College of Psychoanalysts meet CE Marc Seale, Michael Guthrie and PLG chair Diane Waller

This interesting report is published on the website of the College of Psychoanalysts-uk. Click the heading to be redirected


The College of Psychoanalysts-UK meeting with HPC 27.2.08

Darian Leader and Andrew Hodgkiss met with Diane Waller, Michael Guthrie and Marc Seale.

We started by bringing up the claim made at the last PLG meeting that therapists pose a public threat, with their figure being 5%. Seale and Waller admitted that they had no hard data on this, and that their only statistics came from Witness and Fonagy, not based on any published studies, and that HPC had done no research themselves. So, we put it to them that this was anecdotal, reminding them that the Washington State discussion of therapy had insisted that claims about threatened public harm could not be based on tenuous argument or anecdotal evidence. Seale said that the "proof" was that all professions regulated by HPC showed 1.8-2% malpractice. This is the figure then to be expected from the therapies. We pointed out that this was circular and could be an artefact of the HPC framework itself. Social scientists, we suggested, could not take such an argument seriously. Seale said "I don't know what a social scientist is".

There was a discussion of the alleged threat of harmful practitioners, and we asked why, if public protection was the key variable for HPC, they were not pursuing protection of function rather than protection of title. What was the logic behind this? Seale indicated that in the place of protection of function there would be a campaign aiming at public education, presumably with the message that only HPC practitioners were to be trusted.

There followed a long discussion about healthcare and why many practitioners could not situate themselves beneath this rubric. AH contrasted his work as an NHS psychiatrist with his work as an analyst. We tried to explain how many analysts and therapists do not buy into the ideology of health, happiness and well-being or the idea of expertise. Waller could not accept this, saying that there is a shared common view of health and well-being today, different from the old medical model. We went through parts of the HPC booklet 'Standards of Conduct, Performance and Ethics', pointing out how most of them were not compatible with analytic work and many forms of therapeutic work, and Waller seemed to recognise this. Examples included clear communication to a patient, contrasted with a traditional analyst's silence, and the obtaining of prior informed consent, when in analytic work and many forms of therapy the unknown outcomes make this problematic.

We explained the position of the practitioner as object of projections, with clinical examples and emphasised the open-ended nature and unpredictability of the work. Waller felt that anyone going for 'treatment' had to know what to expect - "They have to know the likely outcome", "You wouldn't enter into a relationship without knowing in advance what was going to happen" - but then admitted soon afterwards that "we don't know what's going to happen" in a therapy and that "the patient's expectations cannot be met".

We expressed concern that in the current HPC documentation re proposed generic standards for psychotherapy, there was frequent reference to evidence-based practice. The practitioner, according to HPC, must be aware of "what is known". We questioned the conceptual basis of this appeal to a given, and Waller admitted that the multiple orientations in the field left little room for consensus. Seale added that if a complaint were brought against, say a Kleinian, there would be at least one Kleinian on the panel hearing the complaint.

We discussed at length the HPC sanitised image of the practitioner and explained why this had little to do with the recognition of human weakness and failing involved in our work. We discussed clinical examples, and there was a slight tension and disagreement between Waller and Seale. We emphasised that we do not aim at 'good personal conduct', which seemed to surprise Seale, although these arguments had often been made in prior correspondence with HPC.

Waller was open to rational argument, and would concede points, but Seale appeared unable to. There was a moment in the meeting when it seemed finally we had got through and that they could see that many people just didn't offer healthcare with set outcomes. But Seale couldn't accept this. At one point he divulged that the current complementary medicine division between state registered and voluntary registered practitioners - which was mentioned in the discussion as being a possible structure for therapists - would be destroyed in three years, when a major public advertising campaign would begin to discredit those on the voluntary register. Later in the meeting, when the possibility of a separate list of non-HPC practitioners was returned to, he said that a couple of years after HPC regulation, they would launch a media campaign to discredit them too, with the message 'Don't use these people'. We observed that this would create a lot of protest, and Seale replied - with glee - that "We can afford a better advertising agency than them". When DL took up the 'Don't use these people' at the end of the meeting, he tried to avoid the issue.

At the end of the meeting, Seale came back to the question - what details would you want changed so you will go on the register? He is really anxious just to get on with it and close the case. We asked them 'Who would you trust - someone who is willing to be prosecuted for upholding the ethics of their work or someone who seeks primarily status and credibility?'. Waller of course indicated the former, while Seale said 'I don't understand the question'. We reminded them that the very first point of the 'HPC Guidance for Occupations Considering Applying for Regulation by the HPC' is that "The occupation must cover a discrete area of activity displaying some homogeneity' and this was clearly not the case. Seale now made it clear - probably despite himself - that if a practitioner receives money from a member of the public and does not offer a predictable healthcare outcome, they just shouldn't be allowed to practise. Such practices would presumably constitute exploitation. For him, even if he could recognise the difference between orientations, he seems firmly opposed to letting the forms of non-healthcare therapy continue in modern society. So, a far stronger position than that claimed up till now publicly by HPC.