n e w s , a n a l y s i s , o p i n i o n f o r t h e psychoanalytic c o m m u n i t y i s s u e 2 SPRING 2010

The statutory Autonomy IAPT and Innovation regulation versus brief dynamic at the 2 debate 5 accountability 10 therapy 12 Maya Centre would favourably consider this proposal. Another difficulty for many has been Of course, even if this was on the cards, the proposal from HPC’s Professional it would be no less a ‘state-sponsored Liaison Group to differentiate between Forging body’ than the HPC (instead a profession- the professions of psychotherapy and specific version of it, operating under counselling. BACP is vigorously asserting the same regulatory imperatives and that such a distinction does not stand up constraints). In any case, there is no to scrutiny and there was a large response a modern intelligence to suggest this is a likely to HPC’s consultation supporting this possibility. view. As further work is undertaken on the profession-specific standards Advocates for this proposal (who usually of proficiency, PCB will continue to profession admit in the end that it won’t happen) affirm the validity and truthfulness of will often then revert to claiming that this differentiation. At the same time making such a demand gives them we recognise the considerable points of By Malcolm Allen about the nature of the ‘moral contract’ greater leverage in their ‘negotiations’ convergence between the two professions between the profession and the public. A with HPC. In our experience, much more and the need for a system with a level of The life so short, the craft so long to full update on the latest state of play is can be achieved through a mutually permeability between them. available on the BPC website together learn respectful dialogue with HPC than Hippocrates’ Aphorisms with links to all the relevant documents. by the constant hammering of a ‘four Recently, the United Kingdom Since 2007, all the principal professional legs good [the professions], two legs bad Commission for Employment and Skills bodies have accepted that the choice of [government/bureaucracy]’ message. endorsed the National Occupational ippocrates not only the Health Professions Council (HPC) as Standards put forward by Skills for laid the foundations of regulator was the Government’s settled There are further discussions to be had Health for four major psychotherapy modern medicine but in position. We have therefore all focused with HPC and Department of Health modalities, including psychoanalytic so doing created a new on a constructive dialogue with HPC as around the preparation of the Section psychotherapy. For all the many profession.H The seventy books of the the most effective means of achieving the 60 Order, HPC’s current review of the limitations of competency frameworks, Corpus Hippocraticum mapped out the optimum form of regulation. generic standards of proficiency and this is nevertheless a sign of growing knowledge and skills expected of a certain aspects of its fitness to practise public recognition of the critical physician, alongside stringent However, this is not an easy process procedures. We are committed to working importance of psychological therapies to requirements for ethics and rigorous for the profession. A number of fault- closely with our professional body modern mental health and social care. practice. Together they shaped a concept lines have opened up, representing partners in those discussions. of professionalism that has reverberated some of the tensions and anxieties that Written between the fourth and seventh down the centuries. exist for practitioners. These issues and In our view, the evidence is that HPC centuries BCE, the (Homeric) Hymn to differences of judgement are explored is a pretty good regulator, open and Hephaestus first celebrated the gift of The modern profession of psychotherapy in the discussion between the Chairs transparent in its procedures, and craft to humanity by the blacksmith god is likewise based on a disciplined craft of BPC, UKCP and BACP, as well as responsive to the professions it regulates. of fire. Whilst it is right for us to focus grounded in training, supervision, in the article by Andrew Samuels, the This view tends to be supported by the on the many challenges ahead, perhaps continuing professional experience and newly-elected Chair of UKCP. We also positive experience of art therapists too we need to find an echo of that reflection on that practice. Psychotherapy welcome a contribution from a group described in Helen Morgan’s celebration as the modern profession of as a distinct approach emerged at the of psychotherapists recently formed to interview with Val Huet, chief psychotherapy comes of age end of the 19th century. The term was support regulation by the HPC called executive of the British first popularised within medicine and Integrity. Association of Art Therapists. psychology by Hippolyte Bernheim to Malcolm Allen is CEO describe his school of hypnotherapy; of the BPC it was then widened to encompass the ‘This is not an ‘rational persuasion’ methods of Paul easy process for Dubois and his followers. By 1905, in ‘On Psychotherapy’, Freud was championing the profession.’ this new psychological treatment in a variety of forms, of which his own was Some of the unease amongst practitioners but one. He said: “There are many ways is taking the form of opposition to and means of practicing psychotherapy. regulation by the HPC. But beneath the All that lead to recovery are good.” surface of this often vocal opposition lie a series of conflicting and probably In the past hundred years these various irreconcilable demands. Much of the ‘ways and means’ have burgeoned into rhetoric of the Alliance for Counselling several hundred different models and and Psychotherapy against State schools. Today, psychotherapy faces a Regulation is critical of regulation by range of questions critical to its evolution any ‘state-sponsored body’. Others, and and status as a modern profession. A this includes the new Chair of UKCP, number of articles in this issue explore how are calling for there to be an alternative some of these questions are being played regulator to HPC, but set up by the out currently in the UK. In a challenging same legislative mechanism, the Health piece, Patrick Pietroni takes his cue from Act 1999. This is an attempt to breathe Donald Schon’s 1970 Reith Lectures on life into the corpse of the ‘Psychological modern professionalism and calls for a new Professions Council’ which was discreetly institutional culture that can avoid the buried by the professional bodies in 2007. dangers of entropy and inertia. Claims for the realism of this demand The approaching introduction of statutory are premised on the possibility that an regulation distils a set of crucial questions incoming Conservative administration

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Council meeting in February. I now want practise, the differentiation between Statutory Regulation to ask questions such as: has the remit ‘psychotherapist’ and ‘counsellor’, the changed? has the personnel changed? how child psychotherapists’ register, have many meeting will there be? how long come back on to the agenda. People are has it got, etc.? It’s definitely a change of genuinely scared about going under Debating our direction to reinstate the PLG. something like HPC. Lynne: They are aware that we have a Psychological Professions Alliance ‘HPC is aware Group (PPAG) meeting in February and they have to professional they are interested in us, as professional associations, making comments reassure the about the work plan for the PLG. My professional understanding is that they will hold over future any recommendations to the Council until community.’ after the PPAG meeting, and take into account the information we put to them at Julian: I have concerns too over certain their March Council meeting. aspects of the HPC’s complaints procedure, e.g., that the case is published The Council of the Health Professions The differentiation between psychotherapy Julian: I think HPC is aware that they online once a determination of a ‘case to Council (HPC) met in December 2009 and and counselling was in fact recommended have a substantial amount of work to answer’ has been made. But I didn’t think considered a report from the Professional by the PLG but was challenged by many reassure the professional ‘community’. It in the end that their procedures were Liaison Group (PLG), together with responses during the public consultation. can’t just be a sort of cut-and-paste job. hugely different from ours, especially the results of a consultation on its The Council therefore decided that more They need to make sure the HPC can given how badly our profession has done it recommendations. The Council concluded work was needed on this and other issues. accommodate a non-medical profession and often still does it. that it could meet the regulatory needs of and that the standards of proficiency, psychotherapists and counsellors using its Council decided that further work on especially the generic standards of Lynne: HPC’s procedures are certainly normal ‘building blocks’ such as protected profession-specific standards of proficiency proficiency, actually reflect this. My not so different from ours. titles, standards of proficiency, etc. HPC’s would need to await the outcome of the sense is that a combination of robust chief executive subsequently wrote to current review of the generic standards opposition (to the HPC as regulator) Andrew: HPC’s system is too adversarial the Secretary of State for Health stating of proficiency. That work is intended to and the sustained discussions that we’ve and bureaucratic. We now have a lot of that HPC believed it had fulfilled the ensure that the generic standards are less been having with them on the same information about what does or doesn’t requirement of the Government’s White focussed upon the ‘medical model’ of health issues have together resulted in their get full hearings, and we have a lot Paper that it would undertake a ‘rigorous care delivery, thus providing the basis acknowledgement that there will have to of revealing information about what process of assessing their (the professions’) for regulation which is more inclusive of be a substantial rewrite (of the generic hearings are held in camera. Incredibly, regulatory needs and ensuring its system is therapeutic models of practice. standards of proficiency) in order to the HPC doesn’t know what proportion capable of accommodating them.’ accommodate us. Perhaps wrongly, I trust of fitness to practise hearings are held in The Chairs of the United Kingdom Council that they are going to do that but I have camera and doesn’t know what proportion The letter said that the Council did not for Psychotherapy, the British Psychoanalytic a slightly more benign attitude towards of requests for hearings to be held in reach a conclusion on whether the two Council and the British Association for them than Andrew does. camera are allowed or denied. proposed protected titles should be regarded Counselling and Psychotherapy explore as interchangeable titles for one profession some of the issues now at play around the Lynne: I agree. I think the Westminster Lynne: Are you saying that the or separate titles for two, related professions. question of statutory regulation. debate was a critical point, when we had counselling and psychotherapy profession Anne Milton calling for collaboration should have in camera hearings? from HPC. I think she will hold them to that should she be in post. Andrew: Probably more than HPC does, and it’s not against European law to have Andrew: I agree, and I think that the them. If you go to the website and look at Andrew: Would it be a good idea to talk robust opposition has worked. I want to the practice guidelines about in camera about the history of cooperation between say something about the HPC’s letter hearings, I don’t think you’d be terribly the three organisations: how much has to the Secretary of State sent on 23 happy. there been over the years, has the pace of December. This letter effectively says the cooperation increased or decreased, things HPC is good to go. This really isn’t an Lynne: I understand that. But at BACP, like that? accurate outcrop of what happened with we have recently experienced a huge the PLG. I think they believe that the backlash about the publication of cases Andrew Samuels Julian: During my time as BPC chair, Section 60 will be so general, that they in BACP’s Therapy Today journal. What for the last two and a half years, there can leave all these problematic issues, our professional conduct department has been quite a bit of collaboration with once they have got the ‘go ahead’ back. were doing was bringing things into a whole series of formal and informal I’m not happy with this. The professions line with expected practice within the discussions. The fact that we find ourselves are going to be extraordinarily weakened UK and Europe. I can understand your in different positions on certain things if we are arguing about things that membership’s anxiety because we had shouldn’t undermine that commitment. I matter after a Section 60 has been issued, a similar experience with our members think one of the positive outcomes of the even if it takes 18 months to get one. around the very public notifications of whole HPC period has been that we have cases of misconduct. Julian Lousada all got to know each other a lot better. Lynne: Could we look at whether our respective associations are saying they Andrew: If you don’t write up cases where Lynne: Collaboration has been very are, in principle, in support of HPC or there has been nothing found against important but I think we also need to not as regulator, and whether we are, the defendant. The problem with the acknowledge that whilst we collaborate in principle, supportive of statutory HPC system is that it can cause huge we also recognise our differences. regulation or not? difficulties in the lives of people found utterly innocent. Worst though is that Andrew: Just to get us up to date, UKCP Andrew: The question is: can we get a the thinking rules out mediation and had a meeting in December at which result? Julian thought that a mixture conciliation. However, Marc Seale has Lynne Gabriel Marc Seale (HPC’s Chief Executive) said of relentless pressure over time and confirmed that mediation was allowed that there was still a lot of work left for more recent robust argument had under article 26 of the Health Professions the Professional Liaison Group (PLG) to produced a change. For UKCP, the Order of 2001. But screeners undertaking do; it would be starting again after HPC’s questions around things like fitness to mediation had not been used because

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by the time complaints were considered cannot imagine an alternative that will psychoanalysis. This is something that come up with this extraordinary idea, as by the HPC investigating committee, have statutory authority and not struggle is missing from many of the discussions if it’s a principled position, from which the allegations were usually so serious with some of these difficult issues. It’s got about regulation. I do get from colleagues our profession is going to be strengthened. that it would not be appropriate to to be big enough to accommodate all the and students that actually there are It fragments the profession in the most arrange conciliation or mediation. HPC’s varieties of people that are being thought benefits to being regulated. One is frightening manner. legislation could be amended to facilitate about and trying to get some threshold recognition, professional recognition on mediation at an earlier stage. standards and titles; I cannot imagine an a wider platform, and the status that Andrew: It will be legal and can be made organisation at the moment that is likely comes with that. It also opens up avenues a professionally responsible position. Julian: We all want this to be a to be much better. It doesn’t mean that I to research funding, perhaps some kind At the end of the day there will be thoughtful and fair process, as well as don’t believe in robust negotiation about of centralised funding for training – a regulation. The UKCP is totally open- transparent to the complainant, which it the issues that we have been discussing. number of things that some people say are eyed about it; at the moment HPC is the hasn’t been in many of our organisations. positive. front-runner. We are also trying to look after the Andrew: What I’m saying is that UKCP clinician and their other clients or can see a possible endgame in which we Julian: Yes, I think for young people Julian: So why don’t you say so publicly patients. It’s quite difficult to meet all honestly, hand on heart, can’t recommend joining the profession, it does matter that you think on balance this will be the of these requirements. But what you are HPC; and then we know what we are that they are going into a system that case − even though there are things that saying, Andrew, confirms that HPC is going to recommend because we are very is publicly mandated, i.e., that there is have to be worked out? willing to adjust and develop some of far advanced as regards PNC. a ‘contract’ between the profession and these protocols so that we feel that the public institutions. Andrew: I’ve said a million times that interests of all three parties concerned are ‘There is a risk HPC is the front-runner. However, the as far as possible protected and respected. Andrew: To go back to what would gap is closing, and the Milton meeting that we get happen if we weren’t happy, in those and my election are but two signs of Lynne: I agree. Our three associations circumstances PNC will be an even more that. I would like your two organisations should discuss some recommendations something which attractive and large-scale activity than it’s to join with UKCP in exploring all the at the next PPAG to make to HPC in we don’t think going to be already. Just as there will be avenues. Number one is negotiating with order to amend their fitness to practise independent statutory regulation − and HPC and UKCP is doing a lot of it. I also procedures, to make them more fit for very much of.’ UKCP accepts this − there will be PNC, think, and I hope BACP will agree, that it purpose for our profession. and UKCP accepts that. Our policy, and would be a good idea to look at alternative Julian: The problem is that PNC is not a it now is our official policy, is to take care models and that would be done under Julian: Generally speaking, what is the strategy of citizenship; it’s a strategy of of both scenarios. I’m in an odd position what we could call the Convention. PNC is state of mind of the membership on individualism. If we are trying to create because my version of PNC, and I believe something that you can’t stop people from statutory regulation, and as a professional a modern profession of counselling and UKCP’s emerging version of the PNC, doing. leadership do we continue to support psychotherapy we are struggling with is actually quite stringent. It’s about as an engagement with HPC, subject to quite a large number of our members stringent as conscientious objection is in Lynne: You can’t stop it but you are negotiations? who operate as independent traders. the military context. encouraging it. Many are not comfortable with the idea Andrew: What do you mean by ‘subject to of regulation either within their own Julian: What I find confusing is that you Andrew: I am a leader and I have to negotiations’? Is it possible that BPC would organisation or from a statutory body. (Andrew) think that it’s probable that respond. find HPC in its final form unsatisfactory We need to accept that we are a modern the HPC will prevail. Yet you are always and advise the members accordingly? Can profession, and we are actually trying to arguing from a position of opposition Julian: Are you not also leading it, you imagine that happening? encourage people, at all levels, to join the rather than trying to make something Andrew? You are part of both camps. profession and grow up in it. work. Now we are talking about PNC − I Julian: Hypothetically I can − we are cannot imagine how anybody thinks this Andrew: But if you actually allowed the not giving HPC a blank cheque. We are Lynne: You are picking out some of the is good for the profession. A tiny fraction registrants of the BPC a free choice in working with their political reality and positive aspects of regulation for you and of our membership are active − and you this matter, you and the leadership of the political reality of the state of mind of our membership. I don’t anticipate that being the outcome − but certainly, if I believed that HPC regulation was prejudicial to the future of the psychoanalytic profession I would vote against it.

Andrew: But you won’t be given a vote. The only thing you can do if you don’t like it is enter, as an individual, some form of alternative professional accountability. ‘Subject to negotiation’ means there is a hypothetical scenario in which it wouldn’t be fit for purpose. Lynne I think has bravely and accurately said this with regard to the PLG process. I think that there is a risk that we get something which we don’t think very much of − then what do we do? Where are you going to vote?

Lynne: If we as a group of associations decide en masse that the final tabled statutory regulations framework is not something that the associations can live with, then we can take – hypothetically – the ‘principled non-compliance’ (PNC) route.

Julian: I have been honestly thinking about what an alternative might be. I

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the BPC may find that there is far more that they will collaborate, and we have premise that it’s a medicalised framework. in the discourse. It concentrates their support for something like PNC, and/or to hold them to that. I think if we use But we all know that HPC are committed minds wonderfully. an alternative regulator to HPC, than you PPAG to agree recommendations to put to to making change that’s more relevant for are permitting to emerge at the moment. the HPC, to inform their March Council counselling and psychotherapy. Julian: I’m aware that the one issue we meeting and the plan of work for the haven’t talked about is the differentiation Lynne: The support for an alternative PLG, they will seriously listen to us. Andrew: So we would be able to agree if it between psychotherapy and counselling. often comes from a lack of awareness and was sufficiently de-medicalised, if fitness It’s a very difficult one, and I think it’s understanding of what HPC has said it ‘In this day to practise was fit for purpose and if we one that has to be approached with a lot of will do, which is to work closely with us resolved the problem of the counselling respect. I don’t know how we’re going to towards a regulatory framework. If we and age, self- and psychotherapy differentiation, then find a way through it. were to adopt en masse a principled non- regulation is a HPC would look a lot better. There will compliance position, what is the premise always be PNC as a negotiating tactic, Lynne: I agree, it’s a seemingly intractable underlying that? Why are we doing it? dirty word.’ and I also think that it is intellectually position. My take on all this is that we can Where does that leave our clients or elegant to think about calling some sort hopefully get round the table at PPAG, be patients in terms of their perceptions of Julian: This is something that we have of Convention if the government won’t aware of our various positions, enter into us? all been working on, and now all our do it. I think the government − a new debate, and take further the conversation interventions have brought about this government − might, but they might not. that we’ve had this evening. Julian: I think that our clients will position. Now, with the work that’s still think that here is yet another profession to be done, I don’t think we need to take Julian: I just think it’s hard enough to get Andrew: We have to argue and less organising itself in its self interest. In a sledgehammer to them at this point in our membership and your membership deferentially than we have. If our three this day and age, self-regulation is a dirty time; it’s premature. clear. If we have two tracks [see page 8] organisations get together on key issues word. I would find it very hard to think the confusion and fragmentation and the then we could get a result. that our patients and clients would say Lynne: I agree, we need structured splitting that that we are so good at in our that’s a good stance. movement forward, not bickering as a community will just flourish. Chaos often Julian: I think this discussion has been group of associations, or misleading or sounds attractive. really useful, airing a bit how we’re Andrew: A lot of psychotherapists misrepresenting HPC to our members. going to navigate through these very and counsellors feel that what’s on We need to be giving them the facts as Lynne: I’m challenged by this complicated waters with our respective offer from HPC does not adequately much as we possibly can. multifaceted position on regulation. I memberships represent their work, the nature of their can’t grasp both the willingness to go work. The BACP’s response to the PLG Andrew: The thing is that the with HPC and then also the willingness document refers to the medical model professionals have doubts about what their to say that HPC are not going to shift in Dr Lynne Gabriel is Reader in Counselling and its unsatisfactory nature as regards leaderships have obtained for them thus the way that we want them, and we’ll not and Relational Ethics, Chair of the BACP, to counselling and psychotherapy. The far. go with them. and Head of Counselling and Psychology, BPC’s response refers to the overly rigid Faculty of Health and Life Sciences, York St nature of the requirement to diagnose Lynne: Where are you getting your ‘We need John University. or formulate, instruct a treatment plan, information from? deliver the treatment plan and provide structured Julian Lousada is Senior Clinical Lecturer evidence that you have delivered it. Andrew: Mostly from the election of movement in Social Work in the Adult Department of There are numerous other examples UKCP, and the fact that 4,000 people have the Tavistock Clinic, Chair of the BPC, and in the profession-specific standards signed petitions, and this is normally a forward, not a member of HPC’s Professional Liaison of proficiency, which an awful lot of very passive profession. Group. practitioners feel is utterly foreign to the bickering as way they work. Lynne: What our members are concerned a group of Andrew Samuels is Professor of Analytical about is whether HPC can achieve a Psychology at Essex and holds visiting Lynne: That’s right, but the HPC are regulatory framework that’s fit for purpose. associations.’ professorships at New York, Goldsmiths open to changing that. This fact is and Roehampton. Training Analyst, not being promoted to the members Andrew: I wanted to know really about Andrew: I don’t find it very difficult, and SAP. Registrant, BPC. Co-founder, in our respective associations, and this group in BACP, because we’ve got it people I talk to usually get it. At the very Psychotherapists and Counsellors for Social it’s perpetuating the mythology and in UKCP and I believe they’ve got it in least, the UKCP will continue, as one of Responsibility. Chair, UKCP. the assumptions that are out there. BPC. its tracks, to argue that the HPC isn’t the HPC are not always best at defending right regulator. I don’t rule anything out, themselves. They are not getting out there Lynne: Part of it is about a lack of and I certainly don’t think that HPC are vociferously enough and saying we’re understanding; perhaps we haven’t as closed as they were a few months ago. going to change this. They have made communicated clearly enough or often However, I recommend that the notion of a public statement at Westminster Hall enough. The unease is based on the HPC not being the regulator be retained

The British Association for Behavioural and Cognitive Psychotherapies (BABCP) were also invited to participate in this debate, but sent their regrets that they were unable to join us at the scheduled time.

A special section of the BPC website is dedicated to statutory regulation. Find out more and discuss your concerns at www.psychoanalytic-council.org

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government, the introduction of the Schon and his colleagues perceived Statutory Regulation Patients’ Charter led to a host of other four professional roles. The practical changes further developed by Blair: professional is pragmatic, problem- patient choice, patient partnership, and the solving, and is involved in everyday expert patient programmes. We were now clinical problems. The expert professional fully launched into the commodification claims expert knowledge which may Professional of health care. Managers were busily result in being distanced from everyday developing ‘products’ and ‘packages’ of problems, and implies a body of expertise ‘care’ that the patient/client/consumer which is unique and is difficult to share autonomy to would choose from a ‘menu’ of options with others. The managerial professional delivered by professionals, ratified by – operating as a functionary official of ‘NICE’, the carefully branded National governmental organisation – is familiar practitioner Institute for Clinical Excellence, and to us from the field of social work and put out to tender. A complete cultural social services (also referred to as the change in health and care services had bureauprofessional8). A two-tiered model been accomplished that radically changed applies when an experienced practitioner accountability the nature, language and context of becomes a manager responsible for professional activity of all kinds. personnel, planning strategies and the management of resources, and may also By Patrick Pietroni1 This nightmare scenario is clearly provide supervision. The fourth role – a caricature of how many doctors, the reflective practitioner – is the ideal, We find ourselves in a rapidly changing world and yet, as a Society, we nurses, social workers, counsellors and recognising ‘that others have important have done nothing, I repeat nothing, to meet these changes, to influence psychotherapists practice, but as the and relevant knowledge to contribute them or to adapt to them. That is not the reaction of a living organism but Bowlby quote suggests, our inertia and and that allowing this to emerge is a a moribund one. If our Society died of inertia it would only meet the fate professional tribalism have resulted source of learning for everyone. Reflective in a potential loss of the core values of practitioners look for a sense of freedom it had invited. John Bowlby, 19482 professional practice. We need now to and real connection with rather than 9 There is no established institution, moreover, which now feels adequate to return to Donald Schon’s lifework to distance from their clients.’ This model understand where we may have gone is of a professional who delights in the challenges which confront it. Donald Schon, 19703 wrong and how we may retrieve something making connections with disciplines The ‘Reflective Practitioner’ delights in another’s work and in connecting of these values from this continuing crisis. not their own, whose relationship with their patient is based on encouraging and their own to it. M. Kahn, 19774 not controlling, and who is committed ‘We have to a process of personal reflection and critical analysis that recognises the limits owlby wrote of his b. using expert knowledge as a tool witnessed the not only of their own discipline and its concern that the response of to maintain a hierarchical power- emergence of institutions, but also of themselves. the BPAS to the relationship with their clients; and establishment of the NHS in managerialism, B c. their system of self-regulation Professional organisations that refuse to 1948 was one of indifference. His remarks with accountability only to their own consumerism, adapt to the changing needs of the society are relevant today as we debate our professional group. of which they are a part will, as Bowlby approach to the impending legislation and market articulated in 1948, die of inertia. Already regarding statutory regulation. It is These three characteristics of the liberal- forces. ’ we have seen a markedly reduced intake unfortunate that the aloofness and autonomy professionals were identified of students to the trainings offered by indifference which characterised the by Donald Schon in his Reith Lectures Schon7 attracted much attention to his major psychotherapy institutions. If we professional response to the changes in (1970) as the rationale for his title: The concept of ‘the reflective practitioner’, are to survive and preserve the best of our society led to the imposition of a Crisis of Confidence in Professional applicable in every area of professional psychodynamic psychotherapy, whether ‘managerial’ and ‘consumerist’ solution, Knowledge. The solution to this crisis activity. Schon called for the liberation Freudian/Jungian/Kleinian/Lacanian or introduced by Margaret Thatcher. These described and detailed by Schon and his of the professions from the tyranny of any other specialty, we have much work changes which we have witnessed in the fellow workers unfortunately did not the university-based schools. He was to do on ourselves, our training curricula last forty years were already being reach the ears of Thatcher. She called challenging the influence of misplaced and our willingness to engage with other debated by the Socialist Medical for Sir Roy Griffiths, chair of one of the ‘scientific’ methodologies. In his view, disciplines. Association in the early ’70s. leading supermarket chains, to review the the university-based schools have management structure of the NHS. Since succumbed to the erroneous view that A key factor in creating the flexibility ‘A Labour government will need to the early ’80s and under three subsequent good professional practice is dependent of institutional culture required is some challenge (continually) the validity prime ministers we have witnessed on the use of ‘describable, testable, serious reflection on the psychological of professional activity from the the emergence of managerialism, replicable techniques derived from base of that culture and the history of State’s cost-effectiveness viewpoint. consumerism, and the introduction scientific research based on knowledge our internal and inter-group relations, Are what the professionals do of market forces in the organisation, that is objective, consensual, cumulative which are illuminating to say the least. worthwhile? Are particular clinical delivery and regulation of professional and convergent.’ His different perspective To take just two examples, it is now activities being used though they services – whether in medicine, teaching, involves practitioners ‘making judgments understood that the early ‘controversial would most certainly be useful social work or psychotherapy. Harrison of quality for which they cannot state discussions’ in the BPAS were based on and effective, whilst less useful and Pollitt6 track the emergence of the criteria, display skills for which they primitive splitting and projection rather practices are continued? To influence manager in the NHS in four distinct cannot describe procedures or rules.’ This than on defining healthy differentiations the application of health sciences phases: the professional as autonomous; perspective evokes and underlines the (i.e. war before a negotiated peace in this way, we will need more the manager as administrator; the importance of tacit knowledge and skill settlement); the ferocity of the discussions than a strong DHSS that controls manager as diplomat; and the manager as which, he argues, are some of the most and alienations spoke for themselves. distribution of resources.’ (S. Iliffe) 5 director. important aspects of professional practice. Similarly, the separation of the UKCP and He describes these different approaches to the BPC, and the debates at the margins Politicians of all parties were attempting With the introduction of the manager the professional task as a choice between of those institutions about membership, to address the problem faced by society came the accompanying processes of ‘rigour or relevance’ and uses the much- registration, regulation, training criteria whilst professionals, from teachers, audit, clinical governance, resource quoted metaphor of choosing between the and so on, have had a similar primitive architects, health and social care, to allocation, targets and external ‘high ground’ of sanitised academic rigour quality. lawyers and town planners, attempted to regulation. The professional was not only and the confusing ‘swamp’ in which most retain their centuries-old privileges of: to lose professional autonomy but was professional practice is actually carried a. they alone determining who entered to be made accountable to an outside out. their professions; body. More was to follow. Under Major’s Continued on page 7

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Val: We had to work out quickly how to inquiry that hits the headlines. It has its Statutory Regulation give art therapists a reason to belong to own governance and the question of state the BAAT once state regulation had come regulation needs to be uncoupled from in. We became more professionalised government legislation that comes from as an organization: we developed our ‘knee jerk’ reactions to events. campaigning role, liaised with official Art Therapists bodies such as the Department of Helen: There’s been a lot of concern Health to make sure that the profession with HPC’s generic standards of practice, continued to grow. We looked at what particularly their standards of health the practitioner needs to do his or her job and safety which are irrelevant for and the HPC better. Interestingly, our membership has private work. I gather that the HPC itself continued to grow since state registration, recognises that the generic standards need at a rate of about five percent a year. changing. Are they ready to involve their members in that? The member institutions of the BPC Helen: In terms of the process of Helen: I imagine that it has been made recently had an extremely helpful meeting becoming registered, are there any easier by the BAAT losing the more Val: My experience is that if there is with Chief Executive Val Huet of the things now that you wish you had done policing roles of ethics and registration. something that you feel is not right, British Association of Art Therapists, differently as an organisation? professionally, there has always been a who have been registered with the Health Val: It was such a relief. Any time way to get the HPC in a dialogue about Professions Council (HPC) since 1997. Val: I wish I’d known that another sort of anybody wishes to make a complaint it. But because it’s not always about our Helen Morgan called her for a follow-up work starts when you are State Regulated. about an art therapist I say okay, our views and our beliefs, what has to lead discussion in New Associations. You have to prepare your professional state regulation body the HPC has the the way is the issue of public protection. body for a change in roles, for the infrastructure to do that, this is who you When you approach the HPC it’s got to be Helen: What’s the history of BAAT’s membership getting active and involved need to contact and how. By the HPC argued that we are putting the client first. relation to state regulation? so that you have your professional voice taking on those roles we’ve been freed up I have always found officers of the HPC within the HPC. The HPC works with to develop art therapy as a profession. responsive and able to take on board what Val: We had become concerned over the partners from professional bodies so you is being said. Recently the public debate years by the kind of complaints made to need to have people taking up different about psychoanalytic psychotherapy and the BAAT from the public and, although roles on committees. For example, when ‘State regulation state regulation has been vitriolic, but my our ethics procedures were there, we had a new training comes to be validated one needs to be respect has grown for the HPC in that no real clout. As it is for the BPC now, if of your members needs to be involved. Or the tone of HPC officers has remained we found there had been gross violation of if there is a hearing, one of your members uncoupled from incredibly professional. the ethical code, we could take somebody will be on the panel. It’s incredibly legislation that off our membership list, but there was important that able and experienced Helen: How do you think registration absolutely nothing we could do to stop members are ready to engage in a comes from knee- impacts on the work of the training them continuing to practice. So we working partnership with HPC. organisations? decided to go with state regulation. We jerk reactions had to keep our membership as informed Helen: Does the BAAT coordinate that? to events.’ Val: Most of our training organisations as possible as to what that meant at each are within universities, so whenever step of the way. However, we realised later Val: No, but we advertise every time Helen: Many are concerned for the there is important stuff like validation or that some people hadn’t fully understood the HPC is looking for new partners sacrosanct nature of the consulting room revalidation you have to use different sets the meaning of what state regulation was. and encourage our members to apply. and its boundaries, and are anxious that of standards. Some training organisations’ We also needed very clear leadership in As a professional body there are things it’s going to be interfered with. experience of HPC is less positive because terms of moving forward, because we you can do to make sure your members of the increased work in having to meet wanted to get on to the HPC register are aware of the representation needed Val: Nobody from the HPC is going to the validating bodies’ guidelines and together with the drama therapists and and encourage people to go forward for stand at your elbow and say you must criteria. Having said that, our training the music therapists, so we were having to them. I do know from the other allied do this or that. Their concern is public organisations were actively involved in work across modalities as well as with our professions that there was concern because protection. There is a false belief with a designing the standards of education and own members. some who put themselves forward as lot of private practitioners that the private training. People will be consulted and partners were really unknown and practice room is sacrosanct. It has never they really should be encouraged to have Helen: What were the concerns within unconnected to professional bodies. That been. I think this is something that has to an active part. the BAAT membership about registration? presents a problem because you end up be challenged because should any patient with people who have a voice within HPC commit suicide, for example, your private Helen: Like the BAAT, the BPC would Val: They seem similar to the ones you who don’t really represent the consensus practitioner will be expected to be called argue that its member institutes’ training are experiencing in the BPC now. Will it within the professional body. into an inquiry. We all have to abide by and ethical standards are much higher mean I’m going to be told what to do? Are the law of this land as well as its culture than the basic standards of the HPC. we all going to have practice in the same Helen: What impact has registration had and values. This is not something that the Would the BPC need to retain its capacity way? Will this produce a uniformity of on your professional organisation? HPC creates. Any practitioner must put to validate and develop training? training or of practice? Does this mean the safety and wellbeing of their client at that we are going to lose the richness the forefront. of diversity? In my view none of these concerns have been borne out. Helen: A lot of people who have experience of the NHS dislike the Helen: How do the majority of your increase in rules, regulations, and targets, members now feel about it? and worry that this is now encroaching on private practice. Val: Art therapists don’t come in contact with the HPC very much in Val: I think people should not confuse their ordinary daily working lives. But issues. There is the ongoing attempt by at the level of the BAAT it has been the government at eliminating all risk mostly helpful. For example, last week − which is, we know, completely futile, somebody forwarded me an advert for because any work to do with psychological an art therapist who was clearly neither distress involves risk. But people should a member of the BAAT nor on the HPC not confuse the NHS with the HPC, register as an arts therapist, and all I had because they do different things. The to do was to forward that to the HPC and HPC has nothing to do with the new they dealt with it. So now we have help to guidelines which follow each individual clarify who is and who is not registered.

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Val: I think so. One thing that we haven’t platform saying they will make severe done yet in the BAAT is to place a kind of cuts. I think 2011 is the year when things quality kite mark on some of the courses, could turn bad for a lot of NHS staff. This because we do have standards which we will affect people in private practice too; feel should be met. There is nothing to nobody works within a closed system. We stop you from continuing towards your will find that when money dries up in own kind of validation. Because there will that sector it will have an effect on private be courses which will directly approach practitioners generally. With IAPT the the HPC for validation, which may well government is pushing for evidence based meet HPC standards, but not yours. practice, often CBT, and again, that’s the kind of thing professional bodies should Helen: A huge concern for registrants be very aware of. We really need to get is the ethical guidelines and complaints on with addressing these matters with procedures and how that will impact. considerable urgency.

Val: The situation is quite fair. If there State registration has had little impact is a case to answer a complaint goes to a on the day-to-day work of the individual further stage which involves a member arts therapist. But it has freed up time of the HPC, someone from the profession and energy in the professional bodies to concerned and a lay member. The focus on development and support for the person complained against can also call profession as a whole in someone from the profession to give their view. I have always found that the process has been fairly handled and that Val Huet is the Chief Executive Officer of there were good causes for there to have the British Association of Art Therapists. been a complaint. It hasn’t been a witch She is a qualified Group Psychotherapist hunt. Because the complaint is heard by and Organisational Consultant, and co- the HPC it has freed up the professional founded the Art Therapy Practice Research bodies to be called on as experts and to Network in 2000. give their professional input at hearings, and also to support the individual being Helen: What do you think has been the with our employers, for example, we’d Helen Morgan is a Senior Member and complained against. best and worst thing for your profession write to the HPC. That’s not part of the Training Analyst and Supervisor of the since state regulation? HPC role. Art therapists need to turn to Jungian Analytic section of the BAP. Her Helen: Is there evidence of an the BAAT, not the HPC, if they need some background is in child and adult mental understanding of transference and the Val: I think the best thing has been that advocacy support. health and, apart from some supervision fact that the complaint may be coming the BAAT has been freed up in terms of within the voluntary sector, she now works from within that transference? complaints and validation so that we can Helen: It sounds like you feel that in a mostly in private practice. concentrate on services for members. I way state registration is a distraction, Val: In my experience, if we explain think that works really very well. The that there are other concerns that our simply our professional terms without worst thing? It’s all pretty benign, really. professional bodies need to be focusing on. using jargon, it will be understood. My The most challenging bit has to be to experience of being recently involved make members understand the actual Val: Yes. We are especially concerned in a case was that it was a fair and meaning of state regulation. For quite a about the forthcoming cuts in services. thoughtful process, and I was able to give few years people thought it’s going to be There has never been an election before a professional view which was effective. a Big Brother, so if we had any problems when all the different parties were on the

Professional Autonomy to Practitioner Accountability

Continued from page 5

Each of these institutional crises has Professor Patrick Pietroni DSc(Hon), References also been characterised by the inward- FRCP., FRCGP, MFPH, is a SAP analyst, 1. Pietroni, P. (1999) ‘From Professional 6. Harrison, S. and Pollitt, C. (1994) looking nature of the debate. Outside retired Dean of Postgraduate Medicine, Autonomy to Practitioner Controlling Health Professionals. social and political changes and their London University. He undertakes Accountability’, Gale Memorial Buckingham: Open University Press theorisation by other disciplines that consultancy work for the Department Lecture, RCGP – South West Faculty form the context of the institutional of Health and is involved in regulatory 7. Schon, D. (1992) ‘The Crisis of discussions of psychotherapy played procedures for complementary practitioners 2. Bowlby, J. (1948) quoted in King, P. Professional Knowledge and the Pursuit relatively little part in the big debates, and health workers allied to medicine. and Steiner, R. (1990). The Freud- of an Epistemology of Practice’, Journal relative that is to the most fiercely argued Klein Controversy (1941-45). London: of Interprofessional Care 6(1) 49-63 issues. Intellectual and political energy Routledge. 8. Miller-Pietroni, M. (1998) Beyond has been focussed on sustaining what 3. Schon, D. (1970) ‘The Loss of the Stable the Bureauprofessional: Observational Schon would call ‘the expert’ professional ‘Professional State’, Reith Lectures, The Listener, study as a vehicle for Interprofessional nature of the activity of psychotherapy organisations 19 November 1970. Vol 84. No 2173 Learning and User-Centred Practice in and, within that category, on defining Community Care in Observation and its exclusive homogeneous groupings. The that refuse 4. Kahn, M. (1977) ‘Towards Collaborative Application to Social Work. Le Riche risk therefore is that psychotherapy Health Practice’, 9th Annual Meeting to adapt will, and Tanner: Jessica Kingsley institutions (which are after all a special of the American Society of Allied kind of group) have been established that as Bowlby Health Professionals. Journal of Allied 9. Schon, D. (1991) The Reflective are attempting to sustain themselves articulated, Health Workers (Winter) Practitioner. 2nd Edition. San not through an interest in differences Francisco: Josey Bass 5. Iliffe, S. (1983) The NHS – A Picture in theory and practice, but through a die of inertia. ’ of Health? London: Lawrence and defensive commitment to protecting long- Wishart established homogeneous practices. That is the way of entropy and inertia

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that many thoughtful psychoanalysts, political negotiating it fits the facts on Statutory Regulation Jungian analysts, and psychoanalytic the ground, where there are so many psychotherapists will surely want to know diverse, competing and split interests and what their options are. They may well constituencies. have had enough of being told by their leaders that they have none. Psychotherapists who doubt the value Regulation: of HPC are not immature and infantile ‘Oh,’ I hear you say, ‘I have options? No- rebellious types, poor citizens who one told me. What are they?’ Well, I have constitute a small vocal minority. Over to reply, it depends at the moment on 4000 qualified practitioners have signed Do we have what you belong to. If you are a member the petitions against HPC − not bad of UKCP, you certainly have options. If going for a profession that prefers to you belong to BPC, maybe not. Under operate quietly due to the nature of our the multi-track approach adopted by work. 1250 of them are UKCP members. the Board of Trustees of UKCP, all our Concern about HPC is so widespread in a choice? members will have a choice. They can the professions, beyond the petitions, register with HPC, and we will help that to minimise and psychopathologise By Andrew Samuels them to do so on the back of tireless and it and its significance is, as well as being forceful negotiations, going on at this very insulting and unprofessional, just plain moment, to improve what is on offer. We dishonest. Many of the best known names Ho could have will be deterred by the public, legalistic call negotiating with HPC Track 1. in psychoanalysis and psychotherapy have thought, eighteen and adversarial nature of the process, come out against HPC. months ago, when with no mediation or conciliation on offer At the same time as engaging with HPC we were all being as a means of settling a complaint. Or on our members’ behalf, UKCP is seeking, UKCP accepts that there will inevitably Wtold that HPC was ‘inevitable’ and a the screening panel will find the kinds possibly in concert with BPC and BACP, be some kind of independent statutory ‘done deal’, that there would still be so of complaints we are used to simply not to see if we can start to draw together regulation. Nevertheless, I believe that many unknown factors and so many worth hearing at all. Moreover, we don’t all the alternative means of carrying out members of the other large umbrella serious debates going on – even a move even know how big the present danger statutory regulation. This would take the counselling and psychotherapy for Judicial Review of HPC instigated by is because, as those pursuing Judicial form of the Convention on the Future of organisations such as BPC are starting to psychoanalytic organisations belonging to Review argue, they have not done the Psychotherapy and Counselling. Looking look to their leaderships to develop their UKCP. The purpose of this invited piece research − truly shocking. The fact is that for an alternative to HPC we call Track 2. own versions of what UKCP is doing. is to stimulate discussion within BPC, and HPC is not going to be able to stamp out Far from being a destructive or contrary add to that already taking place between egregiously bad practice, and its devotion But if a UKCP member does not desire movement, I think this is going to be UKCP and BPC. to the medical model is going to damage to register with UKCP, then she or he something that the leaderships and their the good work that we already do. may enter into Track 3 − Alternative members will do together. Psychoanalysis HPC increasingly seems to symbolise a Professional Accountability; and be and Jungian analysis are, after all, the cruel, mistrustful, authoritarian, deathly One recent development has been the helped to do this by the provision of legal traditions of psychotherapy for which state approach to life in society whose time emergence of a detailed conceptualisation advice as to how to present oneself as a regulation will prove the most inimical We has passed. The tick-box surveillance of what is presently called Principled Non- practitioner (what titles to use and what must avoid developing a new ego defence of culture of constant control via audit and Compliance (PNC) but is set to change to titles not to use, what disclaimers to issue). ‘identification with the regulator’! scrutiny is itself being surveilled, audited Alternative Professional Accountability There will also be minimum standards and scrutinised now, and weighed in the (APA). This is a safe, serious, legally of ethical accountability that UKCP will I would like to conclude by challenging balance and found wanting. It ticks very vetted form of alternative professional tolerate on the part of those in APA who BPC to offer its registrants a freedom few boxes in today’s political Zeitgeist. accountability to that offered by HPC. I want to stay as members. For APA should of choice on this, our generation’s most predict that it will be warmly welcomed never be a soft option, and UKCP will be crucial professional decision of our It would have been legally possible, by many therapists and I think thousands making its Central Complaints Process generation. Ask us: ‘Do you want BPC to and actually still is possible, for HPC to will take advantage of PNC. The desire available to all its members who wish to give your name to HPC, or not?’ conclude on December 10th last year that by so many to find a good way into place themselves under its jurisdiction. it could not manage to be our regulator. alternative professional accountability The Government also has options, and is one understanding of my emphatic Please don’t tell me that holding the Andrew Samuels is Chair of the UKCP, HPC has accepted this. election victory a few months ago. tensions between Tracks 1 (negotiate) and a BPC Registrant, Training Analyst of 2 (look for an alternative) is too difficult. the Society of Analytical Psychology, and Moreover, HPC isn’t working. There is I hope space will be made to present APA In the real world, negotiators do such Professor of Analytical Psychology at the no agreement on such key matters as: the to BPC registrants because it is clear now things all the time. As an approach to University of Essex. differences between psychotherapy and counselling, nor on what the profession specific standards of proficiency should be, nor on whether there should be a register of child trained psychotherapists and counsellors, nor on what changes would have to be made to their Fitness to Practise system (what we call ethics, conduct, discipline, etc.) to make it appropriate for us. The whole process has degenerated into a war of manoeuvre between the organisations.

Be warned: on the basis of UKCP’s research into the statistics and procedures of Fitness to Practise, if HPC happens, and if Fitness to Practise is not changed to a huge degree, the public will be more at risk from predatory therapists than it is at the moment (never mind the unknown problems for us as practitioners).

Complainants who wish to raise sensitive matters, involving sexuality, for example,

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Statutory Regulation New group supports HPC regulation INTEGRITY – Integrating Social Responsibility into Psychological Therapies A number of practitioners have recently come together to form a new group called Integrity that supports statutory regulation therapeutic relationship. It is the group’s the profession or resistance to regulation under the Health Professions Council. view that if we engage constructively and in principle. The government has made creatively then the HPC will be more it clear that the HPC is their choice and likely to be able to listen to concerns that have invested large sums of money and Ntegrity is a new body public about the issues regulation presents we may need to raise. They would want time in the consultation process. promoting statutory regulation for is the best opportunity to ensure that these complaints processes to be supportive psychotherapy, psychotherapeutic reflect our collective views about best to all those involved and to include As momentum grows INTEGRITY intends I counselling, counselling, and other practice. If the profession does not grasp rehabilitation as well as sanctions for to launch a petition online to establish psychological therapies. It came from a this opportunity it risks having a system example. and demonstrate that practitioners share group of practitioners who were interested imposed on it by the Government. a commitment to statutory regulation in working constructively with the The group points to several facts: as outlined above. If you believe that a government and professional bodies Regulation will have an impact on many 1. Present and future governments have a petition would express your pro-regulation towards better regulation. The information different aspects of the profession, and huge commitment to mental health. position you are asked to send an email put into the public domain by some in the INTEGRITY will seek to influence the 2. The present government is committed of support to [email protected]. If this profession, they say, has become polarised process. They are asking for all those who to regulation of psychological therapies movement generates interest they will between those who want regulation with are working with adults, children and by the HPC. 3. The timetable for the add forums for discussion. They have the HPC and those who do not, with each families across all sectors to be trained regulation process is in place but is started by identifying and prioritising defending their position. This polarisation to the highest standards, meet common flexible. 4. A very small percentage of specific issues that may emerge in these in their view leaves no space for requirements for continuous professional psychological therapists are standing forums that affect the development, constructive critical engagement about the development and embody moral and against regulation and making a modification or application of regulation details of regulation. INTEGRITY aims to ethical practice. They believe that the disproportionate representation to the of our profession. In this way they create this space by presenting the facts as diversity of psychological therapies should public. hope to develop policies collaboratively they see them and looking at the shared be protected in this so that the public has that can be recommend to professional reality of practitioners, the public, the a choice about how their psychological They claim the HPC have shown they are organisations, the HPC and policy makers government and the professional bodies. well-being is addressed. interested and available for dialogue and in the Department of Health and the that they can be open to change. Already Government. INTEGRITY say they want to gather ‘In a relational HPC have rewritten some of their central the voices of all those in the profession documents so as to address any medical Regulation is a system with the client/ who see regulation not as a threat dialogue, both bias in the language which they welcomed patient, professional, professional to our independence, but rather as a as a positive change, and have made it organisations and an independent regulator demonstration of the commitment of the parties can be clear that more work needs to be done as the main elements. Part of INTEGRITY’s profession’s desire for society’s recognition changed.’ on the standards of proficiency before intention is to bridge between the policy of the importance of what we have to everyone will be able to feel confident makers, professionals and the public who offer to the psychological life of the The group says that regulation will free up and take ownership of these collectively. are most involved in developing or applying country. They believe that through that access to funding both by the government The group feels it is important to work regulation to ensure that everyone is recognition our voice will be strengthened and public-private partnerships for the developmentally with HPC to find the informed of the recommendations that and given legitimacy in many arenas. delivery of services and research in a right way forward on all issues related to emerge from these forums. They will use This includes jobs, social reform, wider range of approaches and settings. training standards and fitness to practise. the media to raise awareness of the issues government issues and status equal to They want us to be able to contribute to They do not support the approach to the and promote these ideas. the position of trust and responsibility the development of these services and to profession for funding towards a judicial we already aspire to and hold. They influence the kind of research evidence review and believe this to be an unhelpful In a relational dialogue both parties believe that regulation means that the that is used to justify the funding of intervention at a time when we are trying can be changed, which is a central tenet psychological therapies have come of age. services. They believe that unless we are to earn mutual trust in a newly emergent at the very heart of psychotherapy, able to do this the richness and diversity of relationship with our regulator. psychoanalysis and counselling. It is the An aim of INTEGRITY is to promote an approaches that exist currently will die out. belief of INTEGRITY that if we enter into open public forum through its website to Those already committed to INTEGRITY an effective partnership with the PCH they inform the debate about how regulation INTEGRITY is also aimed at those who believe that we have important will become the ‘fit for purpose’ regulator should be structured. They want to want our profession to develop more contributions to make in all these we need them to be, and we can develop harness our profession’s vision and robust and transparent systems to ensure areas and that the HPC has already towards the transparent and accountable concerns to formulate a coherent, pro- that we are accountable to the public demonstrated that it will listen to our profession we need to become. The group regulation strategy and present it to the and to each other. They believe that an views. They want to get on with the job is anticipating a good response to this government, the public, the media and independent regulator is vital in the now and not become entangled in tactics initiative, and hopes that in creating this professional organisations. The group 21st century to ensure that the public that may damage what we have achieved space many in the profession who currently believes that engaging in a full and critical is protected, and also want complaint so far. The group is not interested in feel that their views and concerns are not dialogue with politicians, bureaucrats, systems to develop in a way that takes full exploring other avenues of regulation, and represented will express the voice that professional organisations and, most and sensitive account of the complexities thinks that such tactics have more to do they say is being drowned out importantly, the practitioners and the involved in our work, such as in the with maintaining the hierarchies within

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their relationships. Although the patient which organises DIT’s therapeutic thrust, may well experience his or her problem as ‘I then follows, which is to identify typically IAPT supports cannot sleep or concentrate’, the DIT therapist one dominant and recurring unconscious reframes the symptoms of depression as a interpersonal pattern. This pattern is manifestation of a relational disturbance, underpinned by a particular representation of which the patient cannot understand, or self-in-relation-to-an-other that characterises brief dynamic understands in a maladaptive way, attributing the patient’s interpersonal style and that to him- or herself and others motivations leads to difficulties in his or her relationships which are unlikely or unhelpful. Once the because it organises interpersonal behaviour. patient is helped to make some changes in These representations are typically linked to a therapy the way he approaches his or her relationship particular affect(s) and defensive manoeuvres. difficulties, depressive symptoms are typically Affects are understood to be responses to the alleviated. activation, in the patient’s mind, of a specific By Alessandra Lemma self-other representation. As with other brief dynamically oriented ast year nice reviewed its were necessary (e.g. transference focused approaches, the overarching principles in Past experiences, while clearly informing guideline for depression, treatments, supportive and expressive DIT are rooted in psychoanalytic ideas that current functioning and internal object- originally issued in 2004 (see psychotherapy). Acquiring special techniques emphasise: relations, are not the major focus of DIT. Daniel McQueen’s article in such as systematically confronting defenses • the impact of early childhood experiences on They may be included in the formulation NewL Associations, Issue 1). This revision states (Short Term Psychodynamic Psychotherapy), adult functioning shared with the patient so as to meaningfully that the clinician can consider offering short- or focusing exclusively on the transference • the internal and external forces that shape the frame his current difficulties in the context term psychodynamic psychotherapy to adult relationship (Transference Focused mind and therefore inform our perception of of his lived experience over time, but they are patients with depression who decline an Psychotherapy), did not seem necessary ourselves in relationships with others not a central component of the therapeutic antidepressant, CBT, IPT, behavioral procedures for DIT. Many equally efficacious • the existence of an unconscious realm of process. Rather, given the brief nature of activation and behavioral couples therapy. therapies do not require these specialist skills. experience that is a motivating force the therapy, the focus is on a core segment This advice comes, however, with the caveat Incorporating them into the manual would • the unconscious projective and introjective of the patient’s interpersonal functioning that it is incumbent on the clinician to also add considerably to the training burden, processes that underpin the subjective that is closely connected with the presenting inform the patient of ‘the uncertainty of the since their acquisition demands a significant experience of relationships symptom(s). The identification of an effectiveness of psychodynamic psychotherapy commitment on the part of those trained in • the ubiquity of the transference, by which interpersonal-affective focus IPA( F) is the in treating depression.’ Notwithstanding this long term therapeutic approaches. patients respond to others, and to the core task of the initial phase (sessions 1-4). cautionary note, brief psychodynamic therapy therapist, according to developmental The IPAF guides the therapist’s interventions is now going to be made available for depressed Consequently DIT has been developed so that models that have not been superseded or during the middle phase of the therapy patients through the Improving Access to clinicians with a psychoanalytic/dynamic challenged. (sessions 5-12). The last four sessions (13-16) Psychological Therapies (IAPT) initiative. psychotherapy or counselling training can are devoted to helping the patient explore the readily acquire the specific priorities and DIT aims first to help the patient understand affective experience and meaning of ending In December 2009 the IAPT Programme competences associated with short-term the connection between his presenting the therapy, to review progress and to help Board commissioned the Tavistock and therapeutic work. DIT is specifically designed symptoms and what is happening in his him or her to anticipate future difficulties/ Portman NHS Foundation Trust and the to address presenting symptoms of depression relationships through identifying a core, vulnerabilities. Anna Freud Centre, in partnership with the and for delivery within the context of a unconscious, repetitive pattern of relating that BPC and APP, to develop a manual defining primary care or IAPT service. becomes the focus of the therapy; and second, The training takes place over four days, practitioner protocols for the delivery of brief to encourage the patient’s capacity to reflect followed by two supervised cases. It is open psychodynamic therapy within IAPT. This on his own states of mind and so enhance his to clinicians who have a Diploma level manual is based on Dynamic Interpersonal ‘Principles in ability to manage interpersonal difficulties. qualification or equivalent in psychodynamic/ Therapy (DIT) – an intervention that was DIT are rooted in It primarily targets symptoms, interpersonal analytic psychotherapy or counselling. The piloted within a primary care service in functioning and the capacity to think about next course is scheduled for 28 September Tower Hamlets in 2009. Mary Burd and her psychoanalytic and understand changes of mood. It does not to 1 October 2010. Contact Wendy Smith at team of clinicians followed the effectiveness ideas. ’ aim to address characterological problems. [email protected] of DIT using the measures in place currently in IAPT sites, and observed symptomatic DIT formulates the presenting symptoms of Without making any specific, generalised improvement outcomes, equivalent and mood disorders as responses to interpersonal assumptions about aetiology, DIT adopts Professor Alessandra Lemma is Head of superior to those reported in the examination difficulties or perceived threats to attachments an idiographic approach to formulation. Psychology at the Tavistock and Portman of CBT therapies in IAPT settings. Qualitative (loss/separation) and hence also as threats The primary task of the initial phase, NHS Foundation Trust, Visiting Professor in user data also suggests the model is felt to be to the self. It is hypothesized that these Psychological Therapies at Essex University, acceptable and accessible to a wide range of perceived threats can both result from and and Editor of Psychoanalytic Psychotherapy. patients as seen routinely in a primary care cause difficulties in thinking clearly and service in a deprived part of Inner London. realistically, not only about the external world References but also about the internal world, one’s own Fonagy, P., Roth, A., & Higgitt, A. (2005). The DIT is a manualised, time-limited (16 thoughts, feelings and experiences of the self outcome of psychodynamic psychotherapy for sessions) intervention (see Lemma, Target with others. Obtaining a better understanding psychological disorders Clinical Neuroscience and Fonagy, 2009) that was explicitly of one’s subjective reactions to threats, making Research, 4, 367-377. developed out of the Psychoanalytic/dynamic implicit anxieties and concerns explicit Competences Framework (Lemma et al., through improving one’s ability to reflect on Fonagy, P., Roth, A., & Higgitt, A. (2005). 2008). DIT is a distillation of evidence- one’s own and other’s thoughts and feelings, Psychodynamic psychotherapies: Evidence- based brief psychoanalytic/psychodynamic will improve the ability to cope with current based practice and clinical wisdom. Bull treatments put together from manualized attachment related interpersonal threats and Menninger Clin, 69(1), 1-58. approaches that have been tested in at least challenges. Fonagy, P. (in press). The changing shape of two randomized controlled trials (see Roth clinical practice: A comprehensive narrative and Fonagy, 2005; Fonagy et al., 2005a&b; DIT is based on the premise that analytic review. Psychoanalytic Psychotherapy Fonagy, in press). formulations of neurotic conflicts are overspecified.T o this extent DIT does not seek Lemma, A., Roth, A., Pilling, S. (2008) The In examining evidence-based psychodynamic to prescriptively identify particular dynamic competences required to deliver effective treatments as part of identifying skills conflicts and early experiences presumed to psychoanalytic/psychodynamic therapy. and competences for national occupational be associated with mood disorders. Rather, www.ucl.ac.uk/CORE guidelines (NOS), the working group was DIT’s starting point is rooted in the common Roth, A., & Fonagy, P. (2005). What works struck by the variety of specific complex clinical observation that patients who present for whom? A critical review of psychotherapy procedures that different ‘versions’ of brief as depressed and/or anxious invariably also research (2nd ed.). New York: Guilford Press psychodynamic therapy models suggested present with difficulties and distress about

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cases, which are more appropriate to that category. This will not affect the Growing psychotherapist part of our register, but will respect the professional integrity of this other modality in its own part of the the BPC: register. Some of the BPC’s criteria for training in these other categories seem less Frequently stringent than within other registering bodies. Is this right? In some ways it could appear so, particularly in the psychodynamic asked psychotherapy and psychodynamic counselling categories. Some other registering bodies require more hours as a minimum than we do, for example. questions However, this only matters if we are not confident in the quality of the trainings we BPC Registrar Jan McGregor Hepburn MI. These decisions were made following are taking in, or if we feel we are not able and the Registration Committee thought extensive assessment of the trainings and to refuse an application. What matters, we it might be helpful to give an update on their organisations according to previously think, is what is done within the hours. the developments which are taking place agreed criteria. Two other applications are psychoanalytic/psychodynamic section of in widening BPC accreditation, since this in process. There has been considerable the UKCP at that time. What distinguishes our criteria in these policy was agreed at the strategy meeting interest and other serious enquiries. new categories are the requirements in 2008. Is it tactful for the BPC to register, in for at least one long case, and that our Just remind me… why is the BPC doing a separate category, something called psychoanalytic psychotherapists/Jungian What new categories have we this? psychodynamic counselling when analysts/psychoanalysts will do the accepted since the BPC agreed to In May 2008 the BPC held a Strategy it is trying to retain the distinction teaching, training therapy and supervision. expand? Day to which all its MIs sent delegates. between psychotherapy and They are also usually required to have had To date, four new categories have been We discussed the future of the BPC, and counselling for HPC registration? some experience of working or training agreed. the possibility of broadening its remit, When this policy was agreed about a year within whichever of our categories the The Couples Psychoanalytic whilst maintaining our standards and our ago, the BPC Council was given reasons aspirant training would belong. Psychotherapy (CPP) category confers psychoanalytic focus. Overwhelmingly, to suppose that HPC would make such registration in the Couples category, and the meeting voted for expansion of the a distinction: without it the baseline for This means that, whatever the frequency member institute (MI) status on their BPC to take in trainings ‘of rigour’ with a registration, which would have to include of the training therapy of the course, training organisation. psychoanalytic base. short-term and beginning counselling the training therapist would be someone Psychodynamic Psychotherapy (PPT) trainings, would be so general as to be who could be a training therapist for any confers registration in the Psychodynamic The Executive recommended this for meaningless. of our psychoanalytic psychotherapy/ Psychotherapy category, and the training several reasons. Philosophically, we Jungian analysis/psychoanalysis MI organisation would come into the BPC believe that BPC should be able to bring More importantly, however, we believe trainings. Similarly, supervisors and through evolving links with an existing psychoanalytic practitioners, and others that we are best placed to hold the clinical seminar leaders would normally MI. who use psychoanalytic theory in their distinction between psychotherapy and be qualified to act as such in any of Psychodynamic Counselling (TPC) work, under one umbrella. This will counselling, and the associated levels of these same trainings. In some of the confers registration in the Psychodynamic enable us to speak with authority about training, precisely because we do have aspirant trainings, especially in the Counselling category, and the training the profession as a whole, and give people a psychodynamic counselling category. regions, this may not always be possible. organisation would come into the BPC a psychoanalytic ‘family’ to which they We are saying that we know there is a The Registration Committee will look through evolving links with an existing can belong. Pragmatically, we need to difference which can be articulated, and carefully at the current non-BPC staff, MI. find ways of bringing younger people in; those who apply to us in this category and the psychoanalytic quality of the The Application Trainings (APPT) our demographic is truly frightening. are subscribing to that, too. It goes along clinical work being done, and will discuss category does not confer registration, Put bluntly, if you are re-reading this with us being the Psychoanalytic Council with any aspirant training their future since graduates are not trained to in fifteen years’ time, as well as having − i.e., taking under our umbrella all plans to move towards a greater use of psychotherapy practitioner level, but excellent filing, you will be likely to have those practitioners with similarly high BPC registrants where possible. the training would be BPC accredited, excellent health, and possibly a difficulty standards who use a psychoanalytic assessed and overseen by the BPC. in retiring! theory base − and keeping very clear, In these ways we aim to establish that the inside our organisation, the differences psychoanalytic approach is absolute, and In all categories which do not confer MI Politically, if psychoanalytic thinking is to and distinctions. that there is a wish for it to be developed. status, the prospective ‘home’ MI would survive and even flourish in this current The spectre of trainings wanting to join normally be involved in the assessment climate, we need to be a big player on Doesn’t your accepting categories us because somehow we have set our bar process. the national stage. At the moment we of membership which don’t require too low has not much basis in reality if we punch well above our weight; we need individual training therapy go against hold on to our strategy and keep clear that We have also just drawn up criteria for a more members. We have also suffered everything the BPC stands for? we can, and do, assess what is sufficiently group analysis section, and are working politically from the charge of elitism. The BPC continues to hold to its core psychoanalytic in orientation, and outlook, on criteria for IAPT psychodynamic values for individual training therapy for for us. trainings. Why is this different from the situation those practitioners who will be registered which caused the BPC to leave the with it as individual psychotherapists/ What can I do if I have further Who have we accepted so far? UKCP all those years ago? psychoanalysts/ Jungian analysts. We questions? There has been one new MI accepted We should remember that those who require training therapy to be, at a Email the BPC Registrar, in the new couples section: the British apply to the BPC do so because they value minimum, at the same frequency as the [email protected], who hopefully Society of Couple Psychotherapists its basic psychoanalytic principles, and training specifies for training cases. We should know, or at least will find out! and Counsellors / Tavistock Centre for want to participate. There is therefore a always recommend a minimum of three Couple Relationships, formerly TMSI. commonality of interest, which will be times weekly training therapy. Two trainings have been accepted in the tested and held within our accreditation Jan McGregor Hepburn is the Registrar psychodynamic psychotherapy section: processes. However, for applications of of the BPC and a member of the North of one is the Tavistock training D58 and psychoanalytic theory, for instance England Association of Psychoanalytic D59 combined; the second is within the As many of our UKCP survivors can attest group analysis, there will be other Psychotherapists. new BAP training, with the BAP as the this was definitely not the position in the models of training therapy, and training

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On The Frontline

The Maya measures of child wellbeing. What is was abuse. It was such a relief to be able to needed is follow-through in the form of take herself and her feelings seriously.’ ongoing rather than ‘crisis’ funding − bearing in mind that two women a week ‘Working with people not used to the idea Centre are killed in domestic violence in this of unconscious feelings means treading country. a careful path between speaking directly By Julia Vellacott in the transference, and holding in mind Is the lack of funding for the poorest part a psychodynamic way of thinking. One of a distaste for the most deprived and woman, very deprived in childhood, said N JUNE 2009 the Maya Centre individual and group work. In 2008-9 the marginalized in our society, so often seen to me, “I wish you were my mother!” With was the proud recipient of the Centre provided assessments, counselling as the authors of their own misfortune? another, the links between past and present BPC’s first Award for Innovative and group therapy for 322 women and Lynsey Hanley, in her remarkable book on might only very slowly feel real.’ Excellence. This was also the worked with 55 to 60 women each week. council housing, Estates, writes of ‘the fear yearI of the Centre’s 25th anniversary − 25 Members of staff spoke to 360 women and hatred of the impoverished’: years of providing free psychodynamic on their helpline and assisted 380 other ‘Sadness, loss counselling for some of the most deprived professional organisations. Any connection between the physical, women in Islington. Much has changed and grief may economic and social isolation of council over the last 25 years, but the founding Clients come from a range of ages and estates and the sometimes desperate never have aims of the organisation remain the same: ethnic groups. The Centre currently behaviour of their tenants is ignored, first, to promote the mental wellbeing of supplies counselling in English, Farsi, been named.’ or dismissed, or laughed at because women on low incomes through the French, Portuguese, Spanish and Turkish. that’s what they’re there for: to contain provision of psychodynamic counselling; It provides specialist counselling for ‘Seeing very deprived clients once a week the undeserving, un-useful poor. If secondly, to spread the word about work of refugees, Irish, black and older women. makes it very important to understand the feckless poor did not exist, neither this kind as widely as possible. In recent All counsellors are professionally qualified the unconscious dynamics. Counsellors would council estates. Now, do you see years the latter has involved constant and receive professional supervision. have to carry very heavy projections why they’re not worth spending money outreach work by the staff. The and transferential pressures: extreme on? organisation has also put on eight public A core principle of the Maya Centre is the anxiety, feelings of intimidation, grief lectures on ‘Resilience’ (2005-6) and held a provision for the most deprived of high- and hopelessness. You walk away at the There are obvious parallels between the parliamentary briefing on P‘ overty and quality, psychodynamic counselling − as end of the day feeling slightly punch- blaming and exclusion of people who Mental Health’ (March 2009). The Centre opposed to antidepressant medication, drunk, carrying all the feelings yourself. live in council housing and the scarcity has recently started a programme of still the most common form of treatment Supervision is crucial in helping to find of funding for the most abused women. research on its work. available from GPs for emotional some ground and keep your thoughts on Is this rooted in denial and projection problems; and as distinct from behavioural track. Despite all the pressures the work can as well as very real political interests? All women seen at the Maya Centre are forms of treatment such as CBT. CBT, as a be very moving and rewarding.’ Do the young project into the old, the on incomes of £11,000 or lower, £15,000 short-term treatment focussing on rational comfortably off into the poor, the ‘strong’ for those with dependents. None, with the thought in the present without reference As far back as in September 1918, at into the ‘weak’, their own strains and exception of a few refugees, have had any to early experience, is not able to go far the 5th International Psychoanalytic apprehensions? higher education or previous experience enough in exploring the conscious and Congress, Freud proposed a radical of counselling or psychotherapy. Clients unconscious roots of disturbance involved mental health service in the form of free, The Maya Centre stresses the importance are seen once a week for up to a year, for in medium to severe emotional difficulties, psychoanalytic clinics: of the best possible help for those under such as those experienced by virtually all the greatest financial, social and personal Maya clients. A large proportion of women ‘The poor man should have as much strain. Here are some reflections voiced by receiving counselling at the Maya Centre right to assistance for his mind as he Maya counsellors. were physically or sexually abused in now has to the life-saving help offered childhood, may currently be in situations by surgery… out-patient clinics will be ‘Many of the women we see have never had of domestic violence, may have children started, to which analytically-trained the opportunity to speak and be heard. They of their own. It is now accepted that social physicians will be appointed, so that may feel enormous shame about things they change in developing countries needs to men who would otherwise give way have never spoken about before − poverty, start with the proper care of women. This to drink, women who have nearly sexual abuse, deprivation, lack of schooling is no less the case in this country. succumbed under their burdens of − and enormous isolation. They have privation, children for whom there is many stories to tell. If memories are very Another feature that has not changed for no choice but between running wild fragmented there is huge value in being the Maya Centre is the constant battle or neurosis, may be made capable, by able to construct a narrative. Even then they for funding − the Centre is a charity analysis, of resistance and of efficient may feel very numb − feelings of sadness, and has to raise all its own finance. work. Such treatments will be free…’ loss and grief may never have been named, In 2009 a major grant for a domestic they may not even recognise that they have violence project was withdrawn by Safer The first Polikliniks opened in Berlin such feelings. They may wonder, ‘Did this Islington Partnership − because the and Vienna in the early 1920s and were really happen?’ The counselling gives them Partnership’s own budget from central followed by free psychoanalytic clinics a chance to speak about their lives, to be government was £400,000 less than in a number of towns and cities all heard and affirmed, to begin to understand expected. Replacement funding is not over Europe. Today the Maya Centre is the unconscious choices they have made, easy to find. Many organisations report one among very few organisations in the repeating patterns in their families and that domestic violence is ‘difficult to this country to offer free, high-quality their own lives.’ fundraise for’, is ‘unattractive to donors’. psychodynamic help to the poorest. We see, for example, rape crisis centres Innovative indeed ‘Things kept inside can feel enormous and and women’s refuges currently closing overwhelming. One middle-aged woman all over the place. The nation mourns the had never before spoken of the sexual abuse deaths of Victoria Climbie and Baby P. Julia Vellacott is a psychoanalytic she had experienced as a child. She had and is shocked at the UNICEF report of psychotherapist working with adults in always blamed herself: “What did I do to 2007 documenting Britain’s rock-bottom North London. She is a Clinical Trustee at get this?” she asked herself. “I should have position amongst ‘wealthy nations’ on the Maya Centre. said no.” She had never understood that it

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Lastly I think there is now greater As far as universities are concerned, I recognition amongst ‘traditional’ am not sure whether they would be a trainings of the value of once-weekly safe haven. (The University of Exeter, Rethinking and/or NHS work. A stellar example although it has opened its doors to the of this is the NEAPP’s training, which MSc, carries out occasional terrifying since its inception in 1992 has included a purges of unpopular or unprofitable once-weekly supervised case experience, departments.) But universities are training embedded in an intensive (three times support systems par excellence for anyone weekly) training. This acknowledges, wanting to learn about, or undertake, A Trainee’s Perspective and helps trainees to reflect on, the the psychotherapy research which has real differences between more and less been so sorely lacking in our trainings. By Frances Roper intensive practice. One hopes that the Of the handful of American researchers BPC’s recent inclusion of less intensive currently pioneering new and exciting trainings amongst their Member ways of measuring and evaluating N his New Associations article opportunities for people wanting to Institutions will likewise promote psychoanalytic process, almost all are ‘A Training for the 21st Century’ undertake a London-based training from dialogue and greater understanding of on the faculty of major universities (see (Issue 1), Jeremy Holmes other parts of the UK. For example, the the different kinds of practice. Luyten, Blatt and Corveleyn 2006). This addresses the need for Tavistock and Portman’s Interdisciplinary might be a future path if we are serious psychotherapyI trainings to adapt in Training in Mental Health (aka M1), I have the impression that these changes about validating and scrutinising our accordance with the contemporary Option 5 for clinical psychologists, fits are not undertaken lightly – they are not practice through objective means zeitgeist, and describes the University of the formally taught parts of the training simply a capitulation in the face of fewer Exeter’s MSc course as an example of how into one day of the week only. In addition, applicants to the trainings, although that this might be achieved. Robert Wallerstein the use of telephone conferencing – is a factor. The Lincoln, for example, Dr Frances Roper is a Lincoln trainee and expressed similar concerns in his recent pioneered in our field by the Institute thought long and hard about whether currently Secretary of the BPC Trainees’ IJPA article about psychoanalysis within of Psychoanalysis in 1998 – has been to allow me to link in by telephone, Association. the universities. Although Wallerstein taken up by some other trainings, notably and still reviews the process regularly describes an American rather than British the Lincoln Centre at which I am the with trainees and seminar leaders. The References model of psychoanalytic training, he first (though not the only) trainee to be NEAPP too recently reviewed with voices a widespread concern that unless allowed to join the weekly theoretical trainees whether they wanted to keep a Luyten, P., Blatt, S.J., Corveleyn, J. (2006) this training is made secure – for example seminars over the telephone. This practice once-weekly component to their training Minding the gap between positivism and by becoming embedded in a university now enables some of us who could not (they did). Trainings are seeking to adapt hermaneutics in psychoanalytic research. setting – it may ‘become increasingly otherwise undertake an intensive London- in a thoughtful way, recognising as far JAPA, 54: 571-610. marginalized and diminished’ based course to do so. Some (though as possible what the gains and losses are (Wallerstein 2009 p. 1120). not all) analytic supervisors support with all these developments. It remains Wallerstein, R. S. (2009) Psychoanalysis this development by providing varying to be seen whether these changes can in the university: a full-time vision. IJPA, On the other hand, psychoanalysis amounts of supervision via the telephone. help to sustain psychoanalytic training 90: 1107-1121. has always relied on an obstinately This move towards greater accessibility as a valued professional model in the independent capacity to critique and is hopefully loosening up a previous, very 21st century, especially amongst a challenge any prevailing ideology. This restrictive, bottleneck in training which proliferation of other types of therapy applies whether the status quo being I think has, in the past, damaged our training. challenged is an individual’s habitual credibility across the country as a whole. way of thinking, a political dogma or psychoanalytic concepts themselves, ‘Trainings which are always finding new forms. This BPC Trainees’ Association psychoanalytic independence of thought are seeking exerts some tension against the evident I would like to take the opportunity to important that we should have a voice need to adapt according to the prevailing to adapt in a introduce the BPC Trainees’ Association in the way in which we are trained to circumstances in which we find ourselves. thoughtful way. ’ to the readers of New Associations. engage in professional work, and in so The Trainees’ Association arose out doing to have a voice in the future of I suspect this tension exists within every Second, I think there is now a greater of a trainees’ conference held in May our profession. 2009. There was a feeling amongst trainee hoping to survive the training flexibility within trainings, with a move On Saturday 8 May 2010 we many trainees that there is a need for without too much personal discomfort towards helping trainees progress at their are holding our second trainees’ us to have our own organisation under or economic hardship. We want the own pace from one level to another. For conference, at the Institute of the umbrella of the BPC that would training to be practical and possible, but example the Severnside Institute have Psychoanalysis: ‘Making Contact’. specifically cater for our interests. at the same time we do not want it to be split their six-year intensive training Mary Target will be our keynote The Trainees’ Association is here to only ‘do-able’. We have all found at some into two separate components: a pre- speaker. We hope that this will provide represent all trainees on BPC accredited stage that psychoanalytic learning is not clinical and a clinical component, which an opportunity to get to meet and trainings. necessarily easy or straightforward, that it are recognised independently. Along know each other better across the does involve challenging a status quo, and similar lines, the LCP has extended its At the meeting where we brought the membership institutions, and to learn that although this takes time and effort Introductory Course into a two year new association into being we agreed from one another as well as from it can bring valuable rewards. Otherwise Foundation course, the second year of that the benefits of a trainee association experienced trainers. The final part presumably we would have chosen some which replaces the pre-clinical section of are: of the day will be our first AGM, and easier career? the Qualifying Course. At the Institute of • Information-sharing and support that will give everyone an opportunity Psychoanalysis, the New Entry Scheme • Networking to participate in choosing the officers Of course none of us want to carry this allows psychoanalytic psychotherapists of the association for the coming year. to the point of professional suicide, and to progress towards becoming full • A collective identity through discovery For more information please see the it is good that the ‘traditional’ trainings analysts without having to start over of similarities and differences BPC website. have in fact developed many substantial again from scratch. And the BAP offers • Strengthening and creating a cohesive modifications in recent years, which make some flexibility for trainees to move voice/platform for BPC trainees This conference is intended for all of us who are trainees, so please do come them more in keeping with the between a twice-weekly psychodynamic • Contributing to the aims of the BPC 21st century. I think these developments course and a more intensive thrice- if you’re able. If you would like any • Organisation of events of fall roughly into three categories. weekly psychoanalytic version. All these further information please contact common interest to trainees of developments effectively give much your rep from your MI, or contact me psychoanalytically-oriented trainings. First, training has become far less greater control over the process to the at [email protected] restricted to London alone. There are trainees themselves, and should lessen the We also recognise that, as the trainees more trainings outside London (such ‘esoteric guild-like culture of training’ are the future of the profession, it is Rory Reynolds, Interim Chair as the BAP’s Wessex training and which Holmes describes as anachronistic. the NEAPP) and there are also more

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24-27 March 2010 8 May 2010 JUNE Diary EPF Annual Conference: Passion, BPC Trainees’ Conference Love and Sexuality in Psychoanalysis Institute of Psychoanalysis, London W9 5 June 2010 MARCH Hilton London Metrople Speaker: Mary Target Trauma & the Loss of Soul Register online at www.epf-fep.eu [email protected] Staff House, University of Birmingham 13 March 2010 www.psychoanalytic-council.org Speaker: Donald Kalsched Couple work in different contexts 29-30 March 2010 Contact: Sue Harford, Jungian Training TCCR, 70 Warren Street, London BPS Psychotherapy Section: Beyond 8-9 May 2010 Committee Administrator, 0844 631 341 Speakers: Pauline Hodson, Viveka Nyberg, Words: Trauma and the Human Condition Jacques Lacan Today [email protected] Avi Shmueli Van Mildert College, Univ. of Durham University College London Contact: Administrator, BSCPC, Speakers: Paul Gilbert, Phil Mollon Speakers: Lionel Bailly, Bernard Burgoyne, 5 June 2010 020 7380 1979, [email protected] Contact: Mandy Hemsill, 0116 252 9555 Kirsten Campbell, Lorenzo Chiesa, Metaphor & Metamorphosis: [email protected] Jason Glynos, John Phillips, Alain Vanier Staff House, University of Birmingham 14 March 2010 Contact: Nicola Harding, 020 7678 5997 Speaker: Margaret Wilkinson Film and Discussion: Il Postino APRIL [email protected] Contact: Sue Harford, Jungian Training ICA, The Mall, London SW1 Committee Administrator, 0844 631 341 Speakers: Andrea Sabbadini and 17 April 2010 9 May 2010 [email protected] Cheryl Moskowitz Portman Symposium: Film and Discussion: Contact: [email protected] Contemporary Psychoanalytic Ideas The Enigma of Kasper Hauser 13 June 2010 www.psychoanalysis.org.uk/events.htm 112a Shirland Road, London W9 ICA, The Mall, London SW1 Film and Discussion: The Idiots Speakers include Rosine Jozef Perelberg Speakers: Andrea Sabbadini and ICA, The Mall, London SW1 15 March 2010 and Gregorio Kohon Cheryl Moskowitz Speakers: Andrea Sabbadini and Film and Discussion: Laid Down Contact: Jane Delafons, 020 8938 2487, Contact: [email protected] Cheryl Moskowitz Birmingham Medical Institute, [email protected] www.psychoanalysis.org.uk/events.htm Contact: [email protected] 36 Harborne Road, Edgbaston, B15 3AF www.psychoanalysis.org.uk/events.htm Speaker: Emily Cooper 15 May 2010 17 April 2010 Richard Lucas Memorial Event Contact: West Midlands Institute of Young Children: 26 June 2010 The Psychotic Wavelength: Psychotherapy, [email protected] the family and the wider world Illness and Cure: Understanding and The contribution of psychoanalytical www.wmip.org Heaves Hotel, nr Kendal, Cumbria LA8 misunderstandings between analysts and understanding to severe and enduring patients Leaders: Margret Randall, Kathy Duguid mental illness Contact: Mary Block, The Melanie Klein 17-19 March 2010 Contact: Course Administrator, NSCAP, The Great Hall, St Bartholomew’s Trust, 020 8883 1700, [email protected] British and Irish Group for the 0113 305 8750 | [email protected] Hospital, West Smithfield, London EC1A www.melanie-klein-trust.org.uk Study of Personality Disorder Contact: Marjory Goodall, 020 7563 5016 10th Annual Conference 18 April 2010 [email protected] The Nottingham Belfry Hotel 30 June 2010 Jung and Film: Ernest Jones Lecture Speakers: Patricia Cohen, Conor Duggan, Post-Jungian takes on the moving image 15 May 2010 ICH, 30 Guilford Street, London WC1 Nick Benefield, Nick Joseph Brunei Gallery, SOAS, London WC1 Imagination, Creativity & Speaker: Anish Kapoor Contact: Dianne Pflasterer, 0115 955 5437, Contact: Ruth Williams, CAP, 020 7515 the Joys of Being Ordinary Contact: Marjory Goodall, 020 7563 5016 [email protected] 2012 | [email protected] Barber Institute of Fine Arts, Edgbaston, [email protected] Birmingham 19-20 March 2010 18 April 2010 Speaker: David Hewison JULY Nourishing Psychotherapy: Film and Discussion: Of Mice and Men Art, Science and Education Contact: WMIP, [email protected] Queens’ College, Cambridge ICA, The Mall, London SW1 2-4 July 2010 Speakers: Andrea Sabbadini and 15 May 2010 Psychoanalysis, Money and Presentations: Darian Leader, the Economy Peter Stratton, Keith Sylvester Cheryl Moskowitz Going to School: The latency years Contact: [email protected] Heaves Hotel, nr Kendal, Cumbria LA8 Freud Museum, London Contact: [email protected] Contact: Ivan Ward, [email protected] 020 7014 9966 | www.ukcp.org.uk www.psychoanalysis.org.uk/events.htm Leaders: Margret Randall, Kathy Duguid Contact: Course Administrator, NSCAP, www.freud.org.uk 22-23 April 2010 20 March 2010 0113 305 8750 | [email protected] RCPsych Faculty of Psychotherapy: 10 July 2010 BAP Open Day Venturing Upstream: Exploring the Art and A revised theory of the superego in 17 May 2010 British Association of Psychotherapists, the Science of Psychotherapy the light of attachment research Mirroring, Marking & Meaning- 37 Mapesbury Road, London NW2 4HJ The Moller Centre, Cambridge Friends House, 173-177 Euston NW1 2BJ Making: An exploration of the parent’s www.bap-psychotherapy.org Speakers include Donald Campbell, David Speaker: Jeremy Holmes role in an infant’s developing sense of self Bell, Richard Rusbridger, Gerald Wooster Contact: WPF Therapy Training Barber Institute of Fine Arts, Edgbaston, 20 March 2010 Contact: Dela Goka, 020 7235 2351 x 6145 0207 378 2000 |www.wpf.org.uk Birmingham Klein: An introduction to her work & ideas [email protected] Speaker: Joanna Tucker 23 Magdalen Street, London SE1 2EN forthcoming events Contact: WMIP, [email protected] Speaker: Lisa Ferguson 24 April 2010 Contact: [email protected] Lionel Monteith Memorial Lecture 9 October 2010 020 7378 2054 Fame and the Unconscious 20 May 2010 Psychoanalytic Psychotherapy NOW: The Governors Hall, St Thomas’ Hospital Effective treatment for anxiety The Challenge of Complexity with Intensive Short-Term Dynamic Mermaid Theatre, Blackfriars, London 20 March 2010 Speaker: Brett Kahr Psychotherapy Contact: BPC, 020 7561 9240 Babyhood: Becoming a person Contact: Aishleen Lester, The Lincoln, in the family 020 7978 1545 www.edtconferenceoxford.co.uk [email protected] Heaves Hotel, Near Kendal, Cumbria LA8 www.psychoanalytic-council.org Leaders: Margret Randall, Kathy Duguid MAY 21 May 2010 2nd James MacKeith memorial From October 2010 Contact: Course Administrator, NSCAP, lecture: Torture Old and New Psychoanalysis at the 0113 305 8750 6-7 May 2010 RCPsych Northern Ireland Division 112a Shirland Road, London W9 Science Museum [email protected] Aggression: From Fantasy to Action Speaker: Justice Arthur Chaskalson Exhibition and programme including: Hilton Hotel, Belfast Contact: Marjory Goodall, 020 7563 5016 15-17 October: Psychoanalytic 24 March 2010 Speakers include Anne Alvarez, [email protected] Perspectives on Human Engagement with Society for Psychotherapy Lord Alderdice, Donald Campbell, Climate Change Research (UK) Annual Meeting Carine Minne, Rosine Josef Perelberg 24 November: Cambridge Scientists and 24 May 2010 Ravenhall, North Yorkshire Contact: Nora McNairney, 028 9027 8793 Psychoanalysts in the 1920s BPA Open Day Contact: [email protected] [email protected] www.psychoanalysis.org.uk www.psychotherapyresearch.org BPA/BAP, 37 Mapesbury Rd, London NW2 www.psychoanalysisatthesciencemuseum. Contact: [email protected] org.uk (from June 2010) 020 8452 9823

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and as a Christ-like redemptive figure, ‘I realized I still had my eyes shut. I had Shortly after the first edition, the Swiss Classics Revisited the terrifying anti-oedipal mother, Nurse shut them when I put my face to the psychoanalyst Oskar Pfister published his Ratched − are all in to be found in the screen, like I was scared to look outside. claim that he had discovered a concealed original narrative as are many of the Now I had to open them. I looked out of vulture in Leonardo’s Madonna and Child One Flew Over the Cuckoo’s Nest famous scenes such as the marvellous the window and saw for the first time how with St Anne, the icing on the cake which Ken Kesey, One Flew Over the Cuckoo’s fishing trip, the ward party, and so on. the hospital was out in the country’ (page Freud appended to the second edition Nest (1962), London: Penguin, 2003 141). In other words he could begin to see of ‘A Memory’ in 1919. Together they the hospital, the world, from outside, from participated in the psychocryptographic As many will know, each year the ‘McMurphy is a different perspective. game of mining art for latent content ICA hosts a regular series of talks on the return of a that gave birth to pop cultural products psychoanalysis and cinema organised It is this masterly interweaving of the such as The Da Vinci Code. That the by Andrea Sabbadini of the Institute of strong father individual drama with broad universal ‘vulture’ is an avian misidentification Psychoanalysis. The format is that a film who can help him themes that gives this novel its great thanks to an erroneous translation, and is shown, and then a psychoanalyst gives power that the ‘secret image’ in the painting a talk followed by a general discussion. face the world.’ is therefore a red herring, proved a later I have had the good fortune to be the David Bell is President Elect of the British embarrassment but not a deal-breaker. invited psychoanalyst on a number of However, the novel has other major Psychoanalytic Society and Consultant Even so, as one reads the ‘Memory’ with occasions and last year participated in a themes not touched on in the film Psychiatrist in Psychotherapy at the these objections in mind one cannot help series entitled ’Insane Institutions’. I was (they could not be as the film, for very Tavistock and Portman NHS Foundation but root for Freud’s theoretical edifice; it is involved in the first three films of this understandable dramatic reasons, Trust. so elaborately constructed, so engagingly series, ‘Snake Pit’ (1948), ‘Shock Corridor’ dispensed with Big Chief as narrator). We an artifact of his own interests and times (1963), and lastly ‘One Flew Over the learn of Big Chief’s having witnessed the (Egyptology, fin-de-siècle sexuality, the Cuckoo’s Nest’ (1975). decimation of his family’s life as the land genesis of genius), that one has to admire was taken away from Native Americans, the First da vinci code? the bathwater as well as the baby. I am sure the film O’ ne Flew Over the their way of life casually destroyed, Sigmund Freud, Leonardo Da Vinci Cuckoo’s Nest’ will be familiar to many and his father’s subsequent collapse as and a Memory of his Childhood (1910) Losing the ‘vulture’ does undermine but, like me until a few months ago, far a result into alcoholism. The narrative most of Freud’s argument equating the fewer will have read the original book by gives this traumatic event a centrality in One hundred years ago, Freud’s renowned dream-bird with ‘mother’, and hence Ken Kesey – and it is the purpose of this Big Chief’s life critically related to his psychobiography of Leonardo caught the his insistence upon Leonardo’s maternal brief piece is to encourage you to do so. mental collapse. From this perspective wave of early-20th century scholarship fixation. An alternative interpretation The film is in fact extremely faithful McMurphy is the return of a strong father bent on teasing out the ‘hidden content’ of was ventured by art historian Meyer to the book, but the story in the book who can help him face the world and iconic works of art. His interest may have Schapiro in the Journal of the History is narrated by Big Chief Bromden who, redeem himself. been piqued by Viennese art historian of Ideas (Vol. 17, No. 2, April 1956): he because he has pretended to be deaf Max Dvorák’s investigation, published in linked Leonardo’s interest in the kite’s and dumb (reminding one of ‘I Tiresias, A further major theme of considerable 1904, into The Riddle of the Brothers Van tail to Pliny’s description of that bird though blind, can see’), is the ideal interest to psychotherapists is the Eyck; in any event, ‘Leonardo Da Vinci as ‘the symbol of the art of steering’, observer, as others believe they do not extraordinary and vivid description by and a Memory of his Childhood’ (1910) its tail as the model rudder. Schapiro need to bother to conceal things from Big Chief of his own inner world. He lives proved popular and influential. located the story in a literary tradition him. in strange delusional and hallucinatory of the childhood incident as an omen states, but these delusions and Freud examined Leonardo’s suggestive of adult fortune. Cicero, he said, had The main narrative will be known I hallucinations offer a poetic and truthful childhood dream/fantasy of a kite recorded similar instances of symbolic think to most, so I will not dwell on it description of the reality he occupies. He battering the infant’s mouth with its tail, manifestations around the mouths of the here except to emphasise that it is a truly sees Nurse Ratched as a functionary of married this image with the existing junior Midas and Plato, and he suggested allegorical tale. Written by Ken Kesey in ‘The Combine’, an impersonal system that textual evidence of his subject’s early this work will have been familiar to the 1960s, it makes use of the asylum to has total control, a Kafkaesque unseen maternal musical chairs and putative Leonardo. Pliny and Pausanias made provide us with a model of domination, presence. She is hallucinated as being a peccadillos, and concluded that Leonardo similar claims. ‘The omen is located or more properly total domination. Milos machine with extendable mechanical must have been a passive homosexual. in the mouth, the place of speech and Forman, who directed the film, saw in arms and other bizarre features which Leaving aside the cultural prejudices more particularly of the breath or spirit,’ the book an evocation of the systems all suddenly return to normal the and circular reasoning involved in his Schapiro proposed. of absolute control that characterised moment she is observed. Elsewhere she diagnosis, Freud’s detective work and his the Stalinist State. Kesey, who worked is hallucinated as a spider with web-like explanation of the theory of sublimation Ernest Jones (‘The Madonna’s Conception as an orderly in a psychiatric hospital, wires emanating from her body into all remains nonetheless a fascinating journey. Through the Ear,’ Jahrbuch VI, 1914) recognised that this setting provided him parts of the ward where she can detect the wrote of a similar ‘case’ concerning the with a model for expressing the more smallest disturbance (like vibration in a poet Henry Vaughan, in which a youth subtle and pervasive ways that so-called web) and bring it under control before it dreamed his mouth too was assaulted free democratic societies control the can escalate to threaten her authority. by a hawk, and afterwards found he was thinking and action of their citizens, and possessed of the ‘gift of poetrie’. Leonardo, to which the citizen willingly submits One sustained metaphor/delusion is of who so wanted to fly, selected the symbolic surrendering his capacity for thought. (As particular interest. Big Chief believes that pilot to guide him. Freud pointed out, we all have a kind of the ‘Combine’ pumps clouds of fog into longing for submission.) In this sense One the ward which have the effect of luring Schapiro’s argument unleashed a flurry Flew Over the Cuckoo’s Nest belongs in the the inmates into a mindlessness where of defences of and counter-attacks on same genre as Brave New World and 1984. nothing happens and nothing matters. It Freud’s slip, culminating in Peter Gay’s anaesthetises the inmates who are drawn 1988 dismissal of ‘the superstructure that The ward as a microcosm of society at to the pleasures of this mindless world. Freud built on the mistranslation.’ Many large provides a kind of laboratory for ‘Nobody complains about all the fog, I of these critics have themselves conducted exploring the ways in which the state / know why now: as bad as it is, you can dissections of Leonardo’s arts and letters, society seeks control over the individual, slip back in it and feel safe. That’s what potentially falling into the same error something that, as an important figure McMurphy can’t understand, us wanting of interpretation. In the century since of sixties counter-culture, Kesey was to be safe. He keeps trying to drag us out its publication, and today in the shadow particularly sensitive to. of the fog…’ (page 112) of Dan Brown’s appropriation of the tradition of encoding Da Vinci, the debate The central theme of the film − the There is a haunting beauty in the about the rehabilitation of the Leonardo insidious forms of control on the ward, the descriptions of Big Chief’s struggle against theory continues entry of McMurphy as a combination of this cloud of oblivion, his struggle to hold raw libidinal energy seeking to overthrow onto his capacity to think, a capacity Janice Cormie is the BPC’s Head of the sterile controlling culture of the ward which brings him considerable pain: Services.

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Awards The Psychoanalytic Psychotherapy NOW conference will once feature an awards ceremony to celebrate achievement in the psychoanalytic community. Two of the awards presented last year are on a two-yearly basis and so will be presented next year. The three awards for this year will be: Early Career Achievement Award This award recognises an outstanding contribution to advancing psychoanalytic knowledge or practice from someone in the early stages of their career as a psychoanalytic or psychodynamic practitioner (normally within 7 years from qualification). The award will be to an individual for a contribution within a period of 3 years before the award. Award for Innovative Excellence This award celebrates a striking example of ground-breaking work. The innovative nature of the work could be in terms of clinical practice (e.g., Friday 8 (evening) & Saturday 9 October 2010 new psychoanalytically-informed treatment approaches), research, or socially inclusive practice (e.g., working with sections of the community who may Mermaid Theatre, Blackfriars, London traditionally find access to therapeutic treatment difficult). The award will be to an individual or project or organisation for innovative work conducted within a The Challenge of Complexity period of 3 years before the award. ‘The challenge is therefore to a necessary complexity... Psychoanalysis and Culture Award It is in only very complex ways that we truly understand where we are.’ This is an award to someone outside the profession for a special contribution Raymond Williams, Politics and Letters to the understanding of psychoanalytic or psychodynamic work (broadly understood) through a cultural work (in its widest sense). The work could be The second national conference for the psychoanalytic and a novel, a play, a newspaper or magazine article, a piece of music, a film or TV psychodynamic community explores the multi-faceted theme of programme or any other cultural form.The award will be to an individual or complexity, both in terms of complex mental disorders, but also how group for work produced or presented within a period of 3 years before the psychoanalytic psychotherapy relates to a diverse and complex society. award. Join colleagues and an exciting range of international and national presenters for a thought-provoking evening and day. Nominations for the awards Nominations can come from individuals or groups and all nominations will be Friday 8 October considered by the Panel on their merit independent of the number of supporting letters. Nominations should be no longer than 250 words presenting succinctly David Tuckett and a special guest get to grips with the economy the reasons why an individual, group, project or organisation should receive a particular award. Where relevant the nomination should identify evidence the Saturday 9 October Panel can consult in relation to specific achievements. Psychoanalytic approaches to complex mental health problems The awards are focused on the UK. Individual award recipients will live or work • Complexity: a developmental perspective primarily in the UK; groups, projects or organisations will be based in the UK. • Break-out seminars, including: The awards are honorific, with a commemorative object to be presented at the • Treating complex disorders ceremony by the chair of the respective selection panel. • New technology and mental health Nominations for each award will need to reach the BPC office by Friday, 30 July: • Violent men – problems of modern masculinity [email protected] • Young people Psychoanalytic approaches in a diverse and complex world • Overview • Break-out seminars, including: • Psychoanalytic psychotherapy for a culturally diverse society • Moving on – psychoanalytic psychotherapy and the LGBT community Subscribe • Dealing with social conflict to New Associations Reception & Awards Ceremony See www.psychoanalytic-council.org for details Stay informed of the latest issues affecting your profession by subscribing to New Associations. An annual subscription of three issues costs just £10*. Ensure you are prepared for the future of psychoanalytic psychotherapy here and now!

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