introduced several people to set the scene and to provide some information and questions for the later discussions.
The first of these people was Tony BATES. He is senior psychologist at St. James Hospital and among other things is involved in training bereavement counsellors. He argued that a broad, basic understanding of psychological principles, i.e. the nature of being human, was essential. Tony allowed that each model of psychotherapy has its consistencies and inconsistencies.
To illustrate this he chose what he believes is a question common to all the therapies:- “How do you feel?” He indicated that from the answer to this question, the therapist gets an idea of where the client is or needs to go.
Even this question is loaded because, Tony maintains, it involves an understanding of the stage of human development and the self organisation of the client. It includes an understanding of systems theory, i.e. how groups and families work. It includes social psychology and how the individual develops relationships. Learning theory is part of it because it concerns itself with how the individual adapts. There is a personal and political content because it involves gender issues and it requires an understanding of the process of change in the individual. There is also a component of the question that addresses itself to the field of abnormal psychology and requires the therapist to be able to recognise psychosis. Finally, the therapist needs to be aware of current research into the nature of personal growth and being human.
Ruth O’DONNELL was the next speaker. She is Co-director of the EHB Marital & Family Therapy Programme. For her, to be able to recognise her competence and her limitations as a therapist was very important. Training that provided the basis of understanding signs and symbols expressed by the client helped the therapist to appropriately label and decide whether to refer clients on or to work with them.
What I would like to see, explained Ruth, is a training where a sound knowledge and understanding of emotional and mental disturbance and an awareness of the effects of drugs and illness on the human person are included.
Michael FITZGERALD was described as an “innovator”. He is also a child psychiatrist and child psychoanalyst. Michael urged respect for the different disciplines. His thought was that there was a problem with the sections of ISCP because of continuous “splitting”. While his background is psychiatry, he thought it was important to “integrate the values” of a core group of aspects of all approaches to psychotherapy. Having done that it was then possible to choose a “style”. Michael thought that the current compartmentalising of training is necessary for the moment. The aim, in the end, is to discover an “equivalence of outcome” in all the theories. There were, he noted a number of M.Sc’s, Ph.D’s etc., now available. His main concern seemed to be the “difficulty in tolerating differences”.
Imelda McCARTHY is director of the Ph.D programme in UCD. With a background in the social sciences, Imelda thought it was important to have a clear awareness of the socio/political dimension to therapy. This would include sociology, social policy, social psychology and systems theory. An exploration of the concepts of normality and abnormality needed to be encouraged and to include an awareness of culture, race, class, gender and ideology. We have a responsibility to understand organisational, group and family processes.
Ed Boyne who is a director of the Creative Counselling Centre and the Editor of a recent publication “Psychotherapy in Ireland”, said he was concerned about access of people to psychotherapy as a career. He reflected that a foundation course would relate directly to who has access. Ed was not in favour of a specific course to be run by ISCP but rather a generic component, common to all courses. This component would be the responsibility of the trainers of the specific course and would require that the ISCP trust trainers to competently provide such a component.
Such a generic component would need to address defects in training. It would include a study of psychiatric diagnosis and an understanding of drug therapy. Whatever training was undertaken, Ed thought the most important aspect for students was their personal development and the requirement for personal therapy during training.
Professor Anthony Clare was the invited speaker after lunch. His talk was broad ranging. He remarked that since psychotherapy was only now getting itself organised into a profession there is some difficulty in saying what precisely, psychotherapy is. It can be narrowly defined, he said, as classical psychoanalysis or broadly defined as “anything”.
While there is no relation (using the statistical research model) between Outcome and training in psychotherapy in the literature, Dr. Clare says he wouldn’t argue this. He chose the anecdote that “Those with the least training treat the most ill and those with the most training treat the least ill”. This he says is the “root of antipathy in psychiatry”.
Dr. Clare remarked that the psychiatrist approaches the patient with an illness model and he says, it is a pity that medicine and psychiatry have been separated so much over the years. Psychotherapy, he says, thinks in terms of the “Universal Flaw”, that in fact, we could all benefit from psychotherapy since we are all subject to this flaw. In this sense he maintains, psychotherapy might be likened to a religion. There is friction when the illness model and the universal flaw paradigm meet – “they collide.”
From a research point of view, he says, the broad based view of psychotherapy makes its outcomes difficult to validate. Particularly since most psychotherapy “treatment” is dictated by the client.
Psychotherapists have been relatively indifferent to the dangers of psychotherapy. Dr. Clare says he is of the school of thought that maintains “if a treatment is good it also does harm”. Therefore we have a responsibility to have basic standards and good training. “The consumer demands protection”.
Dr. Clare says he doesn’t believe a single definition of psychotherapy will arise but, he says there is a need to explore having one.
There was a reaction from the floor following Anthony Clare’s talk that his anecdotal style was a bit too flippant for the seriousness of the issues involved. He responded that there was often good in humour and his intention was not to be flippant.
Another comment from the floor maintained that there was an aspect of psychotherapy that could be likened to Art and this made it difficult to apply traditional validating models to therapy.
Dr. Clare said that trainees under him did not have personal therapy during their training. This was in response to a query from the floor. A member of All Hallows staff commented that he would be loath to be in therapy with anyone who had not worked on themselves in therapy. Dr. Clare remarked that this illustrated his remarks about psychotherapy and religion:- The client and the therapist shared a common experience/belief.
There was some discomfort with the kind of language used during the day. People talked about the difficulty of using the research model of cause and effect to determine the value of psychotherapy training or client outcomes and satisfaction.
Some of the small groups were unhappy with the idea of “core professions” because it gave rise to the sense that there were some who had more of a right to be psychotherapists than others.
It was commented that during the introductory talks there was nothing said about the role of psychotherapy to “empower the client”. The needs of the client are of ultimate importance. Most groups agreed that there was a need to have a rounded training. One group thought there was too much talk of psychotherapy as a third level pursuit and this was dangerous ground. It is difficult to see psychotherapy as a first qualification. One group thought there should be a sound experiential basis for entry to the profession. One aspect of this would be to continue to include an age qualification. Another comment was that there was to much time given to speakers and not enough given to the groups to address the issue of training.
The idea of a foundation year controlled by ISCP was questioned. Whatever training was eventually decided upon should include a cooperation between the different disciplines in the sharing of resources and knowledge. This would not mean including an in depth study of all other disciplines but rather a “raising of awareness” of their approach and value. It was strongly suggested by some that the training of psychotherapists should include a requirement to engage in personal therapy and development. One group advocated the inclusion of a strong ethics and practice component in all training. The issue of supervision was brought up by another group and its importance for the safety of the client and the therapist was highlighted.
Ongoing training modules for practicing psychotherapists were advocated by one group and such modules would operate with the support of ISCP.
There were a lot of unanswered questions at the end of the day. In some senses it was too “friendly” and yet it did give practitioners from the various disciplines the chance to meet and talk. It is obvious there is need for more of this. It is important to continue to build common ground and language and for the ISCP to be both open and representative of the interests and expectations of the different member organisations.
Phil Kearney said, at the beginning of the day, that it was important to remain “fluid” for the moment. I think this is very much the situation because there is a lot to be worked out before the fears and apprehensions of ISCP members are resolved. It is not enough for therapists to sit back and hope their organisation will represent them. In order for the profession of psychotherapy to emerge in a fair and equitable way it needs the active
participation of all in the debate.
Alan A. Mooney
Copyright Alan A. Mooney (1993). Not for public quote until after publication of INSIDE OUT Winter 1993 issue.