Evidence Based Practice

I don’t know whether it’s worth writing this piece.

This is the week when yet another report is churned out about how awful nursing care for the elderly is, an occurrence so regular that there’s no shock value to it any more. It’s the week in which PC Harwood is being charged with manslaughter two years after he was seen to belt a man who was walking away from him, and the week in which the Met cleared officers of any wrongdoing after they tipped a protestor out of his wheelchair and dragged him across the road “ . . . in his own interests.” 

It’s the week in which the abuses at a home for people with learning disabilities has finally been brought to light and the week in which the BACP has printed a three-page article in the guise of a letter denouncing the ‘wilding’ of psychotherapy as proposed by Nick Totten the previous month. Using words like ‘chaos,’ ‘unfounded,’ ‘unresearched,’ ‘mass destruction,’; so thoroughly demonstrating a complete lack of awareness – let alone understanding - of systems theory or even of basic  archaeological propositions while critiquing them without references; and coming too close to calling tribal people primitive exploitative slave keeping savages in comparison to the peaceful Utopia that we ordered, civilised people live in that the purpose for its publication is baffling, to me at any rate.

What links the first 3 events is that they are are massively regulated. It’s illegal to impersonate a nurse or a police officer. Police officers and nurses go through rigorous training and have to attend professional development events to maintain their registration. 

The Care Quality Commission

“Regulate, inspect and review all adult social care services in the public, private and voluntary sectors in England.”

are paid for with public money, is staffed by professionals who have passed many exams and who ignored what vulnerable people told them.

Regulation, registration, post-training education, writing essays, being in the job for many years, being valued with a publicly paid wage and being employed by a service that is respected and valued and as mainstream as it's possible to be is no guarentee of good practice.

This is also the week when a respectable, successful, accredited psychotherapist attached to GP’s surgeries was sanctioned by the BACP because an undercover reporter blew her cover. Not an ordinary client, not a GP, not her peers – and hey, she passed the Accreditation process, having

“ . . . achieved a substantial level of training and experience approved by the Association.”

which, despite its emphasis on inclusivity, totally missed the fact that she is a homophobic nightmare.

(It's worth noting the beurocratic/shambolic BACP response to the complaint:

"Without being well educated and having free legal help to interpret the BACP's jargon-dense literature and legal letters, I would have found the process incomprehensible and intimidating.")

I’m not sure it’s worth writing this piece because I’ve come to believe, more strongly than ever before, that psychotherapy and psychotherapists are just part of the problem, the problem being institutionalised fear and ignorance which leads to banal evil.

Speak with most individual counsellors and the conversation almost always goes along the lines of “Yeah, we know there are too many counsellors being churned out; we know accreditation means nothing other than that a person can tell the BACP what it wants to hear; we know we have to compromise ourselves beyond what we believe is ethical if we want a paid job.” And still, counselling organisations demand their counselling staff be BACP accredited: I can understand non-counselling employers wanting what they’ve been told is the best, but counselling organisations?

Psychotherapy and counselling are based on philosophical understandings about what it is to be human, fulfilled and unfulfilled, to have a life that has meaning and purpose or otherwise, what it is to be in genuinely therapeutic relationships. Our years of training are spent doing what exactly? Questioning ourselves, questioning our assumptions about the ways the world might be, learning some of the foundational beliefs and values – all of them complex and multifaceted – of people like Buber, Gendlin, Freud, Husserl, Satre, Foucault? Presumably this takes some intelligence and the ability to learn. And then what? Do we pass the test and carry on just as before but with a nice bit of paper, an increased sense of personal status and a language that allows us to believe we're capable of independent thought? With all this incredible knowledge, do we begin to wonder if we might choose to think even minutely differently from people who haven't had access to this privilege? Or do we totally succumb to the overculture?

Where are Therapy Today news pieces about the DWP receiving guidelines on how to deal with the increased risk of suicide in some claimants? Or the on going collapse of so much of the voluntary sector that counselling depends on? Or what happens to people who used to access those charities? Or the psychological impact of cuts to public services for users, or workers who are made redundant or who live in fear of redundancy? Or the well researched psychological fallout  of our bottomless pit of inequality? Or the overwhelming emotional changes in the national zeitgeist in an age of austerity? Or that "One in 20, or 340,800, British families live in "severe housing deprivation" – in overcrowded homes in poor condition, without a bath, shower or indoor toilet."

It's much easier to have a nice piece about how the tango is like therapy, to look inward and inward and inward, becoming more and more sterile. Or is it that counselling and psychotherapy actually have no relationship to the world of the client?

Who is asking why there are four times as many CDP pages in Therapy Today than there are jobs, and what that might mean? Who is asking why we do therapy at all, for whom and for what purpose and to what ends? And how are we – you, and you and you and I – demonstrating that?

Who is asking, “Who has the power here? Where does power lie in British psychotherapy and counselling?”

I hear a sound in the distance and fear it’s just an echo.