The College of Psychoanalysts-UK is staging a conference on 6th June at Birkbeck College in London. One of the speakers is Mary Clark-Glass, HPC Council member, and member of the Professional Liaison Group for Counselling & Psychotherapy. Mary was bewildered at the recent HPC Fitness to Practise Forum when she realised that more than a third of the HPC total budget is spent on FTP processes. According to the Management Accounts of March 2009, that amounted to £4,652,779.
HPC income is made up of the fees paid by registrants. In 2009 New fees amounted to £751,055; Renewal Fees: £11,318,583; Readmission fees £203,592, sundry others to make up a TOTAL of: £13,505,960.
In his talk to the aspiring group of Hearing Aid Dispensers, Marc Seale, HPC CEO said ‘we are not a charity, we are self financing’. This ‘self financing’ is achieved through force of law: once a title is protected (eg Arts Therapist) a practitioner is compelled under threat of legal action to sign up to the HPC and pay the fee, (which is set by an act of parliament) or be prevented from practising. Mr Seale is responsible to HPC Council, who from July are all appointed by as well as answerable to Parliament through the Privy Council.
By the by, some people who have recently written challenging or critical letters to Mr Seale have received replies with this allusive paragraph: “In conclusion, I would like to raise a particular question. It is as follows. On the assumption that statutory regulation of psychotherapy commences within the next few years, will you apply to join the register, or will you stop practising as a psychotherapist? I look forward to your response with interest.” Could it be that instead of engaging thoughtfully with questions and criticisms about the ability of HPC to regulate psychotherapy Mr Seale is simply awaiting the opportunity to exercise the law?
We saw below (blog 8 May) that If you are late with your fees because you didn’t get the invoice, you can expect trouble.
Perhaps, with an annual income of thirteen and a half million pounds, we could expect HPC to put some of that cash to work on a more effective, not to say more polite, process of fee collection. Perhaps, with an annual income of thirteen and a half million pounds, and only a few hundred allegations to think about, the HPC could be able to spend time, money and effort on other more productive and important matters.
Allegations received:
70 for the y/e 2002,
172 y/e 2004, and
424 y/e 2008 (0.24% of total registrants in 08).
That is, 30% of income is spent on investigating 0.24% of the register against whom allegations are made.
I have not been able to find any reference in the accounts to money spent on improving education, nor disseminating information, ideas or findings arising from the work of the 185,000 practitioners on the HPC books. The amount recorded in the account as spent on the Welcome Pack for registrants was: £0. That’s Nought. Zip, Zilch, Zero. I wonder why they reported it.
The FTP annual report for year-end 2009 is not yet published but the report for y/e 2008 can be downloaded from here
For this period there were 178,289 people on the HPC register, and most of the allegations received were about people who live and work in England (as opposed to those in Wales, Northern Ireland or Scotland).
The majority of complaints are made against men. The vast majority of registrants (76%), however, are women.
Of the 299 allegations that were considered, only 186 were referred for a full hearing of which a decreasing number are held to be well founded. Probably 139.
The HPC appoint a law firm, Kingsley Napley Solicitors to present cases on their behalf. Needless to say, the HPC then have to ‘continually strive’ to manage these costs and have had to introduce a ‘capped hours’ arrangement.
The 09 y/e Management Accounts record a figure of £2,516,642 paid in legal expenses of one kind or another.
In answer to questions whilst observing hearings at the HPC I have been told that it is the solicitor who must do the ‘research’ to build the case against the registrant in question.
Although the number of cases being considered by FTP panels is increasing the number of allegations where the outcome was not well founded has also increased. Solicitors are paid whether they win the case or not, which suggests that there is no tension in the system to insist upon a proper investigation.
Employees of the HPC are not involved in the FTP decision-making process. This is trumpeted as a virtue and is supposed to ensure that all decisions are made independently, and are free from any appearance of bias. Being free from bias, and being free from any appearance of bias are, of course, two different things. Being hands off might indicate objectivity, but it may also indicate abdication of responsibility. Furthermore, being ignorant of something could be either a sign of naivety, or of stupidity.
A recurring and disappointing aspect of the HPC is the frequency with which rhetoric replaces reason. For example, at the end of her executive summary, Kelly Johnson (Director of Fitness to Practise) writes ‘the process is not about punishing a registrant, it is designed to ensure that action is only taken when it is necessary to protect the public.’ This is an empty phrase which could surely only be made by someone with little or no experience of the real world. A registrant against whom an allegation is raised deserves to believe - to know - that the investigation into the allegation is going to be fair and impartial. Only in this way could the process approach something akin to justice.
Who makes the complaints? The biggest group of complainers are … employers. 171 in the year 2006-7, which accounted for 40% of allegations. This suggests that when an employer is unhappy with a member of staff they can shunt the responsibility for dealing with it over to the HPC who in turn shunt the cost of it onto the … employees. Also, as the majority of defendants are men, one begins to wonder about the attributes of the complainer, details of whom are not exposed in the annual report. What do the Unions say about this?
A second group of complaints come automatically from the police (35 in 2007/8). The Home Office Circular 6/2006 provides that the HPC must be informed if a registered health professional is convicted or cautioned for an offence (tho only in England and Wales). This is a legacy of Ian Huntley and the tragedy of Soham in 2003.
At the HPC FTP Forum on Friday 24 April, Council members asked why such an adversarial and expensive method was favoured over mediation, even where the latter might be more effective. The law governing HPC regulation only allows mediation to be mentioned at the end of the process, by which time registrant and complainant are well entrenched in conflict, and mediation is no longer viable.
Jonathan Bracken, HPC Solicitor and Parliamentary Agent, is responsible for writing the operating procedures for the HPC, and is engaged to train people to follow these rules.
A Kingsley Napley press release tells us: The Hearing Aid Council is pleased to announce that it has appointed Jonathan Bracken as its new legal director plus Kingsley Napley as its new Disciplinary Committee solicitors and case handlers.
There is no tension in this system where those who are engaged can call each other to account. This appears to be fostering a situation where Kingsley Napley and their colleague Jonathan Bracken are taking up the slack. This all feeds back into the self fulfilling prophecy - that professionals are greedy unethical ne'er do wells, and need to be placed into the hands of the administrators.
Personal ethics more than ever are going to be required until this stupid system is dismantled or reassembled on rational, ethical, reasonable grounds.
Friday, 15 May 2009
Saturday, 9 May 2009
British Psychological Society dismayed
The day after the Lords bowed to tradition (see previous post) the President of the BPS wrote to members expressing her dismay.
"... There are still many details about the arrangements that are not yet resolved. For instance the Standards of Proficiency, and the Threshold Entry level remain to be debated and agreed by the Educational and Training Committee, and the Council of the HPC, this is scheduled for 20 May. Also the detail of the HPC grandparenting criteria remain to be agreed by the HPC and again it is expected that the decision will be made on 20 May.
As we are now ending an era for the Society as a regulator and entering a new phase of our organisation’s life I would like to take this opportunity to thank everyone who has been involved in the statutory regulation process – we haven’t always seen eye-to-eye, although I think we can all agree that the final form of regulation as proposed by the Government and agreed by the parliaments is less than ideal." [emphasis added]
The British continue to grin and bear the stupidity of those in positions of power.
Why?
Perhaps some dream of the chance to be 'raised to the peerage' themselves where they might act out their revenge. Possibly it's the dubious flattery of being held the second best in the hierarchy of the psys. Or maybe it's just the promise of pay rises and power over the new army of mental health workers in the 'Agenda for Change NHS'.
Or perhaps it is just our destiny, our national character, something hardwired into our genes.
"... There are still many details about the arrangements that are not yet resolved. For instance the Standards of Proficiency, and the Threshold Entry level remain to be debated and agreed by the Educational and Training Committee, and the Council of the HPC, this is scheduled for 20 May. Also the detail of the HPC grandparenting criteria remain to be agreed by the HPC and again it is expected that the decision will be made on 20 May.
As we are now ending an era for the Society as a regulator and entering a new phase of our organisation’s life I would like to take this opportunity to thank everyone who has been involved in the statutory regulation process – we haven’t always seen eye-to-eye, although I think we can all agree that the final form of regulation as proposed by the Government and agreed by the parliaments is less than ideal." [emphasis added]
The British continue to grin and bear the stupidity of those in positions of power.
Why?
Perhaps some dream of the chance to be 'raised to the peerage' themselves where they might act out their revenge. Possibly it's the dubious flattery of being held the second best in the hierarchy of the psys. Or maybe it's just the promise of pay rises and power over the new army of mental health workers in the 'Agenda for Change NHS'.
Or perhaps it is just our destiny, our national character, something hardwired into our genes.
Dinner Break Debate in the House of Lords, 5 May 09
On Tuesday 5th May, at 7.30pm, seven nobles took the trouble to attend the Dinner Break Debate at the House of Lords. This is a regular time-slot in the Lords’ programme where an hour is reserved for short debates on particular subjects. ‘These debates help to shape public policy’ says the glossy booklet available to all who enter the Strangers Gallery to observe. They also give the Lords a chance to go have something to eat before resuming the main business of the day. In this case it was the Marine & Coastal Access Bill that was slowly chugging through a very long list of amendments and would resume at 8.30pm to pick up where Lord Hunt finished them off at 7.28pm with amendment 63.
In that last half hour leading to the Break a little joke was made at the expense of a then absent Lord, the noble Lord John Alderdice. Lord Hunt looked over the woolsack to where he might find that familiar figure, thinking he may have arrived early for the debate on the Practitioner Psychologists.
Philip Hunt was raised to the peerage as Baron Hunt of Kings Heath, of Birmingham in the County of West Midlands 1997. John Alderdice pipped him by a year, being raised to the peerage as Baron Alderdice, of Knock in the City of Belfast 1996. Hunt sits centre left as you look down from the Stranger’s gallery (the Government benches, close to the despatch box), or on the right if you happen to be on the Woolsack, which is at the foot of the Throne. Alderdice sits on the right, near the woolsack, on the Liberal Democrat benches.
These two noble Lords had crossed swords before, when Hunt closed down Alderdice’s Psychotherapy Bill in 2000 – an early attempt to regulate the psys. (See Denis Postle’s very useful book Regulating the Psychological Therapies, From Taxonomy to Taxidermy, PCCS Books 2007).
By 7.28pm Alderdice had arrived, but Hunt and the others were off for their supper. This left seven noble members to debate the Health Care and Associated Professions (Miscellaneous Amendments and Practitioner Psychologists) Order 2009. In the Strangers Gallery sat at least three interested and several disinterested tourists. On the other side of the Hall the gallery held several key figures from the HPC.
This debate had not been expected. A rubber stamp was all inked up and ready to do its duty, but the Merits of Statutory Instruments Committee 11th report quietly caused a stir:
“[this Order] introduces, for the first time, statutory regulation of practitioner psychologists throughout the UK … The Committee has received correspondence from a number of psychotherapists and those practising similar disciplines: while many of the concerns expressed relate to a possible future Order, some of the issues mentioned, such as potential distortion of the market as a result of only regulating part of it, might arise as a result of the current instrument. A number of those currently practising in this field argue that the ‘one size fits all’ approach to the regulation of the health professions will cause significant damage to their profession. They are asking that the DH provide stronger evidence of the need to move away from voluntary regulation and how the policy proposed will increase the protection of the public. In debate, the House may wish to explore these issues further.”
Access to this report plus the full report of the debate in Hansards click here.
As the hall emptied Baroness Thornton opened the debate on behalf of the Government. Glenys Thornton was raised to the peerage as Baroness Thornton, of Manningham in the County of West Yorkshire 1998, and is a member of the Cooperative Party. She was chair of the Greater London Labour Party between 1986 and 1991.
“My Lords, the reforms set out in this draft order aim to enhance public confidence in the ability of the healthcare regulatory bodies to protect the public and deal with poor professional standards. The order continues the process of implementing the Government’s programme to improve patient safety through the reform and modernisation of the regulation of the healthcare professions, as set out in the White Paper, Trust, Assurance and Safety.”
I am aware that there has been a lot of interest in the build-up to this debate both in support of and against the provisions… At the moment, the only regulated group is psychiatrists, who are regulated as doctors by the GMC. As doctors they can also prescribe drugs to patients. The next highest qualified providers of talking therapies are practitioner psychologists, who are now being regulated for the first time. They must all have postgraduate qualifications.
Consideration is also being given to the regulation of psychotherapists and counsellors who have descending levels of professional qualification. The Health Professions Council has been working with bodies representing these groups to develop proposals but we are not there yet. Those discussions are continuing but no formal decisions have been made although we understand that the working group is hoping to report to the council of the HPC later this year. Any proposals to regulate psycho¬therapists and counsellors will be subject to further consultation before legislation is brought before the House. Given the weight of interventions on this matter by psychotherapists, we anticipate robust discussion and consultation.” [emphasis added]
Earl Howe who followed and spoke on behalf of the opposition repeated this reference to the number of letters received:
“My Lords, the House will be grateful to the Minister for introducing the order which, as some of us know, is the product of many years of discussion between the psychology profession and the Department of Health, as well as extensive discussion within the profession itself. I should like to be able to welcome it wholeheartedly on that account as being the settled view of all the parties involved, but, unfortunately, I cannot quite bring myself to do that because I am aware, as, I am sure, is the Minister, that there is great disquiet among members of the profession about what this order will mean for them and their patients and clients, and the precedent that it is likely to set as regards the related disciplines of psycho¬therapy and counselling in particular. My mailbag has been full to bursting with letters from psychologists and psycho¬therapists expressing total anguish about what the order contains and about the consultation that preceded it, which they see as having been stage-managed. It has not been particularly easy to tell those correspondents that by longstanding convention this House does not vote down secondary legislation. What we have in front of us, at least the part of it that relates to the regulation of psychologists, cannot, unfortunately, be described as a settled view or one that is universally welcomed.” [emphasis added]
Earl Howe had indeed been diligent in his replies to those who had written in expressing their concerns. He had told many people of this ‘longstanding convention’ whereby the Lords do not scupper a piece of secondary legislation. This is a point worth thinking on. Longstanding tradition is fine and dandy, but has to be seen in the light of more recent events. It is now well known that in the 10 years since Tony Blair took up his position as PM more laws were passed in UK than at any other time ever. This massive increase in legislation was a major topic of concern at the Convention on Modern Liberty on 28th February (http://www.modernliberty.net/), and the subject of the popular 2006 film by Chris Atkins: Taking Liberties (Revolver Films) http://www.imdb.com/title/tt0977667/.
The consequence of this massive increase in business means that many laws are being passed without full discussion (Kate Hoey, Lab MP for Vauxhall, made this point at the Convention). That this particular order was discussed at all must be recognised as a major achievement caused by those therapists who for the first time in their lives, no doubt, wrote a letter to a Lord or Lady.
Although much of Howe’s speech was highly critical of the current Order, (eg possibility of creating state sponsored rigidity; the lowering of standards; the distinctiveness of psychology from healthcare) he did take the time to state his position on statutory legislation, which he agrees with in principle. “With no disrespect to the individuals involved, I have been looking too long at these issues to be able to endorse that point of view. In the 21st century, with a need for full professional accountability, professional standards of practice, transparency and protection of the public, it is difficult to argue that statutory regulation in any form whatever is unnecessary.”
Lord Alderdice (a consultant psychiatrist in psychotherapy who runs the Centre for Psychotherapy in Belfast, a National Health Service facility, and who is a member of the BPC) was next to take the floor. Much of his speech was concerned with resurrecting his proposals for an alternative psychological professions council, which would at least have the advantage of knowing something of the thing it tried to regulate, unlike the HPC which he implied was ‘not fit for purpose’. He also pointed out that the current Order would ‘split the profession’ by registering practitioners and not those engaged in teaching and research. This is a very interesting point when considered alongside the list of competencies which implies an insistence that practitioners subordinate themselves to ‘evidence based research’.
At 8pm Baroness Pitkeathley piped up from the back of the Government benches. Another one raised to a peerage in 1997, Jill Pitkeathley is also the newly appointed Chair at the CHRE (the regulator of the HPC). Ironically, in spite of this recent appointment, Jill managed to keep a straight face when she argued that Regulators should be independent of the Government and the professions that they regulate, so that they can make and be seen to make—that is very important—appropriate decisions in the public interest. This was a point made in recognition of part of the Order which authorises changes to the structure of the HPC Council – removing elected professionals and replac¬ing them with appointments by Privy Council.
Next up was Viscount Eccles. John Dawson Eccles is an elected hereditary peer and sits on the conservative benches. He is also a member of the Merits of Statutory Instruments Committee. I am not as sanguine as my noble friend Lord Howe is about the benefits of statutory regulation and would like to emphasise what the noble Baroness, Lady Pitkeathley, said about independence. The great problem with all systems of statutory regulation that I have been involved with is that it is very difficult to believe that you have the independence that you were promised. I have debated the independence of public bodies a number of times in this House and usually I have been disappointed.
He also argued that no evidence had been provided to support the blank statements made by the Government about the need to regulate, and predicted a rise in imaginative accusations for the Fitness to Practise process given the nebulous nature of psychology: “What results from this state-controlled mechanical agenda is an increase from 134 HPC malpractice allegations in 2003–04 to three times that number in 2007–08, against a 30 per cent—less than one-third—increase in practitioners regulated under the 13 present headings. Psychologists will take the HPC on to new ground: matters of the mind. The attempt to codify and define will open the door to a rapid rise in imaginative allegations. One needs only to look at the prescriptive detail that the HPC thinks is appropriate for psychological qualification. Does the Minister really believe that a rising tide of allegations is, or ever will be, a good indicator of patient safety or public confidence?
He pointed out that the work of so-called consultations and the Government’s attempt to brush conflict under the carpet did not amount to evidence of agreement, and he was the third to mention the influx of well-reasoned letters to Westminster which constituted plenty of evidence of contro¬versy should anyone want to recog¬nise it. He finished up by saying that although we “are probably stuck with the order, or at least the psychological part of it, it should be the last with “psy” in the title.
This left the floor to Baroness Thornton to close on behalf of the Government. One thing worth quoting from these closing remarks is the question she posed in relation to psychotherapists and counsellors? “As I said in my opening remarks, there will be a statutory period of consultation before any further orders are laid. Legislation is not inevitable—although we currently agree with noble Lords that it is desirable.”
The voice from the Woolsack then asked if everyone ‘was content’. There being no-one willing to break tradition and admit to being not content, the Order was passed, and with it the Psychologists on to the register of the HPC in July 2009.
In that last half hour leading to the Break a little joke was made at the expense of a then absent Lord, the noble Lord John Alderdice. Lord Hunt looked over the woolsack to where he might find that familiar figure, thinking he may have arrived early for the debate on the Practitioner Psychologists.
Philip Hunt was raised to the peerage as Baron Hunt of Kings Heath, of Birmingham in the County of West Midlands 1997. John Alderdice pipped him by a year, being raised to the peerage as Baron Alderdice, of Knock in the City of Belfast 1996. Hunt sits centre left as you look down from the Stranger’s gallery (the Government benches, close to the despatch box), or on the right if you happen to be on the Woolsack, which is at the foot of the Throne. Alderdice sits on the right, near the woolsack, on the Liberal Democrat benches.
These two noble Lords had crossed swords before, when Hunt closed down Alderdice’s Psychotherapy Bill in 2000 – an early attempt to regulate the psys. (See Denis Postle’s very useful book Regulating the Psychological Therapies, From Taxonomy to Taxidermy, PCCS Books 2007).
By 7.28pm Alderdice had arrived, but Hunt and the others were off for their supper. This left seven noble members to debate the Health Care and Associated Professions (Miscellaneous Amendments and Practitioner Psychologists) Order 2009. In the Strangers Gallery sat at least three interested and several disinterested tourists. On the other side of the Hall the gallery held several key figures from the HPC.
This debate had not been expected. A rubber stamp was all inked up and ready to do its duty, but the Merits of Statutory Instruments Committee 11th report quietly caused a stir:
“[this Order] introduces, for the first time, statutory regulation of practitioner psychologists throughout the UK … The Committee has received correspondence from a number of psychotherapists and those practising similar disciplines: while many of the concerns expressed relate to a possible future Order, some of the issues mentioned, such as potential distortion of the market as a result of only regulating part of it, might arise as a result of the current instrument. A number of those currently practising in this field argue that the ‘one size fits all’ approach to the regulation of the health professions will cause significant damage to their profession. They are asking that the DH provide stronger evidence of the need to move away from voluntary regulation and how the policy proposed will increase the protection of the public. In debate, the House may wish to explore these issues further.”
Access to this report plus the full report of the debate in Hansards click here.
As the hall emptied Baroness Thornton opened the debate on behalf of the Government. Glenys Thornton was raised to the peerage as Baroness Thornton, of Manningham in the County of West Yorkshire 1998, and is a member of the Cooperative Party. She was chair of the Greater London Labour Party between 1986 and 1991.
“My Lords, the reforms set out in this draft order aim to enhance public confidence in the ability of the healthcare regulatory bodies to protect the public and deal with poor professional standards. The order continues the process of implementing the Government’s programme to improve patient safety through the reform and modernisation of the regulation of the healthcare professions, as set out in the White Paper, Trust, Assurance and Safety.”
I am aware that there has been a lot of interest in the build-up to this debate both in support of and against the provisions… At the moment, the only regulated group is psychiatrists, who are regulated as doctors by the GMC. As doctors they can also prescribe drugs to patients. The next highest qualified providers of talking therapies are practitioner psychologists, who are now being regulated for the first time. They must all have postgraduate qualifications.
Consideration is also being given to the regulation of psychotherapists and counsellors who have descending levels of professional qualification. The Health Professions Council has been working with bodies representing these groups to develop proposals but we are not there yet. Those discussions are continuing but no formal decisions have been made although we understand that the working group is hoping to report to the council of the HPC later this year. Any proposals to regulate psycho¬therapists and counsellors will be subject to further consultation before legislation is brought before the House. Given the weight of interventions on this matter by psychotherapists, we anticipate robust discussion and consultation.” [emphasis added]
Earl Howe who followed and spoke on behalf of the opposition repeated this reference to the number of letters received:
“My Lords, the House will be grateful to the Minister for introducing the order which, as some of us know, is the product of many years of discussion between the psychology profession and the Department of Health, as well as extensive discussion within the profession itself. I should like to be able to welcome it wholeheartedly on that account as being the settled view of all the parties involved, but, unfortunately, I cannot quite bring myself to do that because I am aware, as, I am sure, is the Minister, that there is great disquiet among members of the profession about what this order will mean for them and their patients and clients, and the precedent that it is likely to set as regards the related disciplines of psycho¬therapy and counselling in particular. My mailbag has been full to bursting with letters from psychologists and psycho¬therapists expressing total anguish about what the order contains and about the consultation that preceded it, which they see as having been stage-managed. It has not been particularly easy to tell those correspondents that by longstanding convention this House does not vote down secondary legislation. What we have in front of us, at least the part of it that relates to the regulation of psychologists, cannot, unfortunately, be described as a settled view or one that is universally welcomed.” [emphasis added]
Earl Howe had indeed been diligent in his replies to those who had written in expressing their concerns. He had told many people of this ‘longstanding convention’ whereby the Lords do not scupper a piece of secondary legislation. This is a point worth thinking on. Longstanding tradition is fine and dandy, but has to be seen in the light of more recent events. It is now well known that in the 10 years since Tony Blair took up his position as PM more laws were passed in UK than at any other time ever. This massive increase in legislation was a major topic of concern at the Convention on Modern Liberty on 28th February (http://www.modernliberty.net/), and the subject of the popular 2006 film by Chris Atkins: Taking Liberties (Revolver Films) http://www.imdb.com/title/tt0977667/.
The consequence of this massive increase in business means that many laws are being passed without full discussion (Kate Hoey, Lab MP for Vauxhall, made this point at the Convention). That this particular order was discussed at all must be recognised as a major achievement caused by those therapists who for the first time in their lives, no doubt, wrote a letter to a Lord or Lady.
Although much of Howe’s speech was highly critical of the current Order, (eg possibility of creating state sponsored rigidity; the lowering of standards; the distinctiveness of psychology from healthcare) he did take the time to state his position on statutory legislation, which he agrees with in principle. “With no disrespect to the individuals involved, I have been looking too long at these issues to be able to endorse that point of view. In the 21st century, with a need for full professional accountability, professional standards of practice, transparency and protection of the public, it is difficult to argue that statutory regulation in any form whatever is unnecessary.”
Lord Alderdice (a consultant psychiatrist in psychotherapy who runs the Centre for Psychotherapy in Belfast, a National Health Service facility, and who is a member of the BPC) was next to take the floor. Much of his speech was concerned with resurrecting his proposals for an alternative psychological professions council, which would at least have the advantage of knowing something of the thing it tried to regulate, unlike the HPC which he implied was ‘not fit for purpose’. He also pointed out that the current Order would ‘split the profession’ by registering practitioners and not those engaged in teaching and research. This is a very interesting point when considered alongside the list of competencies which implies an insistence that practitioners subordinate themselves to ‘evidence based research’.
At 8pm Baroness Pitkeathley piped up from the back of the Government benches. Another one raised to a peerage in 1997, Jill Pitkeathley is also the newly appointed Chair at the CHRE (the regulator of the HPC). Ironically, in spite of this recent appointment, Jill managed to keep a straight face when she argued that Regulators should be independent of the Government and the professions that they regulate, so that they can make and be seen to make—that is very important—appropriate decisions in the public interest. This was a point made in recognition of part of the Order which authorises changes to the structure of the HPC Council – removing elected professionals and replac¬ing them with appointments by Privy Council.
Next up was Viscount Eccles. John Dawson Eccles is an elected hereditary peer and sits on the conservative benches. He is also a member of the Merits of Statutory Instruments Committee. I am not as sanguine as my noble friend Lord Howe is about the benefits of statutory regulation and would like to emphasise what the noble Baroness, Lady Pitkeathley, said about independence. The great problem with all systems of statutory regulation that I have been involved with is that it is very difficult to believe that you have the independence that you were promised. I have debated the independence of public bodies a number of times in this House and usually I have been disappointed.
He also argued that no evidence had been provided to support the blank statements made by the Government about the need to regulate, and predicted a rise in imaginative accusations for the Fitness to Practise process given the nebulous nature of psychology: “What results from this state-controlled mechanical agenda is an increase from 134 HPC malpractice allegations in 2003–04 to three times that number in 2007–08, against a 30 per cent—less than one-third—increase in practitioners regulated under the 13 present headings. Psychologists will take the HPC on to new ground: matters of the mind. The attempt to codify and define will open the door to a rapid rise in imaginative allegations. One needs only to look at the prescriptive detail that the HPC thinks is appropriate for psychological qualification. Does the Minister really believe that a rising tide of allegations is, or ever will be, a good indicator of patient safety or public confidence?
He pointed out that the work of so-called consultations and the Government’s attempt to brush conflict under the carpet did not amount to evidence of agreement, and he was the third to mention the influx of well-reasoned letters to Westminster which constituted plenty of evidence of contro¬versy should anyone want to recog¬nise it. He finished up by saying that although we “are probably stuck with the order, or at least the psychological part of it, it should be the last with “psy” in the title.
This left the floor to Baroness Thornton to close on behalf of the Government. One thing worth quoting from these closing remarks is the question she posed in relation to psychotherapists and counsellors? “As I said in my opening remarks, there will be a statutory period of consultation before any further orders are laid. Legislation is not inevitable—although we currently agree with noble Lords that it is desirable.”
The voice from the Woolsack then asked if everyone ‘was content’. There being no-one willing to break tradition and admit to being not content, the Order was passed, and with it the Psychologists on to the register of the HPC in July 2009.
Friday, 8 May 2009
The friendly face of the hpc... not
I am indebted to a colleague for digging out this gem. When a government gives an organisation lots of power and asks them to do an impossible job, you can expect them to resort to rudeness and force fairly quickly, I guess, especially when they have been set up on the assumption that professionals are not trustworthy. Unintended consequences of a poorly thought through law? Self fulfilling prophecy more like:
"....You will soon receive your [HPC] registration renewal form. Remember, if you do not, it is your responsibility to contact the HPC to request one. In 2005, the HPC deregistered over 900 SLTs; many because of problems with the registration process - some had not given the HPC their new address and some did not sign the form. If you are deregistered it can take up to a fortnight before you can get back on the HPC register. You will not be able to work as an SLT during this time. Consequently, you risk suspension from work or having to work as an assistant, on an assistant's pay, until you are back on the register...."
(Royal College of Speech and Language Therapists' Bulletin, May 09 - Issue 685; p7)
"....You will soon receive your [HPC] registration renewal form. Remember, if you do not, it is your responsibility to contact the HPC to request one. In 2005, the HPC deregistered over 900 SLTs; many because of problems with the registration process - some had not given the HPC their new address and some did not sign the form. If you are deregistered it can take up to a fortnight before you can get back on the HPC register. You will not be able to work as an SLT during this time. Consequently, you risk suspension from work or having to work as an assistant, on an assistant's pay, until you are back on the register...."
(Royal College of Speech and Language Therapists' Bulletin, May 09 - Issue 685; p7)
Monday, 27 April 2009
FTP Forum, 24 Apr 09. Why no mediation
At the Fitness to Practise (FTP) Forum on Friday 24 April, Council members expressed surprise that one third of its budget is spent on ‘hearings’, despite FTP concerns affecting fewer than 0.5% of HPC registrants. They also asked why such an adversarial and expensive method was favoured over mediation, even where the latter might be more effective. The answer is that the law governing HPC regulation only allows mediation to be mentioned at the end of the process, by which time registrant and complainant (often a registrant’s NHS manager or colleague, by the way, seldom an ordinary member of the public) are well entrenched in conflict, and mediation is no longer viable.
Who writes the rules that constrain people in this way?
How can the Council move to make a change?
Who writes the rules that constrain people in this way?
How can the Council move to make a change?
Thursday, 16 April 2009
2nd Letter to Marc Seale from IPN Women
A few weeks ago, four women from the Independent Practitioners Network went to see Marc Seale, Chief Exec of the HPC, to discuss their concerns about the process. They found the trip a deeply unsatisfying experience and wrote to him saying why (see blog entry for 10 February). Interestingly, their letter crossed in the post with one from him inviting them back for another bite at the cherry. Below is their response, which they have kindly agreed to allow me to post here:
Dear Marc
Thank you for inviting to us for a second meeting to discuss the idea of state regulation by the HPC.
We have decided not to take you up on this offer, however, we would like to take this opportunity to appraise you of our views.
They are as follows:
. Counselling and psychotherapy are not health professions. Regulation by the HPC is therefore inappropriate.
. There is no evidence of widespread abuse by practitioners.
. There is no evidence that state regulation will prevent abuse.
. State regulation, together with other developments (IAPT, Skills for Health, Proposed Change in Guidelines for Depression) will reduce availability and choice of therapy for people who need it. We are not convinced by your assertion that there is no relationship between these developments.
. We propose self regulation as an alternative, particularly if a non adversarial/mediation process is adopted for dealing with complaints in the first instance. Such a process is far less costly, both in terms of finances and of human misery.
Lastly - we read the report of your meeting with Darian Leader and others. It made us feel that you are unlikely to take on board anything we say.
If you have read this far we will feel that we have achieved something.
Thank you.
Irene Galant
Barbara Hacking
Jenny Nicholson
Els van Ooijen
--
Dr Els van Ooijen
Psychotherapist, supervisor and trainer
Nepenthe Consultancy
www.nepenthe.org.uk
Dear Marc
Thank you for inviting to us for a second meeting to discuss the idea of state regulation by the HPC.
We have decided not to take you up on this offer, however, we would like to take this opportunity to appraise you of our views.
They are as follows:
. Counselling and psychotherapy are not health professions. Regulation by the HPC is therefore inappropriate.
. There is no evidence of widespread abuse by practitioners.
. There is no evidence that state regulation will prevent abuse.
. State regulation, together with other developments (IAPT, Skills for Health, Proposed Change in Guidelines for Depression) will reduce availability and choice of therapy for people who need it. We are not convinced by your assertion that there is no relationship between these developments.
. We propose self regulation as an alternative, particularly if a non adversarial/mediation process is adopted for dealing with complaints in the first instance. Such a process is far less costly, both in terms of finances and of human misery.
Lastly - we read the report of your meeting with Darian Leader and others. It made us feel that you are unlikely to take on board anything we say.
If you have read this far we will feel that we have achieved something.
Thank you.
Irene Galant
Barbara Hacking
Jenny Nicholson
Els van Ooijen
--
Dr Els van Ooijen
Psychotherapist, supervisor and trainer
Nepenthe Consultancy
www.nepenthe.org.uk
Monday, 13 April 2009
A Professor's Perspective on the process
Thanks to Prof Ian Parker for allowing the publication of this letter to the President of the HPC:
Department of Psychology and Social Change
Manchester Metropolitan University Elizabeth Gaskell Campus
Hathersage Road Manchester M13 OJA UK
Ian Parker BA PhD AFBPsS CPsychol FRSA Professor of Psychology
13 April 2009
OPEN LETTER
Anna van der Gaag
President, Health Professions Council, UK
Park House
184 Kennington Park Road
London, SE11 4BU
Dear Anna van der Gaag,
I attended the HPC stakeholder consultation day in Manchester on 31 March 2009. There were three presentations in the morning. The first was by an art therapist, Diane Waller who I have heard before extolling in similar vein the virtues of the HPC, to the psychoanalytic section of the UKCP last year, a meeting where she reassured therapists that all they need to do is send in their registration payments and ‘nothing will change’ for them. The third presentation was by two speech therapists, and they spent much of their time telling of their delight in being consulted by the government on policy issues, so the message here seemed to be that therapists who are brought into the HPC will be recognised in some way.
The second presentation on that morning was the most disturbing, for three reasons. First, there was the content of Jonathan Coe’s presentation, which did indeed make the point that there is abuse of power in therapy. Some of us have long argued, and we did again make the point in our small groups in the afternoon, that resources should be directed to law centres, for example, to demystify the legal process and make it possible for clients who have been subjected to this kind of treatment to have recourse to the courts. Legal remedies are concerned with each separate infraction of the law and do not, as HPC appears to do, chain one crime to another into a moral system (as is the case, for example, in the hearings that view driving under the influence of alcohol or possession of A class drugs as evidence of bad character).
The Coe presentation was disturbing, second, because the patient whose case was described at the end of his talk was, we were told, present at the meeting. This meant (as Darian Leader from the College of Psychoanalysts – UK pointed out) that key elements of the patient’s relationship with her therapist were replicated as she was spoken about as an object of abuse. It is this aspect of the presentation that, whether or not the patient is enrolled to say that she is happy with this situation, already merits what we were treated to that morning being described as scandalous. Abuse in therapy often occurs precisely because the patient believes that it is for their own good.
There is a third reason the morning as a whole was disturbing, however, which is that the second presentation on ‘ethics’ was sandwiched between the two other presentations that were designed to reassure and flatter us as stakeholders. This is an indictment of the HPC approach to the world of psychotherapy. Perhaps the HPC knows, or perhaps the arguments that many of us have been making to it are simply not noticed, that our problem with the HPC regulation is precisely concerned with ethics. The particular psychoanalytic point that was made about the Coe presentation could be articulated in different ways by psychotherapists working in other orientations. Ethics grounds our work, and it means that for many of us the HPC would at least start to make sense if the whole morning had focussed on this question.
Ethical questions are now bringing therapists together who are shocked by assumptions made about good behaviour, and how it may be enforced, that underpin the work of the HPC. If the HPC cannot understand the difference between their conception of good behaviour and therapeutic practice, then surely the organisation could take a minute to reflect on the fact that there is at least a serious misunderstanding, a gulf between the organisation and those it seeks to regulate. Thousands of psychotherapists and counsellors have signed petitions and attended meetings organised by a myriad of groups that have sprung up against state regulation. The HPC should appreciate that regulation as it is presently conceived is anathema to good ethical therapeutic work, and draw the conclusion that it is time to step back, to abandon this process, and to look to other models (such as an open register of practitioners that has been adopted in other countries following consultation). Failure to acknowledge that problem, that gulf, is also, is it not, scandalous?
Ian Parker
Department of Psychology and Social Change
Manchester Metropolitan University Elizabeth Gaskell Campus
Hathersage Road Manchester M13 OJA UK
Ian Parker BA PhD AFBPsS CPsychol FRSA Professor of Psychology
13 April 2009
OPEN LETTER
Anna van der Gaag
President, Health Professions Council, UK
Park House
184 Kennington Park Road
London, SE11 4BU
Dear Anna van der Gaag,
I attended the HPC stakeholder consultation day in Manchester on 31 March 2009. There were three presentations in the morning. The first was by an art therapist, Diane Waller who I have heard before extolling in similar vein the virtues of the HPC, to the psychoanalytic section of the UKCP last year, a meeting where she reassured therapists that all they need to do is send in their registration payments and ‘nothing will change’ for them. The third presentation was by two speech therapists, and they spent much of their time telling of their delight in being consulted by the government on policy issues, so the message here seemed to be that therapists who are brought into the HPC will be recognised in some way.
The second presentation on that morning was the most disturbing, for three reasons. First, there was the content of Jonathan Coe’s presentation, which did indeed make the point that there is abuse of power in therapy. Some of us have long argued, and we did again make the point in our small groups in the afternoon, that resources should be directed to law centres, for example, to demystify the legal process and make it possible for clients who have been subjected to this kind of treatment to have recourse to the courts. Legal remedies are concerned with each separate infraction of the law and do not, as HPC appears to do, chain one crime to another into a moral system (as is the case, for example, in the hearings that view driving under the influence of alcohol or possession of A class drugs as evidence of bad character).
The Coe presentation was disturbing, second, because the patient whose case was described at the end of his talk was, we were told, present at the meeting. This meant (as Darian Leader from the College of Psychoanalysts – UK pointed out) that key elements of the patient’s relationship with her therapist were replicated as she was spoken about as an object of abuse. It is this aspect of the presentation that, whether or not the patient is enrolled to say that she is happy with this situation, already merits what we were treated to that morning being described as scandalous. Abuse in therapy often occurs precisely because the patient believes that it is for their own good.
There is a third reason the morning as a whole was disturbing, however, which is that the second presentation on ‘ethics’ was sandwiched between the two other presentations that were designed to reassure and flatter us as stakeholders. This is an indictment of the HPC approach to the world of psychotherapy. Perhaps the HPC knows, or perhaps the arguments that many of us have been making to it are simply not noticed, that our problem with the HPC regulation is precisely concerned with ethics. The particular psychoanalytic point that was made about the Coe presentation could be articulated in different ways by psychotherapists working in other orientations. Ethics grounds our work, and it means that for many of us the HPC would at least start to make sense if the whole morning had focussed on this question.
Ethical questions are now bringing therapists together who are shocked by assumptions made about good behaviour, and how it may be enforced, that underpin the work of the HPC. If the HPC cannot understand the difference between their conception of good behaviour and therapeutic practice, then surely the organisation could take a minute to reflect on the fact that there is at least a serious misunderstanding, a gulf between the organisation and those it seeks to regulate. Thousands of psychotherapists and counsellors have signed petitions and attended meetings organised by a myriad of groups that have sprung up against state regulation. The HPC should appreciate that regulation as it is presently conceived is anathema to good ethical therapeutic work, and draw the conclusion that it is time to step back, to abandon this process, and to look to other models (such as an open register of practitioners that has been adopted in other countries following consultation). Failure to acknowledge that problem, that gulf, is also, is it not, scandalous?
Ian Parker
Thursday, 2 April 2009
A user's perspective on the HPC process
Betty Bertrand-Godfrey very kindly agreed to my posting this here on the blog:
Report on the Manchester ‘Stakeholder’ Meeting organised by the Health Professions Council for UK stakeholders in Counselling and Psychotherapy. 31 March 2009.
By Betty Bertrand-Godfrey, a 'user' of psychoanalysis
As planned I went to the Manchester stakeholder meeting. Clearly the HPC's intention was to make us believe that statutory regulation is good for us - but they must be deluded and desperate.
Deluded first.
Prof Di Waller (HPC Council member, Chair of the Professional Liaison Group for Counselling Psychotherapy, and Arts Psychotherapist registrant of the HPC) opened the day with a very positive statement: " We have got a pretty good start on the work", she said.
I have observed two PLG meetings and I didn't think so. This was confirmed by the discussion we had at the end of the day when the PLG (at last) asked the floor's views on the matter. It was felt strongly that even the split between titles was a problem and suggested that everything was to be put on hold until the HPC finds a better way of dealing with this mammoth tasks. So not a "pretty" but an "ugly" start then!
One highlight of the day for me was Di Waller being genuinely surprised that the "fear of NOS keeps cropping up" (National Operating Standards). At the break I had a quiet word with an HPC representative and told him that having the Chair of NOS from Skills for Health on the PLG certainly does help this "cropping up". I also said that HPC wants to gain our "trust" but how can we do this when we think Prof Fonagy has been pushed in. I must say that the representative looked uneasy with this issue and I sensed almost agreed with me.
HPC denies categorically that it will refer to the NOS guidelines for setting their standards of proficiency and said that "it will actually be quite unhelpful" (Michael Guthrie, Acting Director of Policy and Standards). But in my little chat I also mentioned that if HPC registration goes through then we know it is an open door for further rules to be implemented that will damage the core of most therapeutic work.
Desperate now.
At 11:40, we had the most incredible power point presentation I have ever seen. Mary Smith (Royal College of Speech and Language Therapists, and HPC registrant) put together images and words destined to five-year-olds. She seemed to want to make us believe that registration is fantastic and that we should all go for it with all our hearts and souls. The way she operated was weird, very weird indeed, and clumsy. I felt she was trying to hypnotise the whole room but all she managed to do was irritate us by taking up precious space that could have been dedicated to proper grown-up debate.
In substance she said we should (I am quoting now) "abandon ourselves to the process and leave the professional bodies behind. You need to pass it all over to the HPC. There will be a moment of bereavement and we ourselves (SLT) felt that we were handing stuff away but we need to have that clear blue water (here was the soothing image of a lake on her power point presentation at the same time!) that can only allow the transition". Basically, she said: go to sleep - resistance to HPC is futile! A shame she had to go and could not reflect on Prof Parker's (Manchester Met University) beautiful intervention: he urged people to be cautious, but most of all to THINK.
At last in the afternoon we broke out into rooms. I happened to be with Sally Aldridge (BACP), Jonathan Coe (Witness) representing HPC but more interestingly the stakeholders Prof Darian Leader (College of Psychoanalysts, UK), Dennis Greenwood (Universities Psychotherapy and Counselling Association) and some serious opponents to this process. This is how it should have been right from the beginning. Darian reminded us that the White Paper (Trust Assurance and Safety) says "whether the HPC can accommodate the profession" not how. The "whether" has had no space to be discussed so far.
Then at 2:40pm (after only 40 min of intense discussions in small groups) we got back to the wider group where at last something more real was debated and animosity, fear and anxieties were emerging (which I think surprised the HPC-PLG people). I must say Janet Low (representing the Philadelphia Association), Ian Parker, and Nick Totton (from the Independent Practitioner’s Network) were brilliant and inspirational. The quality of their interventions allowed more people to join in to challenge HPC.
On departing I asked Michael Guthrie if he had the intention to feed back to this group by setting another meeting as people were anxious as to what was going to become of all that was said during the day. I emphasised the need for a real meeting and not some feedback on the HPC website because this is where it all happens.
He said he will have to think about it and thanked me.
Report on the Manchester ‘Stakeholder’ Meeting organised by the Health Professions Council for UK stakeholders in Counselling and Psychotherapy. 31 March 2009.
By Betty Bertrand-Godfrey, a 'user' of psychoanalysis
As planned I went to the Manchester stakeholder meeting. Clearly the HPC's intention was to make us believe that statutory regulation is good for us - but they must be deluded and desperate.
Deluded first.
Prof Di Waller (HPC Council member, Chair of the Professional Liaison Group for Counselling Psychotherapy, and Arts Psychotherapist registrant of the HPC) opened the day with a very positive statement: " We have got a pretty good start on the work", she said.
I have observed two PLG meetings and I didn't think so. This was confirmed by the discussion we had at the end of the day when the PLG (at last) asked the floor's views on the matter. It was felt strongly that even the split between titles was a problem and suggested that everything was to be put on hold until the HPC finds a better way of dealing with this mammoth tasks. So not a "pretty" but an "ugly" start then!
One highlight of the day for me was Di Waller being genuinely surprised that the "fear of NOS keeps cropping up" (National Operating Standards). At the break I had a quiet word with an HPC representative and told him that having the Chair of NOS from Skills for Health on the PLG certainly does help this "cropping up". I also said that HPC wants to gain our "trust" but how can we do this when we think Prof Fonagy has been pushed in. I must say that the representative looked uneasy with this issue and I sensed almost agreed with me.
HPC denies categorically that it will refer to the NOS guidelines for setting their standards of proficiency and said that "it will actually be quite unhelpful" (Michael Guthrie, Acting Director of Policy and Standards). But in my little chat I also mentioned that if HPC registration goes through then we know it is an open door for further rules to be implemented that will damage the core of most therapeutic work.
Desperate now.
At 11:40, we had the most incredible power point presentation I have ever seen. Mary Smith (Royal College of Speech and Language Therapists, and HPC registrant) put together images and words destined to five-year-olds. She seemed to want to make us believe that registration is fantastic and that we should all go for it with all our hearts and souls. The way she operated was weird, very weird indeed, and clumsy. I felt she was trying to hypnotise the whole room but all she managed to do was irritate us by taking up precious space that could have been dedicated to proper grown-up debate.
In substance she said we should (I am quoting now) "abandon ourselves to the process and leave the professional bodies behind. You need to pass it all over to the HPC. There will be a moment of bereavement and we ourselves (SLT) felt that we were handing stuff away but we need to have that clear blue water (here was the soothing image of a lake on her power point presentation at the same time!) that can only allow the transition". Basically, she said: go to sleep - resistance to HPC is futile! A shame she had to go and could not reflect on Prof Parker's (Manchester Met University) beautiful intervention: he urged people to be cautious, but most of all to THINK.
At last in the afternoon we broke out into rooms. I happened to be with Sally Aldridge (BACP), Jonathan Coe (Witness) representing HPC but more interestingly the stakeholders Prof Darian Leader (College of Psychoanalysts, UK), Dennis Greenwood (Universities Psychotherapy and Counselling Association) and some serious opponents to this process. This is how it should have been right from the beginning. Darian reminded us that the White Paper (Trust Assurance and Safety) says "whether the HPC can accommodate the profession" not how. The "whether" has had no space to be discussed so far.
Then at 2:40pm (after only 40 min of intense discussions in small groups) we got back to the wider group where at last something more real was debated and animosity, fear and anxieties were emerging (which I think surprised the HPC-PLG people). I must say Janet Low (representing the Philadelphia Association), Ian Parker, and Nick Totton (from the Independent Practitioner’s Network) were brilliant and inspirational. The quality of their interventions allowed more people to join in to challenge HPC.
On departing I asked Michael Guthrie if he had the intention to feed back to this group by setting another meeting as people were anxious as to what was going to become of all that was said during the day. I emphasised the need for a real meeting and not some feedback on the HPC website because this is where it all happens.
He said he will have to think about it and thanked me.
Wednesday, 1 April 2009
Centralisation in action: The Manchester Stakeholder Meeting
Yesterday (31 March 2009), in Manchester’s Thistle Hotel, the HPC staged a meeting for those who are not quite engaged in the process to draw counsellors and psychotherapists into state regulation. It was a well organised meeting in a nice venue with a lovely lunch. The acting Director of Policy and Standards (Michael Guthrie), the Director of Fitness to Practise (Kelly Johnson), Director of Communications (Jacqueline Ladds), Policy Officers (Sam Mars and Charlotte Urwin), the Secretary, Education Manager (Osama Ammar), Events Manager (Susan Carini), and some other employees were present: young and charming people, all (about 8 or so people).
The HPC elders were represented by the practitioners (or their close associates): President Anna van der Gaag, Di Waller (chair of the PLG), and Annie Turner (Council Member representing Occupational Therapists), then there were the PLG professionals: Fiona Ballantine Dykes (CPCAB), Sally Aldridge (BACP), Peter Fonagy (Skills for Health), Malcolm Allen (BPC), Brian McGee (Counselling and Psychotherapy in Scotland), Kathi Murphy and Carmen Ablack (UKCP), Nick Turner (Relate) and Jonathan Coe representing Witness (formerly POPAN – a user complaints organisation), about 11 people. The other 30 or so in the room included representatives from NICE, IAPT, Universities, NHS, Umbrella organisations for counselling, psychotherapy and psychoanalysis. An analysis of who was there, and what kind of experience they represented and what their positions and questions were would itself be a work involving some considerable effort and time.
The process, however, will squash the difference and reduce the experience to a size that the HPC can manage. This is very small indeed, and is one of the most straightforward destructive effects of intense centralisation. A second effect will follow: in order to show that they have heard everyone, a document will be produced which captures a sentence here, a phrase there, enough to prove in an imaginary (though possible) future thoughtless court of law that consultation has taken place. The meaning of what has been said will have to be sacrificed – it is simply not possible to understand and take it all on, and it will not be possible to write this up in a way that dignifies truth. The process will force the HPC to manufacture a representation that shows that they have consulted, but that can barely hope to benefit directly from the experience.
However, given that human beings are involved it is at least possible that someone could change the course of this infernal machine. That person would have to be a hero, and an unlikely one at that: “the holistic planner overlooks the fact that it is easy to centralize power but impossible to centralize all knowledge which is distributed over many individual minds, and whose centralisation would be necessary for the wise wielding of centralised power. But this fact has far-reaching consequences. Unable to ascertain what is in the minds of many individuals, he must try to control and stereotype interests and beliefs by education and propaganda. But this attempt to exercise power over minds must destroy the last possibility of finding out what people really think, for it is clearly incompatible with the free expression of thought, especially of critical thought.” (THES editorial, quoting Popper’s Nightmare, 8 June 1984) emphasis added.
In the morning were three presentations, first from Di Waller who wants to paint a rosy picture and said ‘We have got a pretty good start on the work" [see previous blogs for another point of view]. She couldn’t understand, tho, why people ‘outside’ kept asking about the relationship of the HPC to the NOS of the SfH. It would be helpful if she, Anna Van der Gaag, and Michael Guthrie explained their reasons for inviting Peter Fonagy, chair of NOS at SfH, to sit on the PLG – that would aid the understanding.
Jonathan Coe was next up, and delivered a horror story of a relationship gone wrong between a therapist and a client. Jonathan, backed up by Peter Fonagy, has been circulating an unsubstantiated statistic that 5% of therapists represent a serious threat to the safety of the public. In the absence of serious research, Jonathan was reduced to ‘bigging it up’ with a story about a poor woman victimised by an evil greasy man and had to resort to bringing the actual woman with him in lieu of proper proof. Many people in the room found this un-ethical, and Darian Leader (President of the UK College of Psychoanalysts) pointed out that in using this story for his own aims, Jonathan was unwittingly repeating elements in the structure of abuse that the substance of the story represented. The presence of the woman in such a context made any discussion of the case impossible: another nail in the coffin of enlightenment, another point offered up to the bogey-man.
After Jonathan, there were two women representing the Royal College of Speech and Language Therapists. They had evidently been briefed – consciously or not – to reassure the stakeholders in this new profession that everything would be alright. Mary Smith kicked off with a power-point presentation that many thought was pitched at the wrong level, and she went on to recount something akin to a fairy story: there had been a lot of worries expressed by members of the SLT profession when it had been their turn for hpc-ification, but in the end they gave in and left their professional concerns behind, passing control over to the HPC. She said there had been a moment of bereavement when they felt that they were giving important things away, and then she said something mysterious: ‘we need to have that clear blue water [here she had a lovely photo on a power point slide presenting the soothing image of a lake] that is necessary for the transition". What on earth does that mean? The message received by some at least was in the form of a bribe: if you shut up and go with the flow, you will get your hands on some power. For Mary this meant access to the corridors of Whitehall, and a chance to influence government. The kind of mind-numbing effect of the HPC process has left its mark on Mary who wondered why her predecessors hadn’t become arch lobbyists. When I suggested that this was because England had not always been a highly centralized system and that it hadn’t been necessary before, she could only respond vaguely about the devolution of Wales, NI, and Scotland, as if this somehow proved a point.
Her colleague Kamini Gadhok might have produced her talk out of a manual of politically-sanctioned phrases. She said: robust regulation, enhanced protection, raised standards, support for the profession, raised profiles, fit for practice, keeping our agenda on the government’s radar, influencing the commissioners, bringing added value, protecting our practice against pressures, enhancing CPD, in line with government policy, improving outcomes, getting up there with the GMC, being invited to the top table, building our capacity. Newspeak? Or a hidden attempt to hypnotise? Nevertheless her power-point slide showed that over the years the Royal College was losing members to the HPC. I asked Kamini what her organization was doing to protect its members from the HPC. This caused a ripple of laughter in the room, but if you check out the case study of Mr R [see side panel index] you will see a staggering example of how the thoughtless process of HPC FTP hearings ride rough shod over perfectly decent practitioners. Kamini said that this had been discussed in their recent AGM. I look forward to the HPC publishing the apology soon.
In the effort to establish a congenial relationship the professional bodies can easily forget that the HPC has in fact been set up on a prejudice against them. Read Ian Kennedy’s book The Unmasking of Medicine (1981), trace his influence in the Bristol Royal Infirmary Inquiry Report, read the HPO2001, and the Section 60 currently before parliament. Instead of the good old fashioned English presumption that people are innocent until proven guilty, we have the idea that professionals constitute a danger that only HPC can overcome. This is why the HPC is made up of administrators without any experience, and why the difficult questions that relate to reality get squeezed out onto the edge and beyond. Professions are made up of people who are forced by their work to face up to the impossibilities that arise in practise. In reality, administrators can only imagine this, or subordinate themselves to the practice. In fantasy, administrators emerge as the only true pure and innocent.
Some of the stakeholders present knew nothing at all about HPC-ification, and had come hoping to be enlightened. They will have to work a lot harder if they want proper, useful, practical information about what the process will mean to them. Others had clearly done some homework. Ian Parker (Manchester Metropolitan University), for example, has read the Government White Paper Trust, Assurance and Safety more carefully than the HPC. In the detail the documents asks "whether the HPC can accommodate the profession" not how it could. He also asked what evidence there was that the form of regulation proposed by the HPC would actually achieve increased protection of the public. These two sensible questions are incredibly difficult to maintain.
Why?
In the afternoon came the ‘breakout groups’ in which the voices of the visitors could be heard. The chair of each group had been briefed to take back three things to the final plenary session. To their credit, all of them took back more. The assumption behind the construction of this meeting was that simple messages and supportive comments wouldn’t take long to deal with. But for those interested in reality and who have the tenacity to tangle with the truth and the conflicts involved, something more is needed.
Throughout the PLG process, difficult issues have emerged only to be ‘parked’ until some mythical future date. Tricky issues are constantly postponed and left in the mist of imagination. In my break-out group I said I was alarmed that the PLG (who are 2/3 of the way through their predefined life) don’t even know whether it will be possible to legally protect the title of counsellor (Michael Guthrie is supposed to be checking this out with the solicitors). All of the discussion so far in those PLG’s presupposes that they can legally own this title. From my point of view this is another sign that the process is rushed and ill-thought through. The expression of my alarm caused alarm and provoked an effort of suppression. John Nightingale (Association of Christian Counsellors) rescued the situation, and returned to it later to get things said straight.
Adrian Rhodes from the European Association for Psychotherapy also expressed an alarm. He said a constant stream of people was hammering on his European door asking what on earth was happening in the UK. Unfortunately, this was condensed into the rather simplistic idea that Europeans felt that ‘standards were being lowered’ which was more or less translated by Di Waller to mean Europeans are ‘elitist’. This rhetorical move needs unpacking. Elite, etymologically, means simply ‘elected’ - those few who are elected to represent the majority who cannot be present themselves. The HPC group is an elite. However, the word has been totally submerged by a wholly pejorative meaning, which effectively brings all conversation to a halt. So, the letter written by European Psychoanalysts expressing their great concern that NOS and HPC will kill off psychoanalysis didn’t get mentioned at all.
Fiona Ballantine Dykes managed to distil 7 sensible points of concern from the discussion in our group, and the HPC admin staff pledged to write this up in a document. The next PLG meeting is due to debate it again, where several of us will be sitting in silence, waiting to hear what they make of it.
Ian Parker’s point from the morning needs to be brought back here – is the HPC process actually paying attention to the question “can it accommodate this profession?” If it has sped forward to “how shall we force it to fit?” (which is what is articulated time and again by those in strategic positions in the process), then the work and the words of the day will have been in vain and the stakeholders meeting will be reduced to a cosmetic event and questions will crumble away. In the plenary session at the end of the day I asked Michael Guthrie directly how the HPC manages dissension within its structures. He said that the professional partners and groups discuss these things outside the main structure, and this is where the difficult issues must ultimately be dealt with. Within the HPC they are confined to act in ways that Government can accommodate. I heard this as a confirmation of Popper’s Nightmare. Someone else said she heard the exact opposite. Two more people tended to agree with me. It will be proved in the future action: will the machinery simply grind on? Or will human beings gain some control over the action?
On Sunday 5th April a meeting will be held in the ULU building on Malet Street London W1, staged by the Alliance for Counselling and Psychotherapy against State Regulation. It will be an important occasion which might load the dice in favour of the human factor. Here is the link to the web-site - click here.
The HPC elders were represented by the practitioners (or their close associates): President Anna van der Gaag, Di Waller (chair of the PLG), and Annie Turner (Council Member representing Occupational Therapists), then there were the PLG professionals: Fiona Ballantine Dykes (CPCAB), Sally Aldridge (BACP), Peter Fonagy (Skills for Health), Malcolm Allen (BPC), Brian McGee (Counselling and Psychotherapy in Scotland), Kathi Murphy and Carmen Ablack (UKCP), Nick Turner (Relate) and Jonathan Coe representing Witness (formerly POPAN – a user complaints organisation), about 11 people. The other 30 or so in the room included representatives from NICE, IAPT, Universities, NHS, Umbrella organisations for counselling, psychotherapy and psychoanalysis. An analysis of who was there, and what kind of experience they represented and what their positions and questions were would itself be a work involving some considerable effort and time.
The process, however, will squash the difference and reduce the experience to a size that the HPC can manage. This is very small indeed, and is one of the most straightforward destructive effects of intense centralisation. A second effect will follow: in order to show that they have heard everyone, a document will be produced which captures a sentence here, a phrase there, enough to prove in an imaginary (though possible) future thoughtless court of law that consultation has taken place. The meaning of what has been said will have to be sacrificed – it is simply not possible to understand and take it all on, and it will not be possible to write this up in a way that dignifies truth. The process will force the HPC to manufacture a representation that shows that they have consulted, but that can barely hope to benefit directly from the experience.
However, given that human beings are involved it is at least possible that someone could change the course of this infernal machine. That person would have to be a hero, and an unlikely one at that: “the holistic planner overlooks the fact that it is easy to centralize power but impossible to centralize all knowledge which is distributed over many individual minds, and whose centralisation would be necessary for the wise wielding of centralised power. But this fact has far-reaching consequences. Unable to ascertain what is in the minds of many individuals, he must try to control and stereotype interests and beliefs by education and propaganda. But this attempt to exercise power over minds must destroy the last possibility of finding out what people really think, for it is clearly incompatible with the free expression of thought, especially of critical thought.” (THES editorial, quoting Popper’s Nightmare, 8 June 1984) emphasis added.
In the morning were three presentations, first from Di Waller who wants to paint a rosy picture and said ‘We have got a pretty good start on the work" [see previous blogs for another point of view]. She couldn’t understand, tho, why people ‘outside’ kept asking about the relationship of the HPC to the NOS of the SfH. It would be helpful if she, Anna Van der Gaag, and Michael Guthrie explained their reasons for inviting Peter Fonagy, chair of NOS at SfH, to sit on the PLG – that would aid the understanding.
Jonathan Coe was next up, and delivered a horror story of a relationship gone wrong between a therapist and a client. Jonathan, backed up by Peter Fonagy, has been circulating an unsubstantiated statistic that 5% of therapists represent a serious threat to the safety of the public. In the absence of serious research, Jonathan was reduced to ‘bigging it up’ with a story about a poor woman victimised by an evil greasy man and had to resort to bringing the actual woman with him in lieu of proper proof. Many people in the room found this un-ethical, and Darian Leader (President of the UK College of Psychoanalysts) pointed out that in using this story for his own aims, Jonathan was unwittingly repeating elements in the structure of abuse that the substance of the story represented. The presence of the woman in such a context made any discussion of the case impossible: another nail in the coffin of enlightenment, another point offered up to the bogey-man.
After Jonathan, there were two women representing the Royal College of Speech and Language Therapists. They had evidently been briefed – consciously or not – to reassure the stakeholders in this new profession that everything would be alright. Mary Smith kicked off with a power-point presentation that many thought was pitched at the wrong level, and she went on to recount something akin to a fairy story: there had been a lot of worries expressed by members of the SLT profession when it had been their turn for hpc-ification, but in the end they gave in and left their professional concerns behind, passing control over to the HPC. She said there had been a moment of bereavement when they felt that they were giving important things away, and then she said something mysterious: ‘we need to have that clear blue water [here she had a lovely photo on a power point slide presenting the soothing image of a lake] that is necessary for the transition". What on earth does that mean? The message received by some at least was in the form of a bribe: if you shut up and go with the flow, you will get your hands on some power. For Mary this meant access to the corridors of Whitehall, and a chance to influence government. The kind of mind-numbing effect of the HPC process has left its mark on Mary who wondered why her predecessors hadn’t become arch lobbyists. When I suggested that this was because England had not always been a highly centralized system and that it hadn’t been necessary before, she could only respond vaguely about the devolution of Wales, NI, and Scotland, as if this somehow proved a point.
Her colleague Kamini Gadhok might have produced her talk out of a manual of politically-sanctioned phrases. She said: robust regulation, enhanced protection, raised standards, support for the profession, raised profiles, fit for practice, keeping our agenda on the government’s radar, influencing the commissioners, bringing added value, protecting our practice against pressures, enhancing CPD, in line with government policy, improving outcomes, getting up there with the GMC, being invited to the top table, building our capacity. Newspeak? Or a hidden attempt to hypnotise? Nevertheless her power-point slide showed that over the years the Royal College was losing members to the HPC. I asked Kamini what her organization was doing to protect its members from the HPC. This caused a ripple of laughter in the room, but if you check out the case study of Mr R [see side panel index] you will see a staggering example of how the thoughtless process of HPC FTP hearings ride rough shod over perfectly decent practitioners. Kamini said that this had been discussed in their recent AGM. I look forward to the HPC publishing the apology soon.
In the effort to establish a congenial relationship the professional bodies can easily forget that the HPC has in fact been set up on a prejudice against them. Read Ian Kennedy’s book The Unmasking of Medicine (1981), trace his influence in the Bristol Royal Infirmary Inquiry Report, read the HPO2001, and the Section 60 currently before parliament. Instead of the good old fashioned English presumption that people are innocent until proven guilty, we have the idea that professionals constitute a danger that only HPC can overcome. This is why the HPC is made up of administrators without any experience, and why the difficult questions that relate to reality get squeezed out onto the edge and beyond. Professions are made up of people who are forced by their work to face up to the impossibilities that arise in practise. In reality, administrators can only imagine this, or subordinate themselves to the practice. In fantasy, administrators emerge as the only true pure and innocent.
Some of the stakeholders present knew nothing at all about HPC-ification, and had come hoping to be enlightened. They will have to work a lot harder if they want proper, useful, practical information about what the process will mean to them. Others had clearly done some homework. Ian Parker (Manchester Metropolitan University), for example, has read the Government White Paper Trust, Assurance and Safety more carefully than the HPC. In the detail the documents asks "whether the HPC can accommodate the profession" not how it could. He also asked what evidence there was that the form of regulation proposed by the HPC would actually achieve increased protection of the public. These two sensible questions are incredibly difficult to maintain.
Why?
In the afternoon came the ‘breakout groups’ in which the voices of the visitors could be heard. The chair of each group had been briefed to take back three things to the final plenary session. To their credit, all of them took back more. The assumption behind the construction of this meeting was that simple messages and supportive comments wouldn’t take long to deal with. But for those interested in reality and who have the tenacity to tangle with the truth and the conflicts involved, something more is needed.
Throughout the PLG process, difficult issues have emerged only to be ‘parked’ until some mythical future date. Tricky issues are constantly postponed and left in the mist of imagination. In my break-out group I said I was alarmed that the PLG (who are 2/3 of the way through their predefined life) don’t even know whether it will be possible to legally protect the title of counsellor (Michael Guthrie is supposed to be checking this out with the solicitors). All of the discussion so far in those PLG’s presupposes that they can legally own this title. From my point of view this is another sign that the process is rushed and ill-thought through. The expression of my alarm caused alarm and provoked an effort of suppression. John Nightingale (Association of Christian Counsellors) rescued the situation, and returned to it later to get things said straight.
Adrian Rhodes from the European Association for Psychotherapy also expressed an alarm. He said a constant stream of people was hammering on his European door asking what on earth was happening in the UK. Unfortunately, this was condensed into the rather simplistic idea that Europeans felt that ‘standards were being lowered’ which was more or less translated by Di Waller to mean Europeans are ‘elitist’. This rhetorical move needs unpacking. Elite, etymologically, means simply ‘elected’ - those few who are elected to represent the majority who cannot be present themselves. The HPC group is an elite. However, the word has been totally submerged by a wholly pejorative meaning, which effectively brings all conversation to a halt. So, the letter written by European Psychoanalysts expressing their great concern that NOS and HPC will kill off psychoanalysis didn’t get mentioned at all.
Fiona Ballantine Dykes managed to distil 7 sensible points of concern from the discussion in our group, and the HPC admin staff pledged to write this up in a document. The next PLG meeting is due to debate it again, where several of us will be sitting in silence, waiting to hear what they make of it.
Ian Parker’s point from the morning needs to be brought back here – is the HPC process actually paying attention to the question “can it accommodate this profession?” If it has sped forward to “how shall we force it to fit?” (which is what is articulated time and again by those in strategic positions in the process), then the work and the words of the day will have been in vain and the stakeholders meeting will be reduced to a cosmetic event and questions will crumble away. In the plenary session at the end of the day I asked Michael Guthrie directly how the HPC manages dissension within its structures. He said that the professional partners and groups discuss these things outside the main structure, and this is where the difficult issues must ultimately be dealt with. Within the HPC they are confined to act in ways that Government can accommodate. I heard this as a confirmation of Popper’s Nightmare. Someone else said she heard the exact opposite. Two more people tended to agree with me. It will be proved in the future action: will the machinery simply grind on? Or will human beings gain some control over the action?
On Sunday 5th April a meeting will be held in the ULU building on Malet Street London W1, staged by the Alliance for Counselling and Psychotherapy against State Regulation. It will be an important occasion which might load the dice in favour of the human factor. Here is the link to the web-site - click here.
Sunday, 15 March 2009
What evidence is there that HPC-ification increases levels of trust?
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.
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.
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.
Thursday, 26 February 2009
March 3/4: PLG C&P 3rd meeting. Preparation
The Professional Liaison Group for Counselling and Psychotherapy is due to meet for the third time (3rd and 4th of March). There are 320 pages of reading in preparation for this meeting, all down-loadable from the HPC-uk.org website.
The (draft) minutes for the last meeting continue to refer repeatedly to The Group, and avoid being specific about what different people say at certain times (see blogs preparing for January meeting). The minutes give the overall impression of a set of people who are all of one mind, and who constantly agree with one another as they note this, receive that, and feel or discuss the other.
After the last meeting, I took the trouble to note down specifics that were said by particular people in a short spat that was unusually energetic. Eg, after coffee, before lunch, on day two, when the meeting considered the section of a report summarising responses to the call for ideas (in 7 lines of text) under the title point "3.2.2 Conscientious objection" (p37).
If you check the blog entry you will see several different responses to this question, which represented several different positions and some misunderstandings. You will also notice that a level of aggression was expressed which led some people to remind their colleagues to respect the positions of those who did not agree with them. These comments seem to have fallen onto the deaf ears of the minute taker (p5). Instead, he takes the opportunity to blandly restate the ideological position of the HPC before misrepresenting those with other opinions and then dismissing the point and throwing doubt on the intellectual ability of those oponents.
It was Annie Turner, Occupational Therapist Panel member of the HPC, and who said 'these people can't have their cake and eat it', which been translated by the minute taker into: the Group questioned why 'conscientious objectors' to statutory regulation [sic] would wish to be included on a list maintained by a statutory regulator and if the individuals concerned would be prepared to be subject to the HPC's processes and procedures.
One of the most persistent comments made by those with a different opinion to that of the HPC is that they are simply not heard (eg see the letter from IPN members, blogged on 10 Feb). The process of HPC-ification is not one of conversation, nor even that of debate. No doubt discussions at such a centralised level can tend to drift into vague generalisations - a few people have been asked to consider a lot of diversity in very little time. But why present a false front - what can be gained from this masquerade?
The HPC 'call for ideas' produced hundreds of pages of response. These were reduced to a 36 page document for consideration at the curtailed first meeting (enclosure 1, 4 Dec). One of these pages contained a bit more detail of the matter and clearly shows there was no intention of anyone to smuggle themslves onto the HPC register. Instead, it was suggested that another register would be drawn up. Bear in mind that the HPC notoriously state on their 'Road Map' to regulation Counselling and Pscyotherapy (Council Meeting, 13 Dec 2007, accessible if you click this link) that anyone not on the HPC register is a lesser human being:
The (draft) minutes for the last meeting continue to refer repeatedly to The Group, and avoid being specific about what different people say at certain times (see blogs preparing for January meeting). The minutes give the overall impression of a set of people who are all of one mind, and who constantly agree with one another as they note this, receive that, and feel or discuss the other.
After the last meeting, I took the trouble to note down specifics that were said by particular people in a short spat that was unusually energetic. Eg, after coffee, before lunch, on day two, when the meeting considered the section of a report summarising responses to the call for ideas (in 7 lines of text) under the title point "3.2.2 Conscientious objection" (p37).
If you check the blog entry you will see several different responses to this question, which represented several different positions and some misunderstandings. You will also notice that a level of aggression was expressed which led some people to remind their colleagues to respect the positions of those who did not agree with them. These comments seem to have fallen onto the deaf ears of the minute taker (p5). Instead, he takes the opportunity to blandly restate the ideological position of the HPC before misrepresenting those with other opinions and then dismissing the point and throwing doubt on the intellectual ability of those oponents.
It was Annie Turner, Occupational Therapist Panel member of the HPC, and who said 'these people can't have their cake and eat it', which been translated by the minute taker into: the Group questioned why 'conscientious objectors' to statutory regulation [sic] would wish to be included on a list maintained by a statutory regulator and if the individuals concerned would be prepared to be subject to the HPC's processes and procedures.
One of the most persistent comments made by those with a different opinion to that of the HPC is that they are simply not heard (eg see the letter from IPN members, blogged on 10 Feb). The process of HPC-ification is not one of conversation, nor even that of debate. No doubt discussions at such a centralised level can tend to drift into vague generalisations - a few people have been asked to consider a lot of diversity in very little time. But why present a false front - what can be gained from this masquerade?
The HPC 'call for ideas' produced hundreds of pages of response. These were reduced to a 36 page document for consideration at the curtailed first meeting (enclosure 1, 4 Dec). One of these pages contained a bit more detail of the matter and clearly shows there was no intention of anyone to smuggle themslves onto the HPC register. Instead, it was suggested that another register would be drawn up. Bear in mind that the HPC notoriously state on their 'Road Map' to regulation Counselling and Pscyotherapy (Council Meeting, 13 Dec 2007, accessible if you click this link) that anyone not on the HPC register is a lesser human being:
"It should be noted that whilst there are many who will welcome [HPC regulation] there might be "a small but vocal minority of individuals and organisations who may want to avoid [HPC regulation] for a variety of reasons." which include: those who are unable to meet competence standards and ethical standards; or who are reluctant to pay the registration fees. The HPC has made a pre-emptive rhetorical strike by labelling those who don't agree with it as incompetent, unethical, and miserly.
This should help Annie Turner to understand why some people might want to construct a list outside the HPC - in order to dispell the negative image created by the HPC.
Friday, 20 February 2009
Sally Aldridge, BACP Head of Regulatory Policy. Therapy Today
In this month's BACP magazine "Therapy Today" Sally Aldridge writes:
"The decision to regulate counselors and psychotherapists through the HPC is a government one as laid out in the White Paper Trust, Assurance and Safety. "
She goes on to say that although other professional organisations have disputed whether the HPC is an appropriate regulator, the BACP is going along with it because the government has signalled its clear intention to go ahead with the process.
When the HPC first arrived on the scene it launched an advertising campaign which was insulting and not a little sinister. It depicted a variety of health professions (all of them were white, interestingly) each of whom looked like a bad joke, wearing a ridiculous mask. The strap lines were all about the way that people pretend to be other than what they are. The implication was clear enough: a lot of professionals lie. (Four of these adverts have been framed as large pictures and are displayed in the corridor at the HPC; I have commented on them in detail in 19th November blog "Struck Off".)
In the minutes of the Professional Liaison Group for Counselling and Psychotherapy at the HPC there is frequent mention of something called statutory regulation. Back in the late 1990s there was an attempt by Lord Alderdice to introduce statutory regulation for psychotherapy. It was his idea, his Bill, and he sought to bring it before parliament. This is an example of statutory regulation. It was thrown out.
State regulation, on the other hand, is when a government itself says that it must happen, and exerts its power on the nature and manner of that regulation.
It is pretty clear from Sally Aldridge's statement here that she believes that this current process is State Regulation: it is written in a Government's White Paper, a clear intention that the Government wants it done, she says.
Sally notes that other organisations dispute the appropriateness of the proposed regulation. I suppose she is aware that this country has a tradition of democracy, and that even if Government states its intention, it is not necessary (nor the custom) for the population to roll over and help them to carry it out, especially if it thinks this will create more problems than it hopes to solve. Good democratic systems rely on the thoughtful actions of its people.
What is at stake here is straightforward talking. You cannot both say that this is statutory regulation and that it has to be done because the Government insists. This recalls the phrase in the first PLG meeting when the Chair said 'if we don't do it to ourselves, the government will do it to us'. It is worth asking how the Government is forcing the BACP to do it to themselves - there is speculation about the benefits to be gained by the structures of institutional power, and a different set of questions related to who will be suffering from the consequences of such a manoeuvre. What is chilling is the lack of proper consideration to the different voices in this 'debate', and the way that those who may wield institutional power don't hesitate to use all kinds of blunt political manoeuvring to throw other people's arguments into bad light.
Surely if people think that something is wrong, and that there is a strong possibility that damage will ensue, then those people have a duty to stand up and say 'hang on a minute', even if they find it difficult simply to say NO.
At the end of Sally's statement she says that "Much of the opposition to statutory regulation [sic] in the HPC in letters to Therapy Today focuses on the nature of the process with terms such as ‘bureaucratic and statistically managed’, ‘cultures of surveillance’, ‘the stress of monitoring and assessment’, ‘role bound rather than ethical’."
She notices that there is a consistency in the concern voiced by people in relation to the proposed State Regulation. She goes on, however, to make the following interesting statement: "the HPC requirements of registration ... do not differ greatly from those of BACP"
This raises a series of questions the most obvious of which is, if the HPC system is not much different from the BACP then how will it improve things, exactly?
But I don't want to get side tracked. The main point is this: saying that the HPC is almost the same as the BACP is a slippery rhetorical device. The HPC is not the same as the BACP, it is different in quite specific and deliberate ways. At this point someone might call for "Evidence?", and ask what frame of reference she is using.
What a lot of people are saying is that the basis of truth is slipping away, and politics and bureaucracy are creeping into its place. The usual conventions of knowledge and debate that allow one to know more or less what someone is saying have receded from the scene, and more and more we are faced with blunt wielding of power through banal and empty phrases. This is not something many of us are used to in this country. If we haven't found neat ways of conveying this to the satisfaction of Sally Aldridge, well sorry; if we sound alarmed, well we are right to be. When truth is under attack all speech and writing becomes subject to question. This is why those in positions of authority, ie those in bureaucratic systems of power, have even more of a responsibility to speak sensibly, carefully, and as far as they are able, truthfully. If they find that the subject is beyond their comprehension, they should pause and think, and get some good advice. If you were the Head of Regulatory Policy, this responsibility would fall on you.
"The decision to regulate counselors and psychotherapists through the HPC is a government one as laid out in the White Paper Trust, Assurance and Safety. "
She goes on to say that although other professional organisations have disputed whether the HPC is an appropriate regulator, the BACP is going along with it because the government has signalled its clear intention to go ahead with the process.
When the HPC first arrived on the scene it launched an advertising campaign which was insulting and not a little sinister. It depicted a variety of health professions (all of them were white, interestingly) each of whom looked like a bad joke, wearing a ridiculous mask. The strap lines were all about the way that people pretend to be other than what they are. The implication was clear enough: a lot of professionals lie. (Four of these adverts have been framed as large pictures and are displayed in the corridor at the HPC; I have commented on them in detail in 19th November blog "Struck Off".)
In the minutes of the Professional Liaison Group for Counselling and Psychotherapy at the HPC there is frequent mention of something called statutory regulation. Back in the late 1990s there was an attempt by Lord Alderdice to introduce statutory regulation for psychotherapy. It was his idea, his Bill, and he sought to bring it before parliament. This is an example of statutory regulation. It was thrown out.
State regulation, on the other hand, is when a government itself says that it must happen, and exerts its power on the nature and manner of that regulation.
It is pretty clear from Sally Aldridge's statement here that she believes that this current process is State Regulation: it is written in a Government's White Paper, a clear intention that the Government wants it done, she says.
Sally notes that other organisations dispute the appropriateness of the proposed regulation. I suppose she is aware that this country has a tradition of democracy, and that even if Government states its intention, it is not necessary (nor the custom) for the population to roll over and help them to carry it out, especially if it thinks this will create more problems than it hopes to solve. Good democratic systems rely on the thoughtful actions of its people.
What is at stake here is straightforward talking. You cannot both say that this is statutory regulation and that it has to be done because the Government insists. This recalls the phrase in the first PLG meeting when the Chair said 'if we don't do it to ourselves, the government will do it to us'. It is worth asking how the Government is forcing the BACP to do it to themselves - there is speculation about the benefits to be gained by the structures of institutional power, and a different set of questions related to who will be suffering from the consequences of such a manoeuvre. What is chilling is the lack of proper consideration to the different voices in this 'debate', and the way that those who may wield institutional power don't hesitate to use all kinds of blunt political manoeuvring to throw other people's arguments into bad light.
Surely if people think that something is wrong, and that there is a strong possibility that damage will ensue, then those people have a duty to stand up and say 'hang on a minute', even if they find it difficult simply to say NO.
At the end of Sally's statement she says that "Much of the opposition to statutory regulation [sic] in the HPC in letters to Therapy Today focuses on the nature of the process with terms such as ‘bureaucratic and statistically managed’, ‘cultures of surveillance’, ‘the stress of monitoring and assessment’, ‘role bound rather than ethical’."
She notices that there is a consistency in the concern voiced by people in relation to the proposed State Regulation. She goes on, however, to make the following interesting statement: "the HPC requirements of registration ... do not differ greatly from those of BACP"
This raises a series of questions the most obvious of which is, if the HPC system is not much different from the BACP then how will it improve things, exactly?
But I don't want to get side tracked. The main point is this: saying that the HPC is almost the same as the BACP is a slippery rhetorical device. The HPC is not the same as the BACP, it is different in quite specific and deliberate ways. At this point someone might call for "Evidence?", and ask what frame of reference she is using.
What a lot of people are saying is that the basis of truth is slipping away, and politics and bureaucracy are creeping into its place. The usual conventions of knowledge and debate that allow one to know more or less what someone is saying have receded from the scene, and more and more we are faced with blunt wielding of power through banal and empty phrases. This is not something many of us are used to in this country. If we haven't found neat ways of conveying this to the satisfaction of Sally Aldridge, well sorry; if we sound alarmed, well we are right to be. When truth is under attack all speech and writing becomes subject to question. This is why those in positions of authority, ie those in bureaucratic systems of power, have even more of a responsibility to speak sensibly, carefully, and as far as they are able, truthfully. If they find that the subject is beyond their comprehension, they should pause and think, and get some good advice. If you were the Head of Regulatory Policy, this responsibility would fall on you.
Wednesday, 18 February 2009
Dear Tessa Jowell, MP
Dear Tessa Jowell, MP
I came to West Norwood library towards the end of last year to see you, and spoke to one of your very helpful and friendly staff. The upshot of that meeting was that I would write you a follow up letter (in addition to the one I wrote earlier in that year). At last, this is that letter.
I have created a blog: HPCwatchdog.blogspot.com based on a whole series of visits I have been making to the HPC as a member of the public. If you read the case of Mr R (part 1, part 2, part 3), watch the video of Richard Gombrich explaining Popper's Nightmare, and consider the questions raised by Max Weber, this will give you a quick insight into my concerns and my orientation.
I am very worried indeed about the centralisation of power and the destruction of local knowledge that is the unintended consequence of the kind of regulation that is practiced by the HPC. From what I have seen it is already causing harm to ordinary decent people, and I truly believe that this harm has a pernicious quality that will be exponentially increased if the HPC draw the psychological practices within its domain.
Onora O'Neil has publicly voiced her concern about the destruction of trust that will follow the state regulation of psychological practices (especially of psychotherapy and counselling, but the psychologists are also very much in this domain). Michael Power has been writing about the way our audit culture ends up emptying the meaning out of words and practices, and leave us vulnerable to the collapse of the resulting empty shells, and Marilyn Strathern has also pointed to the hostile and aggressive undercurrents at play in moves under the banner of transparency. Aggressivity will increase where real meaning decreases – this is a lesson learned many times over throughout history.
Each of these great British scholars has been working away quietly revealing the otherwise hidden 'mechanisms' that hold our society together. None of them pretends to have the answer, nor the whole truth, but each of them is shedding very helpful light in very careful ways on things that we need to be very aware of.
I don't believe there is one answer to the situation we are currently in, but I am trying to find a way of approaching the questions without fueling aggressivity nor unduly increasing levels of anxiety. I suggest that a space be created which makes it possible to think. The rapid expansion of the HPC is not conducive to thinking. When I attended the Investigating Committee meeting last week (blogged on 12 Feb 2009) I was chilled to learn that the Kent Police had been invited in to train staff how to deal with escalating aggression. A much more sensible approach would be to ask why the aggression is escalating. From the hearings I have observed, and from comments I have received as a result of my blog, I can see a very strong argument that the orientation and mechanism of the hpc (the grounds on which it is empowered) actually fuels aggressivity - this creates a spiral which echoes Popper's nightmare and adds to the idea that this is what is being created.
It is difficult to know how to intervene, but I very strongly believe that we need to slow the process down, and give ourselves more time to think. How can I help to postpone the process of the Statutory Order that would pass the psychologists onto the HPC register? If you can advise me of this, I would be extremely grateful. If you would like me to explain my ideas in more detail - I am easily contactable. I would be happy to respond to a call and very receptive to any help you can give in shaping a parliamentary question on this issue.
Yours sincerely
I came to West Norwood library towards the end of last year to see you, and spoke to one of your very helpful and friendly staff. The upshot of that meeting was that I would write you a follow up letter (in addition to the one I wrote earlier in that year). At last, this is that letter.
I have created a blog: HPCwatchdog.blogspot.com based on a whole series of visits I have been making to the HPC as a member of the public. If you read the case of Mr R (part 1, part 2, part 3), watch the video of Richard Gombrich explaining Popper's Nightmare, and consider the questions raised by Max Weber, this will give you a quick insight into my concerns and my orientation.
I am very worried indeed about the centralisation of power and the destruction of local knowledge that is the unintended consequence of the kind of regulation that is practiced by the HPC. From what I have seen it is already causing harm to ordinary decent people, and I truly believe that this harm has a pernicious quality that will be exponentially increased if the HPC draw the psychological practices within its domain.
Onora O'Neil has publicly voiced her concern about the destruction of trust that will follow the state regulation of psychological practices (especially of psychotherapy and counselling, but the psychologists are also very much in this domain). Michael Power has been writing about the way our audit culture ends up emptying the meaning out of words and practices, and leave us vulnerable to the collapse of the resulting empty shells, and Marilyn Strathern has also pointed to the hostile and aggressive undercurrents at play in moves under the banner of transparency. Aggressivity will increase where real meaning decreases – this is a lesson learned many times over throughout history.
Each of these great British scholars has been working away quietly revealing the otherwise hidden 'mechanisms' that hold our society together. None of them pretends to have the answer, nor the whole truth, but each of them is shedding very helpful light in very careful ways on things that we need to be very aware of.
I don't believe there is one answer to the situation we are currently in, but I am trying to find a way of approaching the questions without fueling aggressivity nor unduly increasing levels of anxiety. I suggest that a space be created which makes it possible to think. The rapid expansion of the HPC is not conducive to thinking. When I attended the Investigating Committee meeting last week (blogged on 12 Feb 2009) I was chilled to learn that the Kent Police had been invited in to train staff how to deal with escalating aggression. A much more sensible approach would be to ask why the aggression is escalating. From the hearings I have observed, and from comments I have received as a result of my blog, I can see a very strong argument that the orientation and mechanism of the hpc (the grounds on which it is empowered) actually fuels aggressivity - this creates a spiral which echoes Popper's nightmare and adds to the idea that this is what is being created.
It is difficult to know how to intervene, but I very strongly believe that we need to slow the process down, and give ourselves more time to think. How can I help to postpone the process of the Statutory Order that would pass the psychologists onto the HPC register? If you can advise me of this, I would be extremely grateful. If you would like me to explain my ideas in more detail - I am easily contactable. I would be happy to respond to a call and very receptive to any help you can give in shaping a parliamentary question on this issue.
Yours sincerely
Master Signifers, Aggression, and Truth.
Developments in linguistics and in anthropology brought this idea into use in the early parts of the last century. I shall not lecture you on it but invite you to cut to the chase.
There are words or phrases frequently uttered that have great power but very little meaning - they appear unattached to other elements either in a sentence or in the world. They point to nothing. The vagueness of this can raise anxiety, especially when uttered by people occupying positions of institutional and legal power. Lets call them 'master signifiers' - they have power 'because I or We say so'.
I should add that they are not always necessarily bad. They are a part of language and life and can be extremely useful and put to the good with care. They are a necessary feature of language, in fact, because when we speak we are usually trying to speak about something beyond speech, something that our speech aims to invoke. I think this might be particularly difficult for native English speakers to grasp, because we are so seldom required to face the foreigness of our mother tongue. If we forget this nature of language, however, we can easily forget how important it is to attend to the invention and deployment of master signifiers. Lets keep this practical.
Three of the major master signifiers that organise the discourse around the hpc are: Evidence, Public Protection, and Regulation. I have been trying to turn Public Protection into a meaningful phrase by attaching it to specific examples and paying particular attention to its use (which section of the public is being protected, from what particular harm, and on which specific occasion?). In this way the signifier is introduced to other signifiers with which it is revealed to have an otherwise hidden relation. The concealed relations leave them unquestionable, and we have seen in the case studies particularly, that this can be seriously unhelpful.
When the relations are left in the dark, the phrase can get wielded rather aggressively - intentionally or not - by someone who happens to be occupying a position of power. If used by someone not in any kind of position of power you can safely ignore them as a babbling fool. Unfortunately, these phrases are very often heard coming out of the mouths of people in positions of power - journalists, politicians, members of panels, committee members, for example. To call these people babbling fools might be true in that particular moment, and there have been times in this country when it has been perfectly acceptable to say so, even if you are no-one in particular yourself. But - and its a big but, and one that needs to be acknowledged and understood - at the moment because these people are supported by society and given positions of power, calling them such without great tact seems likely to provoke much more than their own personal wrath. It is as if the whole edifice will crumble away with them, as if they personally are the power. To speak out seems to risk bringing the power of the institution right down on your head.
So, master signifiers are instruments of power: they are cut off from meaning and draw attention to the power of the person that speaks; and they are used to cut off meaning in other conversations, to disempower other speakers - this is a double whammy.
There are words or phrases frequently uttered that have great power but very little meaning - they appear unattached to other elements either in a sentence or in the world. They point to nothing. The vagueness of this can raise anxiety, especially when uttered by people occupying positions of institutional and legal power. Lets call them 'master signifiers' - they have power 'because I or We say so'.
I should add that they are not always necessarily bad. They are a part of language and life and can be extremely useful and put to the good with care. They are a necessary feature of language, in fact, because when we speak we are usually trying to speak about something beyond speech, something that our speech aims to invoke. I think this might be particularly difficult for native English speakers to grasp, because we are so seldom required to face the foreigness of our mother tongue. If we forget this nature of language, however, we can easily forget how important it is to attend to the invention and deployment of master signifiers. Lets keep this practical.
Three of the major master signifiers that organise the discourse around the hpc are: Evidence, Public Protection, and Regulation. I have been trying to turn Public Protection into a meaningful phrase by attaching it to specific examples and paying particular attention to its use (which section of the public is being protected, from what particular harm, and on which specific occasion?). In this way the signifier is introduced to other signifiers with which it is revealed to have an otherwise hidden relation. The concealed relations leave them unquestionable, and we have seen in the case studies particularly, that this can be seriously unhelpful.
When the relations are left in the dark, the phrase can get wielded rather aggressively - intentionally or not - by someone who happens to be occupying a position of power. If used by someone not in any kind of position of power you can safely ignore them as a babbling fool. Unfortunately, these phrases are very often heard coming out of the mouths of people in positions of power - journalists, politicians, members of panels, committee members, for example. To call these people babbling fools might be true in that particular moment, and there have been times in this country when it has been perfectly acceptable to say so, even if you are no-one in particular yourself. But - and its a big but, and one that needs to be acknowledged and understood - at the moment because these people are supported by society and given positions of power, calling them such without great tact seems likely to provoke much more than their own personal wrath. It is as if the whole edifice will crumble away with them, as if they personally are the power. To speak out seems to risk bringing the power of the institution right down on your head.
So, master signifiers are instruments of power: they are cut off from meaning and draw attention to the power of the person that speaks; and they are used to cut off meaning in other conversations, to disempower other speakers - this is a double whammy.
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