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Wind of change

A recent report by King’s College (McGivern, Fischer, Ferlie, & Exworthy, 2009) on statutory regulation and the future of professional practice in psychotherapy and counselling has pointed out that the proposed regulation of psychotherapy by the Health Professions Council is occurring in the context of an ‘emerging assemblage of regulatory processes’, which includes the government’s Improving Access to Psychological Therapies (IAPT) programme, the National Institute for Clinical Excellence (NICE) guidelines, and the Care Quality Commission. The report, comparing the effects of regulation on doctors with the consequences of planned regulation on the practice of psychotherapy, suggests that psychotherapists’ and counsellors’ perceptions of regulation in practice raises issues about the unintended impact of performance management on therapy. Exploring perceptions of regulation within an integrated mental health service incorporating an IAPT programme, the authors found that pressure to produce good clinical outcomes resulted in a high level of anxiety in therapists. The compulsory use of clinical outcome measures were felt by some clinicians to undermine clinical judgement and resulted in strategies to ‘cover themselves’ in case things went wrong. The emotional aspects of mental health work were felt to be marginalised; and the preferred clinical case supervision format resulted in a lack of ‘formative spaces’ for discussing complex clinical issues or concerns. The dangers of ‘expanding and cosmetic’ regulatory systems are discussed by the authors in the context of what is termed a ‘blame society’ where rare but serious cases of abuse are highlighted and given prominence by the media. The King’s College report is unusual in providing us with empirical evidence of the impact of psychotherapy regulation in clinical practice. As psychodynamic practitioners in this brave new world, we might well wish to step back to consider our own personal response to these and other seismic changes sweeping through public sector services. Many clinicians may understandably feel they have little choice but to submit to the new order and to comply with the mandatory standards of what Power (1997) has evocatively called the ‘audit culture’ – albeit with a degree of resentment and masochistic hopelessness. More optimistically, perhaps, others may wish to challenge the prevailing psychotherapeutic zeitgeist, either by promoting the case for psychoanalytic work in the NHS, or by confronting the political agenda implicit in the increasing ‘assemblage’ of regulatory bodies. Psychodynamic Practice Vol. 16, No. 1, February 2010, 1–5