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Regulation of Psychotherapy in Ireland

by Ger Murphy

In this article I wish to put the question as to whether we, at this stage, need an umbrella body to oversee the regulation of psychotherapy in Ireland. If, as I believe, the answer is an affirmative one, I wish to pose the question as to how we might go about this and what may need to happen within the Humanistic and Integrative Psychotherapy movement as part of this process.

I am prompted to write this article and argue for the beginning of an umbrella organisation by a number of events. Firstly, we hear the rush of advertising regarding the creation of a free labour market in the European community in 1992. This seems to give rise to a mixture of interest, fear, and confusion among psychotherapists here. The free Labour Market to be created will mean that if you are qualified and registered to practice in one country you will have the light to work in any other EC country. Within psychotherapy, as no one is currently registered to work in Ireland as a psychotherapist, how will this affect us? Those registered in Holland, Italy etc. could, in theory, claim the right to work here and under current circumstances, no reciprocal right for Irish psychotherapists would exist.

Secondly the rapid growth of psychotherapy here over the past 5-10 years means that there now exists a sufficiently large pool of practicing psychotherapists to begin a worthwhile debate leading eventually to regulation. This is especially in order as the client population served by the growing profession is now of sufficient size to warrant a system of consumer protection, a major responsibility to be undertaken by any regulatory body.

Thirdly my interest in writing this is sparked off by the recent controversy arising from the inauguration of a register for psychologists in Ireland, and the question it posed for psychotherapy. When this was launched an explanatory article appeared in the Irish Times which stated that one of the concerns out of which this register was formed was the Psychological Society’s concern about “self styled psychotherapists….who may have minimal training. Vulnerable people need to be protected from such charlatans…..” While such protection may be necessary, the question is posed as to who should undertake such protection. It also highlights the absence of a clearly identified professional body for psychotherapy so as to allow the distinction between psychology and psychotherapy to be clearly drawn and boundaries of professional responsibility clearly marked.

The consideration of these three issues, the growth of the profession and the arising need to demark boundaries of the profession both within this country and in the context of Europe highlight strongly for me that the time is now right to develop an umbrella structure to oversee the growth of psychotherapy as a profession in Ireland.

The U.K. Experience

What might this structure look like? In answering this question I wish to look initially at the experience in the United Kingdom, from whom many of the other professional bodies in Ireland, while in their fledgling days, took their model. We at the Creative Counselling Centre have been a member of the growing structure in the UK for the past four years, and I believe that the model arrived at there has a great deal to offer us in Ireland at this time.

In the UK in 1982, in the aftermath of the Scientologists and concern being voiced, a Private Members Bill was proposed in Parliament to regulate the practice of psychotherapy. This bill failed to become law probably due to the complexity of the questions that it raised regarding the many strands emerging in the profession, and the valid belief that Government legislation needs to be the end point and not the beginning of such an important debate. However, out of this, the profession was asked to “put its house in order” and return to government with a coherent structure whereby regulation could eventually become a real possibility. Out of this emerged the United Kingdom Standing Conference for Psychotherapy (UKSCP). This was inaugurated in 1989 after a long debate and exists as an umbrella organisation formed in sections along lines of core philosophical orientation. This includes sections under tides of analytical psychotherapy, Behavioural Psychotherapy, Family, Marital and Sexual Psychotherapy, Humanistic and Integrative Psychotherapy, Hypnotherapy, Psychoanalysis and Analytical Psychology. This model is an exciting one in that it is an inclusive model which does not favour one core philosophy orientation over another and thus fosters unity within the profession. Unity of purpose across the various schools of psychotherapy in the pursuit of a shared identity (recognisable to the public) encourages dialogue, cross fertilisation of views and a concern for the maintenance of the standards of all. This model is in contrast to the models currentl y employed in other European countries and in the USA. In several countries of Europe, psychotherapy is not seen at all as a profession but as an activity to be undertaken by other professionals, e.g. psychiatrists, psychologists, social-workers etc. This is the so-called “core professions” model.

In the absence of a definable and integrated psycohotherapy structure, other professions with an interest in the field have needed to take responsibility for standards etc. However, while these trainings as well as others may offer a good grounding from which to move to train as a psychotherapist, they are not per se any guarantee of psychotherapeutic ability or skillfulness. In contrast in the UK such professions are represented at the Standing Conference where they can voice their concerns to the profession of psychotherapy, I believe that this model is far preferable to the public, in the clarity of professional boundary and role which it offers, and to our own profession as it offers a forum to further develop and enrich our response to the psychotherapeutic task, which is significantly different from that of other professional roles.

To conclude this part of my discussion I hope that I have given adequate cause to add fuel to the already growing move towards unifying the profession under one inclusive umbrella in Ireland. I believe that this needs to happen in the near future having consideration to the natural length that this process will take. Further I suggest that we seek guidance and encouragement from the Standing Conference in the UK and seriously consider the value in emulating the structure which has been created there.

Humanistic and Integrative Psychotherapy

The proposed development outlined above brings into focus the second theme to which I wish to address myself. I see the need to begin developing a coherent sectional structure under the banner of a Humanistic and Integrative Psychotherapy forum. This may also need to happen in other sectional groups. I see this as important as it will begin to draw together practicing psychotherapists and trainings currently operating here within this core philosophical base. I would like to see this forum take on two functions. Firstly the creation of a clear identity for this grouping and a set of criteria for minimum training requirements. Secondly I see the group as potentially developing an accreditation structure for such psychotherapists. This distinction is an important one, for while there currently exists a number of training courses qualifying graduates in this field there does not exist a system of renewable accreditation or licence to practice. At present any humanistic and integrative psychotherapist in Ireland seeking accreditation needs to apply either to a training body elsewhere, e.g. UK or else to the Association of Humanistic Practitioners in England.

How would one belong to such a grouping? A great deal of debate will need to take place on this issue and I will draw out only a few possible pointers. Firstly to belong one would need to be a practicing psychotherapist, having undergone ones own therapy and having adherence to the basic tenets of humanistic psychology, along with an interest in an integration of perspectives in ones work. To explore the basic tenets of Humanistic Psychology I would refer to Rowan 1987 who points to four major threads:

  1. An emphasis on the whole person, in that one recognises that the human being exists on at least four levels – body, feelings, intellect and spirit, and that in our efforts to respect the emergence of human potential we must do justice to all four levels.
  2. A belief that at depth the individual is OK, and that under the socially conceived niceness there may exist a pent up destructiveness, neither of which colour the intrinsic value of the person. This is at variance with some other theories which see the individual as value neutral or perhaps destructive.
  3. An emphasis on abundance motivation arising from the need theory developed by A. Maslow and others where the individual is not only motivated by deficiency but by the need not only to repair damage but also to realise innate potential.
  4. An emphasis on change and development seeing the individual as being set up on a natural and needful growth path through childhood, adolesence and adulthood.

Integrating a Variety of Techniques

The emphasis on an integrative perspective sees that a pragmatic attitude towards the tools of therapy is endorsed where a wide variety of techniques and strategies are used according to the dictate of client need. For example expressive bodywork informed by the work of Reich and Lowen may be used, along with a more analytically oriented holding of the client and use of the transference, by the same therapist with different clients or at different periods of the same therapy. For me this integrationist stance is speaking to the attempted integration of approaches within humanistic psychotherapy e.g. gestalt, bodywork, transactional analysis etc., but also the valid integration of the findings and perspectives of other forms of psychotherapy, particularly analytic and systemic ones.

“Integration unlike eclecticism is concerned with the chasm not by denying that there exists a distance between the sides but by building bridges that unite them”.

WarcheI 1983.

These thoughts as to the ground occupied by a forum for Humanistic and Integrative Psychotherapy may contribute to the debate which is now necessary to fully develop this forum so that we can take our place in the overall umbrella structure in a constructive way. The part that this forum can play in the development of an overall umbrella body and in the growth of the profession as a whole is an important one in arguing for.

a)    growth perspective to be held firmly alongside a pathology perspective

b)    a focus in the body, and feeling expression alongside insight development and behaviour change

c)    a focus on the therapist and his/her part in the therapeutic relationship as being as important as on the client.

In these and other ways I see this forum as being an important ingredient alongside the other major forces in the development of a responsible and healthy profession of psychotherapy in Ireland built not on exclusion but on the acceptance and honouring of difference which will challenge us all in the years ahead to deal with our anxieties and come to a nourishing and vibrant co-existence in a united profession.

March 1990.

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