8 ..9
The medical model leads to a prescription of ‘approved treatments’ for specific diseases, with diagnostic codes, ‘validated protocols’ and checks for compliance with these ‘manualised treatments’. This is what currently happens within the NHS – and increasingly it will contaminate private practice. Our clients read NICE guidelines, and are at liberty to complain if they consider they are not receiving an approved ‘treatment’ for their condition. Adherence to the authority of NICE and its validated protocols – truly an emperor with flimsy clothes – takes the place of the psychotherapist’s inner integrity. Of course, none of this works in practice. Real clients tend to be complex, idiosyncratic, and often stubbornly defy diagnostic categories. One has to work to understand them and to find a way of helping, making use of all available knowledge and skill. The external authority of NICE is of limited assistance. Indeed any assumption that we know and understand our client is an obstacle to real exploration. To my perception, the authority that can often be given most weight is that of the client’s unconscious mind, expressed as an unconscious commentary upon the psychotherapeutic process – a phenomenon particularly explored by Robert Langs in the USA and Patrick Casement in Britain.
Freud’s vision of the ‘secular pastoral worker’ explicitly alludes to the role of priest. Perhaps there is a similar ‘calling’. No-one becomes a psychoanalyst or psychoanalytic psychotherapist because they think it is a good profession. The training, and the work itself, are too difficult and personally demanding. Similarly, psychotherapy is not for everyone. With the new IAPT trainings in CBT I think there probably are some who view these forms of psychological technology, now promoted as being as effective as antidepressants, as being attractive career options. There is scarcely any point of contact between these two professions.
Ethics are at the heart of the psychotherapeutic encounter. There is surely nothing more important in psychotherapy than the integrity of the ethical stance of the practitioner. But this is not a matter of a checklist of do’s and don’ts.
I will quote from an excellent book by Dorothea Hover-Kramer [Creating Right Relationships]
“Highly ethical behaviour means acting with integrity. Another word for integrity is wholeness meaning the therapist’s behaviour is congruent with his values, knowledge, intuition, and feelings. It also indicates there is harmonious, consensual dialogue between the practitioner’s inner process resulting in external behaviour that is consistent and ethical. In other words we act in accordance with our own personal Sacred Contract as well as honouring the covenant with our clients.” [p 137]