Una aproximación local al concepto de RSE

The 2007 Trust and Assurance White Paper (Department of Health, 2007a), and the HPC, both refer to the HPC as planning to regulate the field of ‘counselling and psychotherapy’. Other government papers and the IATP programme tend to refer to ‘psychological therapies’. Generally, though not always, I have opted for the term ‘talking therapies’ as an all-inclusive term that refers to all forms of counselling and psychotherapy. This is partially as short hand, but also because the meaning of the distinction between

counselling and psychotherapy is variably contested across the field. I do not wish to imply a strong commitment to differentiation between counselling and psychotherapy and a view of the structure of the field that this may imply. My use of the term ‘talking therapies’ is not without its problems however. The term emerged initially in relation to psychoanalysis being dubbed the ‘talking cure’ (Milton et al, 2014). Some practitioners and theorist therefore tend to

47 see the term as referring exclusively to those therapies that involve the

unravelling of psychological or psychosomatic symptoms through the

revelation of their unconscious meaning to the patient. My use of the term as ‘all-inclusive’ is partially driven by the Foucauldian tendency to view all forms of therapy as ‘technologies of the self’ (Rose, 2003). All modalities of

counselling and psychotherapy are, at least partially, in my view, forms of discursive practice which to an extent ‘perform’ or construct the realities they reveal, and encompass ‘talking’ as central to practice. This tends to be a challenging proposition for ‘depth’ talking therapies given that there is an emphasis upon revealing ‘underlying’ personal truths. The status of the concepts and phenomena of the unconscious and of transference in relation to the notion of reality as discursive is a fascinating one, but is outside the scope of this research.

This thesis is not primarily an assessment of the relative merits and strengths of different modalities of therapy – between for example psychodynamic and cognitive behavioural therapies – or between diagnostic and non-diagnostic approaches to ‘mental health’ difficulties. Rather, the primary focus is on issues of regulation and governance, and what particular forms of regulation and governance presuppose about the nature of therapy. In the case of the HPC struggle, to repeat one of my key research questions: were the

presuppositions the HPC plans made about therapy congruent with those made by the talking therapies themselves? And if incongruent, what is the significance of this? However, my thesis is not simply a taxonomic exercise, setting out a typology of therapies and regulatory systems. Rather, I seek simultaneously to describe and critique competing policy imaginaries. This

48 thesis is in part motivated by a concern and sense, shared by many, that the government driven attempts to increase the accountability of professionals and practitioners, across many occupational sectors, through a combination of audit and consumer logics, are weighted excessively in favour of conditions conducive to fostering acontextual/transactional forms of practice and

regulation, which arguably diminish the ‘dialogic’, democratic, and creative character of practice, and which ultimately undermine its effectiveness. Given that my focus is on the projected influence of the HPC plans – as opposed to a focus on an existing regulatory regime – this case study does not afford the opportunity to explore how a regulatory system functions when actually already in place, and how such a regulatory regime is or can to an extent be resisted or subverted by practitioners (either to the benefit or the detriment of client and public interests) in everyday practice. As regards the IAPT

programme and the SfH project to map the National Occupational Standards for counselling and psychotherapy my primary aim is not to conduct a detailed assessment of their effectiveness, though it is interesting to note that SfH were unable to direct me to any places where the NOS for counselling and psychotherapy have been used since the completion of the project, and when I asked Malcolm Allen, who was involved within the project, in what way NOS for counselling and psychotherapy had been put to use, he responded

emphatically: ‘no [.. ] I might be wrong, but I’d be amazed if more than ten people have looked at those Skills for Health competencies in the last six, seven, eight years’.10 _{My primary aim at looking at the IAPT and SfH projects}

is to furnish an understanding of the immediate context of the HPC plans.

49 The more ethico-ideological dimension of my analysis, concerning the political dynamics, is motivated in part by a sense of frustration by the fact that across many professions and occupations, especially social and healthcare ones, more context sensitive ways of working – such as ‘practice based evidence – and of regulating, are often side-lined, not only on the basis of the perceived superiority of transactional ways of working, but also, sometimes even exclusively, on the basis of perceived political and economic inevitability of ‘progression’ to more acontextual ways of working – that there is no viable alternative.

Now let us turn to the existing literature.

50 CHAPTER TWO

THE REGULATION OF PROFESSIONS AND TALKING THERAPIES: