Contribution to the conference of The College of Psychoanalysts-UK ‘Are you fit to practise? From ethical framework to model of good behaviour’- London, 6 June 2009
As parliamentarians have now discovered, established ideas about ways of achieving what appeared originally to be sound objectives, sometimes have to be blown out of the water and exposed for scrutiny, in order to arrive at a new way of doing things that better meets the interests of the professionals concerned and members of the public alike. Maybe psychoanalytic practitioners have now reached a similar position in their own profession.
The situation that concerns me here, arises out of a principle which originally applied only to complaints against medical practitioners but which has since become the established norm and basis for dealing with complaints against practitioners from many different professions in the UK. I am concerned about how this principle now threatens to extend to psychoanalytic practitioners. It all hangs on three simple words: fitness to practise, which are the words that formulate the principle in question. These words comprise, perhaps, a rather innocent-sounding phrase. They constitute, in fact, a term loaded with the dynamite of a revolution which lies at the very core of recent regulatory processes.
When the term fitness to practise first appeared, some years ago, its meaning was very literal. The question to be answered then, in relation to professional complaints, was whether the professional concerned was physically or mentally fit to practise and it was therefore limited to issues of physical and mental health. It still means that but now, additionally, it means far more than just that. The word fitness has now become synonymous with the word suitable. The question are you fit to practise? is no longer confined only to issues of physical and mental health but has now become, in effect, the question are you a suitable person to practise? This constitutes an enormous shift and a fundamental extension of the original question are you fit to practise? It transfers that concept from entirely objective issues to ones that are far more subjective in nature.
The danger for psychoanalytic practitioners, if complaints against them do become subject to this principle, would be that almost any complaint a patient might make against them could be formulated within the context of that single word fitness. The risk would then encompass all aspects of competence and would inevitably encourage patients to question the ability and reasonableness of practitioners, at every level of their endeavour and behaviour.