Brink

The United Kingdom Council for Psychotherapy (UKCP) shows sudden signs of pulling back from the brink it has been staggering towards for the last while. A final stagger might still result in catastrophe, but there has been a kind of positive mood swing.

Following a recent election, Prof. Andrew Samuels will become chairman of the UKCP from 2010. Samuels is a founder member of the Alliance for Counselling and Psychotherapy Against State Regulation, and a determined opponent of state-controlled psychotherapy.

The catastrophe that might yet be avoided is domination of psychotherapy by government-appointed bureaucrats, leading to criminalization of any kind of therapy that government does not approve, and extensive use of therapy techniques to enforce government social policy.

A video message

In a powerful public response to personal attacks on him by Marc Seale, Chief Executive of the government’s Health Professions Council (HPC) quango, Samuels has published a video message. In it, he notes that the HPC’s:

…standards for registration are scandalously low…

‘Regulation’ by the HPC will certainly not protect the public.

Furthermore, he sees the HPC’s proposals as in effect redefining the meaning of the word ‘psychotherapy’, so that it no longer refers to the work that Samuels engages in with clients. Therefore, he argues, it would make no sense for him to register as a psychotherapist according to this altered definition, and he does not plan to do so.

Here’s the video message, (only about 3½ minutes long):

CBT

The present government’s flagship (but increasingly troubled) Improving Access to Psychological Therapies (IAPT) programme is another of Samuels’ targets. As IAPT’s main focus is on what it calls CBT, Samuels tends to take a dim view of CBT generally. However, he’s far from completely daft, and he seems to have some kind of lurking intuition that CBT is not all bad.

There is a sound recording of a rambling lecture in which he touches on the subject. Unfortunately the sound quality is poor, and the content difficult to interpret. At one point he quotes someone on the subject of CBT, expressing some agreement with the point of view, but I was not able to identify the author or the book (26:12):

…in an amazing piece of polemical writing, [he] tries to nail the distortions of a typical CBT relationship as mechanical, controlling of the client, therapist-led and hence abusive of power, normative, and so on and so forth…

Here’s the lecture:

What’s wrong with CBT?

Criticisms

There are really only two closely related criticisms in that quote, both of them criticisms of what I have called ‘fake CBT’. A mechanical approach is certainly favoured by some trainers and therefore by some practitioners, and I suspect it is particularly favoured within IAPT. It goes hand-in-hand with a therapist-led approach, which aims to control and normalize clients by using the therapist’s power over them, and that could be considered abuse.

Real CBT, in contrast, is personal and collaborative. It puts patients back in charge of their own emotions and inner lives, freeing them to pursue their own goals.

In 2007 Samuels clashed with the then president of the BABCP, Prof. David Veale. In the lecture he refers to this clash (19:33):

I think the president of the [BABCP] might have had his tongue in his cheek when he told me in our published written disputation that, quote, “The only reason why the NHS plans to expand the delivery of CBT is because it is empirically grounded. This is what keeps us in good stead.”

And he goes on without a blush I’m sure being [?] ironic, quote, “Being empirically grounded guides us in deciding which approach will help our clients function and return to their roles as a parent, partner, worker, and full member of the community.“

Samuels seems to understand well that to be a sane person is not simply the same as functioning in a social role determined by government, and also to understand the severe limitations of research evidence in mental health as a way of grounding anything. These are signs of hope for the UKCP.

On the other hand, he seems to find it difficult to articulate his understanding with clarity, preferring to make vague and somewhat emotionally loaded statements instead. For example, it’s pretty clear to everyone who has encountered David Veale that he does not make statements like that tongue-in-cheek or ironically — he really does have an uncritical and simplified view of the world and of CBT (as anyone can easily verify by reading the descriptions of CBT on his website). Any lack of clarity by Samuels, and any tendency to evade unpleasant truths, are signs of danger for the UKCP.

A subtle political problem

There’s a subtle political problem for anyone who wants to provide leadership in the psychotherapy world. It’s that the great political divide in UK psychotherapy is unreal. The divide between CBT and all the rest does not make sense in terms of outcomes for patients.

In both camps there are competent therapists who have the skills to help mentally ill people, but in both camps there are also incompetents, and some of the incompetents are well-organized. So Samuels needs to colour the political map of psychotherapy in a different way, if he’s to make a significant difference to the political outcome.

He needs to get real CBT therapists strongly aligned with him, on the basis that CBT is one of many therapeutic orientations that are effective ways to improve patients’ lives. I think he would be amazed how many BABCP members would support him in this, if he were to articulate it clearly.

But at the same time he needs to distance himself from so-called therapists whose methods and goals are anti-therapeutic. This is easy in the case of IAPT form-fillers whose goals are to support government social policy, but it is challenging in the case of those who profess other orientations within the UKCP and whose goals are, for example, the pursuit of personal power.

It’s unlikely I’ll agree with everything Samuels does in his term of office, but nevertheless I wish him luck unconditionally. He’s a man who thinks deeply and speaks his mind. Psychotherapists deserve such leaders as him, not to be the puppets of nameless quangocrats.