Monday, 20 September 2010

Psychotherapy and Money

Psychotherapy began as a private practice and thrives in a free market economy. A good number of psychotherapists treat their practice as a way of making a great deal of money from the unhappy wealthy. Every psychotherapist with a private practice will have come up against the ethical dilemma of wanting to be with the client in a particular way but hesitating because the client is a source of much needed income.

It is a fact that the profession is absolutely dependent on the poor as clients and that the poor are denied the opportunity to join the ranks of the profession. As the professionalisation of counselling becomes the dominant model so courses move from local colleges and into universities. University courses are obliged to become accredited by the British Association of Counselling and Psychotherapy (BACP) so tutor workload increases which in turn means that they can justify higher wages and so the cost of the course increases.

Students are required to gain at least 100 client hours and those hours are gained via counselling agencies that offer a low-fee or free service to clients – that is, those people who cannot afford private counselling. Which in turn means that people on a low income in need of counselling are also most likely to encounter the least experienced counsellors.

Agencies offer some supervision but a majority don’t offer adequate supervision, in some cases requiring that volunteer counselors first prove that they have a private supervisor before they’re allowed to offer their services. In addition, some agencies also require volunteers to show proof of personal insurance cover which costs at least £100. BACP membership at the time of writing is £60 a year for student counselors in receipt of state benefits. Psychotherapy courses start at around £2,000pa and can be as much as £15,000. A single person on Job Seekers Allowance gets around £60 a week.

Once qualified, many counsellors will continue to volunteer in order to gain experience as well as client hours towards BACP accreditation. Some of us will feel a kind of duty to continue offering a service to clients who cannot afford private counselling, and some of us will not. There are counsellors who on qualifying are given a Harley Street practice as a congratulatory gift from a spouse. In therapy today, the magazine for members of the BACP, there is the occasional classified advert for ‘Prosperous Private Practice.’

The Byzantine BACP accreditation process has created a new way of spending and making money: BACP accreditation workshops, paying supervisors or counsellors who are already accredited to help the applicant complete the process; the cost of the BACP administrative process which is at least £90 and which takes around 3 months for them to process, plus £110 more if one mistake is made. The ads at the back of Therapy Today have 2 pages of jobs, some voluntary, and 27 pages of CPD: counsellors making money from each other.

So money is absolutely central to the profession of counselling and psychotherapy and one that remains taboo. As one of the founders of  the BACP noted, it is the elephant in the room. Intimately entwined with this taboo is the way in which counselling perceives and works with ideas of poverty, class, income and what a ‘good life’ might be. This is so taboo that the BACP campaigns manager can write
. . . access to psychological therapy and/or support, with the aim of helping people achieve improved mental health and wellbeing, thus improving their ability to gain and/or maintain employment.
Robinson 2008:5
The above is from Therapy Today and as such represents the BACP’s opinion on the importance of the links between employment to mental health. Importantly, it also places the BACP in political relation to the importance of employment, suggesting that getting people to work is a positive thing for counsellors to work towards with their clients. Interestingly, this conclusion is not the one that the Royal College of Psychiatrists drew from the joint Department for Work and Pensions (DWP) Medical Research Council and Royal College conference.
Work is broader than ‘employment’ and should encompass voluntary work, home making etc. The majority of the research evidence refers to full time work whereas it might be more informative to consider ‘activity’.
Waddel 2007:5
Of course, what a client chooses to do in terms of employment or unemployment is none of the counsellors business, just as what a client chooses to do with an intimate relationship is none of our business. If the purpose of counselling is to allow a person to explore their lives and relationships in order to gain a better understanding and perhaps better mastery of their life then the counsellor must be very clear in their own mind about what their own expectations might be.

This can be difficult when the counselor lives in a society that equates poverty with victimhood at best and more often as badness, a position that isn’t helped when it’s 'common knowledge' that good mental health is helped by being employed and that the reverse is also true, that being unemployed results in poor mental health. When the BACP reinforces this, clients on a low income are doomed to second class work from counsellors.

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