by Aoife Ruth

Attending the Irish Association of Humanistic and Integrative Psychotherapy (IAHIP) pre-AGM meeting on Friday 3rd March, I was extremely grateful to be able to hear and contribute to the discussion around the pre-accreditation phase. It is beyond doubt that even when opinions on this matter differ, everyone is grappling with this issue in a generous and well-meaning way.

I heard a range of concerns being voiced from all sides. To name a few, these included maintaining professional standards, sufficiently holding and supporting newly qualified therapists embarking on their professional journey, the expense of the journey to full accreditation, and concerns around engaging in unpaid work to reach the requisite hours for accreditation.

In this article, I would like to discuss the pre-accreditation phase within the context of group membership and associated social psychological dynamics. Though writing for and with IAHIP in mind, it is important to say at the outset that I think these processes apply across the psychotherapeutic community of accrediting bodies in Ireland.

Membership of IAHIP confers many things, including status, social capital, access to resources and social networks, representation, guidance, legitimacy and belonging. Within the psychotherapy community IAHIP is a powerful in-group – a dominant and socially attractive collective. Thousands of students and pre-accredited psychotherapists seek to become members precisely because of the positives attached to group membership (McLaughlin- Volpe, Aron, Wright & Lewandowski, 2004).

Interestingly, it can also be argued that within the broader context of mental health in Ireland, IAHIP is also an out-group. This means that the organisation is slightly outside of the mainstream in-group, in this case, the dominant HSE mental health system. I have often heard it lamented (indeed I lament it myself) that psychotherapy is not a more established and available profession in the framework of national and ‘regular’ services. In the Expert Group’s A Vision for Change consultations (2006), there were clear demands that talk-therapies would be more integrated and accessible. However, psychotherapists and counsellors appear to be seen as ‘add-ons’, or ‘it-would-be-great-if-we-had-the-budgets…’

So, within the larger context, psychotherapists (via their representative bodies) are also seeking to join the mental health mainstream in-group as vital, embedded, necessary and valued members on par with psychologists, psychiatrists, occupational therapists and so on. We are trying to assimilate to the in-group norms and values as the worth of psychotherapists as a group is threatened. This behaviour is consistent with out-groups’ conciliatory approaches to exclusion (Hutchinson, Abrams & Christian, 2007).

Though newly qualified, I have already picked up one example of this culture of assimilation, seeking to prove psychotherapy’s value to this larger group. I see it in the vigorous pursuit of Irish research in psychotherapy, demonstrating efficacy and results. In a sense, to appear desirable for membership to the mental health in-group, psychotherapy is ‘playing by their rules’ and seeking to communicate reasons for psychotherapy’s legitimate claim to in-group membership through the medium of objective, scientific knowledge – something the in-group values.

So why is this relevant to pre-accreditation and membership of IAHIP? Well, it might be that this very threat to the psychotherapists’ group identity from wider sources impacts how the group perceives variability in its own membership. Hutchinson et al. (2007) reported several studies showing that smaller groups who have less status feel a threat to their identity and self-esteem. They also perceive their group’s membership as homogenous, that is, they view their members as all the same. One function of this solidarity may be to prepare the group to collectively resist their exclusionary status.

The history of chaotic training and regulatory standards for psychotherapists and counsellors has damaged trust in the profession. Just in the week I am writing this, the Fianna Fail spokesperson on mental health has again called for urgent regulation of psychotherapists and counsellors after “this week’s revelations that a celebrity ‘psychologist’ was providing bogus advice over an extended period of time” (Brown, 2017).

In this sort of climate, there is a real need to display objectively measurable professionalism, commitment to ethics and competence, in order to resist any threat to how the profession is viewed. But to be secure in those claims, the group making them must be defined, distinct, exclusive.

In the view of social identity theorists, group membership contributes deeply to self- concept – essentially, how I view myself. So, you might say IAHIP membership is a kitemark that communicates to the person themselves and to others, that the member is reputable, competent, effective, trustworthy, ‘not like those other cowboys’! Further to this,

when a group provides a psychologically meaningful basis for self-definition, members are motivated to establish and maintain a positive distinction between that group and other relevant out-groups.

(Hutchinson et al., 2007: 40).

The standards of membership become paramount in both the resistance to external factors and the feelings of subjective worth, self-esteem and efficacy, both for the group and individual member. Members can make a distinction between other (bogus?) non-member, practising psychotherapists. However, they are also motivated to make a distinction between other out- groups, namely, newly qualified psychotherapists who are seeking group membership but whose profile is not deemed to be consistent with existing members.

Accreditation is the process of becoming a group member and in thinking about all of the above it was with a wry smile that I read IAHIP’s website. Here, accreditation is phrased as being ‘accepted’ to the group rather than, say, using the word ‘joining’. This emphasis reflects the power of the organisation to control membership status, to confer privilege and a sense of belonging – in short, who is ‘in-group’ and who is ‘out-group’.

As discussions unfolded at the pre-AGM meeting and in reflecting afterwards, I found that the most pertinent issue for me (about to embark on the pre-accreditation phase) was not so much the requirements or minutiae involved, but the label ‘pre-accredited associate’. What this term actually communicates, loudly and clearly, is that pre-accredited associates are out-group. We are excluded and that has consequences.

I have no doubt that everyone has clients that have suffered and struggle with their own forms of exclusion. From the manager who is isolated from co-workers, to the family member who is ostracised. I am even sure that many of us have experienced it. For instance, in childhood and our teenage years when we were left out of the invitations to a peer’s birthday party, or simply not asked to join the others in the school yard. Just as group membership contributes to self-concept, so too does exclusion and it is one of the reasons that offering positive regard for clients is such a powerful thing. It contradicts the feelings of not being accepted.

The emotional and personal effects of exclusion, I believe, are extremely relevant to another aspect that came up in discussions. That is, the practice of pre-accredited associates being asked to work free-of-charge in order to build up hours. Just to put in perspective how common this is, I went back through three months of the weekly Activelink Jobs and Volunteering E-Bulletin. Every week since the beginning of February 2017 has included an advertisement specifically seeking ‘pre-accredited’ psychotherapists. Most even explicitly state that this would suit someone who is working to build up hours.

It was clear that this is something that troubles IAHIP members, pre-accredited associates and students alike and most appear to view it as exploitative to some degree. From listening to colleagues, most see unpaid labour as a regrettable but inevitable component of reaching the requisite hours for membership of IAHIP. Therefore, being an area of major concern, it was raised at the meeting and I was surprised to hear one response in particular – “but this has nothing to do with IAHIP!”

It is true that IAHIP is not a policing body. The organisation cannot impose upon another organisation that is looking for volunteers and attempt some sort of ban on the practice. Nor should the organisation take responsibility for an individual’s agency and decision to pursue non-paid labour. However, to suggest that this practice happens in a vacuum, that it is has ‘nothing to do’ with IAHIP, is naïve in the extreme.

The category ‘pre-accredited’ exists because it was created by the accrediting bodies. I believe that when IAHIP makes a distinction, through the use of different accreditation labels, it contributes to the perception in the wider caring-society that newly qualified psychotherapists lack value. This is the flip-side of defining the in-group positively. It affects views of the out-group as less desirable, less valuable.

Now to be sure, IAHIP is proud of its associates – both student and pre-accredited alike. The organisation is not putting out an explicit message that these groups are undesirable, far from it. For me personally, I read the label as ‘not fully cooked’, ‘good, but not quite there’, ‘L-plates’ and other notions that hold that, ultimately, I have value as a psychotherapist but I’m not a fully-fledged member yet.

Perhaps some of my own less-than-positive perceptions, my less-than-positive therapist’s self-concept, relate to my out-group identity. Hutchinson et al. (2007) provide an excellent overview of studies showing that out-group self-concept is correlated with increased feelings of hopelessness and worthlessness, and a decreased sense of self-efficacy. Out-group members are also more likely to engage in self-defeating behaviour.

In plain terms, like so many other times in this discipline, we have a triangle!

1) An accrediting body who, through their own promotion of in-group identity, subtly devalues non-members.
2) Newly qualified psychotherapists, whose out-group status affects self-concept, feelings of self-worth, and an increased tendency to engage in self-defeating behaviour.
3) An external organisation (with presumably no funds to pay for fully accredited workers) that explicitly uses the system of accreditation to their advantage when seeking cheaper means to provide services.

Exploitative practices take place within this space.

I wrote at the beginning of this article that IAHIP members are considering the issue of pre- accreditation in a very well-meaning and generous way and I wish to reiterate this. There are carefully thought-out ideas being put forward, creative approaches to the problems, and commitment to consider the issue. As I enter the pre-accreditation phase, I’m grateful to see the efforts and care that members are taking, for example, providing the space pre-AGM to talk about this.

There are genuine concerns and really tough questions here – questions which I ask too. How can the organisation balance inclusion with upholding standards? How many requirement hours equal competence? And being truthful to my own desires and shadow, perhaps the few years of hardship I will endure will be worth the privilege and standing I get with membership of this auspicious group? In calling for change, are associates short-sighted turkeys voting for Christmas?

One thing that I found strangely absent from discussions at the pre-AGM meeting was what the effect of any altering to the accreditation process would have on the privilege conferred by IAHIP membership, or discussions on the power and status that an exclusive approach to membership brings. In short, I would have loved a recognition and reflection on what IAHIP members gain from excluding others seeking to join. In the parlance of our time, IAHIP, it would have been nice to see you ‘check your privilege’!

In viewing this borderline of membership, there are no easy answers but I would call on members to honestly reflect on how in-group power, status, privilege and acceptance might impact how some of these questions are answered.

Aoife Ruth holds a BA in Sociology and Politics, and H.Dip. in Psychology. Enrolled at Turning Point, she is completing her Masters psychotherapy research on her passion, supporting musicians’ mental wellbeing. Aoife’s other areas of interest include the sociology of mental health, liberation psychology and critical psychology.

References:
Activelink. (2017). Activelink jobs and volunteering [Weekly e-bulletin; personal email correspondence]. Retrieved 28 April 2017 at https://www.activelink.ie/content/newsletter- info.

Expert Group on Mental Health Policy. (2006). A vision for change: Report of the expert group on mental health policy. Dublin: Stationery Office.

Browne, J. (2017, April 22). Government must move to regulate counsellors and psychotherapists. Retrieved 28 April 2017 at https://www.fiannafail.ie/government-must- move-to-regulate-counsellors-and-psychotherapists-browne/.

Hutchinson, P., Abrams, D., & Christian, J. (2007). The social psychology of exclusion. In D. Abrams, J. Christian & D. Gordon (Eds.), Multidisciplinary handbook of social exclusion research (pp. 29-57). Chichester: John Wiley & Sons.

McLaughlin-Volpe, T., Aron, A., Wright, S.C., & Lewandowski, G.W., Jr. (2004). Exclusion of the self by close others and by groups: Implications of the self-expansion model. In D. Abrams, M.A. Hogg & J.M. Marques (Eds.), The social psychology of inclusion and exclusion (pp. 113– 134). New York: Psychology Press.