The government is planning to regulate providers of psychotherapy. The Health Professions Council is already set to register psychologists, and moves are afoot to bring in psychotherapists and counsellors. The idea is that this will ‘protect the public’, and some of the largest psychotherapy and counselling organisations are behind the government on this because this kind of ‘protection’ will actually reinforce the power these organisations already have to say who is and who is not permitted to engage in psychotherapy.
Instead of empowering users of services it is looking now instead as if all state regulation will do is reinforce the protection rackets that rule the roost. Psychiatrists, for example, are already officially registered (through the Royal College of Psychiatrists), but we know that this has not stopped abuse of patients, nor has it curbed the pharmaceutical companies who peddle the drugs to those ‘professionals’ who write prescriptions and enforce ‘treatment’.
It is sometimes said that state regulation or ‘registration’ is needed to prevent another Harold Shipman (the GP who murdered many of his patients). But the big flaw in this argument is that Shipman was already regulated by the General Medical Council! And the biggest flaw in the scare-story argument here is that ‘registered’ practitioners are sometimes the most dangerous, and it is those who are outside the registers who do the most creative, supportive and radical work.
The user movement has thrived outside official registers, outside official treatment centres, and outside state structures. If anything, here is a lesson in the history of the user movement for psychotherapists, which is that they should ally themselves with the outsiders and refuse to be registered, refuse to be regulated, and refuse to do what the authorities decide upon as legitimate treatment.
There are two key points we need to keep in mind when the government and its supporters tells us that it would like to ‘protect’ us, and that state regulation of psychotherapy is necessary. The first point is that this is an issue not only for psychotherapists, and to be honest we wouldn’t shed many tears if some of them were stopped from practising, but it is also an issue for service users. Why? Because state regulation in psychotherapy is an extension of regulation and surveillance of our lives throughout society, regulation and surveillance that ranges from the millions of CCTV cameras on the streets and in hospital buildings to the thousands of rules that define what you can and cannot do, where you are allowed to protest and what you are allowed to say. We have to ask ourselves when we are faced with a massive increase in diagnoses of ‘psychosis’ and ‘paranoia’ how the administration of our everyday lives and encounters with professionals fuels paranoia. We should even ask whether in this world of bureaucratic checklists and monitoring procedures, we are actually paranoid enough. And in this administered society, there are very few spaces left where we have the freedom to speak without it being checked and corrected by those in power.
Psychotherapy is one of the few spaces where it should be possible to speak openly, but the government’s plans to ‘regulate’ this space will effectively close it down. So, this is not an issue of pitying the poor psychotherapists, but defending a space where these practitioners can enable us to speak freely.
The second point is that there are radical approaches in psychotherapy that are especially vulnerable to state regulation, approaches that really do provide the space to speak freely. Some approaches like ‘cognitive behavioural therapy’ are unfortunately compatible with state regulation because there is an assumption in them that there is a correct and incorrect way of thinking about the world. Even so, there are therapists working in these frameworks who will still be hard hit by the government proposals – those who work with users rather than against them. Some approaches, like psychoanalysis, are necessarily outside the state and the work of psychoanalysts, if they were to be brought into the Health Professions Register, would be badly compromised. It should be said that there are some psychoanalysts with old-school ties to the Royal College of Psychiatrists and the House of Lords that are prepared to adapt their work to the state regulation agenda. These are the ones we should worry about. The psychoanalysts who should be our allies in the fight against state regulation are those who refuse to ‘adapt’ people to society, psychoanalysts who are more closely connected to the continental European tradition of work. We should remember here that while psychoanalysis in the UK has been closely allied to psychiatry, many psychoanalysts in France and Italy were allied to the anti-psychiatry movement.
Things are not simple, and it is not clear who our friends and enemies are, and this uncertainty is what the government preys upon in its argument for more regulation. Some professionals who were trained as psychoanalysts, like Ronnie Laing, were supportive of the user movement, and some psychiatrists even, like Alec Jenner, Marius Romme and Franco Basaglia, have been sources of inspiration in the struggle against abusive psychiatric practice. On the other hand, some psychoanalysts now, even the ‘European’ ones, will not listen to objections to their attempts to diagnose and direct their patients in treatment. But psychoanalysis as such is a practice that is based on ‘free association’, the attempt to speak freely and discover how we also do the work of power ourselves, and it is this space of ‘free association’ that is the diametric opposite of any attempt to regulate how people should speak.
These are matters to be kept to the forefront of discussion when we make any alliance with psychotherapists in the UK now who are complaining against state regulation, and when they would like to involve us in petitions against state regulation, or ask us to be supportive of their own petitions when they speak as psychotherapists or counsellors (like the one at www.petitiononline.com/statereg/petition.html), or when they have a ‘Rally of the Impossible Professions’ (like the one in London in September 2008, see www.londonsociety-nls.org.uk). I have signed the petitions and attended meetings, and I have done so because one of the resources for a radical alternative in mental health, psychoanalysis, is under threat from state regulation. There are high stakes in these debates, and if the government gets their way every kind of psychotherapy and counselling will be affected. This is now an issue not only for the professionals but for anyone who uses mental health services and demands something better than what we have at the moment.
Ian Parker is professor of psychology at Manchester Metropolitan University, a registered psychoanalytic psychotherapist and associate editor of the Journal of Lacanian Studies