Art, literature, and bureaucracy

Picking up the Archbishop’s thread from Easter Bank Holiday Monday – can literature defeat bureaucracy? – I’m sorry to report that there was a clear win for bureaucracy at last weeks International PEN meeting ‘Free the Word’ at London’s South Bank. Internationally celebrated writer Donato Ndongo-Bidyogo (a political refugee currently living in Spain, exiled from his home in Equatorial Guinea) was denied entry into the UK to take the stage on Saturday because the beleaguered bureaucrat got tangled up in the red tape of the new border control agencies (UKBA, formed in April 2008). Donato had applied to enter as a ‘business visitor’, but the poor fuddled civil servant got hopelessly lost in the labyrinth of rules and ended up quoting chapter and verse from the wrong page of the book. Donato was rejected without hope of appeal and thus prevented from entering good old bastion of liberty, free speaking Britain.

The Labour Party Manifesto links this new agency with crime reduction policy in chapter 5 entitled Crime and Immigration. “Our borders are stronger than ever” it declares, though it may simply be that piles and piles of red tape are simply in the way. This “new Border Agency has police-level powers and thousand more immigration officers, 100 per cent of visas are now biometric, and new electronic border controls will be counting people in and out by the end of the year… Genuine refugees will continue to receive protection.” Or not…

In the absence of Donato Ndongo-Bidyogo’s bodily presence, someone read a passage from his book: Shadows of your Black Memory (Swan Isle Press, 2007), around about page 84. Told in the voice of a boy this piece describes him watching with glee as his Uncle, the leader of the tribe, sparred and jibed with the visiting Catholic Priest whose mission was to impose his superior culture on these poor guys who were evidently stuck in the dark and dismal past. The Uncle’s work was to constantly subvert the Priest’s mission by reminding him to practice what he preached. But the Priest was deaf to his witty reminders and carried on obliviously. The justifications for the Priest’s unwelcome rescue package were uncannily familiar and reminded me, of all things, of the HPC. A man convinced he is right, and employed in a state backed institution excuses himself the effort to think and takes pleasure from telling the other how to live.

Which reminds me, I received a letter from Marc Seale today, replying to the letter I sent following Malcolm Cross’s hearing in which I asked a series of questions about the way the HPC conducts itself. Mr Seale quotes chapter and verse from his big book of rules to prove that I am wrong to raise these questions, and invites me in for re-educating.

Last night at the National Theatre, Alan Bennett’s play, The Habit of Art, (in which, by the way, Alex Jennings, who read the part of the CBT therapist in Josh Appignanesi’s play Therapy! plays the Benjamin Britten) was filmed and broadcast live across the world to thousands and thousands of people. Fabulously rich, layered, funny, thought provoking, intelligent, and mysteriously moving this play sent me off to discover Auden on You Tube reading his poem In Memory of Freud in which so many lines are worth quoting but these especially:

If he succeeded, why, the Generalised Life
Would become impossible, the monolith
Of State be broken and prevented
The co-operation of avengers.

Other lines also reminded me of Therapy! whose most moving scenes come in the analytic session when, between them, analyst and analysand managed to find the truth that Auden puts like this: “to be free is often to be lonely”. And,

But he would have us remember most of all
To be enthusiastic over the night
Not only for the sense of wonder
It alone has to offer, but also

Because it needs our love…

Literature alone doesn’t solve it, of course. Bennett’s play was very different from that of Mark Haddon currently playing at the Donmar – Polar Bears. This one tries hard to look directly at Bi-polar living with the help of philosophy, post-mortem anatomy, and post-modern style. Although engaging in parts, the cut up nature of the play gives everyone the chance to avoid asking themselves what the hell they thought they were doing. It gave a glimpse of the world in which Sigmund Freud’s work was already long forgotten.

In Auden’s poem, written in 1939, he could say of Freud

To us he is no more a person
Now but a whole climate of opinion.

Climate Change, apparently, has evaporated his wisdom.

Only Hate was happy, hoping to augment
his practice now, and his shabby clientele

At the Dulwich Village yoga class on Tuesday evening two women talked enthusiastically about what they’d learned on the Radio 4 programme “Between Ourselves” earlier that morning (9.am, 20th April) in a discussion between Oliver James and Laverne Antrobus. If a baby doesn’t receive the right amount of love, they said, then the brain does not develop, and there’s nothing more to be done. They went on to explain that this was the reason for Jamie Bulger’s murder. Listening again (on iPlayer) Oliver James (who I learned is the son of two psychoanalysts) didn’t exactly say this, but the general drift of his interventions take us directly into this difficult water and look very much like the current climate of opinion.

Back in the Manifesto, in a section of chapter 5 (Crime and Immigration) entitled Early Intervention and Preventing Crime, the Labour Party boldly state: “We need to do more and act earlier to stop children going down the wrong path. So we will expand Family Nurse Partnerships to all vulnerable young mothers, reducing future crime and behavioural problems. For the 50,000 most dysfunctional families who cause misery to their neighbours, we will provide Family Intervention Projects – proven to tackle anti-social behaviour – a no-nonsense regime of one-to-one support with tough sanctions for non-compliance’. All three major Party Political Manifestos contain a line or two about mental health. Labour promise to provide ‘access to psychological therapy for those who need it’. The Liberal Democrats say they will ‘improve access to counselling for people with mental health problems, by continuing to roll out cognitive and behavioural therapies’. The Tories will ‘increase access to effective ‘talking’ therapies.’ The question remains in all cases, however, how these policies relate to the State. In particular, who defines mental illness, who defines the talking therapy, the behavioural adaptation, the cognitive modification, and how the practitioner who delivers this policy is going to be policed.

The Institute of Group Analysis, in the 7th edition of their newsletter Dialogue (March 2010) illustrates how the insipid creep of the modern British State infiltrates even (!) analysed minds. At their conference (Can Group Therapy Survive NICE: Examining the Evidence) Glenys Parry and Chris Blackmore presented their findings from what is known in these circles as ‘a systematic review’. They were searching for ‘evidence’ of the ‘effectiveness’ of psychodynamic group therapy and group analysis, something they described as ‘difficult’ in the ‘deluge of articles picked up by their search terms’. Nevertheless, they were able to conclude that there was, indeed, broad and consistent evidence for the aforesaid therapies, tho ‘insufficient to distinguish between the various group therapies, and, get this, ‘insufficient randomised controlled trials’.

And thus they can conclude, this puts them ‘in the position of not being able to make a case for inclusion in NICE guidelines apart from in a combined treatment for personality disorder.’
What do do? Chris Mace ‘usefully’ suggested that they do a Cost Benefit Analysis on their Group Analysis! Apparently the Powerpoint presentations can be accessed from the IGA website.

Perhaps you too have had experience of doing a systematic review. You will know that it is made possible by the powerful computerised search engines ploughing mindlessly through databases to pick up keywords across disparate fields. The quantity of papers that line up to be read is literally mind-blowing. Each paper, once a pearl of wisdom situated in an agonistic field, is plucked from its context and thrust into a such a heap that difference, meaning and value are reduced, mashed and beaten to a pulp and any goodness is utterly destroyed.

Perhaps you too have had experience of learning a poem off by heart, or of learning a part in a play. You will know that it is only possible by constantly going over one text. Could there be two more different approaches?

Auden, again, on Freud:

He wasn’t clever at all: he merely told
The unhappy Present to recite the Past
Like a poetry lesson till sooner
Or later it faltered at the line where

Long ago the accusations had begun,
And suddenly knew by whom it had been judged
How rich life had been and how silly
And was life-forgiven and more humble.

The whole poem is well worth a longer look - published by Faber and Faber in the collection Another Time.

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.

Investigating Committee, Feb 09

There are 555 food days arising from Fitness to Practise activity.
And £300,000 is spent each year on hiring the shorthand writers.

I am now attending various committee meetings at the HPC to find out what is talked about at strategic level.

Most people have not really thought about the implications 0f the HPC - why would they, when there are so many other things to do in life? Those people who are forced to think about the HPC tend to leave it in the abstract realm of a TLA and at most associate it with the figure of the CE, Marc Seale. Well, the HPC in practice is a very different thing. I know of people who make appointments to visit Marc Seale in the belief that they will speak to a man and persuade him with reason. None have yet succeeded. There is little reason to think that they would. First of all Mr Seale is placed in a highly particular position. This organisation did not come into existence through the desire of a man, not the demand of the market nor of local people, nor from the exigencies of practice - it came into existence through a highly particular, and alarmingly flawed, political will. Discussing things with this CE is not going to work, because, in effect, he has been set up in a highly constrained position and given the power, in effect, to print money.

There is a second thread to take into account: the organisation is large, has a history, and is stitched into the fabric of life in many different ways. There are sandwich makers and stenographers makers who depend upon it for their living, for example.

By going along and observing I have two different aims. One is to allow readers to realise that this organisation supports the living and the careers of a lot of real people (and won't disappear overnight, nor give up its wish to make money). Second is to gradually reveal what the day to day business of the place really is. I have been an ethnographer in my time, and it is this that is giving me an orientation.

In the meeting there were some familiar faces around the committee table, and a nod of recognition from Anna van der Gaag. I sat behind another familiar figure - Diane Waller, chair of the C&P PLG - and was surprised that she said nothing at all throughout the whole of this meeting. I recognised the new Secretary, and was pleased to see Kelly Johnson, head of FTP, who I had read about at the Tribunal. I was surprised at how young and inexperienced she looked.

The committee meeting itself is, of course, based on a large number of documents which are numbered more than named, eg: 100026AC20090205Investigating-enclosure7-complaintsliterature, and 100026AA20090205Investigating-enclosure5-workplan2009-10. Teams of people are employed full time to compile and take care of these documents. Panel members are probably paid a fee to read them and to come to London to discuss them. Little by little, I shall find a way through too, and try to reveal something which renders them accessible and perhaps gives a fresh view.

Where to begin? I'll take two points of humour.

There's an HPC CPD DVD, and will be an HPC FTP DVD, several people laughed quietly at this, perhaps enjoying the poetry in the letters.

The second thing that made members laugh was the idea that the figure for costs invoked by a High Court Appeal had been increased, which means that someone failing to win an appeal against an HPC decision would be obliged to give up several thousand pounds. One panel member punched the air with joy and Kelly Johnson giggled.

A little less funny is the fact that by the end of the month the Kent Police will have delivered their special 'escalation procedure' training programme which is aimed to help the FTP employees in their business of conflict management.

So let's turn to something more comforting. Sylvia works on reception, and has done so for more than 13 years. She has seen many refurbishments in her time, as well as the re-naming of the organisation and changes in its relation to the public. She told me that her desk has been moved around the building. First she sat in the basement, then in the heart of the building, now she sits at this nice little number in a double locked chamber right next to the glass front door. Before, visitors and public were trusted to come in and find their way through the corridors. Now they are forced to obey magnetic locks, wear large name tags, and wait to be escorted wherever they want to go.

There are other important things to say about the meeting, and relate to the planning, forecasting, and expansion that formed a bulky and central document. I'll have leave it here for the moment, and return to the task later on.

IPN women's delegation to Marc Seale, CE, HPC

This letter is brought to my attention:

Marc Seale
Chief Executive and Registrar
Health Professions Council

8 February 2009

An Open Letter to Marc Seale:
First of all we really appreciate your taking the time to meet with us on 27th January and would like to thank you for that. We should say though that we were rather surprised to also meet with Diane Waller, as that had not been part of our agreement. However, the meeting was instructive as it helped to clarify our thoughts and feelings about statutory regulation, although probably not quite in the way you intended.

As you may remember, your invitation came about as a result of your meeting with Denis Postle, when you said you would like to meet with other members of the Independent Practitioners Net-work. We trusted therefore you would be interested in our views on the proposed statutory regula-tion of the psychological therapies. Perhaps naively we assumed that you would first want to hear our reasons for not welcoming this proposal and then, having listened to us, counter our arguments point by point. This might have allowed for an interesting debate, but sadly this was not what hap-pened.

You did agree with our suggestion that we could perhaps all take a few minutes to expand on who we were, what had brought us to the table, what we would like from the meeting and perhaps even what we felt passionate about. After that, however, instead of listening to our views, in which you ap-peared to have no interest, you did your best to dominate the meeting with your views. You then said ‘I don’t understand your argument!’, which surprised us, as we had not had a chance to inform you of what our argument might be! It was hard for us to break into your or Diane’s monologues and when we tried, we ended up feeling talked over. At the end of the meeting you did not ask what it had been like for us, but told us that it had been ‘useful’. Really? We left your office feeling disap-pointed and very frustrated with a clear sense that you really did not want to hear anything that might be anti regulation.

You left us with only one hope: that if not enough counsellors and psychotherapists wish to find a safe home ‘under your tent’, then, by your own admission, being regulated by the HPC would not work. If we may be so bold as to make that assumption, where would you and everyone else go from there?

To conclude, did you happen to see the article in the education section of the Guardian of 27th
January, 2009, the date of our meeting, regarding Universities and red tape entitled “Regulation, regulation, regulation”? Steven Egan, HEFCE’s deputy chief executive is quoted as saying:

“…Our sector is still over-regulated proportionate to the risks that arise from it. As a general proposition, the country will gain more value from us if we devote our resources to doing rather than measuring?”

Could this not also apply to the psychological therapies?

Yours Sincerely,


Irene Galant, Barbara Hacking, Jenny Nicholson, Els van Ooijen

More on the meaning of a 'Public Gallery'

Dear Mr Seale

Thank you for your letter dated 21 January, which I received yesterday.

I am surprised and pleased to hear that I am the first to take the trouble to draw to your attention the strange seating arrangements of your rooms, and the first to spend time reflecting on the unintended or unexpected consequences of this. It is good to be of use and to bring something new to light. I wonder, though, why you decline to engage with me on the point. When I described the layout to a colleague, he was most surprised. He had thought that 'public gallery' meant what it said.

I had no idea you were also seated here during the course of that meeting, but am happy to hear you were not uncomfortable. However, I am surprised you are not aware that you and I are in different positions and that this has a bearing on my experience, also it seems necessary to say that though you weren't made uncomfortable this is not evidence that I was not uncomfortable. I do wonder why you are so quick to dismiss my point.

My suggestion that the coffee tables could easily give way to the comfort of the public remains true. It was a simple suggestion made in good will, which you have completely overlooked.

I have been unable to fathom the meaning of your third paragraph (that the public is not expected to participate in the actual meeting itself). In a court of law, a lecture room, or indeed an opera house the audience might not be expected to participate in the actual thing itself, but nevertheless has a role to play. Moreover, it must be rare for the audience to be confined to a corner, and obliged continually to look askance at the backs of many players’ heads.

My other question related to designating the speakers with names and positions - both seating and substantial. Your reply addresses only 2 of my 4 points. You supplied a list of names and organisational associations, but I also asked for their position statements and where they were seated. Even the minimum would have been a welcome addition to the day - my neighbours also spent many minutes looking for such a list on and about the chairs. I understand that you are not obliged, and that we might have brought our own copy, etc but be assured a few of us at least had expected it as a courtesy.

There is little courtesy here, in fact, and I am indeed surprised. Your reply is rather mechanical and lacks a human touch. This gives me cause for concern.

One final point – I should like you to know that I have been writing a blog called ‘hpcwatchdog’ for a few months now, and that I would like to record this correspondence there. May I suppose that you will let me know if you don't agree to this act?

Yours sincerely

Marc Seale (HPC CEO) talks to Denis Postle, Ipnosis

Here is a link to an important conversation between Denis Postle and Marc Seale, quoted from eIpnsosis (click the title to link to full report)

Report on eIpnosis meeting with Marc Seale, CEO of the Health Professions Council, October 3rd 2008
"At the end of August eIpnosis received a pair of messages that offered very contradictory views on the HPC's reputation. I emailed extracts of them to Marc Seale, his response was to invite me in for a meeting.

Marc met me in reception and led the way down to a basement room at HPC ‘s Kennington headquarters where we occupied two red settees. Tea was served, and Michael Guthrie, Director of Policy & Standards, joined us. Marc Seale is a genial, vigorous conversationalist and he began with an outline of the HPC’s current process." [click the title of this blog to read the full report. If you would like to make a comment, use this blog...]