Lament of an old-school psychotherapist
by Matthew Henson
“Rogue psychotherapists” (Finn, 2019) working for “rogue crisis pregnancy agencies” (ibid) may or may not have appeared to intervene with a client or clients in a manner which was abusive and/or reflected politically unpopular values. Whatever the actual extent of the alleged roguery, it seems that the impetus for what was ultimately the swift designation of ‘psychotherapist’ and ‘counsellor’ as protected titles was closely if not exclusively linked to the Government’s agenda concerning abortion law. And in that stroke, the future of psychotherapy in Ireland was forever changed.
It is a well-trodden aphorism that change offers both opportunities and threats. We have repeatedly heard about the potential opportunities brought by the regulation of psychotherapy. I have repeatedly argued that the Irish Association of Humanistic & Integrative Psychotherapy (IAHIP) also needs to pay attention to the potential threats. As an ordinary member of the Governing Body (GB) of IAHIP and later as Honorary Treasurer, I took every chance that presented (and I hijacked a few others) to ask concerned questions about the risks of moving from a system of voluntary self-regulation as a diverse and disparate craft, to statutory regulation as a homogenous ‘health care’ profession.
From the floor of this year’s AGM, other IAHIP members also expressed concerns and asked questions: What happens if I have ethical reasons for not wanting to join the register? What happens if the Government oversteps its mark and tries to interfere with practice issues? We know about the fit between IAHIP and CORU standards, but what about the fit between IAHIP and CORU values? Please can we do something about the implied slur to all psychotherapists, all of us, by the media’s common depiction of psychotherapists as ‘rogues’? How can we protect humanistic integration on future training courses after the very limited ‘window of influence’ closes? Awkward and inconvenient questions, not asked for the sake of being awkward and inconvenient, but because they reflect very real concerns.
I understand CORU had been invited to attend our IAHIP AGM but did not respond. I am told CORU will only speak with the Irish Council for Psychotherapy (ICP), which has positioned itself as the ‘one voice’ of psychotherapy. Unfortunately, this left us trying to answer our own questions and we fell into a familiar pattern. Questions about threats were answered with statements about opportunities. Questions about values were answered with statements about standards. We know what the process of regulation will be in terms of legal mechanisms, but what will be the impact upon our unique process(es) of humanistic integrative psychotherapy?
In equal measure, I am concerned for both practitioners and clients. Not clients as abstract, faceless service users, but clients as real people; the client I was and might be again, the clients that the people I love most in this world, were, are and might be. Often when I try to talk about my concerns, I become agitated and I appear angry. The main feelings I have now are those associated with sadness. Sadness at the imposition of a system that in its very definition is exclusive, and is also fundamentally mistrusting, suspicious and threatening.
The reflections set out here, on the future of IAHIP, humanistic integration, roguery, psychotherapy and optimism, are not a bugler-like attempt at a clarion call to arms. The time for that has probably passed. The tone of this reflection is more of a quietly hummed lament; the lament of an old-school psychotherapist.
On the future of IAHIP
A connection or cooperative link between people or organisations
My own formal ‘association’ with IAHIP is still very young, less than three years old in fact. I don’t share the long and close affinity with IAHIP that many of our members feel; that affinity which can only come through cherishing something over a considerable length of time. But even to a relative newbie like me, the value of IAHIP is immediately obvious, as is its heritage and place at the heart of Irish psychotherapy. Practitioners are, quite rightly, proud to be associated through voluntary membership with IAHIP; with its rich traditions, its ethics, its standing in the profession, its values. I count myself among those proud to be associated with IAHIP.
Stripped or relieved (depending upon your viewpoint) of its regulatory function, the future of IAHIP is uncertain. For some of our members, this offers exciting opportunities, freeing IAHIP to be more active in the promotion of humanistic values and to support any members facing fitness to practise hearings. Others feel less optimistic about IAHIP’s future role.
The question of what IAHIP will look like post-regulation featured occasionally as a topic of conversation at GB meetings during my tenure. There is no certainty that IAHIP will survive. The strongest reassurance that it will survive post-regulation, comes with the suggestion that membership of a professional association such as IAHIP is likely to be a condition of inclusion on the state register.
Every time I hear that suggestion, my heart breaks a little.
I don’t know what the future of IAHIP will be, but I hope it isn’t as a mandatory extension of statutory registration, where membership stops being about voluntary association based on shared humanistic values and becomes instead an enforceable requirement ‘punishable by a class A fine or imprisonment of up to six months’ (Department of Health, 2019). Personally, I would rather allow IAHIP a dignified death than see it mutated into such a Frankenstein’s Monster. I hope that others, more influential in IAHIP than me (whether it’s our elders steeped in IAHIP tradition, our youngsters with fire in their bellies or our current GB, which contains both), will prevent any change from voluntary association to forced membership.
At the risk of sounding like a rat on a sinking ship, this threat to IAHIP was one of the reasons why I recently stepped down from the GB. If enforced membership of IAHIP happens, I can’t bring myself to be at the helm when it does. History will judge each one of us. May it forgive my cowardice on this point.
On humanistic integration
I am struck by how little I hear people talking about empathy these days, even in humanistic circles. I raised this with a colleague recently. It was a snatched conversation over a working lunch, so maybe I am misinterpreting her point here, which I took as reassurance that empathy was currently so central to psychotherapy trainings that it could be considered a ‘given’ which didn’t need to be talked about.
I hope so, but I’m not so sure.
It is notable that in the Awards Standards – Counselling and Psychotherapy (Quality and Qualifications Ireland (QQI), 2014), the baseline standards by which all future Irish psychotherapy and counselling trainings will be assessed, the word ‘empathy’ does not appear once.
I recently had cause to try to find a way to describe empathy in a presentation I gave on psychotherapeutic wisdom and ecological awareness. Empathy is a tricky thing to talk about as a concept, because it isn’t an idea, it’s a lived experience. For sure, we find ways to talk about empathy, but these are imperfect. When I try to conceive of empathy, the image of the Claddagh often comes to mind; something about two entities (hands) coming together to support fidelity (crown) to emotional truth (heart). We draw upon notions such as Buber’s I-Thou (1970), we use words like emotional resonance, attunement and relational depth. When those of us who still talk about empathy have these conversations between ourselves, and with our students and supervisees, we understand each other not through knowing the theory but though knowing the lived experience that the words approximate.
Is empathy not referred to in the QQI standards because it is so much of a given that it doesn’t need naming? Or has it been forgotten/ignored/omitted because it is an awkward and inconvenient value, incommensurable with and therefore unmeasurable by academic standards? My guess is the latter. I suspect this is also true of notions like ‘emotional attunement’ and ‘relational depth’, which are also omitted from QQI standards.
I hope this can be rectified. Stating the obvious, my psychotherapeutic practice involves integration. There is room for skills and techniques, philosophy and theory, psycho- education and sometimes, on very rare occasions, even advice. All of those have useful places in the therapy I offer. But where does the real therapy happen? We well know the answer. It is in those fleeting moments of empathic attunement at relational depth; those moments that we can’t describe to anyone who doesn’t already know them through direct experience. Without those moments of empathic attunement, there is no humanistic integration; there can be integration, but not humanistic integration. I hope that the central value we place on that nebulous phenomenon we refer to as empathy isn’t lost in the way I fear it will be.
Conduct characteristic of a rogue, especially acts of dishonesty or playful mischief
Rogue is a very interesting choice of word when applied to psychotherapy. The archetype of rogue as trickster has a wonderfully creative and extremely valuable role in psychotherapy, particularly psychotherapy practised from a Jungian perspective. The trickster “is a symbol of the liminal state itself and of its permanent accessibility as a source of recreative power” (Pelton, 1980, cited in Russo, 2008). The trickster’s ‘playful mischief’ energy taunts, teases and pokes fun. It can be the perfect foil for despondency, lethargy and despair.
Rogue as unscrupulous, dishonest quack is less helpful and very hurtful. The (mis) conceptualisation that psychotherapy and counselling are professions rife with quackery is the sole reason why state regulation is regarded by some as necessary. Yet, as has been previously pointed out, the case for state regulation has never actually been made. It is simply assumed (Henson, 2017). Doubtless there are some practitioners misrepresenting their levels of training, but precisely how many such ‘quacks’ are there? What crimes are they committing? What harm is being caused, by whom to whom? Is the statutory regulation of every psychotherapist, even those of us who already voluntarily exceed the proposed standards, a necessary and proportionate response? The fact of this matter is that we don’t know. No substantial evidence has ever been put forward. Instead we are basing the future of our profession on hearsay, conjecture and assumption; information which would not meet the legal test in any criminal or even civil court.
Public protection is often used to justify regulation, but little is said about the risk of harm to the public by what many see as the inevitable move further down the road of defensive practice that state regulation will bring. For example, how will we safeguard clients from the unnecessary time and financial costs of remaining stuck in their therapeutic process because their therapist is too afraid to take even measured, calculated and defensible risks? And perhaps more importantly, how will we protect the rights of potentially the most vulnerable people, who are likely to find it very difficult to access therapy if the risk of them making a complaint is assessed as anything above minimal? Do we know with any degree of certainty that the exclusion and harm likely to be caused by fear-based defensive practice will be less than the harm caused by the so-called quacks? No. I respectfully assert that these and other risks to the public have not been adequately addressed.
I sincerely hope that the war on rogues will succeed in its stated objective of protecting clients from charlatans. I sincerely hope that in the same movement, we don’t eliminate the trickster’s therapeutic energy from our craft. I also sincerely hope that fear-based practice doesn’t result in some of the people most in need of therapy being de facto excluded because our regulatory system cannot support the relational challenges of the work.
To future clients, please don’t accept without question the common media portrayal of therapists as quacks. Likewise, please don’t assume that a therapist is an ethical and safe practitioner simply because their name appears on a list or that they are an unethical and unsafe practitioner simply because they might struggle to write theory essays to QQI’s academic standards. In fact, don’t make any assumptions at all, or rather, make your assumptions, then test them out; reality-check them.
The advice I give to anyone looking for a therapist is: try a few out. Ask around for personal recommendations, then go to an initial session or two. Ask your awkward, inconvenient questions. Cry, shout, show a little of your despair, your anger, your confusion, your doubt. Tell your potential therapist what you hope for and what you’re afraid of. Assess your potential therapist’s responses. How well did they do? Did you feel safe, listened to, supported, challenged? Did you feel ‘met’? Therapy is a relationship, co-created between client and therapist. Find one that works for you.
That is how good quality therapy is accessed. No certificate of government approval will short-cut the process.
It strikes me that QQI standards for counselling and psychotherapy are perfectly good standards for what might be described as psychological counselling. I would like to be clear that I have no problem with this model of psychological counselling, it has a valid and very valuable place amongst the range of service options and I would see it as falling firmly under the broad psychotherapy umbrella. The difficulty is that it is only one ‘flavour’ in the wide range of psychotherapeutic approaches currently available. I am adopting the flavour metaphor because it is one that has been used by advocates of state registration in several discussions I have had, to assert the position that psychotherapy is best served by ‘one voice’.
Clients, it is suggested, are confused by too many flavours to choose from. Better for them that we simplify the choice. I believe every single one of my clients would be offended to learn that some therapists think they couldn’t be trusted with rudimentary information about different therapeutic values, to make informed choices for themselves. If clients never try the mint choc chip because they (we) really like the raspberry ripple, then so be it. That’s their (our) choice. Educate clients about the range of flavours, but don’t patronise them (us) and, more importantly, don’t take away their (our) choice. Vanilla is lovely, but it’s not for everyone.
I had one of these ‘too many flavours’ conversations on the same day that I learned that the constructivist section of ICP had been disbanded. I confess to ignorance about why that section closed, but regardless of the reason, I am sad that it did. To me, Irish psychotherapy feels a little impoverished now that the valid and valuable flavour of constructivist psychotherapy is less readily available to the sections of Ireland’s communities who might benefit from it. What other flavours will be lost, discarded by the ‘one voice’? Is humanistic psychotherapy safe? Probably, in the short term, it is. I think there are enough humanistic psychotherapists around who will find a way to negotiate state regulation without compromising professional values. But long-term, once our autonomy in establishing our own values and standards on our own training programmes is a dim and distant memory? I don’t know.
Many approaches to psychotherapy view contemporaneous socio-political contexts as extremely important in understanding individual difficulty. I am concerned that psychotherapy might lose some of its ability to address and heal this aspect of client experience when QQI criteria become the only formal basis of our work. Of course, most clients enter therapy seeking help with their individual malaise or presenting problem. Psychotherapy must address and meet those client needs, and as we know it is often extremely effective in that pursuit. However, as we also know, many psychotherapists do not simply treat symptoms within individuals in the way that (other) health care professionals might.
Psychotherapists are privileged perhaps more than any other profession in that we are trusted not only with information about our clients’ public and private personas, but also their secret lives. We are trusted with information about what is really going on in the lives of our clients, including the real, lived experience impact of contemporaneous socio-political issues. To meet clients in this therapeutic need, therapists require freedom to move and respond; freedom to walk with our clients along their unique paths until they find and fully stand in their own place in the world. This is how psychotherapy empowers individuals and in empowering individuals, psychotherapy empowers communities. In empowering communities, psychotherapy has the potential to bring about global change.
The psychotherapeutic terrain of this aspect of our work with clients is often the edge spaces, the margins, the complex, the liminal, the nomadic, the non-binary, the grey and in-between areas. Psychotherapeutic change is often a form of transition, sometimes literal, sometimes figurative. We facilitate transition across borders, both in and out; in and out of jobs, in and out of gender roles, in and out of personal identity, in and out of intimate relationships, in and out of mood states, in and out of family systems, in and out of firmly held beliefs, in and out of world views, in and out of crisis, in and out of health, in and out of life. In a world where Brexit is possible, a wall across America is openly talked about and the gap between the financially rich and poor has never been greater (Independent.ie, 2018), it saddens me that psychotherapy in Ireland appears to be moving with the trend towards suspicion and exclusion. My preference would be for psychotherapy to move the other way, to focus more on inclusion and to foster trust; to straddle borders in their many forms and facilitate transition across them – which is what we do so well – rather than erect our own excluding walls. The imposition of a system singularly and heavily weighted towards the ‘treatment’ of ‘mental health problems’ above all other socio-political considerations, hinders our ability to move freely around the terrain of our craft. I fear therapists are now tasked with empowering clients in a system which mistrusts, infantilises and disempowers the process.
If there is one true note of optimism in my lament, it is that I still believe in the value of old-school psychotherapy and I believe that should it become necessary, something new will emerge to fulfil the functions that psychotherapy at its best currently serves. My personal preference has always been for the term psychotherapist rather than counsellor, but if I’m honest I have also always found the term (psycho-the-rapist) somewhat problematic. Like many colleagues, I am much more interested in preserving the spirit and intention of psychotherapy – the spirit of inclusive, socio-politically wise relational healing – than I am about the word we use to describe it. I have to believe that the healing practices that I associate with psychotherapy will survive in some shape or form and in no small measure I am excited about the potential for something completely new to emerge. Perhaps my fears will be unfounded, and under state governance psychotherapy will continue to be able to fulfil all its current functions? Perhaps it won’t and something else will take its place, with a new title, to meet these needs? Who can say for certain? We shall have to watch this space…
I hope that, post-regulation, IAHIP will continue to have a strong role in protecting the public from harmful practice (including the harm caused by fear-based defensive practice), but it’s difficult to see how, now that our self-agency has been handed over to state control. I hope that humanistic integration in healing practices might continue to flourish after our autonomy to set our own training values has dwindled. I hope that statutory regulation might at least curtail the media’s hurtful portrayal of psychotherapists as charlatans. And I hope that the socio-political potential of psychotherapy to bring about global, as well as individual, transformation won’t be seriously diminished.
With a sense of complex, anticipatory grief, I lament the potential losses that will accompany the potential opportunities brought by state regulation of psychotherapy. I hope that with hindsight, some if not all of the expressed concerns prove to be unfounded. And, if something new and exciting does emerge out of this, in which old-school psychotherapeutic values can thrive and develop, I very much wish to be a part of it.
Matthew Henson is an IAHIP and UKCP registered existential psychotherapist and an ecopsychologist, group facilitator and trainer. He is a former ordinary governing body member and honorary treasurer of IAHIP, a former member of BACP’s Fitness to Practise Panel, a former Fitness to Practise panel member of the Medical Practitioner’s Tribunal Service, a current member of Psychotherapists and Counsellors for Social Responsibility and current interim vice chair of the Ecopsychology and Ecotherapy Association of Ireland.
Artwork produced with the kind permission of my daughter, Indra.
Buber, M. (1970). I and Thou. New York: Charles Scribner’s Sons.
Department of Health (2019). Minister for health appoints psychotherapist and counsellors registration board, Retrieved 2 April 2019 from https://health.gov.ie/blog/press-release/minister-for-health-appoints-the-counsellors-and-psychotherapists-registration-board
Finn, C. (2019). Minister appoints counsellor board that will deal with ‘rogue’ psychotherapists and crisis pregnancy agencies, Retrieved 2 April 2019 from https://www.thejournal.ie/counsellor-registration-crisis-pregnancy-agencies-4518258-Feb2019/?amp=1
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Oxforddictionaries.com (2019a) Association Retrieved 2 April 2019 from https://en.oxforddictionaries.com/definition/association Oxforddictionaries.com (2019b) Roguery Retrieved 2 April 2019 from https://en.oxforddictionaries.com/definition/roguery
Russo, J. (2008) A Jungian analysis of Homer’s Odysseus, in Young-Eisendrath, and Dawson, T. (Eds.), The Cambridge companion to Jung. Cambridge: Cambridge University Press.
Quality and Qualifications Ireland (2014) Awards Standards – Counselling and Psychotherapy, Retrieved 2 April 2019 from https://www.qqi.ie/Articles/Pages/Active-NFQ-Standards- for-HE.aspx