Baroness Onora O'Neill challenges the current approaches to accountability and explores the public's perception of scientists in a long you-tube posted in the Series: "Science Futures" [4/2005] The heading here is linked to it. She asks 'which forms of accountability support trust' and notes that some systems heighten mistrust, which is sad, she said. She contrasted the provision of epistemic support for trust, with systems that just go in for control. Some systems may damage, rather than improve both the actual practise and the trust people place in it. Some regulatory regimes can incentivise defensive practise, and this can sometimes become aggressive practise: this is wrong. Also, if regulators subject professionals to Mickey Mouse procedures or tell them that they are not trusted they can damage the morale of people who are working extremely hard trying to do very difficult things.
A good question seems to be 'what is the evidence that HPC-ification supports or increases levels of trust'... How you would measure that, in which communities, and on what occasions, is still to be resolved. Trust, after all, is not an objective quantifiable object that can be picked up and put down at will, and is linked to love, no matter how mildly.
Sunday, 15 March 2009
State regulation of the psychologists, quis custodiet ipsos custodes
The Joint Committee on Statutory Instruments now has an Order to consider which, if passed, will put 13,000 psychologists onto the register of the HPC in July. This order is called The Health Care and Associated Professions (Miscellaneous Amendments and Practitioner Psychologists) Order 2009. It is simultaneously laid before the Scottish Parliament.
The Order relates to the General Dental Council, the Health Professions Council, and the Royal Pharmaceutical Society of GB.
It includes governance changes which will effect the Council of the HPC. At the moment, HPC Council is made of members who are elected by the 13 professions already on the register plus 13 lay members who are appointed by Privy Council. This Order will remove the elected members and all will then be appointed by the Privy Council.
The power is moved (yet again) away from the people who practise, to a private group appointed by the Sovereign.
The explanatory memorandum puts it like this:
it is "to ensure that purely professional concerns are not thought to dominate its work"
"Regulators must be seen to be independent and impartial..."
"Doubts based on a perceived partiality have threatened to undermine .. trust"
"The regulators may be seen as partial ..."
"The composition is central to .. these perceptions"
"Regulators may be seen as partial to their professionals because [they] form the majority of their council or may be seen to be partial because their councils are thought to be elected to represent the particular interests of health professionals. Hence the moves to parity of membership and having independently appointed councils rather than professional members being elected by the profession." (Clause 7.1) [emphasis added]
There's a few things to note: these excerpts are all about manipulating an image rather than reflecting or establishing a system grounded in reality. It would be valuable to ask 'not thought by who?', 'perceived by who?' 'seen by who?', and 'on what occasion'? The vagueness does not encourage clear thinking. Second, the idea that purely professional objectives are a bad thing is odd. It sort of implies that the particular interests of health professionals are primarily against, and dangerously against, the interests of someone else. The vagueness leaves a nasty taste and encourages suspicion - abstract suspicion. Thirdly, the structure of the HPC is already predisposed towards destabilising the knowledge and practise of each of these groups of people, which makes it more likely that a group would to try to act in its own favour, to protect its boundaries, and to redefine its speciality - and all these things have already been insinuated as bad. An effective self fulfilling prophecy has been put in place which this new Order can only add to.
Couple this with the realisation that 13000 new people could be added to the register in summer, and that these people are working with other people's minds, and you have quite a prospect.
Quis custodiet ipsos custodes - who will guard the guardians of the psychologists? The question has an infinite regress, remedied here by ... the Queen.
The Order relates to the General Dental Council, the Health Professions Council, and the Royal Pharmaceutical Society of GB.
It includes governance changes which will effect the Council of the HPC. At the moment, HPC Council is made of members who are elected by the 13 professions already on the register plus 13 lay members who are appointed by Privy Council. This Order will remove the elected members and all will then be appointed by the Privy Council.
The power is moved (yet again) away from the people who practise, to a private group appointed by the Sovereign.
The explanatory memorandum puts it like this:
it is "to ensure that purely professional concerns are not thought to dominate its work"
"Regulators must be seen to be independent and impartial..."
"Doubts based on a perceived partiality have threatened to undermine .. trust"
"The regulators may be seen as partial ..."
"The composition is central to .. these perceptions"
"Regulators may be seen as partial to their professionals because [they] form the majority of their council or may be seen to be partial because their councils are thought to be elected to represent the particular interests of health professionals. Hence the moves to parity of membership and having independently appointed councils rather than professional members being elected by the profession." (Clause 7.1) [emphasis added]
There's a few things to note: these excerpts are all about manipulating an image rather than reflecting or establishing a system grounded in reality. It would be valuable to ask 'not thought by who?', 'perceived by who?' 'seen by who?', and 'on what occasion'? The vagueness does not encourage clear thinking. Second, the idea that purely professional objectives are a bad thing is odd. It sort of implies that the particular interests of health professionals are primarily against, and dangerously against, the interests of someone else. The vagueness leaves a nasty taste and encourages suspicion - abstract suspicion. Thirdly, the structure of the HPC is already predisposed towards destabilising the knowledge and practise of each of these groups of people, which makes it more likely that a group would to try to act in its own favour, to protect its boundaries, and to redefine its speciality - and all these things have already been insinuated as bad. An effective self fulfilling prophecy has been put in place which this new Order can only add to.
Couple this with the realisation that 13000 new people could be added to the register in summer, and that these people are working with other people's minds, and you have quite a prospect.
Quis custodiet ipsos custodes - who will guard the guardians of the psychologists? The question has an infinite regress, remedied here by ... the Queen.
Sunday, 8 March 2009
Observer Front Page News: Victims of recession to get free therapy
Looking sideways at the problems of today:
Back in the 60s writers of the day were confidently anticipating that ours would be the Leisure Society: we would only have one day’s work each week because our technology and economic position in the world would be doing it all for us.
Few foresaw governments reluctant to let us enjoy our leisure. First they funnel us into never ending target led education, then they encourage us to audit each other by filling in more and more forms that make less and less sense, and now they plan to recruit half of us to therapize the other half and create a kind of smoke screen to conceal the real scene (Observer, 8th March).
Who will ask you how it feels to be all alone and without a home now that the bubble has burst? An army of newly recruited form filling government trained ‘therapists’ whose own good character will be policed and guaranteed by the hpc.
Back in the 60s writers of the day were confidently anticipating that ours would be the Leisure Society: we would only have one day’s work each week because our technology and economic position in the world would be doing it all for us.
Few foresaw governments reluctant to let us enjoy our leisure. First they funnel us into never ending target led education, then they encourage us to audit each other by filling in more and more forms that make less and less sense, and now they plan to recruit half of us to therapize the other half and create a kind of smoke screen to conceal the real scene (Observer, 8th March).
Who will ask you how it feels to be all alone and without a home now that the bubble has burst? An army of newly recruited form filling government trained ‘therapists’ whose own good character will be policed and guaranteed by the hpc.
Thursday, 5 March 2009
CHRE Conference 2009
A one day conference in London to which a large number of people were drawn from all over the UK for the launch of the new look CHRE. A new law (yes - another one) has been recently passed to reduce the Board of the CHRE down to six members plus a chair (removing the reps from the regulated bodies), all of whom are now new to the job. The strapline for this streamlined outfit is "Building Partnerships: from self regulation to shared regulation", which in itself is extremely ambiguous, if not downright misleading.
This is an emerging feature: something is being murdered - all reference to the previous incumbents of the Board is gone. The CHRE was invented by the HPO2001 to cure what was supposed as the problem of Self Regulation. What has happened to those intervening years?
In the morning's workshops there was a little bit of time to ask a question:
Question: what evidence is there that this kind of regulation increases levels of trust between professionals and their patients?
Dame Professor Professor Dr Dr Dr: What do you mean this kind of regulation?
The Dame in question is a perfectly lovely woman with 3 honorary doctorates, 2 honorary professorships, and fellowships etc at four prestigious national bodies. What, then, reduces such an accomplished lady to such a degree of blankness?
what evidence is there that the regulation practised by CHRE and its ilk reduces real risk and increases true trust? What ground is there for supposing that the new modus operandi is actually achieving its much trumpeted aim?
Onora O'Neill's 2002 Reith Lectures happened to be close to hand, so I quoted a little to situate my concerns: some arguments against performance auditing are that it creates a huge administrative burden that damages delivery of service; that professional work cannot be measured in the same way as the financial health of a company; and, worst of all, these kinds of measures are misleading and can create perverse incentives.
Dame: The world has moved on since that was written.
Well, yes, it is 2009, but Onora O'Neill's points might as easily be seen to have grown in significance and pertinence, rather than to have conveniently faded away. Here's another quote "Our revolution in accountability has not reduced attitudes of mistrust, but rather reinforced a culture of suspicion. Instead of working towards intelligent accountability based on good governance, independent inspection and careful reporting, we are galloping towards central planning by performance indicators, reinforced by obsessions with blame and compensation. This is pretty miserable both for those who feel suspicious and for those who are suspected of untrustworthy action - sometimes with little evidence." (click here for link to OU + BBC page)
Dame: I don't think I agree with the basis of your question.
OK - it is true that anyone asking for 'evidence' these days is usually on the attack (as Onora O'Neill predicted). Lets try a different angle: "O'Neill is especially known for her universalist and cosmopolitan standpoint. She believes that institution building can specify and allocate obligations to the needy. They are to specify who is obliged to fulfill economic rights. O'Neill firmly holds that the institutions have to be made accountable. This can be done through new technologies that are ideal for achieving transparency and openness. Justice, according to her, means finding the means for the vulnerable to express legitimate consent.finding the means for the vulnerable to express legitimate consent." [quoted from 4to40 website, click for link]
A major stumbling block that separated us in that room was the idea that there was any other kind of Regulation. 'What kind of regulation', seemed to produce a hole in the fabric that threatened to pull everybody in. Is there another way to speak, a way that doesn't produce such a terrifying void? I am fond of thinking etymologically:
Regulation: "Regular 'according to a rule' is the most instantly recognizable English descendant of Latin regula 'rule' ... It goes back ultimately to the same Indo-European base as produced Latin regere 'rule' (source of rector, regent, etc) and rex 'king' (source of English regal, royal, etc). From it was derived the late Latin verb regulare, which has given English regulate [17] and may also lie behind rile 'annoy' [19], ..." quoted from John Ayto's remarkable Dictionary of Word Origins (Bloomsbury, 1990, p437)
Governing is not reducible to a universal set of principles. We knew that. So where has this wisdom gone? I think it is being murdered, murdered by the way we speak.
This is an emerging feature: something is being murdered - all reference to the previous incumbents of the Board is gone. The CHRE was invented by the HPO2001 to cure what was supposed as the problem of Self Regulation. What has happened to those intervening years?
In the morning's workshops there was a little bit of time to ask a question:
Question: what evidence is there that this kind of regulation increases levels of trust between professionals and their patients?
Dame Professor Professor Dr Dr Dr: What do you mean this kind of regulation?
The Dame in question is a perfectly lovely woman with 3 honorary doctorates, 2 honorary professorships, and fellowships etc at four prestigious national bodies. What, then, reduces such an accomplished lady to such a degree of blankness?
what evidence is there that the regulation practised by CHRE and its ilk reduces real risk and increases true trust? What ground is there for supposing that the new modus operandi is actually achieving its much trumpeted aim?
Onora O'Neill's 2002 Reith Lectures happened to be close to hand, so I quoted a little to situate my concerns: some arguments against performance auditing are that it creates a huge administrative burden that damages delivery of service; that professional work cannot be measured in the same way as the financial health of a company; and, worst of all, these kinds of measures are misleading and can create perverse incentives.
Dame: The world has moved on since that was written.
Well, yes, it is 2009, but Onora O'Neill's points might as easily be seen to have grown in significance and pertinence, rather than to have conveniently faded away. Here's another quote "Our revolution in accountability has not reduced attitudes of mistrust, but rather reinforced a culture of suspicion. Instead of working towards intelligent accountability based on good governance, independent inspection and careful reporting, we are galloping towards central planning by performance indicators, reinforced by obsessions with blame and compensation. This is pretty miserable both for those who feel suspicious and for those who are suspected of untrustworthy action - sometimes with little evidence." (click here for link to OU + BBC page)
Dame: I don't think I agree with the basis of your question.
OK - it is true that anyone asking for 'evidence' these days is usually on the attack (as Onora O'Neill predicted). Lets try a different angle: "O'Neill is especially known for her universalist and cosmopolitan standpoint. She believes that institution building can specify and allocate obligations to the needy. They are to specify who is obliged to fulfill economic rights. O'Neill firmly holds that the institutions have to be made accountable. This can be done through new technologies that are ideal for achieving transparency and openness. Justice, according to her, means finding the means for the vulnerable to express legitimate consent.finding the means for the vulnerable to express legitimate consent." [quoted from 4to40 website, click for link]
A major stumbling block that separated us in that room was the idea that there was any other kind of Regulation. 'What kind of regulation', seemed to produce a hole in the fabric that threatened to pull everybody in. Is there another way to speak, a way that doesn't produce such a terrifying void? I am fond of thinking etymologically:
Regulation: "Regular 'according to a rule' is the most instantly recognizable English descendant of Latin regula 'rule' ... It goes back ultimately to the same Indo-European base as produced Latin regere 'rule' (source of rector, regent, etc) and rex 'king' (source of English regal, royal, etc). From it was derived the late Latin verb regulare, which has given English regulate [17] and may also lie behind rile 'annoy' [19], ..." quoted from John Ayto's remarkable Dictionary of Word Origins (Bloomsbury, 1990, p437)
Governing is not reducible to a universal set of principles. We knew that. So where has this wisdom gone? I think it is being murdered, murdered by the way we speak.
Wednesday, 4 March 2009
PLG C&P March 3rd meeting - day 2
What wasn't talked about yesterday: the threshold for entry onto the register. What wasn't talked about today: how to distinguish counsellors from psychotherapists.
What was talked about today was the number of voluntary registers that are known to exist (33 according to Sally Aldridge) and the traumatic effect this will have on the HPC. The Section 60 designates a legal date of transfer when a cd-rom is handed over, popped into a slot and dragged and dropped into a brand new folder. Usually there is one cd.
Here's a paragraph quoted from the web site of the Alliance for Counselling and Psychotherapy against State Regulation which introduces the problem:
"The therapeutic field is a rich and complex ecology, built up of many different approaches. This diversity is intrinsically valuable – since clients and their issues are equally varied – and is part of what we want to protect; however, from a regulatory point of view it is awkward and inconvenient, and needs to be ironed out. Good training helps the practitioner to develop their own unique style of work, rather than making them conform to a supposed ‘best practice’. The proposed regulation bids fair to flatten this rich ecology into a monoculture, with devastating consequences for the profession and for its clients."
The fact is that this profession is based on conversation, includes aspects of conversation that can't be put into words, and is a conversation that really must be made in private. You can see why the centralised planner might be uncomfortable with that.
Today someone suggested that the HPC would have to take this profession in 33 different registers. The room laughed, and Michael Guthrie spluttered, then said the Department of Health couldn't cope with that.
It occurred to me then that in swallowing this profession, the HPC might risk choking to death.
What was talked about today was the number of voluntary registers that are known to exist (33 according to Sally Aldridge) and the traumatic effect this will have on the HPC. The Section 60 designates a legal date of transfer when a cd-rom is handed over, popped into a slot and dragged and dropped into a brand new folder. Usually there is one cd.
Here's a paragraph quoted from the web site of the Alliance for Counselling and Psychotherapy against State Regulation which introduces the problem:
"The therapeutic field is a rich and complex ecology, built up of many different approaches. This diversity is intrinsically valuable – since clients and their issues are equally varied – and is part of what we want to protect; however, from a regulatory point of view it is awkward and inconvenient, and needs to be ironed out. Good training helps the practitioner to develop their own unique style of work, rather than making them conform to a supposed ‘best practice’. The proposed regulation bids fair to flatten this rich ecology into a monoculture, with devastating consequences for the profession and for its clients."
The fact is that this profession is based on conversation, includes aspects of conversation that can't be put into words, and is a conversation that really must be made in private. You can see why the centralised planner might be uncomfortable with that.
Today someone suggested that the HPC would have to take this profession in 33 different registers. The room laughed, and Michael Guthrie spluttered, then said the Department of Health couldn't cope with that.
It occurred to me then that in swallowing this profession, the HPC might risk choking to death.
More Regulation, Global Regulation
The news just now had poor old Gordon Brown wriggling on a hook about the economic collapse around the world. Gordon rightly said you need to diagnose the problem before you come up with the solution, then ignored his own advice by talking about robust regulation, strongest possible regulation, global regulation. He's right and also wrong. It all depends what you mean by regulation.
The idea of Popper's Nightmare is that this steady process of centralisation has been going on for years, the slow undermining of local practice and knowledge leads to a position where local knowledge and the structures that support it is destroyed. Technology plays a part in this, just as it plays a part in the re-animation. But, if you were the bloke in Central HQ facing an imminent election, and not terribly popular, you might not want to think about long term solutions to the crisis screaming in your face. BUT, a short term knee jerk increase in centralised power weilding (often what politicians mean by Robust Regulation, Strong Regulation, and Global Regulation) is going to make things worse. It keeps us locked into the nightmare.
Still, as this is likely to be the strategy, the rest of us need to think up some tactics. Humour, and humanity, theatre and maybe music, poetry perhaps. Antidotes to the boredom and lifelessness inflicted by the increasing administering of rules and their policing.
We should wish each other luck.
The idea of Popper's Nightmare is that this steady process of centralisation has been going on for years, the slow undermining of local practice and knowledge leads to a position where local knowledge and the structures that support it is destroyed. Technology plays a part in this, just as it plays a part in the re-animation. But, if you were the bloke in Central HQ facing an imminent election, and not terribly popular, you might not want to think about long term solutions to the crisis screaming in your face. BUT, a short term knee jerk increase in centralised power weilding (often what politicians mean by Robust Regulation, Strong Regulation, and Global Regulation) is going to make things worse. It keeps us locked into the nightmare.
Still, as this is likely to be the strategy, the rest of us need to think up some tactics. Humour, and humanity, theatre and maybe music, poetry perhaps. Antidotes to the boredom and lifelessness inflicted by the increasing administering of rules and their policing.
We should wish each other luck.
Tuesday, 3 March 2009
PLG C&P March 3rd meeting
18 uniformed officers were waiting at the gate of the station tonight when I returned from the 1st day of this 3rd meeting of the HPC PLG for C&P. 18 uniformed officers to check the validity of our train tickets. Such a concentration of power for such a silly job is a rather stark example of how out of balance stuff is in the UK today. Perhaps they are protecting the public from leaving the station quickly. 18 uniformed officers (half of them wearing padded flack jackets over already portly tummies) rather choke the little underpass to the street.
Meanwhile in a bland office in a back street near Elephant & Castle 11 non-representatives of the counselling and psychotherapy world met together with about 20 other people in order to say nothing of importance from 10.30am till 3.30pm. They will meet again tomorrow, and I can only hope that they manage to muster the courage to utter a coherent and definitive sentence between them at least once in the meeting.
To be fair, two or three people did make valiant attempts to keep it real, but they were swimming against a tide of platitudes, point scoring and polite snipes.
The 11 non-representatives from the world of counselling and psychotherapy were selected by Diane Waller (an arts psychotherapist) in conversation with Anna van der Gaag (a speech and language therapist) and Michael Guthrie (an administrator). There had been 40 or so applications, some from individuals, some from organisations. A little list of criteria had been written down and Di, Anna and Michael made their longer list with this. Since then, they have been bombarded with emails and letters and visits about the non-representative nature of the 11 they selected. Today, at the opening of the meeting Diane Waller set out to make a statement. She wanted to set the record straight: the 11 non-hpc people round the table should know that they had not been selected to represent their particular group, but were simply there to ... err, to, well, the only specific thing I heard her say was to hold onto Wales as an idea (because not one amongst them was Welsh).
This is just one example of the mad rules that the group are supposed to abide by. How can Sally Aldridge not represent the BACP? She is their paid Director on precisely this question. They have several thousand members. If she has anything sensible to say, it would be from her experience in that job. Surely she should restrict herself to this, not exclude herself. She should inform the rest of the group about the real practical issues at stake in transferring this particular membership onto the HPC register - this is her specialist subject. What about Mick Cooper? He is a professor of counselling (a relatively new breed of professor, the evolution of which would be very interesting to track) from Strathclyde University. He does not represent the University. So he can speak from a different position, and people can hear him in his capacity of intellectual and scholar, or whatever indeed he is. Peter Fonagy? He is there under the auspice of the Skills for Health - he can restrict himself to talking about the National Operating Standards that are his responsibility to coordinate. Each member of the group has a specific position from which they can speak authoritatively, what's the problem? They have been chosen according to those criteria, haven't they? So why does Diane begin today's meeting by describing the rationality of their selection, then forbidding them to be precisely that? She ended her little lecture by strongly emphasising that those 11 non-representatives should Reinforce and Remind people of their non-representativeness, 'that would be helpful' she said.
Mad.
Difficult questions get parked, reparked and parked again. Topics are constantly left for another day. Another day? There are only 4 days left for this group of people to come up with something that is destined to be turned into law. LAW. Do we need any more laws in this country? There are already more laws than Parliament knows what to do with, and a handful of politicians at Saturday's Convention on Modern Liberty were even pledging to repeal dozens at a time. What is the point of turning this mess into a legal document? The field we know as counselling and psychotherapy is so diverse, so rooted in relationships and places, so firmly fixed amongst ordinary people that the wish to legislate it into a neat standardised package should rather be written into next DSM as a sectionable mental illness.
It is so difficult to sit silently watching this process. It feels like being forced to watch a child being drowned, and forbidden even from throwing a rope.
It is extremely difficult to report on anything of substance. Nothing of substance emerged. However, two things are worth passing on. In the moments before the meeting started this morning one of the HPC lay members on the PLG suddenly came over to show us a CHRE document. This was one of the documents that teach doctors not to have sex with their patients. This document was offered to us in answer to the question raised at the last meeting about the source of the data that Fonagy and Jon Coe were trumpeting that 5% of C&P practitioners constitute a real and present danger. Here is a great example of the real trouble that this group has. A group of eminent and intelligent people are unable to think clearly in this process. We were offered this document as the evidence that 5% of therapists and counsellors were dangerous. I thought she meant that the reference to the paper that produced the statistic would be in there. But no. What was there was the fact that some doctors have sex with or marry their patients. This is absolutely barmy. Well meant, but barmy.
The second notable moment came at lunch time: three of us 'public' were eating lunch together when one of the 11 non-representatives came and sat down beside us. She asked us for our advice - what would we say if it were us who had landed at that powerful table? This was a real live thinking human being and it was a massive relief to discover it. So what would we say? Keep it Real. And she did - after lunch she tried and tried and tried again to keep reality in the picture. I'm not talking about anecdotes - she was furnishing the meeting with real information about things that she knows about, that are actually happening out there. What a relief. I'm going to start a collection to raise a statue for her if she carries on like this.
Meanwhile in a bland office in a back street near Elephant & Castle 11 non-representatives of the counselling and psychotherapy world met together with about 20 other people in order to say nothing of importance from 10.30am till 3.30pm. They will meet again tomorrow, and I can only hope that they manage to muster the courage to utter a coherent and definitive sentence between them at least once in the meeting.
To be fair, two or three people did make valiant attempts to keep it real, but they were swimming against a tide of platitudes, point scoring and polite snipes.
The 11 non-representatives from the world of counselling and psychotherapy were selected by Diane Waller (an arts psychotherapist) in conversation with Anna van der Gaag (a speech and language therapist) and Michael Guthrie (an administrator). There had been 40 or so applications, some from individuals, some from organisations. A little list of criteria had been written down and Di, Anna and Michael made their longer list with this. Since then, they have been bombarded with emails and letters and visits about the non-representative nature of the 11 they selected. Today, at the opening of the meeting Diane Waller set out to make a statement. She wanted to set the record straight: the 11 non-hpc people round the table should know that they had not been selected to represent their particular group, but were simply there to ... err, to, well, the only specific thing I heard her say was to hold onto Wales as an idea (because not one amongst them was Welsh).
This is just one example of the mad rules that the group are supposed to abide by. How can Sally Aldridge not represent the BACP? She is their paid Director on precisely this question. They have several thousand members. If she has anything sensible to say, it would be from her experience in that job. Surely she should restrict herself to this, not exclude herself. She should inform the rest of the group about the real practical issues at stake in transferring this particular membership onto the HPC register - this is her specialist subject. What about Mick Cooper? He is a professor of counselling (a relatively new breed of professor, the evolution of which would be very interesting to track) from Strathclyde University. He does not represent the University. So he can speak from a different position, and people can hear him in his capacity of intellectual and scholar, or whatever indeed he is. Peter Fonagy? He is there under the auspice of the Skills for Health - he can restrict himself to talking about the National Operating Standards that are his responsibility to coordinate. Each member of the group has a specific position from which they can speak authoritatively, what's the problem? They have been chosen according to those criteria, haven't they? So why does Diane begin today's meeting by describing the rationality of their selection, then forbidding them to be precisely that? She ended her little lecture by strongly emphasising that those 11 non-representatives should Reinforce and Remind people of their non-representativeness, 'that would be helpful' she said.
Mad.
Difficult questions get parked, reparked and parked again. Topics are constantly left for another day. Another day? There are only 4 days left for this group of people to come up with something that is destined to be turned into law. LAW. Do we need any more laws in this country? There are already more laws than Parliament knows what to do with, and a handful of politicians at Saturday's Convention on Modern Liberty were even pledging to repeal dozens at a time. What is the point of turning this mess into a legal document? The field we know as counselling and psychotherapy is so diverse, so rooted in relationships and places, so firmly fixed amongst ordinary people that the wish to legislate it into a neat standardised package should rather be written into next DSM as a sectionable mental illness.
It is so difficult to sit silently watching this process. It feels like being forced to watch a child being drowned, and forbidden even from throwing a rope.
It is extremely difficult to report on anything of substance. Nothing of substance emerged. However, two things are worth passing on. In the moments before the meeting started this morning one of the HPC lay members on the PLG suddenly came over to show us a CHRE document. This was one of the documents that teach doctors not to have sex with their patients. This document was offered to us in answer to the question raised at the last meeting about the source of the data that Fonagy and Jon Coe were trumpeting that 5% of C&P practitioners constitute a real and present danger. Here is a great example of the real trouble that this group has. A group of eminent and intelligent people are unable to think clearly in this process. We were offered this document as the evidence that 5% of therapists and counsellors were dangerous. I thought she meant that the reference to the paper that produced the statistic would be in there. But no. What was there was the fact that some doctors have sex with or marry their patients. This is absolutely barmy. Well meant, but barmy.
The second notable moment came at lunch time: three of us 'public' were eating lunch together when one of the 11 non-representatives came and sat down beside us. She asked us for our advice - what would we say if it were us who had landed at that powerful table? This was a real live thinking human being and it was a massive relief to discover it. So what would we say? Keep it Real. And she did - after lunch she tried and tried and tried again to keep reality in the picture. I'm not talking about anecdotes - she was furnishing the meeting with real information about things that she knows about, that are actually happening out there. What a relief. I'm going to start a collection to raise a statue for her if she carries on like this.
Sunday, 1 March 2009
Recalling the Call for Ideas (October 2008): What do the British Want? not all
In the preparation period leading up to the sumbission of ideas to the HPC last autumn, this comment was made by Dr Richard Klein. It's a beautiful piece of writing: enigmatic, rhythmic, wise.
"The specular image of the mirror stage is the banal instrument that keeps us in the scene, that keeps us where we like to be, and that protects us from the world. The scene, of course, is imaginary - it is dominated by the image, and it introduces inertia into our mind.
"Politicians use it for electioneering purposes, or for moral goals. In psychoanalysis, we call this goal an ego ideal. Our political leaders embrace this ideal quite frequently - if not all the time. If you want to call a network of signifiers out of which come rules, regulations and laws - if you want to call that the symbolic, you would be following Lacan a little bit. The neo-labour politician speaks at the level of the ego ideal in order to shore up what he or she perceives to be unravelling and in order to ensure its citizens protection from all sorts of criminals.
"He promises from the point of the ideal to keep all “his people” (usually an American politician that uses this expression) safely in the scene, offering them protection from the world. For instance, Britishness is perceived to be unravelling. It has become an ego ideal that does not keep enough people in the scene anymore. We hear the signifier “British” uttered with increasing frequency and desperateness by our political leaders. It’s not only Europe that the British don’t want. The British don’t even want Britain. Freud’s famous question has never been answered. What does the woman want? Our politicians have to cope with a question that produces an even greater enigma that Freud’s: What do the British want?
"Life is difficult for a politician in this country. The ideal signifiers have weakened. Moreover, I am not too sure what the world is from which I need political protection. I think it is probably the atmosphere which is wearing out as an effect of whatever is falling out of the scene: storms, volcanoes, earthquakes, tsunamis, oceans, mountains, animal life, drains and sewers to catch what is falling out of the scene. None of this fits very well into the categories of the symbolic and the imaginary.
"But there is still one trick left to symbolise the world: we can’t have God without a plague of locusts. We can’t have the Father without real effects.
"These very politicians who do not know what the British want, now invite us to provide them with some ideas about what we want. "you tell us how we can protect everyone from the world. We are reasonable people. We will play with your ideas." this invitation is no more and no less an attempt to demonstrate to the world that our government runs on reason from the Scottish Enlightenment.
"What does the psychoanalyst want? Not all. That's what the psychoanalysts want. We must confront the government with that same enigma; the one that the woman confronts Freud with, and as it turns out, the one that the British do too. Not all."
"The specular image of the mirror stage is the banal instrument that keeps us in the scene, that keeps us where we like to be, and that protects us from the world. The scene, of course, is imaginary - it is dominated by the image, and it introduces inertia into our mind.
"Politicians use it for electioneering purposes, or for moral goals. In psychoanalysis, we call this goal an ego ideal. Our political leaders embrace this ideal quite frequently - if not all the time. If you want to call a network of signifiers out of which come rules, regulations and laws - if you want to call that the symbolic, you would be following Lacan a little bit. The neo-labour politician speaks at the level of the ego ideal in order to shore up what he or she perceives to be unravelling and in order to ensure its citizens protection from all sorts of criminals.
"He promises from the point of the ideal to keep all “his people” (usually an American politician that uses this expression) safely in the scene, offering them protection from the world. For instance, Britishness is perceived to be unravelling. It has become an ego ideal that does not keep enough people in the scene anymore. We hear the signifier “British” uttered with increasing frequency and desperateness by our political leaders. It’s not only Europe that the British don’t want. The British don’t even want Britain. Freud’s famous question has never been answered. What does the woman want? Our politicians have to cope with a question that produces an even greater enigma that Freud’s: What do the British want?
"Life is difficult for a politician in this country. The ideal signifiers have weakened. Moreover, I am not too sure what the world is from which I need political protection. I think it is probably the atmosphere which is wearing out as an effect of whatever is falling out of the scene: storms, volcanoes, earthquakes, tsunamis, oceans, mountains, animal life, drains and sewers to catch what is falling out of the scene. None of this fits very well into the categories of the symbolic and the imaginary.
"But there is still one trick left to symbolise the world: we can’t have God without a plague of locusts. We can’t have the Father without real effects.
"These very politicians who do not know what the British want, now invite us to provide them with some ideas about what we want. "you tell us how we can protect everyone from the world. We are reasonable people. We will play with your ideas." this invitation is no more and no less an attempt to demonstrate to the world that our government runs on reason from the Scottish Enlightenment.
"What does the psychoanalyst want? Not all. That's what the psychoanalysts want. We must confront the government with that same enigma; the one that the woman confronts Freud with, and as it turns out, the one that the British do too. Not all."
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.
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.
Philip Pullman and Fergal Sharkey at the Convention on Modern Liberty
Yesterday was the Convention on Modern Liberty - an extraordinary thing that happened in many cities in the UK and that brought together a very mixed bag of Brits. Lucky enough to live in London I was able to get a seat to see Philip Pullman deliver his 10 minutes worth of political poetry. He spoke from the heart - literally a voice of courage, speaking of courage: to act kindly, with good judgement, thinking of the long term, and not afraid of headlines in the Daily Mail. He said many memorable things:
"Joy does not flourish in the garden of anxiety."
"Acquiring modesty would give a proper sense of position in this world and remove the self-importance of politicians who think they are fighting an extensional war to defend western civilisation, when they are actually throwing their weight about behind the bike shed like playground bullies."
"When there came a threat from external nations a courageous nation would take a clear look at the danger and take realistic steps to avert it not take up a machine gun to defend itself against a wasp."
and most delightful of all:
"A modest Kingdom would have to think for a moment whether or not it was a republic, because its Royal family would be small and its members would be allowed to spend most their time in interesting careers as well as being Royal, their love affairs would remain their own business and people would always be glad to see them cycling past."
At the end of the day a small panel of writers and artists addressed those remaining. Fergal Sharkey was amongst the speakers, he is now Chief Exec of UK Music. He read out a clause from the Licensing Act 2003 which requires venues to fill in form 696 (or 57, or something) which insists on a risk assessment for any forthcoming performance of belly dancing, or live music etc. Two things stuck in my mind: first, the form required that names and addresses and other personal details of all of the performers be submitted to authorities two weeks in advance of the act. The second thing is that this law was passed into the practice of the majority of London Borough Councils seemingly without close scrutiny. Sharkey is now writing to various Councils asking them what on earth they think they are doing. His letters so far have received no reply.
I thought that his work exemplified the kind of courage Pullman calls for, once adored as a popular singer, he doesn't shirk from doing mundane work - reading through pages of legal documents, and following up the consequences and their preconditions. I think this way turns blunt acts of power into situated stories and re-introduces joy into a garden that might otherwise be overrun by anxiety. Inspiration, really.
"Joy does not flourish in the garden of anxiety."
"Acquiring modesty would give a proper sense of position in this world and remove the self-importance of politicians who think they are fighting an extensional war to defend western civilisation, when they are actually throwing their weight about behind the bike shed like playground bullies."
"When there came a threat from external nations a courageous nation would take a clear look at the danger and take realistic steps to avert it not take up a machine gun to defend itself against a wasp."
and most delightful of all:
"A modest Kingdom would have to think for a moment whether or not it was a republic, because its Royal family would be small and its members would be allowed to spend most their time in interesting careers as well as being Royal, their love affairs would remain their own business and people would always be glad to see them cycling past."
At the end of the day a small panel of writers and artists addressed those remaining. Fergal Sharkey was amongst the speakers, he is now Chief Exec of UK Music. He read out a clause from the Licensing Act 2003 which requires venues to fill in form 696 (or 57, or something) which insists on a risk assessment for any forthcoming performance of belly dancing, or live music etc. Two things stuck in my mind: first, the form required that names and addresses and other personal details of all of the performers be submitted to authorities two weeks in advance of the act. The second thing is that this law was passed into the practice of the majority of London Borough Councils seemingly without close scrutiny. Sharkey is now writing to various Councils asking them what on earth they think they are doing. His letters so far have received no reply.
I thought that his work exemplified the kind of courage Pullman calls for, once adored as a popular singer, he doesn't shirk from doing mundane work - reading through pages of legal documents, and following up the consequences and their preconditions. I think this way turns blunt acts of power into situated stories and re-introduces joy into a garden that might otherwise be overrun by anxiety. Inspiration, really.
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