1989 OUP, £18.88 stg.
This book is not about the theory and practice of psychotherapy in the usual sense. Instead Findley and Holmes consider psychotherapy in its social and political contexts (within the UK) and ask, Is psychotherapy of value? If so, then in what respects? Is it cost effective? Should psychotherapy become a profession in its own right? Should it be publicly funded? Should the state intervene to ensure the fair distribution of psychotherapy geographically and in terms of social class? Is psychotherapy intrinsically biased against working-class clients? Etc., etc.
Not surprisingly, one of the authors, Richard Findley, is a philosopher. Philosophers love questions. For “answers” he draws on some classical sources – Marx, Bentham, Kant, Hume, Mill, as well as the more modern Popper and Marcuse. However the overall approach is unmistakably utilitarian in the mould of Mill rather than Bentham. Psychotherapy is of value because it promotes personal autonomy. Personal autonomy is an intrinsic constituent of human wellbeing. It is superior to pleasure because the pursuit of pleasure can compromise wellbeing (it can certainly compromise autonomy). The greatest wellbeing of the greatest number is the ultimate aim of social policy, and so on.
It is not clear how they arrived at the conclusion that psychotherapy promotes autonomy. By what ‘objective criteria’ could you measure ‘autonomy?’ Research into the effects of psychotherapy tends to be inconclusive, but that is hardly an excuse for the authors to sidestep the problem of accurate research. This is an important weakness in a book which is aimed at political, academic and administrative decision-makers.
The most interesting arguments they rehearse are on topics like access to psychotherapy for the less well-off, and the professionalisation of psychotherapy. At present in the UK psychotherapy is really a marginal activity, undertaken by people who are already mem bers of other, more established professions such as psychiatry, medicine and social work. Members of these other professions are not necessarily well-equipped to engage in, monitor or evaluate psychotherapeutic work, since it demands a different approach. For example, it is abundantly clear that all therapists must engage in a lengthy and substantial therapy themselves. Ongoing supervision is also required of a sort that takes into account and works with the therapist’s own counter-transference. It is arguable that professionals in the fields of medicine, psychology and psychiatry need to unlearn a great deal of their training in order to function effectively in the world of psychotherapy.
These are points which the UK Standing Conference on Psychotherapy has taken strongly on board. Holmes and Findley discuss the Standing Conference at consider able length. In their view it is the single most important development in psychotherapy in the UK for many years. The Conference manages to include all the main strands within psychotherapy, eg systemic, humanistic and integrative, analytic etc. Standards for training courses have already been established and work on a register of therapists who meet the professional standards of the UKSCP is well advanced. This represents an important departure from the idea that psychotherapy is a marginal activity engaged in by certain “core” professions towards the goal of psychotherapy as a profession in its own right – a profession with stria standards but open to people of ability from a wide range of backgrounds.
Not content with the huge range of issues connected with the “value” of psychotherapy, the second part of the book is devoted to “values” within psychotherapy. Ethical issues surface here as well as questions of ideology. Is psychotherapy ideologically neutral? What about the moral choices facing clients in psychotherapy? How are they influenced by therapists? What are the moral responsibilities of therapists when taking on a new client? What is the role of “truth” in therapy and how can it become compromised?
A whole chapter is devoted to moral dilemmas within psychotherapy. As might be expected, paradoxical interventions (beloved of family therapists) are considered in detail. The theory issue of “informed consent” is also aired. A surgeon can usually give a patient sufficient information on which to base a decision about having an operation. Therapists find it much more difficult to provide comparable information prior to a lengthy and costly therapy.
These are just some of the many issues raised in this most stimulating book. Many chapters or even paragraphs could serve as the outlines for separate and lengthy theses. Sometimes there is an impression of an over-loaded table and half-digested topics. The particular philosophical approaches developed often seem inadequate, incomplete and reductive. Nevertheless the book is a timely and important reminder of the agenda that is before us in this country. All of the issues dealt with in the book will have to be debated and worked through if psychotherapy is to be understood as fully as it should be and valued as a serious, emerging profession in its own right.