Conversation: Martin Pollecoff in conversation with Pauline Dolan

Martin Pollecoff was elected Chair of the UK Council for Psychotherapy (UKCP) in March 2016. He was previously a member of the UKCP Executive Team and its Editorial Board.

Pauline: Martin, in your election pitch for the position of Chair of UKCP in 2015, you said “I don’t want to build a website, I want to build Rome”. I’d like to ask how that’s going for you, and if you could tell us about UKCP’s experience with statutory regulation, but before we talk about those, I want to start with an easy question about unconditional love.

Until he was seven years old, Daniel Solomon slept in a sitting up position, not because of a medical condition, but because he lived in an orphanage in Romania and was forced to share a cot with another child his age. This American life documented the journey of the American family that adopted Daniel, and faced the profound question of love and whether it can be taught to a child who has all sorts of reasons not to learn (Glass & Spiegel, 2006). What do you think: can love be taught and where does that fit into our work as therapists?

Martin: Love is not a theory that can be taught. No discussion of love can give you an experience of it – that discussion would be like giving a menu to a starving man – but love can certainly can be exemplified, experienced, and learned.

Every psychotherapy session is an act of love. It’s the nature of our profession – the alpha and omega of our work.

In our attempts to be taken seriously as grown-ups, or to try and gain scientific and medical status, we change the language – we talk about transference, resourcing the client, or the containment of the client. What’s that, if it’s not love made solid?

Heinz Kohut, who was called ‘Mr. Psychoanalysis’ & ‘Freud’s bulldog’ for his strict adherence to classical psychoanalytical technique, spoke about the way in which the ideal therapeutic view of the patient has to be like that of two parents standing over a crib holding hands and smiling down appreciatively at their newborn. At the end of his life, Kohut gave a speech at Harvard, abandoning theory altogether, and preaching “the power of love” (Lifespan Learning Institute, 2009).

Sometimes we take terrible stick from clients but we refrain from retaliation, just like a mother of a two-year-old child can contain hatred without abandoning the child. That’s love. More to the point, we are there every week, same room – unchanged. The constancy of our boundaried presence is a confirmation of the endurance of love. Look, there will be clients that for whatever reason you dread seeing, yet you see them and do your best. That’s love.

Humanistic psychotherapy is built on the B-values of simplicity, beauty and goodness. In the world of medicalised mental health, this all sounds naive woo-woo, but love is the basis of our work; it’s what we exemplify and what we all receive from our clients. When we talk about ‘relational’ work, that is another less cringey and toe-curling way of talking about love. I really don’t think you can fall in love with everyone, but in my view, you have to go beyond suspending judgment, you have to find something about the client that you can love; otherwise the therapy simply does not happen. It flounders and never takes off.

Now, does that mean that all psychotherapists have terrific personal relationships full of intimacy? Not really, far from it, for we teach what we most need to learn; however, we can often do intimacy for 50 minutes at a time, and that is more than enough.

Now, let’s go back to the problem – can a seven-year-old who has been orphaned, abandoned and neglected, learn to love? Sure he can. However, that path back to life may be very hard, very long and very painful for all concerned. And the results should not be judged by the standards of others who have not got through those experiences. When it comes to normality, i.e., our expectations, that kid will not be in centre of a bell curve, and we can fail a child by expecting too much. Or by holding narcissistic hopes of being the one who defeats evil, by rescuing someone who has been abandoned and damaged by others. The anxiety to get results can destroy the child’s feelings of containment. It becomes obvious to that child that he is not OK. And it has to be OK by someone who loves that child, that the child cannot love in return.

When you are learning to love, it’s best to take baby steps. A child has to get the experience of looking after something other than him or herself. Sometimes, that has never happened (yet). I asked one client to start growing mustard and cress on blotting paper. It made a start. She found herself nurturing life.

Sometimes loving people might be a bit of a stretch, but nurturing a plate of mustard and cress or growing a few flowers is sometimes just enough to launch you off the blocks.

Pauline: Recently our Minister for Health, Simon Harris TD, requested submissions and comments on Statutory Regulation. What has been your experience of that process?

Martin: Several years ago, ourselves (UKCP), the British Association for Counselling & Psychotherapy (BACP), and the British Psychoanalytic Council (BCP) negotiated with Government over statutory regulation. At least half of our members were clear that they did not want anything to do with it. They felt that we would be selling our freedom to practice in exchange for protection of title. The other half were keen to join and gain a safe, protected status. At the end of the day, the Government pulled out of the negotiations and decided we did not need state regulation. So, nothing happened.

Today, when I am speaking to students, I say: “as you go through your tuition, think on how you are going to make a living – hone your dissertation to be interesting to employers, and give you a calling card for your future career or speciality”. There are no promises any more. You can no longer say that the training leads to a set career. But that’s the same as if you studied History or English at college.

Now this sounds pessimistic, and it is, but we have to consider these very important issues and re-examine the set-up of our trainings. The world has changed and we need to change — big time. We have big questions to answer, ones that we have kicked into the long grass for too long, like ‘What is the difference between a Counsellor and a Psychotherapist?’ and ‘How do you grow from one to another?’ What do we do about wellness practitioners? Do we train them in our schools so that at least they have an idea about working with the unconscious, and they have to do their own therapy? That’s a big discussion. Do we form a charity and raise money to offer real psychotherapy? [The Certified Wellness Practitioner ‘CWP’ credential is awarded to practitioners from multiple disciplines and backgrounds, such as health promotion, counselling, wellness coaching, nutrition, social work, nursing, and education, who use a wellness approach in their practice.]

We also have to look again at the modalities. We find it difficult to present a single face to Government. Anyone peering into our consulting rooms will see the same thing – two people talking. What they talk about is not really relevant, but that issue alone makes us weak, for we are so split.

Again we are back to – do we want to be outsiders or insiders? Do we want to be right or satisfied?

Here is my test of a real profession. Can a single mother with no wealthy family to support her, someone who works in an ordinary job, possibly think about training as a psychotherapist? At the moment, the answer is probably no. But they could train as a wellness practitioner and then go on to learn more. And to my mind, we have to create a stepped programme for that single mother or working guy to become a psychotherapist. If we are demanding social justice we have to create that within the profession.

And here is the strange thing, we have more and more people who want to train as psychotherapists. This is despite the difficult fact that on average they would be better off financially being a wellness practitioner. This goes against all the laws of economics, so we must be doing something right.

We have terrific schools, great teachers – the UKCP is in fine fettle. We have never been stronger or better organised, but the profession itself is facing a time of great change, just as the public we serve are facing the same changes.

Pauline: Do you think there is any hope of psychotherapy being able to represent itself as a profession worthy of being paid a decent wage? I said ‘worthy’ – I’d have preferred to have said ‘demanding’.

Martin: Pauline, of course we are worthy and deserving – it’s just that right now we are on the outside looking in. In the UK, we have social medicine in the form of the NHS. Only around 20% of our members are working in the NHS (down 5% in five years) and of those workers, I am not sure how many are paid or unpaid/honorary workers.

Most of the work we do is not ‘evidence-based’ within the definitions laid down by the National Association of Clinical Excellence. We have practice-based evidence, they want evidence-based practice. Nor can we meet their standards because to do so means manualising our work and that is impossible.

That’s like taking your car for an MOT and the guy says “Just drive your car into the crusher and we will MOT it”. You say “But that’s insane, if you crush the car then it’s useless even if it has an MOT”, and he says “Sorry pal – I don’t make the rules”.

We are welcome to work as honoraries in the NHS, or staff the charities, but when there are paid jobs advertised, they do not to seem to be for us. In my own area, Westminster, there are nine full time psychotherapists (Clinical Psychologists) and 100 honoraries to serve five million people. The scandal is that the hospitals get paid for each hour an honorary delivers, but the workers get nothing. At the same time, in England at least, mental health beds have been cut. Merseyside lost 50 in one year, Norfolk and Suffolk have lost a quarter of their beds. And these are just headline areas. Between May 2000 and May 2005 the NHS lost 10% of their mental health nurses (and they were all unionised).

The good news is that in the private sector we have a surge of demand because the NHS service is so poor, but that is a consolation prize, and not all of our members can set up in private practice.

Pauline: I believe there is a Union started in the UK. Are UKCP supporting that initiative?

Martin: Yes, there is a Union. I was an early member and I personally support the Union. It does a good job, but it has to force a place at the table, because it’s not part of the Union Congress, and can never be because the majority of its members are self-employed and that’s not what a Union does. Unions are for employed workers.

If we were all members of a Union that was already in the NHS, that might be different. But we have a problem. The NHS has always found placements for us. If we go on strike, then I think that will end. If we go on strike, they would spin against us and we are vulnerable. There are plenty of wellness practitioners who would fill our shoes. Outsiders like ourselves cherish their freedom to speak their version of the truth. The price is that we are ignored by the insiders, who make the important decisions.

Right now we have an election on, and mental health is on the agenda. Every party will find money for that cause. In the UK, the papers talk about a Children’s Mental Health Crisis – but that is no surprise, because funding has been cut for children’s mental health year on year. True funds were ring-fenced in the NHS, but in the UK, it’s local authorities that really fund social services and therefore services for children.

If you have good medicine, then sickness falls. Over the past decade, money has been put into IAPT (Improving Access to Psychological Services), but taken out of everywhere else, and this shows in the results.

Governments like to give shiny things to the voters, and I am guessing that positive psychology training programmes will be put into schools. Now of itself, that’s probably a good thing, but once more, it will not help those with serious issues. It used to be that if you burn your school down you could get into a therapeutic community – today you would have to incinerate several schools to get a place.

We have to ask if this is the way in which we want it to go. And what should be an open and shut question is not at all open and shut. If we are outside the NHS, we have no power to influence. You gain the best training within an NHS context. You have a team around you and you can work with patients who are really ill. It’s a great place to hone your craft. Plus many of our members really want to support the NHS. They feel it’s the right place to be.

There is a recording of Sigmund Freud made in December 1938. It was part of a BBC radio series – Celebrity voices. He was too ill to get to the studio, so a BBC crew braved the early snows of that year and drove up to Hampstead to interview him. He tries to give a potted history of his life but he keeps coming back to how hard it was to create Psychoanalysis. In the recording, Freud says:

I started my professional activity as a neurologist trying to bring relief to my neurotic patients. Under the influence of an older friend and by my own efforts, I discovered some important and new facts about the unconscious in psychic life, the role of instinctual urges and so on. Out of these findings grew a new science, Psychoanalysis, a part of psychology and a new method of treatment of the neuroses. I had to pay heavily for this bit of good luck. People did not believe in my facts and thought my theories unsavoury. Resistance was strong and unrelenting. In the end, I succeeded in acquiring pupils and building up an International Psychoanalytic Association. But this struggle is not yet over.

(Transforming Art, 2008)

Now, if one man can do all that he can do – think of what we could do together. This struggle is not yet over.

Pauline: We have the information. Do we have the courage, confidence, and ability to lead the way?

Martin: We are going back to a 1950s model of using therapy to normalise people. Between the founding of Humanistic Psychotherapy at Old Saybrook College in 1964 and the late 1990s, the model of psychotherapy has been to work with issues of individuation, creativity, autonomy, relationship and to encourage eccentricity, in other words, to climb out of the box. Today’s therapy, or at least the therapy that the state pays for, is being used to convince people to step back in that box. Now, not everything done in the name of Humanistic Psychotherapy was great. We made mistakes – remember T Groups? – and I am not saying we go backwards and return to previous models, but as therapy becomes industrialised for large scale application by the State, it is based on a wellness agenda in which depression and anxiety are mistakes. You think wrong – therefore you feel wrong. This has shades of 1984. As REM (1991) sang, we are going to have “Shiny happy people all around”. I am not alone in considering this to be vacuous. Here is a therapy in which the unconscious and relationship play no part – but it’s cheap.