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CHOOSING
a PSYCHOTHERAPIST
Psychotherapy
and
marketing
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Psychotherapy, is not
regulated by law in the United Kingdom. People who
practise it are subject only
to the standards of behaviour that can reasonably be expected of
anyone who provides a personal service.
Many practicians belong to associations who claim to offer better, more
trustworthy services
than those offered by non-members, because they provide putative
training, accreditation and supervision by other members.
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Professional
qualification
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Psychotherapy
is not a profession based on any well-established,
recognised body of knowledge. It is simply a
process. The best practicians
are usually people who have considerable experience, personal and/or vicarious, of the tribulations of
living. More importantly, they are people who have thought seriously about the ways in
which we live and the possible consequences.
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Training
and accreditation
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In
contrast to aviation, architecture, construction
engineering, medicine, plumbing and so on, the skills required by
people who practise psychotherapy and the standards of practice needed to ensure competent, scrupulous
behaviour cannot be measured objectively. Although the necessary skills can be enhanced by attending courses, lectures, seminars, ‘workshops’ and so
on, any 'qualification' awarded as a result is worthless as
an indication of the practician's competence or integrity.
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Supervision
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‘Supervision’ has several different meanings.
It is generally used to describe the examination of a person's work by
someone else who accepts the ultimate responsibility for its quality.
In
academic research, 'supervisors' are consultants who help scholars
organise their research, challenge some of their ideas and offer
appropriate support.
Conscientious practicians of psychotherapy tend to rely mostly
on ‘self-supervision’.
This involves reflecting on their meetings with clients, trying to
appraise their own conduct honestly and, if necessary, seeking critical advice from
someone who is
disinterested.
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True
accreditation
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Psychotherapy
has no 'career
structure'. The
professionalism of its practicians
is best measured by the efforts that they make to become
redundant. The value of accreditation by fellow
practicians is impossible to assess and
the only people truly qualified to assess practicians' competence
and integrity are their clients.
Prospective
clients must therefore decide what such terms as 'professional
qualification', 'accreditation', 'training' and ‘supervision’ mean
in practice.
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'We must not expect that the
personal qualities of the psychotherapist will
spring from formal instruction; the professional
demands are much more far-reaching and among them
there is something that most decisively cannot be
taught.' Karl Jaspers(1)
'A person is usually assumed to be competent
because he or she has had a specific amount of
academic training and supervised experience,
although why this should ensure competence is not
specified. Ignored are the subtle questions of
what precisely it is that professionals are
supposed to do, and how well they do it. These
two issues are more complex than is often
realised and deserve further elaboration.' Daniel
B. Hogan(2)
'... the prospective client should take
nothing for granted where the qualifications of a
therapist are concerned. The most essential
consideration is to be able to form a proper
working relationship; all other factors should be
examined in this light.' Joel
Kovel(3)
'(Psychotherapy) ... is a craft the aptitude
for which derives more from a general experience
of living than is generally supposed.' Peter
Lomas(4)
'(Training in psychotherapy) ... should
start from the recognition that a learned
technique not only cannot substitute for a more
elemental capacity to heal, but may actually
inhibit this capacity: that it should be less a
course of instruction than an attempt to increase
the individual's unique capacity to help.' Peter
Lomas(5)
'Though (simplified models of human
behaviour) may be of some use in marshalling the
"facts" of mass behaviour, they are
unlikely to deal effectively with the
complexities of the individual case and it is
small wonder that a reasonably intelligent and
sensitive person is likely to make better guesses
about others if he relies more on the skills he
has spent his life developing than on the crudely
insensitive conceptual equipment of traditional psychology.' David
Smail(6)
'There are many schools of
psychotherapy but results appear to depend on the personal qualities,
experience and worldly wisdom of the therapist rather than on the
theoretical basis of the method.' Robert M. Youngson (ed.)(7)
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Exploitation
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The
nature of psychotherapy is such that it is easy
for incompetent or unscrupulous practicians to find subtle ways of abusing
clients'
trust. Particularly vulnerable are those clients
whose minds are in turmoil. For that reason, psychotherapy has sometimes
been compared to an aberrant religious cult.
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Forms
of exploitation
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Financial
exploitation is not the only way in which clients' trust can be abused.
They may be persuaded, for example, that the problem is more
serious than they thought, be given unrealistic assurances and
discouraged from seeking other forms of help. Some may be
persuaded to ‘remember’ events that did not happen, such as
sexual abuse in
childhood.
Negligent, manipulative or devious practicians and those employed by
the National Health Service and similar organisations may, without seeking
their clients' permission, pass on information that was revealed
to them in confidence.
They may also neglect to forewarn clients about
the risk of becoming emotionally over-dependent on them and may
even persuade them to consent to physical intimacy.
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Codes of practice
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Is
it safe to assume that members of a professional association are more
trustworthy than non-members? Many
probably are, but the codes of practice published by professional associations
offer clients no
more protection than common law provides. Claims that their members are 'properly trained and qualified',
'accredited' and/or 'supervised' merely increase the risks of clients being unjustly exploited.
Apart from common law, the only realistic protection against
unjust exploitation is what lawyers call caveat
emptor: that prospective
clients (or their advisers) should be wary!
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'... no amount of training,
supervision or personal therapy are guarantees
that professionals will not abuse their position
of trust. There is some evidence for the view
that the more qualified and high-powered a
practitioner, the increased likelihood of abuse,
because of the diminished likelihood of
challenge.' G.Cooney(8)
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Avoiding the risks
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Some of the questions that prospective
clients or their advisers need to ask :
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Does
the service offered comprise standard procedures, or is it shaped to
the client's particular needs?
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How many sessions
are likely to be needed?
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How long and how frequent are the sessions?
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 | What
assurance does the client have that, with the exception of emergencies, the
practician will keep appointments and be punctual? |
 | What are the fees and when are they
payable? |
 | Will everything the client says in the
consulting room be kept confidential?
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Is the contract explicit or implied,
written or oral?
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What
rights do clients have if they are not satisfied with their progress?
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Although personal recommendation
is often a good indication of a practician's competence
and probity, relying on it may not always
be prudent.
Care is also needed in assessing a practician's experience. Practice
does not invariably make perfect. It is no less likely to encourage bad habits
than good
ones!
(1)
p. 41
The Nature of Psychotherapy (7th
edition) Manchester University Press 1964
[Back
to Text]
(2) p. 101
The Regulation of Psychotherapists: A
Study in the Philosophy & Practice of Professional
Regulation. Ballinger Publishing Co., Cambridge, Mass. 1979
[Back
to Text]
(3) p. 229
A Complete Guide to Therapy. Penguin,
Harmondsworth 1978
[Back
to Text]
(4) p. 11 The Case for a Personal
Psychotherapy.
Oxford University Press 1981
[Back
to Text]
(5) p. 138 The Case for a Personal
Psychotherapy. Oxford University Press 1981
[Back
to Text]
(6)
p. 139 Psychotherapy: A Personal
Approach. J.M. Dent & Sons, London 1978
[Back
to Text]
(7) p. 217
Encyclopedia
of Family Health. The Royal Society of Medicine, London 1995
Back to Text
(8) pp
15/16 'Openmind 55' (February/March
1992)
[Back
to Text]
SUGGESTED
READING
Katharine Mair: 'The myth of
therapist expertise' pp 143-168 in Psychotherapy and Its
Discontents (Windy Dryden & Colin Feltham, eds) Open
University Press 1992
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