Arthur Musgrave – The Emergence of ‘State-endorsed Therapy…?

http://matthewbowespsychotherapy.co.uk/emergence-state-endorsed-therapy/

Click on the link to visit Matthew Bowes’ website for this paper by Arthur Musgrave, delivered at the UPCA Conference in November under the full title: ‘From Cottage Industry to Factory Production – The Emergence of ‘State-endorsed Therapy…?’. Gratitude to Matthew and Arthur.

Arthur’s paper concerns the British Association for Counselling & Psychotherapy (BACP)’s proposed revisions to its Ethical Framework. Arthur places these in historical and political context. He provides some useful background, and raises ethical and therapeutic questions.

We agree with Arthur, Matthew and many other therapists, that ‘there is a good deal to be concerned about’ here. We feel deep unease about BACP’s politics, ambitions and direction, and what seems like a drift towards values of standardization and conformity in the great areas of the therapeutic world.

In our view, this arises in part from a misperception that rules and accountability make us ‘safer’ (‘accountability’ defined here in culturally sanctioned terms of blame and punishment as an effective model – a therapeutic nonsense in itself). There is no evidence to support this proposition, and plenty to question it – but this debate takes us into the non-rational. It is fuelled and characterised by fear, not reason.

Taking Arthur’s example of trust (and we think this is relevant, whether we are looking at a supervision or therapeutic relationship):-

‘The argument seems to be that introducing standardised practices is a good thing because it makes matters more explicit and a greater degree of explicitness is the route to establishing greater trust between therapist and client. This is evident in the overarching structure of the commitment to clients, which frames everything that follows –

“We recognise that our clients must be able to trust their practitioners with their well-being and sensitive personal information. Therefore we have agreed…that we will…”

The detail then follows – for instance in paragraph 26 in the section on ‘Good Practice’ there are the new requirements about written contracts between therapist and client. In this way the building of trust is reduced to a standardised procedure.’

But standardized procedures are not where trust lives, in the sense trust matters in therapy. Trust is a delicate relational emergence over time, arising between two human beings through connecting in relationship. It cannot meaningfully be created in the harsh light of the ‘explicit’, and fixed in words. It builds (or not) with each subtle verbal, energetic, embodied exchange, in the answers we experience to our fundamental questions: ‘Are you what you seem?’; ‘Will you hurt me?’; ‘Will you reject me if I allow you to see me’; ‘Will you stay the course?’; ‘Will my need be too great?’; ‘Will you offer me what I need?’; ‘Dare I hope?’.

Imposing a written contract at the outset does not serve this – indeed, it risks saying instead: ‘I can’t be trusted’; ‘Neither can you’; ‘We need these rules to keep us from harming each other’. I might want that from a lawyer, or a banker. I do not want it in supervision or therapy. Instead I want someone to work with, who has engaged in their own journey sufficiently deeply to be able to meet me where I am, at depth, and offer me loving presence and the core conditions. That’s rare; it’s a big ask. But it is the only road to therapy with the potential to birth healing, growth and transformation.

Contracting in the way BACP suggests imposes the therapist’s external locus on the person they are working with – right at the beginning of the relationship. From a person-centered perspective, this is profoundly counter-therapeutic – because the shared task is to co-create a way of working that supports internal locus in the person seeking therapy.

Formal contracting of this kind imposes external locus whether or not the contract is negotiated – even with a negotiated contract, we as therapists are imposing the negotiation. We are effectively saying we know better, assuming a power position, removing client choice – in the name of building trust. All my experience and intuition as a therapist tells me this is not helpful.

In this service, we worked for years within the BACP Ethical Framework, as organisational members. We have never experienced a client complaint, in our 18 year history. We decided not to renew our membership in October 2013, in circumstances outlined below. We have continued to support our therapists choosing individual BACP membership in working within the parameters of the Ethical Framework (for us, such memberships are not how we define good therapy, and are a matter of therapist choice). In the light of the current revisions, we will need to revisit that from the perspective of what actually serves those who come to our service for therapy, and the kind of work we want to do.

BACP of course itself uses the language of ‘clients’ “best interests”‘ to support its agenda:-

‘…….BACP has deliberately put at the core of the 2014 Ethical Framework the notion that therapists will work in clients’ “best interests”.

That sounds unarguable, on the face of it. But as Arthur puts it:-

Who defines “best interests” and from whose point of view?’

The BACP is again conceptualizing this in terms of external locus – the idea that there is in therapy or supervision a ‘right’ way of doing things, capable of being defined outside the relationship and the moment. The previous version of the Ethical Framework was drafted in terms of values and principles, for practitioners to reflect upon as navigation aids for an internal ethical sense, rather than absolutes. BACP has for a considerable time added absolutes in its interpretation of the Framework, as revealed by any examination of its professional conduct decisions, or registration process. It’s now taking the logical next step.

From the medical/psychiatric model perspective towards which the BACP is moving, the answer to Arthur’s questions is: the ‘expert’, the ‘clinician’ – with this ‘expertise’ captured in the form of standardized ‘best practices’. As Arthur puts it, the revisions to the Ethical Framework:-

‘……need to be understood in the context of two notions …..(a) that therapy can be conceptualised as a product and (b) that supervision can be thought of as part of a quality assurance system.’

These ideas are inimical to any conception of therapy or supervision as deep relationship, which in and of itself creates healing, change and growth. From a person-centered perspective, meaningful compass bearings for any of us come from within – from a place of internal locus. There are some distinctions between the tasks in person-centered therapy and in supervision, but the essence of the process is essentially the same: for the practitioner and the person they are working with to co-create relationship, which allows engagement and emergence of that person’s deep inner wisdom and resources. This is a self-organizing process, in a relational environment characterized by presence and the core conditions.

For myself, I have had deep and growing qualms over years about BACP’s political ambition, apparent lack of an ethic of service or any real engagement with ethics, and punitive application of its Ethical Framework in its professional conduct process. I joined as a student in around 2004, and finally decided not to renew my membership in January 2013. My decision crystallized when in mid 2012 this service received two complaints from ex-work colleagues, both therapists. The complaints were essentially collaborative back-door complaints against a non-member, one of our supervisors, about peer-peer work those therapists had chosen to do with him in private practice (therefore outwith BACP remit, a fact it has consistently ignored). At the point the therapists first told us or him they had an issue, they had already taken steps in the world to cause substantial harm to him. Sentence before trial. We think that was unacceptable.

Initially neither therapist expressed any issue with our service, one describing it as ‘a marvellous service to Devon’. This changed when I and two other senior therapists considered the facts, took the view we were seeing profoundly unethical behaviour and fabricated/distorted allegations, and decided we had an ethical imperative to challenge the complainants. At that point, they broadened their allegations to include our service, and put in complaints to BACP, as well as four public bodies (none of which made any finding against us or our supervisor). From the outset, our experience of BACP was dire. We believe their professional conduct process and their final decisions (against us) to be unreasonable and unsafe, for many reasons. We have covered this elsewhere, and I am including a link at the end, in case you feel moved to read any of the (considerable) amount we have published on the specifics.

One of the complainants is active in social media, and she and her small group of supporters have suggested that anything I may say on the subject of BACP is to be discounted. I don’t really get that myself. Surely having extensive direct, personal experience of an organisation is useful, when commenting? I am by no means alone in my perspective. I have things to say in this debate, and I have no intention of allowing myself to be silenced by that person or anyone else. No doubt readers will make up their own minds.

From my experience and perspective, I cannot see that BACP is actually engaged with ethics or client interests. It may or may not be serving some aspects of the interests of its members, but it is not serving the interests of the provision of therapy to those who need it or the growth of any of us as therapists (and thereby not serving us culturally). As Arthur concludes:-

‘Looking into what’s going on in this kind of detail reveals the underlying thrust of the present revision of BACP’s Ethical Framework. If you want further evidence, look no further than the new title – ‘BACP Ethical Framework for the Counselling Professions’.

So there we have it – an organisation, whose mission includes being the lead body for counselling and psychotherapy, is subsuming both coaching and psychotherapy under such a heading – and is thereby marginalising both psychotherapy and in depth counselling whilst, at the same time, privileging a narrow definition of counselling that is actively not supported by the research evidence.

Not only that, BACP is preparing to redefine coaching, psychotherapy and counselling as subsets of health and social care.

And, whilst claiming that this is a review of ethics, BACP is overtly (as was quite clear in the webinar seminars) redrafting those ethics in order to seek to protect members’ jobs – and, I would argue, promote itself and curry favour with Government.’

Somebody I work with makes sense of our dehumanizing and unhelpful cultural journey into the ‘mental health’ model, in terms of our having taken a societal wrong fork in the road – when psychological well-being became subsumed under ‘Health’. We might be looking at a very different landscape now, had the choice been ‘Education’. Therapy is not the science of diagnosis and disorder. It is the art of loving relationship. BACP neither recognizes nor promotes this.

Lindsey Talbott, Therapist

Palace Gate Counselling Service, Exeter

https://palacegatecounsellingservice.wordpress.com/the-conflict/