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How Much?Why Some Things Should Not Be for SaleWisdom, Intuition and EthicsWithout ConscienceWomen and Borderline Personality DisorderWomen and MadnessWondergenesWould You Kill the Fat Man?Wrestling with Behavioral GeneticsWriting About PatientsYou Must Be DreamingYour Genetic DestinyYour Inner FishYouth Offending and Youth Justice Yuck!
Although editors Yvonne Bates and
Richard House have striven man- (and woman-) fully to corral thirty short
essays about psychotherapy into sober-sounding categories like
"Challenging Professionalisation" (a British book, hence British
spelling) and "Enabling Practice," their 300-page book contains an
exciting and wildly eclectic collection of personal reflections, philosophical
and theoretical explorations, and suggestions for practical reform, all on the
subject of professional psychotherapy and psychological counseling
(particularly as practiced in the U.K. today). There are too many essays to
review each individually or in depth; still, all belong, in one way or another,
to the growing body of work in postmodern "critical therapy," and
most share the goal of helping therapy "move towards becoming a mature, client-centred
healing practice at the death throes of modernity" (2), "a therapy
which is facilitative of a healthy human evolution, rather than being just one
more ideological trapping of late modernity" (255). If the book has a
weakness, it is precisely this "in-group" feeling – in essay after
essay, contributors refer to one another's work (and their own), echoing rather
than amplifying one another. Still, for those interested in the reception of
postmodern theory into psychotherapy, this book provides a broad panorama as
well as some vivid snapshots.
Some contributors paint in broad
strokes, raising large-scale concerns about the role of individual
psychotherapy and counseling. David Smail (Chapter 2, "Psychotherapy,
Society and the Individual") thoughtfully criticizes the way therapy not only
"disembodies" the person, by privileging the mental, but also
"dissociates" him or her from social and political contributors to
psychic distress, because of its individualistic and family-centered approach.
The easy-to-read essay contributed by Dharmavidya David Brazier (Chapter 29,
"The Future of Psychotherapy"), a Buddhist psychotherapist, situates
psychotherapy in the history of spirituality, and addresses the "constant
pressure for psychotherapy to adopt and incorporate the very same structures of
sophistication from whose pernicious effects it is attempting to deliver
others" (285). In a really excellent, wide-ranging and deep essay
(Chapter 4, "Power and Psychological Techniques"), Nikolas Rose
illuminates some of "the dimensions of power in therapy" (29), and
situates therapy philosophically, as both springing from and contributing to a
distinctive, twentieth-century perspective on the person, as will as
bringing a set of spiritual-like practices, to classical ethical
questions about how human beings should live.
The bulk of the essays, however,
are unified by a theme articulated by John Heron in the Foreword, in his
description of what he regards as the central current challenge facing
psychotherapy and counseling: "clarifying and enacting ethically
appropriate ways of exercising empowering hierarchy" (i). Hence most of
the essays focus not on the conceptual underpinnings of therapy, but on the
practice and profession, and call for psychotherapy to be conducted on a
greater footing of equality between therapist and client.
In service to that goal, the
editors selected three interesting essays written by psychotherapy clients
(writing pseudonymously). 'Natalie Simpson' (Chapter 20, "Verbal and
Emotional Abuse in Therapy: Encounters between therapy clients on
therapy-abuse.net") quite candidly discusses both the advantages and the
disadvantages of a moderated Internet "discussion list," www.therapy-abuse.net, in which she
and others who feel they have been the victims of abusive therapy participate.
'Rosie Simpson', who has authored a book about her negative experience in
therapy, contributed the book's final essay (Chapter 30, "A Client's Wish
for the Future of Psychotherapy and Counselling"), a call for wider
therapist-client dialogue about the potentially harmful effects of therapy,
including specifically the "iatrogenic" phenomenon of unresolved
(perhaps irresolvable) transference so powerful it is seriously damaging to the
client. 'Anna Sands' (Chapter 2, "Seeking Professional Help")
understands transference instead as a feature of certain psychotherapeutic
methodologies, harmful but avoidable. Sands further regards honest
self-evaluation as a cornerstone of professionalism, and suggests that
"therapy needs to grow up, become more intelligent and more truly
Most of the other contributors,
however, turn a much more jaundiced eye to the idea of greater
professionalization of therapy, at least where that is taken to mean more
institutionalization – such as more regulation and more certification
requirements, such as career-long supervision of therapists (Colin Feltham,
Chapter 6, "A Surveillance Culture?"). Stephen Pattison offers a
philosophical ethicist's critique of professional codes of ethics, expressing
doubt that such codes "actually foster and elicit ethical awareness and
behavior" (46) (Chapter 5, "Are Professional Codes Ethical?").
Gari Tomkins (Chapter 18, "The
Fallacy of Accreditation: Re-ensouling psychotherapy as an alternative to
accreditation") takes an almost Luddite position, advocating the
restoration of a "master and apprentice"-like (183) relationship in
training analysis, coupled with a de-emphasis on academic and other
accreditation, in the hopes of "re-ensouling psychotherapy." Tomkins
is deeply skeptical about the value of professional trade organizations for
providing redress for injured psychotherapy clients, and advises "anyone
seeking redress with a recalcitrant practitioner…to go directly to court"
(181). By contrast, Brian Thorne (Chapter 14, "Regulation: A Treacherous
Path?") defends "rigorous voluntary self-regulation" (149),
rather than statutory regulation.
Several contributors, including the
editors, wrote more than one chapter. Editor Bates wrote both "Still Whingeing:
The professionalisation of therapy" (Chapter 10) and "Aknaten's
Folly: Imposed beliefs in counseling and psychotherapy communities"
(Chapter 19). In the first, she suggestively and concisely identifies a number
of risks associated with increasing professionalization: that the client
obtains only the illusion of security and safety in therapy; that professionalization/medicalization
encourages a view of therapy as only for the dysfunctional, rather than as a
tool for personal growth; is at odds with therapy's role in resisting our
"materialistic, cost-efficiency-driven society" (113); will favor
short-term therapy in a cognitive-behavioral style, to the detriment of other
approaches; will drive more creative, non-traditional, less credential-minded,
less affluent and privileged practitioners out of the field – all in all, that
it impedes rather than enhances the opportunity for therapy to be "a
genuine human encounter with an equal human being" (116). The second,
weaker essay is a polemic against professionalization and paean to an imagined
non-heirarchical therapeutic "space"; the essay, ultimately
unpersuasive, suffers from under-argumentation and a labored, self-glorifying
comparison between professional organizations of therapists and the ancient
Egyptian Pharaoh of the title, remembered for his ultimately unsuccessful
attempt to impose monotheism.
Arnold Lazarus contributed two
useful essays, both of which directly challenge familiar therapeutic principles
relating to boundaries and "dual relationships" (therapist-client
relationships outside of therapy). The brief "How Certain Boundaries and
Ethics Diminish Therapeutic Effectiveness" (Chapter 1) is self-explanatory;
"Psychologists, Licensing Boards, Ethics Committees and Dehumanising
Attitudes: With special reference to dual relationships" (Chapter 15),
goes further in the same direction.
Editor House's presence is felt
throughout the book; he is cited often by other contributors and wrote three
chapters himself, "Limits to Counselling and Therapy: Deconstructing a
professional ideology" (Chapter 9), "The Statutory Regulation of
Psychotherapy – Still time to think again" (Chapter 13), and
"Reflections and Elaborations on 'Post-professionalised' Therapy
Practice" (Chapter 26). Chapter 9 argues that "the professionalised
institution of 'Therapy' is…in danger of perpetrating net harm at the cultural
level" (94), inside the relationship of therapist and client itself
(setting aside larger-scale social effects). His approach is openly postmodern
– he "propose[s] that therapy must routinely and ongoingly embrace a
radical deconstruction of its theories and practices, paradoxically entailing a
continual undermining of its own conditions of existence" (101).
No sooner has House critiqued
therapy's "mystifying language" and "arcane terminologies"
(96), than he is coining more to identify his primary target: the "Professionalised
Therapy Form (hereafter, the PTF)" (96), his admittedly useful shorthand
for "the increasingly commodified and professionally boundaried form"
(96) of contemporary psychotherapy. House effectively develops the contrast
between "the healthy and fundamentally good therapeutic impulse"
(97), and nearly everything else about PTF – from the office itself, to the
perhaps unavoidable infantilization and dependency of clients, to the inherent
paternalism resulting from a client agreeing to a process he or she cannot
really understand in advance, even to the way psychoanalytic discourse has come
to structure subjectivity itself. At every point he seeks, quite
self-critically, to remind us of the difference between the professionalized
therapist and the person, in Carl Rogers' phrase, who is "truly excellent
in offering helping relationships" (105). He extends this to a critique
of further statutory regulation of psychotherapy in Chapter 13, for reasons
similar to those discussed by Bates, and defends the importance of part-time,
non-career practitioners. In Chapter 26, he argues that institutionalized,
professionalized therapy may even be "intrinsically abusive" (248)
and speculates about a "'post-professionalised' therapy practice,"
and specifically about possible non-hierarchical organizational arrangements of
therapists like the British Independent Practitioners Network.
The "existential" therapy
approach is well-represented. Ernesto Spinelli's contribution (Chapter 28,
"The Mirror and the Hammer: Some hesitant steps towards a more humane
psychotherapy"), drawn from his book of the same title, serves mostly as a
valuable albeit third-hand introduction to the work of Leslie Farber, a very
unconventional psychoanalyst deeply influenced by philosopher Martin Buber. Spinelli,
for whom Kierkegaard is a philosophical muse, also shares his personal
ambivalence about the practice of psychotherapy itself, and his hope that
"its practitioners come to acknowledge that in their encounters with their
clients, they are not the only ones who hold up mirrors and wield hammers"
(284). Arthur Bohart and Karen Tallman (Chapter 27, "The Active Client:
Therapy as Self-Help") share the approach, but come to a more optimistic
conclusion: focusing on the client as the crucial agent of change, and
comparing the role of therapist to that of midwife, who "facilitate[s] a
process but do[es] not make it happen" (260), they argue that "the
active client…is the therapist" (264). In their view, almost any
type of therapy is potentially useful, even what may look like poor-quality
practice, because the client ultimately changes him- or herself.
A few essays are weak. For
example, it is safe to skip Petruska Clarkson's contribution (Chapter 7, "Citrinitas
– Therapy in a New Paradigm World"), a stream-of-consciousness essay
that rambles from poetry by Rumi, to remarks about the "Big Bang,"
the pre-Socratic Greek philosophers, and (of course) quantum mechanics
(including crackpot theories about how Heisenberg's Uncertainty Principle is
linked to cancer). Only the references to the ozone layer, the 'Gaia'
hypothesis, and Chernobyl suggest the essay was written later than the
mid-1970s. It says precious little about therapy, and what little philosophy
the essay contains is no better: while one page states, "It has become
more and more difficult to 'know for certain' what is 'good'" (68); the
next pronounces, "we grow, we develop, we evolve, we strive for greater
and greater perfection, we move towards 'the good'" (69), as if such a
claim were utterly unproblematic. On the whole, however, the book is a rich
resource of thinking in critical therapy today.
© 2005 Diane J. Kein
J. Klein, J.D. (UCLA School of Law), Ph.D. candidate (philosophy) (U.C.
Berkeley), is Associate Professor of Law at Albany Law School, Union University, Albany, New York. Her philosophical areas of interest include virtue
ethics and moral theory; her areas of legal scholarship include professional
responsibility, race and gender, and trusts and estates.
Note that this book is not
available through Amazon.com but it is available through Amazon.co.uk.
Ethically Challenged Professions:...