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Before going deeper into the reasons why such a system will not work, I want to address yet another issue. The very idea that it is possible to regulate psychotherapy on a behavioural level testifies to a very particular interpretation of what psychotherapy is. I think it is very important to make this clear, because this interpretation concerns a very limited number of psychotherapies, whilst it creates the impression that it goes for all psychotherapy as such. Indeed, today a growing number of people are convinced that a psychotherapeutic practice is more or less similar to a medical practice. You diagnose a patient in an objective and scientific way, and then you pick the most appropriate form of treatment that is considered the best practice for this particular disorder. In this kind of reasoning, a control system in terms of competences and skills seems perfectly feasible. The trouble is that this kind of reasoning is a purely academic one, both in the literal and the metaphorical sense of the word. As always, we have to study its history if we want to understand what is right and what is wrong.
This is not too difficult, because it is a very recent history. At the end of the previous century, there was an increasing demand for psychotherapies to prove their effectiveness. Nobody with a sound mind can be against such a demand, but the trouble is that the way in which this question was answered might very well mean the end of psychotherapy as such.
When researchers in the academic world were asked to set up a design to measure the usefulness of a certain kind of therapeutic approach, they copied the methodology that was originally developed for the evaluation of medical and pharmacological treatments. This means that they tried to compose at least two large research groups of exactly the same patients, who were treated with two different methods, one of them being the target method that needed evaluation, whilst the other group received the standard treatment. In order to make the comparison possible, the therapy given to all the patients within one group has to be completely identical, hence the need for a strictly manualised treatment – the therapist has literally to follow the book. This is the philosophy of Evidence Based Medicine and Randomized Controlled Trials: identical patients, identical therapists, identical treatments.
Such an approach has enormous implications, because it means that in this approach a psychotherapeutic method can only be researched on its effectiveness if it meets at least two criteria beforehand. Firstly, it must be possible to standardize the treatment completely, in order to rule out the impact of the individual therapists. Secondly, the treatment has to be short; ideally it takes only 6 to 16 sessions, in order to rule out other influences. I think it is obvious for everyone with knowledge of the field that only a very limited number of psychotherapies meet these criteria, meaning that all the other forms cannot be evaluated within this approach. On top of that, this research design can only be applied to a very limited number of patients as well, because of another inherent requirement. Indeed, the patients that can be used in this kind of research are only allowed one diagnosis based on the DSM, co-morbidity is out of the question.