The IAHIP Pre-Accreditation Phase – A Liminal Experience

by Brian Gillen

The following article is a short summary of recent research carried out by Brian Gillen and Carmel Byrne on attitudes and experiences regarding the IAHIP Pre-Accreditation Phase. It is part of an ongoing process of consultation within IAHIP, which will hopefully lead to positive changes and improvements in the pre-accreditation phase and process this year and beyond.

Context of the research
At the IAHIP AGM in March 2015, during a Regional Group feedback session, initial research carried out by members of the City Centre and North Dublin Regional Group about the status and experience of pre-accredited associates (pre-accreds) was communicated to all members. During the ensuing debate, many Regional Chairs said that the same issues regarding pre-accreditation had been coming up at regional meetings around the country. The topic was further explored at the IAHIP Consultative Forum in April 2015, and the IAHIP Governing Body decided to appoint Brian Gillen and Carmel Byrne to carry out further research into the experience of pre-accreds, with a view towards reporting their findings and conclusions to the organisation.

History of the pre-accreditation phase
The history of IAHIP’s requirement that an applicant for accreditation have already completed, following graduation from a psychotherapy training course, a further minimum specific period of time as a psychotherapy practitioner (under supervision) with a specific minimum number of completed practitioner hours with clients, goes right back to the organisation’s beginnings in 1991. The terms of those original requirements, still reflected in ‘Bye Law 10’, remained unchanged until 2009 when, as a result of the agreement to bring training standards in line with those being demanded by EAP of all five sections of ICP, they were somewhat modified, as reflected in ‘Bye Law 11’.

IAHIP’s original attachment to the idea that there needed to be a post-training period of ongoing supervised practice before a person should become an accredited member of IAHIP was based on two relevant considerations:

1. In the interest of establishing high standards for humanistic psychotherapists, it was felt that practitioners should have considerable experience before being accredited by IAHIP – hence the 600 hours stipulation.
2. Since humanistic training courses at that time and for many years afterwards tended to be at most three years long, and with students seeing clients for one year or two years at most during training, it was inevitable that candidates for IAHIP accreditation were not going to have built up 600 practitioner hours by the end of their training.

When the Irish Council for Psychotherapy (ICP) approached IAHIP in 2009 to agree common training standards in line with those applicable throughout the European Association for Psychotherapy (EAP), the IAHIP reps were surprised to learn that the concept of a required post-course pre-accreditation period was foreign to EAP thinking and that, instead, candidates for accreditation were expected to have met all the accreditation requirements by, or close to, the end of their four-year psychotherapy training. Unlike IAHIP’s 600 hours supervised practice requirement before accreditation, EAP’s equivalent requirement was 300 – 500 hours. This created a significant challenge for IAHIP who had become very married to the idea that candidates for accreditation needed more clinical experience than EAP was demanding, as well as the ‘benefit’ of the maturing process associated with conducting a post-training clinical practice. The outcome, reflected in ‘Bye Law 11’, is a compromise with ICP thus, reducing firstly, the pre-accreditation period from two years to one year and, secondly, the required clinical practice hours from 600 to 500 hours. However, to fit in with the EAP concept that training should normally lead immediately to accreditation, a further change was made in ‘Bye Law 11’ by describing the IAHIP pre-accreditation period as ‘Phase 2’ of a two-phase training period.

Research findings
The research, which was both quantitative and qualitative, reported the attitudes and experience of pre-accredited associates under four different headings or themes. Whilst there is some inevitable overlap amongst the feedback in each theme, each one stands alone as an area of concern and issue for respondents. There follows below a summary of these findings:

A. Practical and financial challenges
A very high proportion of respondents (81%) said that the challenge of transitioning from free/low cost centres or clients, to paid client work, during the pre-accreditation phase was ‘difficult’ or ‘very difficult’. Only 19% said it was ‘easy’, meaning that the work/employment and financial aspects of the pre-accreditation phase pose a very significant challenge for new therapists, and may often lead to some unduly delaying or relinquishing the accreditation process for reasons of financial over-burden, or insufficient client hours. Almost three-quarters of all respondents (72%) said that the level of practical help they received in finding full-time work as a therapist during the pre-accreditation phase was either ‘poor’ or ‘very poor’. This suggests that IAHIP may have to improve or develop its role in supporting new therapists in such practical matters as finding appropriate and sustainable professional work or indeed setting up in private practice.

Many pre-accreds spoke of a perceived and real gap between ‘being qualified’ and ‘being accredited’, with a minimum of one-to-five years further client work required before becoming accredited. During this time, they are often employed in a full-time job or other professional work and this limits their availability for paid client work. They will often have debts/outstanding loans from a college course, and they are still not eligible to apply for institutional jobs, e.g., Student Counsellors, HSE positions, EAP work, etc.

B. Professional development
Seventy-six percent of respondents stated that the experience of being a ‘qualified therapist’ but not a ‘fully accredited therapist’ during the pre- accreditation period was either ‘difficult’ or ‘very difficult’. This suggests the existence of many practical challenges during pre-accreditation. However, it also reinforces a perceived deficit in ‘professional status’, which may undermine credibility as a therapist, confidence in progressing in one’s professional career as a therapist, and their sense of fairness and equality with therapists from different associations who are not required to undertake a pre-accreditation phase but automatically get accredited upon completion of training. Three-quarters of respondents said that the level of professional and work-related support they experienced during the pre-accreditation phase was either ‘good’ or ‘very good’. This is an encouraging aspect of the survey, however, when we take into account individual interviews and qualitative feedback from the survey, some of this support can be attributed to individual supervisors, former training peers and other therapists/associates, rather than any direct involvement or support from IAHIP. Even though the stated dissatisfaction levels for this question only represent a quarter of the survey (i.e., ‘poor’ and ‘very poor’ support experienced), it is still a significant proportion of respondents who do not feel supported in the transition phase between training and accreditation.

For the newly pre-accredited associate, formal skills training ends and they must end supervision with their current supervisor and find a new one (under IAHIP ethical guidelines). They may have to end personal psychotherapy (for financial/time/work reasons) and this can unduly affect their client work. They may have to finish with existing clients at a training centre, and this can interrupt or frustrate their professional development. Because their formal role as a ‘therapy student’ ends, they may experience less support from family or work to stay in the field. They can often become disillusioned in attempting to find new clients alone, or trying to join an established therapy centre. Many therapy centres insist on only retaining fully accredited therapists, which is an impediment to developing professionally, and furthermore, they often require a commitment to block-book a number of hours when renting a therapy room and the cost is therefore prohibitive.

Unlike the training/college stage of development, there is no formal body or organisation such as a ‘college placements officer’ to vouch for, or facilitate a placement for the newly pre-accredited therapist. Furthermore, the pre- accred may have to do their own client intake (without any interview/ screening process as pertains in counselling centres) and therefore may be more exposed to starting work with inappropriate clients. The pre-accred may even become unduly driven by financial pressures and thus the need to ‘keep clients’, which can negatively affect the therapy process. Client work is no longer part of a wider ‘training process’ and therefore somewhat temporary in nature. It now becomes more real. The context is more open-ended and long-term; it also becomes more about the pre-accred’s own livelihood.

C. Personal process
Forty-eight percent of respondents said that the level of personal and emotional support they experienced during the pre-accreditation phase was ‘poor’ or ‘very poor’. Despite the fact that 52% said it was ‘good’ or ‘very good’, it is concerning that almost half said it was not.

For the newly qualified therapist, their sense of achievement and personal satisfaction on completion of studies is soon met with the uncertainty and confusion of ‘what next?’ There is an ending of current routine, including weekly college and study, academic work and thesis. Peer support from co- students and trainees (on a consistent basis) ends, along with other regular supports such as Process Group. This transition period can feel lonely and isolating and there is an even greater need for self-care. The changes/ sacrifices made during the training phase may negatively affect personal and family relationships, which need more attention post-training. Some pre- accreds set up working from home (for financial/practical reasons), which can add further isolation or potential vulnerability or exposure. There can also be a resistance in some cases to becoming ill or taking a holiday for fear of loss of clients and thus revenues.

The most common words and phrases used by interviewees to describe their experience of the transition from training to pre-accreditation are: Stressful; Anxious; Loss; Isolating; Lonely; Challenging; Disappointment; Unsupported; Poor self-care; Wake-up call; Overwhelming; Significant change.

D. Relationship with IAHIP
In the most direct question posed regarding the relationship between pre- accredited associates and IAHIP, almost two-thirds of respondents (62%) stated that IAHIP had been either ’unhelpful’ or ‘very unhelpful’ to them during this period. This represents a significant cohort of pre-accreds who think that IAHIP has not been at all helpful in their personal and professional development and progress towards full accreditation. Thirty-eight percent of respondents said that IAHIP had been ‘helpful’, which is a positive and encouraging statistic, however no respondents said that IAHIP had been ‘very helpful’, which would reinforce a perceived or real gap in pro-active support, i.e., support that goes above and beyond what might be expected from IAHIP towards pre-accreds.

The IAHIP ‘Code of Ethics’ (2005) defines pre-accreds as ‘Associates’ and not ‘Members’, which may reinforce a perceived difference in status within the organisation. There exists a perception amongst many pre-accreds that membership of IAHIP committees is restricted for them if not forbidden outright. This is of course the case regarding certain committees where an ethical boundary would preclude the involvement of pre-accreds, e.g., the accreditation committee, however, such exceptions can be unclear or not communicated properly, and become generalised as the rule. There is a perceived lack of encouragement of pre-accredited members to become more involved in the organisation (the recent effort to encourage pre-accreds to present papers at the 2014 conference was considered an important first step, but this momentum needs to be built on). In some cases, the pre-accred application process is the first introduction to IAHIP new associates have, i.e., they may not necessarily have been student associates prior to their application, or may have come through a different counselling organisation. Therefore, IAHIP, its culture, its code of ethics and the organisation in general, can be completely new to them. There is a perceived lack of IAHIP’s presence in the training colleges (formally and informally, directly and indirectly) and this represents potential missed opportunities for the promotion of IAHIP, accessibility of IAHIP to students and vice-versa, and influence of IAHIP on training. Many pre-accreds wish to see more pro-active engagement and services provided by IAHIP, e.g., facilitation of process/supervision groups; work placements; personal support; advice (i.e., those services previously provided by their training college). This also includes a dedicated advice/ support service for pre-accreds on establishing a practice, and business/tax advice, etc.

Pre-accreditation phase requirement
The research also explored attitudes towards retaining the pre-accreditation phase requirement or not. Given the challenges of being a pre-accredited associate, one might have expected that a majority of respondents would question the need to have it in the first place. However, 75% of respondents said they believed that the pre-accreditation phase was necessary in the context of becoming a fully competent and accredited therapist. Twenty-five percent disagreed with this. It is important to note here that most respondents in the ‘yes’ category (75%) proceeded to qualify the meaning of their response and suggested changes or improvements that should be made regarding the pre-accreditation phase. This suggests that they welcome the retention of a post-training pre-accreditation phase but not in its present form.

The pre-accreditation phase was seen as an invaluable stepping-stone in every therapist’s development, providing space to reflect on one’s own process and work. Many trainees are not fully prepared for client work immediately after qualifying, and it graduates the process of ‘becoming a therapist’ in a more organic and professional way. It places greater emphasis on supervision and the importance of good and consistent supervision practice throughout a therapist’s career. Many said, however, that more supports need to be put in place that recognise pre-accreditation phase difficulties and that place more value on therapist development during this period.

Changes and improvements regarding the pre-accreditation phase
The research garnered the views of participants as to what changes and improvements might be introduced by IAHIP in this area. The points below are a summary of some of those ideas:

Administration

• Greater clarity and streamlining of the overall training process and in this context, a clearer, simpler and shorter pre-accreditation process (also, to clarify any confusion between ‘Bye Law 10’ and ‘Bye Law 11’).
• Applications for accreditation received by the due date be processed at the intentioned accreditation meeting or during an extra ‘emergency’ meeting if required.
• Consider integrating/aligning the pre-accredited phase more with the final phase of training, e.g., pre-accreditation begins when the trainee starts seeing clients/practice. This would provide more connectivity between IAHIP and the student colleges, keep student/pre-accredited therapists more reliably within the IAHIP structure (with a view towards final accreditation and not ‘falling off’ towards the end of training), and provide IAHIP with greater influence in the direction and quality of training and training schools.
• Remove the pre-accredited phase for graduates of QQI Level 8 and higher.Decrease ‘client hours’ requirement for final accreditation.
• Introduce a post-graduate Provisional Membership Period of one year requiring sign-off after 12 months by approved supervisor and or Accreditation Committee.
• Introduce a final face-to-face interview into the accreditation process for all applicants.

Communication and organisation

• Greater communication from IAHIP on the services available from IAHIP or elsewhere during the pre-accreditation phase.
• Pro-active follow up with pre-accreds to assess if and how they have gained employment, and possible dissemination of that information and advice (this could also be done through an online facility). Seek to help everyone with job opportunities by promoting a networking approach.
• Ongoing structured support for pre-accredited associates, regular meetings perhaps, or pro-active integration with existing Regional Meetings.
• Specific, free or low-cost seminars/meetings/groups for advice, mentoring, info sharing.
• An information day/evening for new members. Information, advice, support as to options after qualifying, e.g., starting your own practice/ tax requirements, etc. (This could be integrated into the AGM for those being presented as newly accredited).
• Development of an online forum dedicated to students and pre- accreds where participants can ask questions and receive suggestions and answers to any problems or practical challenges they may have.
• Explore providing media training for a small, representative, core group of pre-accredited associates with a view towards advocating and representing the ‘career choice’ of psychotherapy to the wider population.

Practical and financial support

• Facilitation or organisation of salaried internships, similar to those offered for addiction counsellors.
• Set up a bi-annual ‘Accreditation Workshop’ to act as an introduction/ guide to the final accreditation process, including writing a ‘Personal Statement’.
• A mentoring or ‘buddy’ scheme, where pre-accredited associates can access help and advice when starting out as a therapist or seeking work, etc.
• Subsidised or discounted supervision for pre-accreds (This doesn’t have to be a direct subsidy from IAHIP but could be a membership fees discount given to any supervisor who provides less expensive supervision to students and pre-accreds over a fixed period).
• Provide more support and access to training, training courses and resources outside of Dublin, e.g., in the North, South, West, Midlands and South-East.
• Provide a Co-op with therapy rooms which can be rented by the hour to facilitate an individual to build their practice. This could be operated through a network of therapy centres, or IAHIP could trial setting up its own city-based centre as a temporary ‘cradle’ for new therapists. It might include online or hard-copy library resources for loan.

Conclusion
One of the research participants referred to their experience of being a pre- accredited associate of IAHIP as a ‘liminal’ experience. Liminality (Van Gennep, 1908) is the quality of ambiguity or disorientation that occurs in the middle stage of rituals, when participants no longer hold their pre-ritual status but have not yet begun the transition to the status they will hold when the ritual is complete. During a ritual’s liminal stage, participants ‘stand at the threshold’ between their previous way of structuring their identity, time, or community, and a new way, which the ritual establishes. ‘Being a psychotherapist’ and choosing psychotherapy as a full-time career can be seen as the ritual that IAHIP facilitates and helps to establish among those who decide to start a new life-journey in a training school or college. In this research the experiences of pre-accreds can be summed up as liminal, in the sense that it aptly describes the experience of qualifying as a psychotherapist and counsellor, however not yet being a ‘fully accredited’ one.

Winnicott (1990) talks about ‘The Facilitating Environment’, where becoming a therapist, i.e., the transition from student to fully-fledged therapist, needs to be supported by the relevant institutions that surround it, i.e., colleges, workplace and the accrediting body. In properly facilitating and supporting pre-accredited associates, IAHIP needs to take a more pro-active role in key areas of its communication, administration and organisation. Moreover, the very role and status of the pre-accredited associate within the organisation needs to be re-evaluated and either reconfigured or abolished. This research concludes that participants do not wish to remove the pre-accreditation phase, as it still represents an important function and purpose, however, they strongly wish to see changes in its positioning, duration, status and associated support mechanisms through IAHIP.

The changing social, economic and ethical context surrounding psychotherapy as a profession, as well as current psychotherapy training requirements both in Ireland and abroad, and the new and evolving demography, profile and needs of candidates entering the psychotherapy and counselling field, have changed significantly since the inception of the pre-accredited phase (essentially contained within the original ‘Bye Law 10’). ‘Bye Law 11’ has attempted to reflect some of these changing needs, however, it was based primarily on aligning standards between EAP, ICP and IAHIP, and not so much on looking at the pre-accreditation phase in the round. The pre-accreditation phase can be an important cradle for emerging therapists, however it is too long and restrictive in many cases, doesn’t adhere sufficiently to the realities and challenges facing the increasing number of graduates emerging from training colleges, and doesn’t support or foster new therapists as well as it might. It needs to be more fully integrated into the overall training requirement and process in a more flexible, supported and practical way, brief enough to enjoy the benefits and supports that being a pre-accred can bring, and long enough so that pre-accreds gain the relevant experience and quality of skills in therapy practice to justify accreditation. This will allow new therapists to engage more fully and freely in the expansion and growth of their career, work and personal process, and minimise unnecessary external obstacles in that endeavour.

Brian Gillen MA Psych, MIAHIP, ICP, is the Director of LifeChange Psychotherapy and Counselling in Dublin, and a full-time psychotherapist. He can be contacted at brian@lifechange.ie.

References:
Irish Association of Humanistic and Integrative Psychotherapy (2005). Code of Ethics. Accessed on 19th January, 2016 at https://www.iahip.org/professional-conduct.

Van Gennep, A. (1908). The Rites of Passage, Chicago: Chicago Press.

Winnicott, D.W. (1990). The Maturational Processes and the Facilitating Environment: Studies in the Theory of Emotional Development, London: Karnac Books.