Hello uACT,
I am certainly one of those wondering what I can usefully contribute to uACT. But first thank you all for the work you and your colleagues put into the launch. I particularly valued James’s slot, which provided a very clear analysis of what’s going on and how much worse things have become in the last decade and a half. I have since got hold of a copy of ‘Sedated’ which gives a brilliant account of the mess in which we find ourselves. I like it – it’s more sophisticated than the stuff we used to produce in the Alliance.
And my apologies for taking so long to get back to you. What follows is my perhaps rather gloomy assessment of where the best opportunities for uACT lie now. No doubt most of it will be familiar to you. The short version is that I’m inclined to believe, as was said during the launch, that uACT needs to be ready for a long haul.
As for the counselling and psychotherapy world, one of the changes that struck me over last 15 years since Alliance was formed is that of growing fragmentation. Advertised trainings it seems increasingly focus on additional qualifications rather than on reflection, interesting questions or a deeper understanding of what therapy is. This fragmentation is of course also driven by practitioners’ keen desire to generate a viable income.
This fragmentation of counselling and therapy into separate specialist subject areas is also driven by funders who focus in ever more detail on outcomes – in other words they focus on the fixing people and their problems aspect of therapy. As a result we get Student Wellbeing Services rather than student counselling; a move away from the talking therapies in drug and addiction agencies in favour of more tightly targeted initiatives; the plethora of interventions IAPT covers in order to address anxiety and depression; and so on. What I’ve noticed as a supervisor is that these specialisms tend to draw practitioners deeper into the fixing people and their problems dimension of therapy at the expense of considering life satisfaction and meaning making. As a result all too often practitioners feel over responsible for fixing things. In this they are aided and abetted by their clients’ expectations as well as by their managers, who themselves can overload them with too much work so that creativity and reflective thought gets pushed to one side in favour of meeting targets. Nowadays the difficulties that supervisees bring to me very often revolve around them not having enough mental space to be able to step back and think.
Such fragmentation is further facilitated by managers who want power, status and money for themselves, their organisations and their members. BACP seems to be redoubling its efforts in this respect. It buys into the rhetoric, irrespective of whether the rhetoric is intellectually credible. Sometimes I wonder how much of this obfuscation is deliberate and dishonest. Mostly I think they just can’t afford to pay attention to gaps and inconsistencies. Hence SCoPEd, its engagement with argument about evidence based treatments, DSM – and so on. The BACP supervisor competencies focus only on the supervisory dyad and omit anything else – no mention of peer supervision, group supervision or any grasp of the wider context within which the work takes place. From one point of view I find this narrow perspective astounding, but given BACP’s priorities I suppose it’s entirely predictable.
My experience of teaching on a counselling diploma course is that most of the students are overwhelmingly focused on establishing their careers and on earning an adequate income. They are reluctant to adopt anything but a deferential attitude to professional bodies and their requirements. This includes avoiding adopting critical views of these bodies – they find this simply too stressful. They want to pay their annual membership fees, tick all the relevant boxes and not think any further.
As a result at some level or another they buy into all the received wisdom about qualifications, hours of training, hours of practice, hours of supervision, the need for further certification and so on – none of which is ‘evidence-based’. On the other hand they also buy into NICE guidelines, IAPT and ‘evidence-based’ approved therapies.
In order to establish themselves they have to jump through innumerable hoops. In the first place they have to establish that they have enough preliminary experience to be accepted on to a training. After that they have to find a suitable placement where than acquire enough practice hours in order to qualify. Once qualified they have to acquire further (usually unpaid) practice hours in order to gain accreditation. At some point many will start a modest private practice, which will generally take a few more years to establish.
At a later point, perhaps a decade or so after embarking on this journey, some practitioners find they have a thriving practice. It’s at this point I have found I have more productive conversations with supervisees. We can more easily talk about aspirations and ideals, about being confident about being able to earn an adequate living whilst also achieving a satisfactory life/work balance, about continuing to learn and develop, about keeping their curiosity and enthusiasm alive, about making a contribution to the future of the planet and the wider society – and about whether they need to stay in hock to a professional association like BACP. Answers to this last question vary to some degree depending on how old the supervisee is. Those who are within a few years of retirement tend to have more confidence about breaking free of bodies like BACP. Others have longer to wait and find it more difficult to predict the future legislative environment.
uACT challenges all this received wisdom. It asserts the crucial importance of being able to bring questions of life satisfaction and meaning making into therapy, because otherwise it’s all too easy to find that nothing makes sense. But I can’t see government ever whole heartedly buying into funding ‘real therapy’ – they just want narrow problem areas fixed. And yet it’s vital that the vision that uACT stands for is kept alive for future generations. uACT is one of the strands in this longer term view as are, amongst other bodies, IPN and the PCU.
Perhaps our field of work is dividing into two. One of these is funded by the state in order to ‘fix’ people in an increasingly professionalised manner, while the other – represented by those drawn to uACT – is more collaborative and addresses the questions that arise when the work moves beyond fixing people, whether or not the fixing has been done. Fixing people now requires endless further specialisation (eg therapy for young people, for people with eating difficulties, for people addicted to one thing or another, for people who are traumatised as well as people with anxiety or depression)
In some ways I am reminded of where the therapy world was in the 1980s when they was an energy and enthusiasm for exploration and curiosity, but where there was little in the way of funding or employment for practitioners. Initiatives came from grassroots organisation and voluntary endeavour. It may be that ‘real therapy’ will be strongest in private practice and counsellors and therapists will need to be encouraged to think about what they can provide, as in FPN and similar initiatives. My own energies recently have been tied up with the attempted revival of IPN as a base in which critical thinking about therapy can find expression.
To preserve my sanity most of my time and energy is increasingly focused on things closer to home – my friends, my family and especially my granddaughters as well what I want to do before I become too decrepit to enjoy very much. Even so I will keep talking to colleagues about uACT and its vision.
All best wishes to you, Paul, and everyone active within uACT,
Arthur Musgrave April 2022
uACT 