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?

Sally Goes To A DWP Assessment.

As soon as the woman comes out of the lift she said, “O my god” because there were 10 of us waiting outside the door. She rushed into the room and yanked tables around and then clicked her tongue and waved to make us hurry in. “Have you got the form? No that’s not the right form.” Even when it was. She reminded me why it isn’t so bad not having to work, she reminded me why I hated working with people like her.

Three men had been sent to the wrong college. One woman had been sent at the wrong date, it was all written down they hadn’t made the mistake but they had to come to the wrong place on the wrong day, and then had to make new arrangements. About 6 of us hadn’t been told to bring a particular bit of paper, we’d all been referred on the same day by the same person but it was our fault and so the 6 of us couldn’t register for the course that day, we had to come back with the form.

The computer assessment was alright, and then we had to go up to be told where to go next. There was another form to fill in but nowhere to sit. She was sat down, I had to stand, it reminded me of being at school. She gave me some dates and asked if I could do them. I told her about my sons appointments with the doctor and she said “You have to attend all of them.” So I asked her, “Why did you ask if I could do all the dates, why didn’t you just tell me I had to attend all the dates?” And she just said something about having to attend all the dates.

She had an assistant who was nicer, she was Japanese I think, very polite, very calm, and then this mad old bitch in charge of her.

Some of the men panicked, one had to leave, he said he felt unwell, A couple of others had never used computers so just clicked ‘next’ for 15 minutes and then left. The rest of us just got on with it. It was something I had to do, it could have been alright, it might be alright depending on what it leads on to and if the Job Centre allows me to attend all the days. I don’t know what I have to do about signing on, ‘cos you have to sign on and you have to be at this place 9-5.

Cause of Death: Individual Civil Servants.

Please read this demolition of the Work Capability Assessment  by the LSE.

"There are also increasing stories of suicides committed by people left without any means of income fighting and winning appeals, only to find they are called for WCA reassessments shortly after. As part of the recognition of the increasing trend of those going through assessments to take their own lives Job Centre Plus staff have been issued with guidelines on how to deal with people who they think might be suicidal because of the WCA testing."

Well, Dole Office staff were also issued with guidelines on how to identify and deal with people who might be susceptible to loan sharks. They don't have the time. A majority don't have the inclination. I had an extraordinary, Kafkaesque conversation with a DWP operative last week on behalf of a non-counselling client. After listening to the long list of reasons Why Not, I attempted an empathic response along the lines of, "It sounds as if you might be under a lot of bureaucratic stress." Fully 10 seconds passed in silence. I sit opposite a clock and counted! In your next formal phone call I challenge you to leave a 10 second silence. Her eventual response was this:

"That's nothing to do with me. If she [the client] doesn't turn up I'll stop her benefits."

And then she put the phone down.

It makes me a less than perfect counsellor but I don't care what pressure this person is under. "Just Doing My Job"is also known as the Nuremberg Defense, and like the other very ordinary individuals who did a job to feed their families, even if that job was dropping pellets of Zyklon B into air vents, you cannot process disabled people through demeaning, painful processes and not expect to be involved in abuse. You cannot be involved in a system that for many years has been responsibile for suicides without knowingly being involved in abuse. Then again, I know that a person who works in this kind of system is also being abused. And then some wretched machine part will come out with this kind of statement, which makes me lose all understanding again:

"We are sorry to hear that Mr Deighan has [killed himself]. I understand that you are dealing with his affairs. We have looked again at Mr Deighan's Income Support claim and found that he was paid £160.55 too much Income Support. . . the amount is recoverable from the estate of Mr Deighan."

I have a strange acquaintance with a man who works at my local JobCentrePlus office. It's highly boundaried because he knows I disapprove of his job and because I've told him I would rather someone like him did the job than the callous horror on the end of the 10-second silence. He often seems desperate to talk and knows that this would make his life complicated in all kinds of ways, not least the likely outcome of whistleblowing  (I don't know whether to laugh or cry or take up arms over this dripping-with-hypocrisy page.)  He's getting visibly older by the day. He always has the option to leave.

Thinking Allowed

An extraordinary interview with the social science researcher, Tracy Shildrick. People who depend on others to provide them with food and clothes 'without exception' do not describe themselves as poor but blame each other for being 'feckless.' Ms Shildrick and her fellow researchers were surprised by the levels of poverty they found and with some of the attitudes of the people living in poverty, which for me describes the chasm between the poor and the not-poor.

Here's the report the interview is based on but I strongly urge you to listen to and hear the rather shocking conclusions.

If you do no other work on poverty this month, please listen to this.

Stress of Poverty Changes the Brain

I'm mildly deflated by the election results and so can only muster up the energy to refer you to some interesting research from 2008.

Hey ho.