Endings

    . . . Personal narrative is all we have, whether as individuals or a society.
Like any narrative the Western self-view is riddled with contradiction. Decisions rarely have anything to do with the rationale that supposedly provoked them. And as with personal narratives, what does not fit is conveniently ignored. The difficulty for anyone who tries to step outside the dominant narrative to present a different view is that we cannot, by definition, provide the ‘evidence’ that is required by the narrative that demands such evidence – a bit like going into the pub at 10pm on a Saturday night and preaching the benefits of sobriety. Neither can we provide evidence from within that narrative. The minute we step back into that world we are governed by its conventions, and any attempt to explain ourselves becomes a nonsense.

William Johnson
Therapy Today March 2008

This blog has been a personal journey of exploration into the relationship between social justice and counselling and I wanted to share some of what I discovered. Some counsellors, I’d say about 10, have shown a positive interest. It feels as if I’m William Johnson’s person in the pub at 10 on a Saturday night preaching sobriety: it’s a waste of my time. Counselling as exemplified by the BACP, if it makes any acknowledgement of it's relationship with society at all, is dismissive and contemptuous of anyone who suggests that counselling might look at the way it perceives and relates to itself and to people with far less power.

In today’s Times Dr James P Smith writes about nursing, a career that includes a goodly number of excellent nurses and which prides itself on it’s professionalism but en mass seems to ignore the experiences of the huge number of patients who’ve been brutalised and neglected, often to death whilst in their care:

As a Fellow of the Royal College of Nursing since 1978 . . . I want to thank you for your editorial in which you finally explode the myth that there is a shortage of qualified nurses in the NHS. We have come a long way since 1956 when I was a young staff nurse on a 46 bed cardiothoracic unit, working five nights a week on 12 hour shifts. In spite of the intensity of our work all our patients got an early morning cup of tea. 

Even though the Royal College of Nursing knows it and the Times knows it and a great many nurses know that understaffing is not the issue the profession of nursing still falls back on understaffing as the reason why so many patients are suffering unnecessarily rather than taking a brave look inwards.

Thankfully, counsellors are nowhere near as important as nurses. Whilst we have many excellent counsellors our exploration of ourselves as people with power over people with less power is academic where it exists at all. Yes, BACP Professional Standards offer a useful tool for sanctioning counsellors and the fact that they name counsellors who’re sanctioned suggests they’re interested in humiliating individuals – do you make note of those people named and shamed in Therapy Today to ensure that if ever they darken your agencies door you can shun and denounce them? Yes, the Ethical Framework is valuable and well thought out but the BACP doesn’t apply it to itself. Letters, if not totally ignored, will be condescendingly responded to ‘in due course’ and apparently the BACP has always functioned perfectly; if any changes are made it’s not because anything may have been inaccurate or done badly.

For me, that the BACP can stand outside of the decades of debate, politics and struggle that surround the issue of abortion to support the recent Dorries/Field amendment solely on the basis that, like the punitive DWP proposals which it also supported, it offered ‘increased opportunities for counsellors’ is a reflection of counselling itself. It doesn’t matter how or where the money comes from, we’ll work for anyone under any circumstances as long as we can clutch tightly to the status and identity of ‘counsellor’. I'd be interested to know if we have any limits at all.

Have a look at counsellors social network profiles. Many only communicate in Inspirational Quotes, almost all are written as if by experts responding to people who need this counsellor’s knowledge and experience. Some are written as if the potential client is a sad idiot in need of sympathy.

A great many counsellors are probably very concerned about social justice but clearly there are not enough. Organisations like the Independent Practitioners Network have a committed core of highly experienced (and ageing) members who value functioning face to face rather than paperwork to bureaucracy and inevitably have a minute membership. They're not concerned about competing, they're vitally interested in relating - and prove it. 


I'll put a fiver on most counsellors never having heard of them.


The BACP deny monopolising counselling but why then, in the face of 1 in 6 BACP counsellors feeling fine about ‘converting’ gay people into straight people, and BACP accredited counsellors being most likely to abuse their power with clients, do they have the greatest membership, with non-counselling and counselling organisations alike employing only BACP accredited counsellors? It is not, be assured, that BACP accredited counsellors are always the best. It is because the BACP is a glossy, hugely marketed presentation of acceptability and safety which openly suggests that non-BACP counsellors are unprofessional, unsafe, and unacceptable. And you and I as individual, responsible people allow that.

Even in the teeth of raging and increasing poverty, charities providing British families with food, social unrest that made news across the western world, an increase in suicides linked to benefits, UN recognised child misery and a national reading age of 7, counselling has absolutely nothing to say about any of it. We stand above it all, perhaps watching as interested observers of rats in a cruel experiment, uninvolved unless it might offer us an 'opportunity'.

So here I am, in the pub on a Saturday night or rather, a tightly packed morgue. There are some very important rules to follow and one or two people are not in drawers with a sheet over their head able to hear and talk, but as we chat my breath evaporates and I wonder what on earth I’m doing, spending my time in a morgue on a Saturday night.

Thanks to those individuals who’ve commented, popped in or promoted my work over the last two years. Were it not for you I’d wonder if there was any vitality left at all in counselling. My final statements here are: Who’s benefiting from our current way of being? and, Follow The Money.

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.

Professionalism Does Not Equal Care or Good Practice.

‘The urge toward professionalism builds up a rigid bureaucracy… Bureaucratic rules become a substitute for sound judgment… the bureaucrat is beginning to dominate the scene.’

Rogers C. A way of being. Boston: Houghton Mifflin; 1980.

Back in the last century when I trained as a nurse we worked full time on the wards as students with 2-week blocks in college. I bloody hated it, it was horrific hard graft, I spent a great deal of my first 6 months confused and at 18 part of me felt mildly outraged that I was mopping floors. I was deeply concerned about my status – me, with excellent A levels, washing old ladies: wasn’t I better than this? It took me some years to learn how important that intimate, thorough, routine act of care was; how vital it was to my understanding of the overall wellbeing of the patient; how it could be a tender and meaningful opportunity to touch and be touched in a world where touch usually involves pain.

When I qualified 3 years later and met some student nurses at the end of their first year I thought they were joking when they told me I’d need to show them how to take a blood pressure.

What had happened was Project 2000, a scheme to professionalise nursing.

The knock-on effect was enormous: care assistants, untrained or semi-trained people who are paid a pittance, took over the bulk of patient care, nurses changed from people intimately involved in and minutely informed about patient wellbeing to university trained academic professionals. There are never ending court cases and a growing debate about patients being neglected, positive cruelty and, if it didn’t happen in a hospital, manslaughter.

My daughter is moving into the world of work and wants to train as a midwife. In a haze of middle-aged nostalgia I got out my first wage packet from 1983 when I earned £65 for 3 weeks work after rent for my room in the nurses home was taken out. My girl is supposed to feel grateful that she doesn’t have to pay in order to become a member of a profession that serves the country, and she’ll have to get a paid job at the same time as training and living at home. But she’ll be a professional.

What’s all this got to do with counselling?

The discourse around the professionalization of counselling in modern times has been going on for at least 20 years and I note that so many of the names cited in this article – Anderson, House, Heron, Pilgrim, Thorne - have inevitably become older and distanced from the shaping of counselling. I note also, and with no satisfaction whatsoever, that everything that this article foresaw has come to pass other than the predicted ‘closed ranks’ of counsellors: instead we’ve atomised into individuals who work in fear of being featured on the back pages of Therapy Today, scrabbling about for a paid job.

There is an ebb and flow in all philosophy and the talking therapies over time have moved from elite private practices to institutionalised medical models, from a deep concern about the humanity of the individual to an objectification of the client as an ‘opportunity’ (as an illustration of the problem, this article which used to be free is now not available while the fee gathering service is being set up. You can find the reference to the independent research on a decades worth of counselling complaints here.)

For me, this is a central issue:

“The client will have access only to privileged, affluent and academically gifted counsellors. Not all clients would choose a counsellor with that general background. The cost of training and the tilting of the balance towards demand exceeding supply will drive counselling prices up - the client will have to pay more for counselling and it will become even less accessible to those on low incomes (House, 1995). The increase in counselling fees will be reflected in increased supervision fees and the combined effect of these increases may be cumulative in successive generations of practice.”

After all these years of debate my 18 year old can still legally set herself up as a counsellor tomorrow. After all the years of hoop jumping and box ticking, status-anxiety and portentous intoning about ‘protecting the public’, we still ignore the fact that clients make hardly any complaints that accreditation was quickly taken up by many counsellors most likely to be abusive and speaks volumes about our delusions of grandeur and fear of our own legitimate power – Protecting The Public From The Omnipotent, Dangerous Counsellor (that’s you, by the way.) Clients aren’t stupid and particularly vulnerable people are cared for by systems that are already massively regulated, and which still continue to fail, depressingly often.

The dynamic between status and money has always been complex. I’d go so far as to propose that in the absence of money, the desire for status becomes acute and we know that counsellors seldom make money from counselling. We are naïve if we don’t see the link between money and care at the most fundamental levels. The US, where the connections between money and care are brutally demonstrated, is now experiencing the extraordinary situation of pioneering practice and research running alongside a system that is moving steadily back into the medieval, as one in five hospitals is run by the very wealthy Catholic church.

Why? Because the system wants to save and to make money and will take it from the highest bidder, no matter their philosophy. In business hard cash comes before life or choice so relatedness and connection come way down the list of prioroties. Our NHS, schools and other public services are inexorably being groomed into this mindset. What would you chose for yourself? Have you made the same choice for the ‘profession’ of counselling?

Keeping it simple.

 Here’s a wonderful video from the official 'No To AV' team which demonstrates just how confusing and complicated the Alternative Vote system is, far too difficult for you to grasp – not that you’re stupid, even celebrities have a hard time understanding it.

For me, this argument demonstrates a technique that we all use to some extent to disempower each other. “They want to bring in this new fangled way of doing things but it’s so complicated that you won’t understand what They’re doing until it’s too late. The way we do things right now isn’t perfect but it is simple, and that’s how you like life to be.”

The temptation is to follow that line in explaining unfamiliar concepts to people who might be resistant and threatened, particularly concepts that ask us to look at the way we are in the world, and change.

Some months ago I wrote to the BACP about the cost of accreditation. For people on benefits it’s £110, for people not on benefits £220. The UK average wage is £499 a week so is it reasonable to expect someone who isn’t on benefits to pay £998 for accreditation? Because this is equivalent to what the BACP expect people on benefits to pay.

Of course, the BACP first ignored my letter, then misunderstood it to mean that I was asking the cost of accreditation for a counsellor on benefits, then said they’d answer ‘in due course,’ then told me that these were standard rates. There was absolutely no interest in the subject. Just keeping it simple, because we like things simple.

In a world of woefully increasing simplicity some of the most thoughtful people I come into contact with are counsellors. The majority of us are able and willing to engage in contemplation at a deep level; we’re becoming more used to concepts of privilege and passing but I wonder just how many white, straight, able-bodied, above-average-income counsellors really do get it. Frankly, I’ve never expected much from the BACP, they’ve always seemed far too concerned with status over anything else and have done more than any other group, including government, to make counsellor training and practice less accessible and more expensive.

But we join them. We jump through their hoops. We say we adhere to the Ethical Framework. The BACP itself doesn’t adhere to the Ethical Framework, it publicly humiliates counsellors who have a complaint made against them, makes counselling a preserve of the high-incomed and doeesn't have the manners to address a direct challenge to their principal of Justice

A commitment to fairness requires the ability to appreciate differences between people and to be committed to equality of opportunity, and avoiding discrimination against people or groups contrary to their legitimate personal or social characteristics.

In doing so (as I have done) we give them power so that we don’t have to think for ourselves. Consequently all employers now want accredited counsellors (even though the BACP’s own research shows that more complaints are made against this group than any other) and the BACP has become the entire professions de facto governing body.

The subject is paradoxical but where there’s paradox, there’s power. On one hand it is supremely simple: people who are poor are directly and indirectly discriminated against within counselling. On the other hand it is complex and problematic: could the BACP use a principal of proportionate paying for its services? How might that work? How do you and I address the fact that people who have very little experience of counselling often counsel people with desperate problems?

Or is it true that counsellors do, in fact, like to keep things simple and don't want any new fangled, complicated nonsense getting in the way of keeping things just as they are? Is counselling another industry, like car making, banking or construction, just using the language of reflection and philosophy rather than actually practicing it? Does counselling have anything a little more genuinely human to offer itself? Or not?

Self Awareness

. . . the highly peculiar nature of the therapeutic project, whose very essence is typically that of self-interrogation and awareness – but which typically and uncritically takes the pursuit of that very process itself as an unproblematic given . . . therapy can be routinely and intrinsically abusive to the extent that it self-fulfillingly constructs a framework – professionalized therapeutic discourse and practice – which serves to guarantee the legitimacy of their own existence within a discursive regime of truth, and outside the confines of which it can become very difficult for clients and therapists even to think.

House 2002 iiv

There is a long and intricate dance between the forces of standardisation and dissent and this dance is, I believe, central to the manner in which psychotherapy perceives itself and is perceived; its role in the voluntary, private and public sectors; the manners in which it offers itself to vulnerable people; and the manners in which vulnerable people are used to fulfil the training and accreditation needs of psychotherapists; the targets of the Health Service, the Department of Work and Pensions and central government; and the relationships between government and psychotherapy. It would appear that counselling is uncertain about its own societal status and purpose.

In a profession which holds relationship, empathy and positive regard dear discussion around the casual exclusion of people on a low income from being able to enter the profession, and the use of people on low income to facilitate the training and accreditation needs of counsellors is deafening in its silence. This is simply – as always in issues of discrimination – a consequence of the uses and abuses of power. It covers every aspect of the counselling relationship and is not limited to people on low incomes.

The counsellor just couldn’t understand what I’d been through. I spent 6 of the eight sessions just explaining what the religion was about and the way it worked.

Underhill 2008

I was given 6 sessions but I only went to two. She couldn’t offer me a time when I could go.

Personal  conversation

I couldn’t go, they didn’t have any childcare.

Personal conversation

One of the BACP Ethical Framework  ‘Values of Counselling and Psychotherapy’ is

Striving for the fair and adequate provision of counselling and psychotherapy services.
2007: 2

The ethics and practicalities of ‘fair and adequate provision’ is very patchily covered in the Framework and then only in terms of statutory provision and does not include the practised (rather than expressed) values of individual counsellors, training facilities and placements.

One source of information about the performance and behaviour of counsellors is clients, the people most directly affected. A lot of research has been done on clients – what variables affect their continuation in therapy, how their personalities change, compliance in rehabilitation – but I could find very little on what clients actually said rather than what the researcher thought they were saying. Further, psychotherapy publications tend not to focus on the clients experience of the world but on ways of managing the client.

Although there has been a steady interest in the client’s point of view it is still unusual to begin an investigation into the nature of counselling and therapy by looking at the world from the perspective of the client. Traditionally, one starts by describing the theoretical position of the therapist, or one begins by outlining the basis on which the client and her or his difficulties can be explained and treated.

Howe 1993:2

Wonderful Opportunities For Counsellors!

The October 2009 issue of Therapy Today, the BACP journal, led with the edifying news that "one in 6 therapists still sees fit to offer gay clients treatments that aim to make them straight" In the same issue comes the entirely uncritical piece “Work Is Good For You” a puff for government policy with added ‘Opportunities for Therapists’.

Counselling is splitting right down the middle; on one side people who enjoy the conveyor belt of uncritical engagement with everything from political strategy to their own practice, and on the other people who prefer to look behind the research findings, statements of what’s best for counselors, clients and society. BACP, the largest representative of British counselors, falls firmly on the side of convention. Where this affects the working conditions of articulate professionals the damage can be limited, not least by counselors leaving the organization. But where the BACP perceives vulnerable people as an ‘Opportunity’ we are on to some very dodgy ground.

The piece references no research on what makes for good mental health in relation to employment and yet the final sentence is “All [these opportunities for counselors are] based on the premise that work is good for your health and wellbeing.” They may be referring to the results of the 2007 joint conference of the Dept of Work and Pensions and the Royal College of Psychiatrists. The DWP reached a very different conclusion from the RCP: one decided that employment was good for mental health, the other than activity was. It doesn’t take a genius to work out which organization came to which conclusion.

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

In 2008, the BACP campaigns manager wrote another puff piece for the DWP

. . . 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

Cui Bono? The BACP, like the majority of counsellors, wouldn’t dream of questioning assumptions around mental health and employment: counsellors might lose a source of income.

Governments of any colour don’t give a fig for anyone’s mental wellbeing, which is why our children are the most unhappy in Europe. What is important is that unemployment figures are kept low and in the past this meant encouraging people to move from unemployment to disability benefits. We are fed a constant steam of approval for ‘Hard Working Families’ not just working, but working hard, and virulent disapproval for ‘dole scroungers.’

Jung’s Red Book is number 3 on the Amazon bestseller lists, a rich exploration of a mans inner world, his spirit. As a nation, we’ve entered the machine world where peoples only value is in how much they spend and how much tax they pay. Today, Jung would join the other sensitive failures in a hostel, on sickness benefit, raving on a street corner and wouldn’t have a hope in hell of training as a counsellor. I doubt very much that with the state counseling is in, he’d have any desire to.

Brown, K. (2009) Work Is Good For You. Therapy Today October Vol.20 issue 8 pp17
Robinson, L. (2008) The Future Is Now. Therapy Today April Vol. 19 no. 3 pp4
Wadell, G. (2007) Employment and Mental Health. Absence from work due to mild and moderate mental ill health. Conference Report. Royal College of Psychiatrists.

Tags: DWP, mental health, professionalisation, Royal College Psychiatrists.