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CHOOSING a PSYCHOTHERAPIST

 

Psychotherapy and marketing

Psychotherapy, is not regulated by law in the United Kingdom.   It is subject only to the standards of behaviour that can reasonably be expected of anyone who provides a personal service. 
Many psychotherapists belong to professional, or trade, associations that claim to offer a more skilful and ethical service than that provided by non-members.   Members are accredited by fellow members on the basis of what they call ‘training' and in some cases ‘supervision’ by fellow members.    

 

Accreditation and ‘training’ 

Unlike aviation, architecture, construction engineering, medicine, plumbing and so on, the skills required by psychotherapists and the standards necessary for competent, scrupulous consultancy cannot be measured objectively.   The necessary skills can certainly be enhanced by attending courses, lectures, seminars, ‘workshops’ and so on, but any paper 'qualification' awarded is worthless as an indication of competence or probity.  
In reality, the only people truly qualified to assess the competence and integrity of their 'therapists are their clients.   
The value of accreditation by fellow professionals is impossible to assess.
 

Qualifications

Ideally, the 'therapist is someone with considerable experience, albeit sometimes vicarious, of the tribulations of living.   More importantly, s/he will have thought seriously about the ways in which we live and their possible consequences.

 

Supervision

The word ‘supervision’ has several different meanings.    Mostly, it is used to describe an activity in which someone's work is examined by another person who accepts the ultimate responsibility for the quality of the finished work  to customers or clients .
In academic research, supervisors are consultants who help scholars organise their work, perhaps challenge some of their ideas and offer appropriate support.
Some psychotherapists make use of ‘self-supervision’, by which they mean that they reflect  on meetings they had with clients, try to appraise their own conduct critically and perhaps seek advice from a disinterested person.

Prospective clients have to decide, therefore, in what sense the word ‘supervision’ is used by the 'therapist they intend to consult.   

 

'We must not expect that the personal qualities of the psychotherapist will spring from formal instruction; the professional demands are much more far-reaching and among them there is something that most decisively cannot be taught.' Karl Jaspers(1)

'A person is usually assumed to be competent because he or she has had a specific amount of academic training and supervised experience, although why this should ensure competence is not specified. Ignored are the subtle questions of what precisely it is that professionals are supposed to do, and how well they do it.    These two issues are more complex than is often realised and deserve further elaboration.' Daniel B. Hogan(2)

'... the prospective client should take nothing for granted where the qualifications of a therapist are concerned.   The most essential consideration is to be able to form a proper working relationship; all other factors should be examined in this light.' Joel Kovel(3)

'(Psychotherapy) ... is a craft the aptitude for which derives more from a general experience of living than is generally supposed.' Peter Lomas(4)

'(Training in psychotherapy) ... should start from the recognition that a learned technique not only cannot substitute for a more elemental capacity to heal, but may actually inhibit this capacity: that it should be less a course of instruction than an attempt to increase the individual's unique capacity to help.' Peter Lomas(5)

'Though (simplified models of human behaviour) may be of some use in marshalling the "facts" of mass behaviour, they are unlikely to deal effectively with the complexities of the individual case and it is small wonder that a reasonably intelligent and sensitive person is likely to make better guesses about others if he relies more on the skills he has spent his life developing than on the crudely insensitive conceptual equipment of traditional psychology.' David Smail(6)

 

'There are many schools of psychotherapy but results appear to depend on the personal qualities, experience and worldly wisdom of the therapist rather than on the theoretical basis of the method.' Robert M. Youngson (ed.)(7)
 

Exploitation     

The nature of psychotherapy is such that it is easy for incompetent or unscrupulous practicians to find subtle ways of abusing the trust that clients place in them.   Clients whose minds are in turmoil are particularly vulnerable.   We should not therefore be surprised that psychotherapy has sometimes been compared to a perverted religious cult.

Financial exploitation is not the only way in which trust can be abused.   
Clients may be persuaded, for example, that the problem is more serious than they thought or be given unrealistic assurances and discouraged from seeking other forms of help.   Others may be persuaded to ‘remember’ events that did not happen, such as childhood sexual abuse.   An unreliable 'therapist may break confidentiality without seeking the client’s permission  (although this is apparently standard practice in the National Health Service and similar organisations!)   Clients may not be warned against the risk of becoming emotionally over-dependent on the 'therapist and may even be persuaded to consent to physical intimacy. 

 

Codes of practice

Is it safe to assume that members of a professional association are more trustworthy than non-members?     Many probably are, but the codes of practice published by professional associations provide clients with no more protection than they have by virtue of common law.   Spurious and misleading claims that their members are 'properly trained and qualified' can only increase the risk of clients being unjustly exploited.   
The only real protection is what lawyers call caveat emptor; let prospective clients (or their advisers) beware!

 

'... no amount of training, supervision or personal therapy are guarantees that professionals will not abuse their position of trust.   There is some evidence for the view that the more qualified and high-powered a practitioner, the increased likelihood of abuse, because of the diminished likelihood of challenge.' G.Cooney(8)
 

 

Avoiding the risks

Some of the questions that prospective clients or their advisers need to ask :

Does the service offered comprise standard procedures, or is it shaped to clients' particular needs?  

How many sessions will be necessary?  

How long and how frequent are the sessions?

What are the fees and when are they payable? 

Will everything the client says in the consulting room be kept confidential?

What rights do clients have if they are not satisfied with their progress?  

Is the contract explicit or implied, written or oral?

What assurance does the client have that, with the exception of emergencies, the 'therapist will keep appointments and be punctual?  

 

Although personal recommendation is often a good indication of a 'therapist's competence and probity, relying on it is not always prudent. 

   
Care is also needed in assessing a 'therapist's experience.   Practice does not invariably make perfect.   It can as easily encourage bad habits as good ones!  

 


References:

 

 

(1) p. 41 The Nature of Psychotherapy (7th edition) Manchester University Press 1964

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(2) p. 101 The Regulation of Psychotherapists: A Study in the Philosophy & Practice of Professional Regulation. Ballinger Publishing Co., Cambridge, Mass. 1979

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(3) p. 229 A Complete Guide to Therapy. Penguin, Harmondsworth 1978

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(4) p. 11 The Case for a Personal Psychotherapy. Oxford University Press 1981

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(5) p. 138 The Case for a Personal Psychotherapy. Oxford University Press 1981

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(6) p. 139 Psychotherapy: A Personal Approach. J.M. Dent & Sons, London 1978

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(7) p. 217 Encyclopedia of Family Health. The Royal Society of Medicine, London 1995

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(8) pp 15/16 'Openmind 55' (February/March 1992)

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SUGGESTED READING

 

Katharine Mair: 'The myth of therapist expertise' pp 143-168 in Psychotherapy  and  Its  Discontents  (Windy Dryden & Colin Feltham, eds)  Open University Press 1992

 

 

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For more information, without obligation, telephone: 01773 833267 (24 hours). All calls are confidential.