psychotherapy in Scotland

Last updated:

9 March 2004

psychotherapy and charlatanry

by James Baxter

From time to time, those of us who like to be well informed come across accounts of psychotherapists or counsellors abusing their clients. For reasons that are fairly obvious, the most widely publicised accounts are those about physical seduction; but these are really only the tip of the iceberg. Other forms of abuse, more subtle but no less harmful, include breaking confidentiality, fostering emotional dependence, recommending more sessions than necessary, discouraging help from other sources, relocating without providing an alternative source of help, and so on. Such misconduct clearly points to a need for regulating the practicians.

Many professional psychotherapists have formed themselves into trade associations who claim to have established appropriate regulation by accrediting only those who have received appropriate training, abide by a code of conduct and, in some cases, are supervised by other professionals. Therefore, they argue, opportunities for deception and abuse could be minimised by prohibiting anyone from practising who is not accredited by them.

But would it? Dig deeper and we find that this accreditation is spurious and offers no greater protection than is provided by common law. The approval of fellow professionals does not mean that one practician is more proficient or trustworthy than another; but it may give that impression. Consequently, being accredited by an association makes it easier to imply that one's craft is more recondite than it really is, and thus to manipulate clients' thoughts and feelings. (It is hardly surprising that psychotherapy has sometimes been compared to a religious cult.) Fortunately, it seems, relatively few practicians exploit this. But, despite what we may wish to think, there is no evidence that the proportion of accreditees who succumb to temptation is fewer than those who are not association-accredited.

Most clients are able to confirm the findings of research that the effectiveness of psychotherapy or counselling is largely contingent on discovering that the practician is honest, trustworthy, open-minded, flexible in approach and dedicated to their joint purpose. Also that s/he understands and accepts them for what they are rather than as others see them. Finally that, while being tutored in the art of making their lives more fulfilling, they are encouraged to challenge the practician's views, without jeopardising the emotional support s/he offers. Specialised techniques, such as psycho-analytical interpretations, desensitisation exercises, hypnosis, relaxation exercises, role-playing and biofeedback, are merely ancillary to these factors.

To most of us, 'supervision' usually implies that the supervisor is responsible for what the supervisee does; but, in spite of what some association members assert, that is not true of psychotherapy and counselling. There, it is a form of support and/or challenge to the practician's thinking. Depending on the kind of relationship between supervisor and supervisee, it may or may not improve the practician's proficiency.

On the face of it, too, we might suppose that the courses of instruction the associations deem essential are a reliable indication of the service we can expect from the members they accredit; but are they? As someone who has had considerable experience of such 'training', I can vouch for it as a means of learning more about oneself and one's interactions with others; but research has shown that it is not a valid measure of a practician's proficiency - or probity. Fundamentally, training involves the objective measurement of certain clearly defined skills against generally accepted standards, as in the training of a fighter pilot, say, or in that of an infant who seeks to graduate from dependence on nappies, where what constitutes proficiency is hardly in doubt.

Association members profess to work to high standards; but it is anyone's guess what those standards actually comprise. Some years ago, a task force appointed by the Department of Trade and Industry set out to establish some, only to find there were none that could be measured. In other words, that moonbeams could not be carried home in a jar! So, in the absence of objectively measurable standards, no practician can truthfully claim to be trained - or qualified. The only authentic assessment of proficiency and probity is that made by clients, not by other practicians.

Moreover, the kind of 'training' cherished by the associations cannot provide their members with the most important item they need in their armamentarium: 'hands-on' experience of understanding and dealing with people from diverse backgrounds. It is perhaps not surprising, therefore, to discover that 'untrained' practicians are sometimes more effective than those who are 'trained and qualified'. I doubt if I am the only one to have discovered that some of the latter seem unable to understand exactly what it is that we struggle to put into words.

The skills, values, knowledge and attitude required for safe and effective psychotherapy and counselling are indeed specialised, but only because they are so sparse in society as a whole. Can these qualities be inculcated by courses of instruction, or can they be acquired only over a long period of time by people who are sufficiently self-aware and dedicated?

Because of their heightened vulnerability, many people who seek help from psychotherapy or counselling are in especial need of protection from charlatans. The main question is whether they should be protected by the professional associations or from them? As the Roman poet Juvenal commented, 'Who will protect us from our protectors?', and George Bernard Shaw, 'All professions are conspiracies against the laity.' Perhaps we should be asking ourselves what it is that impels some practicians to form trade associations? We might then be better placed to compare the allure of a path that has already been carefully prepared against a less devious and more reliable one: statutory registration, based strictly on public knowledge of registrants' probity and on evidence that they are fully aware of their responsibilities.

© 2004 James Baxter. All rights reserved