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CHOOSING a PSYCHOTHERAPIST

 

Psychotherapy and marketing

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.

Professional qualification

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.

Training and accreditation

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.   

Supervision

‘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.  

True accreditation

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.   

 

'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)
 

Exploitation     

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.

Forms of exploitation

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.
 

Codes of practice

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!

 

'... 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)
 

 

Avoiding the risks

Some of the questions that prospective clients or their advisers need to ask :

Does the service offered comprise standard procedures, or is it shaped to the client's particular needs?  

How many sessions are likely to be needed?  

How long and how frequent are the sessions?

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?

Is the contract explicit or implied, written or oral?

What rights do clients have if they are not satisfied with their progress?  

 

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!  

 


References:

 

 

(1) p. 41 The Nature of Psychotherapy (7th edition) Manchester University Press 1964

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(2) p. 101 The Regulation of Psychotherapists: A Study in the Philosophy & Practice of Professional Regulation. Ballinger Publishing Co., Cambridge, Mass. 1979

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(3) p. 229 A Complete Guide to Therapy. Penguin, Harmondsworth 1978

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(4) p. 11 The Case for a Personal Psychotherapy. Oxford University Press 1981

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(5) p. 138 The Case for a Personal Psychotherapy. Oxford University Press 1981

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(6) p. 139 Psychotherapy: A Personal Approach. J.M. Dent & Sons, London 1978

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(7) p. 217 Encyclopedia of Family Health. The Royal Society of Medicine, London 1995

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(8) pp 15/16 'Openmind 55' (February/March 1992)

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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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For more information, without obligation, telephone: 01773 833267 (24 hours). All calls are confidential.