Janet Low, MA PhD. Clinical Associate (CFAR), MBACP. Visiting Honorary Fellow at Manchester Metropolitan University.
Author: HPCwatchdog.blogspot.com
When Professor Richard Gombrich spoke at the Rally of the Impossible Professions (September 2008) he quoted from Karl Popper’s 1940s essay, Piecemeal Social Engineering. Since then, I have found myself dipping into this old essay and finding much of interest and use for understanding the predicament we face today. I have decided to kick off this submission with a quote from that essay, in which he considers the virtues of the piecemeal social engineer as opposed to the recklessness of the idealistic holistic planner. I hope that his words might find an echo in the soul of the person delegated to read my submission, and that some of the Popper’s wisdom and experience might help to redirect us back onto a more practical path.
“while the piecemeal engineer can attack his problem with an open mind as to the scope of the reform, the holist cannot do this; for he has decided beforehand that a complete reconstruction is possible and necessary. This fact has far-reaching consequences. It prejudices the Utopianist against certain sociological hypotheses mentioned which state limits to institutional control… For example expressing uncertainty due to the personal element, the ‘human factor’. By a rejection a priori of such hypothesis, the Utopian approach violates the principles of scientific method. On the other hand, problems connected with the uncertainty of the human factors must force the Utopianist, whether he likes it or not, to try to control the human factor by institutional means, and to extend his programme so as to embrace not only the transformation of society, according to plan, but also the transformation of man. ‘The political problem, therefore, is to organise human impulses in such a way that they will direct their energy to the right strategic points, and steer the total process of development in the desired direction."
It seems to escape the well-meaning Utopianist that this programme implies an admission of failure, even before he launches it. For it substitutes for his demand that we build a new society, fit for men and women to live in, the demand that we ‘mould’ these men and women to fit into his new society. For those who do not like living in it only admit thereby that they are not yet fit to live in it; that their ‘human impulses’ need further ‘organising’. But without the possibility of tests, any claim that a ‘scientific’ method is being employed evaporates. The holistic approach is incompatible with a truly scientific attitude.” p311 of A Pocket Popper, edited by David Miller, andpublished by Fontana in 1983
Responses to the consultation questions:
1. Do you agree that the Register should be structured to differentiate between psychotherapists and counsellors? If not, why not?
No. The HPC has not grasped the difference between counselling and psychotherapy and it would be irresponsible to blunder in and impose the distinction without an intelligent and realistic explanation as to why. There are many differences, not only between counselling and psychotherapy but amongst those that would go under each name. Without an appreciation of the reality of the work, the effect of HPC regulation will almost certainly distort and obfuscate the situation which will in turn actively not protect the public. It is possible that the men and women charged with putting the system to work in the real world may succeed in overcoming this tendency to distort, but this would be a strange thing to expect people to do, and unrealistic to expect them to do it for long.
2. Do you agree that the Register should not differentiate between different modalities? If not, why not?
Q2 Yes. The complexity of reality will be damaged and should not be contemplated by the HPC, who have no obligation to understand the reality or experience of the field.
3. Do you think that the Register should differentiate between practitioners qualified to work with children and young people and those qualified to work with adults? If yes, why? If not, why not?
No. To attempt this is to fundamentally misunderstand the nature of regulation as practiced by the HPC. The request to split the register in this way will simply result in a false segmentation in the market for training.
4. Do you agree that ‘psychotherapist’ should become a protected title? If not, why not?
No, the prospect of state, statutory, and HPC regulation on this field has already distorted it to the point where the words psychotherapy and counselling have been and continue to be detached from any meaningful subject. A mixture of entrepreneurial politics, and a failure to really address the meanings and uses of the titles has led some members of the field to fudge the labels and use them as marketing tools with an eye to possible pay differentials in a post regulation world. This is a good example of the distortion that can happen when statutory regulation looms large on the horizon. Unless and until sensible, level headed, cool and calm thinking is allowed to happen around this question, the title should not be protected. The confusion cannot foster an enlightened public, and will leave members quite vulnerable to misunderstanding. Daniel P Hogan’s work (1978) concludes that unless there is a well defined body of knowledge to define a practise, statutory regulation should be avoided.
5. Do you agree that ‘counsellor’ should become a protected title? If not, why not?
No. The generality and normality of the word is the value of the word. To bring it within the jurisdiction of the HPC or statutory power will set up all kinds of unexpected difficulties in unexpected places. It has already been noted by the HPC that changes in law will be necessary to make it possible to protect the title. This is a good example of the way labyrinths of bureaucratic structures become necessary when the centralised planner does not recognise the truth of reality. In extreme cases this can lead to the application of force, as the powerful structures try to force reality to fit, rather than admit defeat. A point made succinctly by Popper, in the quote that preceding this response.
6. Do you agree with the approach to dual registration outlined in the report? If not, why not?
No. Dual registration threatens to get out of hand (as the recent Council discussion on Sonography testifies). The power of good regulation emanates from the fact that the practice in question can be clearly defined and known. The idea of a profession is that of something a person dedicates their life to. Whereas this is true for some who engage in counselling and psychotherapy, it is also true that many do so alongside other occupations (and don’t forget, many people work voluntarily). The life experience, and the open mindedness of this is itself a valuable resource, which prevents counselling and psychotherapy from mistaking themselves for discrete and immutable objects. There is little indication that the HPC process will be able to distinguish well enough between the various practices to know whether or not someone is doing one thing or another. Arts Therapy and Counselling Psychology are good examples of this. They are currently used to justify the inclusion of psychotherapy and counselling in the HPC register, yet this argument holds within it a logical contradiction. There may also be difficulties arising from the practice of body psychotherapy and some other parts of the register. Border disputes might be another unintended consequence of the process. The beauty of the wide field of counselling and psychotherapy is that it draws from such a diversity of experience in society. The fact that almost anyone can in principle speak and listen is a reason for not regulating it via the HPC. The practice is distinct in this way, and poses special problems for HPC regulation. The true nature and extent of trouble caused by this state of affairs is not known in any useful way. For those who are particularly animated by this, may I recommend some level headed and objective research be done into the literature before a careful and sensitive inquiry be opened up in the actual time and place that presents the most concern.
NB. On several occasions during the course of the PLG I heard members of the HPC advise their new colleagues to ‘forget what happens in practice at the moment, and invent a totally new profession’ (Prof Annie Turner was the most consistent proponent of this view). This advice is wrong and puts in question the whole direction of HPC regulation for the field. A similar line was also articulated by Jonathan Bracken at the HPC Council meeting when the groups within the Psychologists were arguing for PhD entry level criteria. Bracken reminded Council members that they had decided upon the correct standards for practice and should not give in to ‘what currently happens in reality’. This is highly questionable, and throws serious doubt on the ability of the HPC to regulate any practitioners. It appears to belie an underlying cynicism which would predict perverse consequences. I shall return to this in due course.
7. How appropriate are the draft criteria for voluntary register transfers?
Inappropriate – it is the way that an organisation puts them into practise that is the most valuable criteria, and this can vary over time. The system in use by the HPC does not afford the time or skill to forge the kind of relations that are necessary to make a judgment on the quality of the various registers.
8. Do you have any comments on the outline process for identifying which registers should transfer?
The very large number of registers being considered by the HPC is cause for much concern. HPC cannot make a relationship with each register, and is therefore in a very difficult position to trust and judge. If the HPC must rely on answers from a questionnaire such as this, we should all be very worried about the quality of data entering the system.
9. What evidence might an organisation holding a voluntary register provide in order to support their submission?
Unfortunately, over the last 10 years or so, the word ‘evidence’ has been distorted to such a degree that in many contexts it has become almost meaningless (there are of course exceptions to this, but in general, unless the discursive space is carefully protected, the word tends to becomes a political weapon rather than a valuable way of transmitting information). This is, to put it mildly, a pity. However, it does furnish us with another good opportunity to observe the way that political power can twist and pervert the ordinary course of things (the phrase Evidence Based Medicine was invented as a political slogan by Archibold Cochrane back in the 70’s, it only became popular after the new Labour Government promoted it as a policy for ‘modernising’ the NHS, and for solving the BSE/CJD problem.).
In the ‘old days’, before the capture of ‘evidence’ by politics, it would be possible to think that your question included an idea of a real human being looking for a variety of information from a number of sources and weighing up reality in order to make a judgment. Here we can also draw on the parallel field of law, where evidence takes part in a complex system of investigation, prosecution, defense, cross examination, review and assessment by jury, and, finally judgment. In other words, evidence must always be weighed up in relation to the social arrangements that are made around it. In answering this question, then, I must make an assumption about the way that the ‘evidence’ will be used – ie, what is the context in which information will be turned into evidence, and what is the quality of the personnel that will interpret the information and form judgments. I think there is rather a high chance that the computerized context of the HPC will favour an automatic reading of evidence which will reduce information to little more than ticks in boxes. In other words, I strongly recommend you reflect seriously on what you are asking for here.
10. Do you agree that the grand-parenting period for psychotherapists and counsellors should be set at two years in length?
If the HPC cannot avoid becoming the regulator of this field, the grand-parenting period should surely approach infinity to allow conscientious and serious practitioners to remain safe from the threat of the distorting effects of its power until a proper solution is found. Even those who are actively seeking HPC regulation know that there are very many problems indeed to be sorted out before regulation will be functioning effectively. It is sensible to leave a very large margin in order to reduce what is likely to be inadvertent damage, and thus to increase the possibility of protecting the public. In doing this, the HPC would also gain a realistic view of the opinions of those in practise as to the quality of the regulation it proposes. At present the HPC cannot hope to gauge a measure of success as the regulation already comes with the force of law. At this year’s Annual Meeting I heard Mr Seale laugh cheerfully and say that many professionals are embarrassingly positive about being regulated by the HPC – this ‘evidence’ could be interpreted in a number of ways, not all of which would be flattering to the HPC. The presence of statutory power can easily distort the context in which information is produced. To be embarrassingly cheerful could as easily parody a highly distorted relation not unlike that between a cheerful slave and its cruel or stupid master.
11. Do you think that the standards support the recommendation to differentiate between psychotherapists and counsellors?
No.
12. Do you think the standards are set at the threshold level for safe and effective practice? If not, why not?
No. The vast majority of the standards are completely irrelevant (the generic standards), and are almost certainly going to set up a distortion in this particular field of work. This will actively not protect the public – ie, will make the public less safe. Secondly, those standards which have been written specifically for counselling and psychotherapy were cobbled together from a variety of other aborted attempts, and are only here presented as a finished item to fit in with an arbitrary time table. There has been no testing out in pratise of these standards, and no attempt has been made to think through the possible negative consequences in the various practices and modes of training that exist up and down the country.
There is something crucial to say at this point. Those who have been engaged in this process have revealed a lot of different motives and justifications for their participation. For one, it is to prevent certain specific others from practicing (a personal motive), for another it is to make sure that they have some say in whatever happens, the better to make a buffer to protect their members from the worst effects of the new system. A third says openly that these standards will have no effect whatsoever on practice, so for him they are a façade to be erected behind which ‘business can carry on as usual’. Several of those PLG members drawn from the counselling and psychotherapy field have also openly said that they would not chose the HPC as the regulator, but were participating in a process they didn’t agree with, because they had no choice. One even said she was dragged to the table, though she conceded she had been willing to be dragged but only in order to influence things from inside the system.
From those PLG members who were there from other parts of the HPC, two thought they should persuade the counsellors and psychotherapists to actually invent a brand new profession so that the HPC would be able to regulate it! Another thought that the variety and diversity in the field of counselling and psychotherapy was a ‘mess’ and intended to use HPC mechanisms ‘to tidy it up’. A third, or rather, fourth, was preoccupied with bringing professionals into fitness to practise procedures in order that the HPC triumph over it’s rival the GMC in an imaginary competition of ‘show trials’. Yet another member of the PLG held up proceedings for almost half an hour to consider how to prevent people from practising who had ‘a boy scouts badge in counselling’ thus insulting the institute of boy scouts!
The list of examples goes on. The process was not set up in such a way to ‘bring out the best’ from its constituents. The chairing of the meeting was insipid, un-inspiring, not rigorous, and became famous for a set of phrases: ‘we’ll park that for the moment’, ‘put that in the pot’, ‘we’ll come back to it later’. Each of those phrases might be put to good use in such a context, but here they signified stalling, avoiding, postponing and almost completely succeeded in preventing any serious sensible discussion from taking place at all.
This, however, was no ordinary incompetence and even seems possible to signify an underlying cynicism. From the beginning of the process the chair and other practitioner members of the HPC Council emphasized that the meeting was not one in which decisions should be made, but that it should be thought of as a place to ‘keep it vague, and make a sketch’. This somewhat extraordinary aim was made especially clear when the Chair brought the meeting to a ‘false close’ at the end of a very short first meeting, and again in the second meeting after a short and largely sneering discussion on the question of ‘conscientious objections’. She said: ‘we can be seen to have done justice to the question’ presumably because a small amount of time could be recorded in the minutes. Being seen to do something, here, sounds remarkably like ‘pretending to do something’ and in fact this latter would be a better description in this case.
This is a strong claim, and one not to be made lightly. However, the constant prevarication also meant that at the 11th hour the PLG had to resort to the extraordinary measure of asking Peter Fonagy and Mick Cooper to ‘get together over lunch’ to come up with a differential to settle the tricky question of distinguishing counselling from psychotherapy. Kathi Murphy objected strongly but was pretty much ignored as Diane Waller eagerly took up the suggestion (made by Julian Lousada). This meant that, for those of us watching from the back of the room, the complexities of the matter were being taken out of the hands of those who had knowledge of the realities of this distinction and were given to two individuals. That is, Mick Cooper was there as Professor of Counselling, and to Peter Fonagy whose place on the PLG has been obscured and left ambiguous.
It is important now to say something of this. Peter Fonagy has very many titles, but probably it is an important aspect of many of these that he is, or at least has been, a training analyst in the British Psycho-Analytical Society, now known as the BPC. Julian Lousada is openly attributed as a member of the BPC and this is further confirmed when his absence draws forth a substitute, the BPC CEO Malcolm Allen. This leaves Peter Fonagy as the ‘representative’ of Skills for Health. The Chair of the PLG therefore took advice from the BPC (Julian Lousada) to allow another member of the BPC to define psychotherapy, and overruled objections from the UKCP (UKCP rep Kathi Murphy later said she would not dispute the definition at the meeting because she knew that this would go out to public consultation). The history of psychotherapy in the UK makes this move an extremely controversial one, and exposes Diane Waller as, at best, extremely naïve.
A second reading of the same scenario is also left wide open – that the chair of the PLG delegated the defining of psychotherapy to Skills for Health. This is the official line, given the official designation of Fonagy to that organisation in all the HPC paperwork. This is an extraordinary thing to do in any case, but is made worse but the frequent plaintive cries of the HPC (Waller and Guthrie for example at the Manchester Stakeholder Event) that the SfH has no influence on the HPC.
It is not unreasonable, of course, to invite someone from one place (is Fonagy an employee of SfH?) and to make use of his wide-ranging skills while he is there, but in the interests of transparency, an effort must be made to explain the logic, reasons, rationalities of such a decision. What is clear in all this is that complex and difficult issues were rushed, squashed, collapsed and condensed, and their consequences were not given much consideration.
13. Are the draft standards applicable across modalities and applicable to work with different client groups?
No.
14. Do you think there are any standards which should be added, amended or removed? To begin, all of the generic standards should be removed. To follow, all of the specific standards are contentious, disputable and highly partial. None of them has been tested out in practice, or at least no attention has been given to any knowledge or experience of this.
15. Do you agree that the level of English language proficiency should be set at level 7.0 of the International English Language Testing System (IELTS) with no element below 6.5 or equivalent? (Standard 1b.3)
No.
16. Do you agree that the threshold educational level for entry to the Register for counsellors should be set at level 5 on the National Qualifications Framework? If not, why not?
No. The NQF is not appropriate to this field. It is the mix of people that is important, rather than creating a homogenized ‘army’ of workers. The revolution in education in the UK at present is a further problem here. This was discussed many times at the PLG without coming to any useful conclusion. Again we have the dispiriting situation where people working in the real world are having to stretch the truth extremely thin in order to make the centralist planners dream appear to come true.
17. Do you agree that the threshold educational level for entry to the Register for psychotherapists should be set at level 7 on the National Qualifications Framework? If not, why not?
No. See above.
18. Do you have any comments about the potential impact of the PLG’s recommendations and the potential impact of statutory regulation?
There is good reason to believe that HPC regulation of this field will produce - has already produced - perverse unintended consequences which will not only destroy important knowledge and experience within the field, create divisions and conflicts, and damage the experience of those who wish to consult someone in order to overcome their difficulties, but will create an illusion of public protection which indeed then constitutes a clear and imminent danger to the public.
19. Do you have any comments about the potential implications of this work on the future regulation of other groups delivering psychological therapies?
There is good reason to think there will be many negative implications of HPC regulation within the field as well as beyond it. There are good reasons to be very cautious indeed when approaching the regulation of talking and listening.
20. Do you have any further comments?.
The HPC stands to gain at least £4m a year in fees by regulating this field and is hardly disinterested. The HPC is not answerable to its constituents: it is undemocratic. The HPC has repeatedly ignored difficult questions which threaten to contradict its belief system. The HPC has allowed itself to be used as an agent of aggression against those who question it (eg by circulating the letter of Jonathan Coe after the Manchester Stakeholder Meeting in March 09, and not then circulating the responses to that letter). The HPC has shown no evidence that it engages in serious self reflection, but conducts itself on the belief that it alone knows what is best for the good of society. I recommend a rereading of Karl Popper’s interesting and pertinent essay: piecemeal social engineering. Those more up to date and are already able to take on ideas from further a-field, might wish to turn directly to the work of Michel Foucault.
Post Script
Having closely observed the proceedings of the HPC over the course of the last year, I have very little reason to believe that my work here will be given proper consideration. Since the Call for Ideas (Oct 2008) I have been repeatedly dismayed at the way the HPC and its agents have waived aside ideas and arguments that don’t coincide with their own. It is true that I have been given the opportunity to sit silently at the back of the room and watch all the proceedings, thank you for that, but I have seen much to make me doubt the wisdom of placing my trust in the organisation.
My investigations into the history and workings of this organisation have shown how the flawed logic of the HPO2001 coupled with the lack of proper debate caused by a government’s reliance on secondary legislation has produced a thoughtless apparatus in which even minor amounts of self interest and blind prejudice are easily magnified and go on, inevitably, to cause harm.
I am very concerned by the cavalier use of the political slogan ‘to protect the public’ which without due consideration amounts to little more than scaremongering and goes on to produce cynicism.
During the course of my observations I have seen a Council member punch the air in joy to hear the ‘good news’ that registrants will be subject to higher costs if they appeal decisions of the HPC. I have heard a HPC Solicitor maliciously interpret a practitioner, and by implication, all those who have worked along side him, as long time liars who have got away with sloppy practise for twenty or more years (FTP of Paul Manktelow, Registration Number: PA08359, Allegation Number: FTP01149). I have myself been subject to ridicule in front of the Annual Meeting when the CEO Marc Seale laughed at the idea that my writing on the HPC might be useful or interesting to the organisation.
None of this can be dismissed as one off chance events when seen in the context of the advertising campaign used to launch the organisation a few years ago: the picture of ‘stupid white people’ dressed up in false noses, joke moustaches and villainous eyebrows revealed the disrespectful attitude that makes up a fundamental part of this organisations culture. Incidentally, I was pleased to see the relics of this removed from the walls of HPC HQ in the summer (where they had been displayed ‘proudly’ as art works, framed and displayed on a busy corridor), but when I asked the HPC for copies of the art work from that campaign, I was stonewalled by the administrators.
I have traced the thread of this idea (‘that behind the mask lies a charlartan’) to Ian Kennedy’s 1980 Reith Lectures. The book produced as a result appeared a year later as The Unmasking of Medicine, and the cover carried the picture of a medical man who was indeed wearing a mask. The simplistic idea of Kennedy was that the mask worn by the medic was not so much done for the good of the work and the safety of all those involved, but to disguise the truly villainous nature of the man behind it. Although Kennedy said this was not his thesis, it is not difficult to read it on every page of the book. We all know that Kennedy went on to be invited by Lord Levy (on the strength of this Reith lecture work), to chair the Bristol Royal Infirmary Inquiry whose conclusions led directly to the creation of the HPC.
This is not to say that an ‘evil conniving’ man is responsible for this mess, but that a man’s prejudice has entered unchecked and has left an indelible mark. I have already mentioned the lack of proper debate surrounding the invention of the HPC (I refer to the process that allows secondary legislation to be passed that constitutes the structure of this organisation). The continual lack of proper space to think and talk through the issues is leading us towards a disaster. This is why I have chosen to bring Karl Popper into the picture.
Such a centralisation of power cannot but make fools of all of us. Anyone who gallantly enters the process and tries to make it work better, almost qualifies as a modern Sisyphus. There is, however, at least one important difference. Though Sisyphus was destined to watch his work constantly be undone, those engaged in the HPC have no such friendly enemy! The work they do is mangled, yes, but that then goes forward to become law. It then could easily then go on to be used to distort and even destroy the work of all those who are then obliged to sign up to it. Professor Micheal Power has been documenting an aspect of this process (dubbed Audit Culture) since 1994.
One important and possible good thing to come out of all of this is that those of us actively thinking about all this may learn first hand just how easy it is to turn a good thing bad. The mundane mechanisms and bland rhetoric that supports the process of HPC regulation of counselling and psychotherapy can easily pervert the good intentions or ordinary people and end up manufacturing foul deeds.
I’ll end this response by recounting something I witnessed at the final PLG meeting. One well educated and experienced professional was forced to agree to something that went against his wisdom, experience, and intellect. He said ‘ok I’ll accept it, but I may give up the will to live” (Julian Lousada on the PLG for C&P).
It does not augur well.
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