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Ethically Challenged ProfessionsReview - Ethically Challenged Professions
Enabling Innovation and Diversity in Psychotherapy and Counselling
by Yvonne Bates and Richard House (Editors)
PCCS Books, 2004
Review by Diane J. Klein, J.D.
Feb 15th 2005 (Volume 9, Issue 7)

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") quite candidly discusses both the advantages and the disadvantages of a moderated Internet "discussion list,", 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 professional" (16).

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, "CitrinitasTherapy 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

 Diane 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.


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