Comments by The College of Psychoanalysts on the above document, published by the Health Professions Council in December 2007
This document from HPC sets out a number of aims and issues relating to the proposed regulation by the state of talking therapies and recommends the establishment of a liaison group to tackle the specific tasks of regulation. Protection of the public is the main variable. It is immediately surprising that the document does not consider whether the training standards, complaints procedures and regulatory frameworks of the current counselling and psychotherapy organisations are adequate to protect the public or not. UKCP and BPC have worked for years to establish such frameworks, yet the document proceeds as if they did not exist. It must be a question, if protection of the public is the avowed aim, why no consideration is given to making the public more aware of the strict frameworks of these regulatory networks.
No psychotherapy group, to our knowledge, opposes regulation: what they do oppose is regulation by the state conducted within the framework of health care. Arguments for such regulation must first demonstrate what is genuinely lacking in current regulatory frameworks rather than set up arguments with straw men in order to push through legislation that will be damaging to patients, therapists and the field of psychotherapy itself.
We are also unaware of any psychotherapy group which opposes the idea of rigorous training standards and transparent complaints procedures. This is indeed the reason that such procedures are in place. But any credible regulatory framework must start from a study of the nature of psychotherapy itself, rather than using models that may be germane to other fields and then trying to adapt them to suit the talking therapies. This means a serious consideration of three main issues: the symptom, the concept of health and transference.
Psychoanalytic therapies, in contrast to many other forms of therapy, do not aim at the removal of symptoms, even if this is one possible effect of a treatment. Rather, the aim is to access what is being expressed through symptoms. In many cases, despite complaining of a symptom, careful work with the patient reveals that the symptom is a source of unconscious satisfaction for them. Hence it may not be in their interest to give it up. Beyond the patient’s conscious complaint lie other unconscious factors which mean that the idea of ‘the patient’ is a divided one: split between what they might want consciously and what they might want unconsciously.
This clearly has implications for how health is conceived. Many psychotherapies are highly critical of how contemporary society ‘sells’ the idea of ‘health’, promising happiness and cures. These therapies are thus resolutely opposed to the very concept of ‘health’, and see their work as involving an exploration of each person’s unique history. Nothing can be predicted in advance or promised to the patient. The therapist here does not know in advance what is best for the patient, although other forms of therapy today claim to know precisely this. They thus involve different ethical positions. Some therapies will offer to satisfy their patients: others make no such claim.