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CHOOSING
a PSYCHOTHERAPIST
Psychotherapy
and
marketing
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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.
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Accreditation and ‘training’
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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.
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Qualifications
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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.
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Supervision
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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.
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'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)
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Exploitation
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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.
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Codes of practice
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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!
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'... 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)
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Avoiding the risks
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Some of the questions that prospective
clients or their advisers need to ask :
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Does
the service offered comprise standard procedures, or is it shaped to
clients' particular needs?
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How many sessions will be
necessary?
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How long and how frequent are the sessions?
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What are the fees and when are they
payable? |
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Will everything the client says in the
consulting room be kept confidential?
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What
rights do clients have if they are not satisfied with their progress?
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Is the contract explicit or implied,
written or oral?
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What
assurance does the client have that, with the exception of emergencies, the
'therapist will keep appointments and be punctual? |
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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!
(1)
p. 41
The Nature of Psychotherapy (7th
edition) Manchester University Press 1964
[Back
to Text]
(2) p. 101
The Regulation of Psychotherapists: A
Study in the Philosophy & Practice of Professional
Regulation. Ballinger Publishing Co., Cambridge, Mass. 1979
[Back
to Text]
(3) p. 229
A Complete Guide to Therapy. Penguin,
Harmondsworth 1978
[Back
to Text]
(4) p. 11 The Case for a Personal
Psychotherapy.
Oxford University Press 1981
[Back
to Text]
(5) p. 138 The Case for a Personal
Psychotherapy. Oxford University Press 1981
[Back
to Text]
(6)
p. 139 Psychotherapy: A Personal
Approach. J.M. Dent & Sons, London 1978
[Back
to Text]
(7) p. 217
Encyclopedia
of Family Health. The Royal Society of Medicine, London 1995
Back to Text
(8) pp
15/16 'Openmind 55' (February/March
1992)
[Back
to Text]
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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