Alliance in Liverpool, July 11th: lessons from a beekeeper

"This kind of bees - little brown furry bears - are much less aggressive than most other types" said Mark as he handed me the all-in-one veil and suit so that I could help him tend to the hives. "If you take care of the smoker (a little can of smouldering leaves to give the impression of a nearby forest fire, and encourage the bees to crawl deep within the hive), I want to see if I can introduce some new frames". If you don't keep the frames in place the bees tend to build honey-combs that are unsupported, and which fall off when you try to take the honey. This was a totally unexpected pleasure for the weekend I spent in Liverpool, where I had been invited to speak to a group of counsellors and psychotherapists in a fine Edwardian town house close to the centre of the city.

Organising a bee-hive is a matter of making sure the conditions are right, and letting the bees get on with it. If you want to have a drop of their honey too, there's a bit more work to do. But generally speaking you don't have to interfere too much - they know their business better than you.

Mark had invited two of us to speak to the group on Saturday morning. Pat is a local counsellor, who began this line of work in 1993 with a 4-year diploma. She began practising with 5 years of voluntary work and has worked with people in all kinds of difficulties, some of the people she met get categorised as suffering from Severe Enduring Mental Illness - a recent management category invented to help governments decide how to divvy up funding.

After her initial training Pat had moved from voluntary to paid work mainly through short-term schemes like the EAP. She describes her approach as humanistic. Then the 'powers that be' withdrew the funding, and she was back to voluntary work once again.

Having set up a private practise, and allowed it to wane as her EAP work took off, Pat is now faced with having to start up all over again. Part of the backdrop is the fiasco of IAPT in the NHS which is forcing CBT into the frame as Managers are exercising more power. When the local PCT's switched their funding in favour of an IAPT provider not only did local voluntary/charitiable agencies lose funding and jobs, but large sections of the local NHS psychotherapy service had to be decommissioned. This had been a service that offered group analysis, CAT, individual psychodymanic therapy, drama therapy as well as behavioural therapy and CBT. Pat was clearly fed up to see her training and experience being destroyed, and watching the great diversity of pratice being reduced to a very poor version of a new fashion that the funding managers favoured. She could feel herself become cynical as she read documents claiming to 'retain choice' for patients and clients at the same time that she was being forced onto a CBT course to save her job. "I'm feeling a bit of a dinosaur" she said " There's no dialogue - the manager is only conscious of his own job". She was on the point of giving up.

This struck a chord, and Mark expressed his concern at the new computerised system for 'delivering' IAPT. IAPTUS - "If you get into to their comprehensive patient data set, as well as standard patient information it can be set to record marriage status, single or cohabiting, whether on benefits - if so what sort of benefits you are on. In addition IAPTUS can ask patients about the ethnic and national origins ...... it also can enquire whether you are gay, heterosexual, or other!!!" A database can capture loads of information - the power of its scale can be mesmerising: why not get it all now, as you never know when it might come in handy. In the ordinary course of events, this kind of nonsense would be overcome pretty quickly. But, we are not in ordinary times.

Mark drew on his long experience as a psychoanalytic therapist within the NHS to ask: 'how long will this fad last - we've seen the Defeat Depression campaign, and don't forget CAT (cognitive analytic therapy) - these were things that got everyone excited and attracted the funding in their day. Isn't this CBT just one in a line of Miracle Cures that sweep through the NHS from time to time, only to be discarded a little while later?"

Few, including Mark, seemed convinced by this. Not only are there more government initiatives - eg IAPT, CBT, NICE, SfH, HPC, etc - all bubbling away at the same time, but the underlying assumption seems to have changed.

The work I've done tracing the factors contributing to this shift was what I had gone to speak about. I was very pleased, then, when a few days later, Pat emailed me to say "your explanation was immensely helpful - now I know why I felt so confused for so long and so isolated". The frames of reference for counselling and psychotherapy are changing fundamentally. It is becoming very difficult for people to maintain a productive orientation to their work as their horizon is swept out of view. Unless we get real information out to existing practitioners, and reframe this as a struggle for survival, there is a good chance that an established, trusted, network of practice could lose its way for ever.