John Heron
This paper was first published in Self and Society, Volume 18, No.1, 1990. And later in R. House and N. Totton (eds), Implausible Professions: Arguments for Pluralism and Autonomy in Psychotherapy and Counselling, Ross-on-Wye: PCCS Books, 1997, pp 11-18.
In 1971 the government published a report on the scientologists, who were at that time causing much public disquiet. It was written by a well-known QC, J. G. Foster, who knew very little about psychotherapy, and therefore took advice from the psychoanalytic lobby. Following this advice, he condemned the scientologists on the grounds that they were exploiting emotionally vulnerable people and abusing the dynamics of the transference. And he recommended the statutory registration of psychotherapists in private practice in order to protect the public from this kind of abuse (Foster, 1971).
This led to the formation of a working party on the statutory registration of psychotherapists in private practice, attended by all the primary established bodies in the field. Their report hit my desk at the British Postgraduate Medical Federation, where I was Assistant Director, some time after 1977. The majority of organizations involved supported nominal registration, that is, the names ‘psychotherapist’ and ‘psychoanalyst’ would be registered, with a list of associations providing approved training and accreditation. The report argued that this was all necessary in order to protect the public, quoting with approval the 1971 recommendation.
The behaviour therapists disagreed in a minority report. They wrote that since there was substantial research evidence that psychotherapy did not do anyone any good, there could be no case for giving it statutory recognition. Privately, they put it to me in much stronger terms. They said that statutory recognition, far from protecting the public, would lead to widespread exploitation, because it would legitimate psychotherapists taking money under the pretence of offering a service that did some good – when studies showed that it did no better than having no therapy at all.
They also said, in more radical tone, that psychoanalysts in particular were hypocritical in wanting to protect the public from transference abuse, when their own therapy was riddled with this very phenomenon. They let their clients slip into emotionally regressed attitudes, sustained them there over long periods by manipulative interpretations, and exploited this state of disempowerment to make money by recommending an increase in the number of sessions per week. What the psychoanalysts really wanted, said my behaviour therapy sources, was to manoeuvre the government into protecting their lucrative monopoly on transference abuse. Strong stuff indeed, but with an important grain of truth, in my judgment and my experience.
The report of that working party came to nothing. A private member’s bill, the Bright Bill, based on it was put forward, but the government, having been advised that there was too much dissension in the field to warrant statutory intervention, made sure that there was no time available for the bill to be taken up by parliament. The Royal College of Psychiatry was secretly opposed to a bill, for fear that it would expose many of their members, consultant psychiatrists who were, alongside their NHS appointments, in lucrative private practice as psychotherapists without any proper training whatsoever.
However, in several European countries, authoritarian and restrictive legislation was already afoot and in some cases in place. This has led to the fear that as the UK participates more fully in the European Community, it may have to take on board after 1992 a pan-European model of accreditation or statutory registration. Thus the Association of Humanistic Psychology Practitioners, getting itself ready for 1992 and beyond – or for any separate UK registration – through affiliation with the Standing Conference for Psychotherapy, says that applicants must show they have had a long training and supervision in the understanding and handling of transference and counter-transference, if they want to be accepted as a member. The concept of transference again becomes central to the political argument. There is, however, a disturbing paradox here.
For it is fear that has, in my experience, characterized the response of psychotherapists to the whole political process of professionalization. They fear loss of livelihood, loss of status and recognition, loss of legitimacy. And in this fear I detect a strong element of transference itself: the acting out of infantile survival patterns in the face of all powerful authority figures. So the political argument for professionalization based on legally accredited competence in handling transference, is itself a rationalization of a more deep-seated transference phenomenon. This is the paradox. One can scarcely have much confidence in psychotherapists whose need to have their management of transference government approved is itself a sign of unresolved transference material.
The case against statutory registration of psychotherapists, especially the case built on the exclusive professionalization of transference competence, is as strong as ever it was. The phenomenon of transference is very widespread throughout our emotionally repressive society, whose rigidity is sustained by distorted and unprocessed psychosocial dynamics. People carry around a great deal of buried infantile distress which drives them to act out in adult life submissive and dependent behaviours in the presence of those on whom they unawarely project oppressive parental status. Most professions – medicine, law and the judiciary, education, social services, politics, to name but a few – exploit this. The professionals, caught up in the same widespread patterns of repression, deal with their own infantile insecurity by identifying with their internalized authoritarian parent, and exercise too much power and control over their clients – upon whom they unawarely project the repressed, hurt child within.
If the insecure child within psychotherapists drives them to use this whole distorted system to legalize a new, exclusive, highly trained and protected profession to handle transference, they too will fall foul of their own introjected authoritarian parent – which will subtly contaminate the way they theorize about and work on their clients’ transference material. In the guise of protecting their clients from the unqualified, they will oppress them. They will use the transference dynamic improperly to sustain it. This is the half-a-head-out half-a-head-in phenomenon: the therapists both have insight into a distorted dynamic process and at the same time fall foul of it within themselves when working on it in others. Put in other terms it means that a lot of their counter-transference is not spotted for what it is and is displaced unawarely into a warped form of therapy. This is a peculiarly unfortunate kind of helping treason.
Competence in handling transference by its very nature cannot, without serious distortion, be professionalized and legalized in an emotionally repressive society. The professionalization of it takes it away from the public domain into mystification and expert knowledge accessible only to the few. And this exacerbates and reinforces the very processes which it is supposed to be dealing with. There is no better way to sustain compulsive infantilism in society (and thus an endless supply of clients) than by setting up a highly specialized, government-protected profession that alone is qualified to deal with it. This is the ancient corruption of priestcraft: to organize your hierarchy in such a way that you generate the sins you are appointed to redeem. It is significant that the pressure for statutory registration in this field always comes in the first instance from those who are already caught up in some kind of transference abuse and want to preserve and protect the improper exercise of professional power.
The concepts of psychotherapy and therapy are historically close to the concepts of psychopathology, treatment and the patient. The tendency of such association is to relegate the notion of transference to the domain of those who are in a state of psychological deficit, with emotional problems, and who have fallen out of the mainstream of social life. This obscures, and distracts awareness from, the fact that transference is a psychosocial dynamic that affects every aspect of life in our society. And the relegation reinforces the bad old distinction between education and training on the one hand, and emotional therapy and treatment on the other. Once this distinction is made, then education – which is of universal application – excludes the acquisition of emotional competence, which is purveyed only by an esoteric profession for a disturbed minority of citizens. This creates the absurd anomaly that the majority remain emotionally incompetent, and only patients with problems qualify for affective growth.
There is another profound anomaly in the argument that seeks to protect the public from transference abuse in psychotherapy. It overlooks the fact that one area where transference abuse readily occurs is in the sphere of religion and the spiritual life. Gurus, perfected masters, evangelical preachers, traditional priests of all persuasions, mediums entranced by spirit guides, the hierarchs in psychic and occult groups, charismatic teachers with a spiritual message – all these abound in our society today. They generate and often exploit, wittingly or unwittingly, a great deal of transference material. The exploitation is for purposes of power, control and dominance; and often for money as well. This indeed is where the story began in the UK in 1971, with a concern about the scientologists – who were operating as a church.
There was, however, no talk in 1971 or thereafter about the statutory registration of practitioners of the spiritual and religious life, about protecting the public from the transference abuse perpetrated by many of them. The reason is not far to seek, for such talk would offend one of our deepest and most cherished traditions – that of religious liberty and toleration, the right of every person to affirm and practise whatever creed they choose. To define a religious practitioner, and specify the training required, for statutory purposes would inevitably protect some limited dogmatism by law, and cause an outcry that the state was busy with religious oppression and persecution. A deeper reason is perhaps our tacit awareness that everyone has a right at some time to be a spiritual practitioner for others – praying, blessing, invoking, exhorting, healing – and that this universal right transcends matters of legislation.
So in this field the claims of religious tolerance and liberty are so strong that they override any concern about protecting the public from transference abuse. We leave people to find their own way, through trial and error, and to exercise the right of the pilgrim to undergo – for however long a period – whatever travails and snares are to be found upon the path. Why, then, such protective paternalism in the field of psychotherapy?
The answer is uncompromising and rigorous. To define transference for purposes of training and accreditation, in order to underwrite statutory registration of psychotherapists, will enshrine a limited dogmatism in law. This is logically inescapable: for any definition is bound to exclude the transference dynamic – for both putative practitioners and the public – involved in the very pursuit and application of such legislation. In other words, the widespread social and political dimension of transference will be absent from the definition. Hence psychotherapists, in possession of a half-truth, repress their anxiety involved in handling the whole truth, through the social defence mechanism of statutory restriction. In claiming legal protection for themselves as personal change agents, they abdicate their responsibility as social and organizational change agents. The legislative claim is in reality nothing to do with protecting the public, but everything to do with protecting the unresolved transference material – in its social and political dimensions – of the psychotherapists themselves.
What, then, is the way forward? There seem to me to be some simple and quite fundamental principles to guide us. The first is that, both theoretically and practically, the intrapsychic and interpersonal dimensions of transference are to be seen always in relation to the society-wide and political dimensions. This leads on to the second principle, which is that the right to be emotionally competent – which includes the ability to understand and master the dynamics of transference – is the birthright of every person in society. Until this claim is acknowledged, the whole social, organizational and political process will be distorted by people unawarely acting out compulsive victim, compulsive oppressor, compulsive rebel and compulsive rescuer roles.
This in turn leads to the third principle, that the right to emotional competence is an inalienable and central part of the right of everyone to a proper education. What we need, therefore, is an educational system for all in which emotional and transference competence is the hub around which intellectual, technological, interpersonal, organizational and political competence revolve.
These three principles entail certain consequences for current practice. We need to interrupt every tendency to hive off the handling of transference into restrictive psychotherapy. We need progressively to introduce it into general education. One obvious place to start is in adult education through the provision of personal development workshops for the general public. This, of course, has been going on now for several decades in the UK, both in independent and in institutionally-based centres. What is perhaps needed more and more on these courses is that in-depth work on emotional competence should relate the intrapsychic and interpersonal aspects of transference to the social and political aspects.
The other obvious place to start is in continuing education, especially in-service further training for the teaching, helping, management, political and other service professions. What is needed here are more and more experiential courses in which professional and personal development are seen as inseparably combined, in which skill on the job has transference competence as a central component.
The psychotherapists can aid all this educational development by ceasing to call themselves psychotherapists and by abandoning the term ‘therapy’ and the lugubrious and out-moded language of ‘psychopathology’, ‘cases’ and ‘case-work’, ‘referrals’ and ‘supervision’. They could serve the purposes of social transformation much better if they were to call themselves affective educators, facilitators of personal growth, practitioners of emotional competence, and thus stake out a claim to be central to much needed educational reform. They could quite overtly – as a matter of policy and public nomenclature – supplement and augment, through intensive one-to-one tutoring and facilitation, the development of emotional competence through group-based programmes in adult education and professional in-service education. And they could still reach out, using an educational model and working over long periods, to those with special emotional difficulties.
For it is clear that good psychotherapy does not and should not involve a treatment and cure model. This model derives from physical medicine, where the physically diseased and passive patient is treated by the expert doctor who thus procures a cure. Even in medicine today this model is now out-moded with a new emphasis on education for patient power and active self-direction in promoting the healing process. Where psychotherapy has been contaminated by the treatment model, it has made the patient too passive – lying back and free associating, and the therapist too active and controlling – with a series of unilateral, theory-laden interpretations imposed upon the client’s mental process.
To treat the psyche like a body with the fluid of association flowing through it – a fluid into which interpretations are injected – is to adopt the method of indoctrination and subtle dominance. It induces passive regression and may prolong it with a degree of disempowerment that can turn into sustained depression and, in some instances, depressive suicide. Some psychotherapists today still use this method.
By contrast, to relate to the psyche as a person is to enable, educe and cultivate the client’s emerging awareness, insight and skill in dealing with deep-seated emotional processes. The client is being facilitated, through active regression, in self-directed emotional learning and growth. This educational model – of the client acquiring understanding and skill – is the one which in practice a large number of humanistic psychotherapists today to a greater or lesser degree espouse. It is surely time they made this explicit, dissociated themselves from indoctrination-psychotherapy, and abandoned the narrow and ultimately self-defeating pursuit of statutory legitimacy.
Of course, on the wider canvas of emotional education, there are still very important issues about the competence, training and accreditation of the affective educators, whether working with groups or one-to-one. But these matters should be entirely outside the jurisdiction of government and of state legislation, as they are in relation to the competence, training and accreditation of spiritual teachers.
Our society has already grasped the point that general education and religion relate to such fundamental human rights that anyone can, and should be allowed to, set themselves up as an independent educator or an independent religious teacher. For this is the only way to honour the right of people to acquire knowledge and spiritual practice from any source they choose. It also honours the responsibility of people to sort out the consequences of whatever choices they make. The extension of education from intellectual to emotional competence only serves to take this right even deeper – into the domain of self-knowledge and personal mastery.
The right to emotional growth is too profoundly related to the exercise of human autonomy for the state to have any say in who is or is not fitted to facilitate it – just as the right to spiritual growth is too deeply engaged with the inner freedom of the soul for the state to prescribe who is allowed to foster it. These two rights are closely related, for emotional growth rooted in human autonomy sooner or later leads over into spiritual growth expressing the freedom of the soul. It is the business of the state only to affirm and protect the unfettered exercise of these twin rights. It is the business of the facilitators of these kinds of growth to develop forms of training and accreditation that are both responsible and at the same capable, in terms of their content and method, of unlimited progression and unfoldment.
The 1989 guidelines for membership of the Asssociation of Humanistic Psychology Practitioners, in the section which gives details for applying for full membership, represent a sorry mess. This section falls between the stool of self-assessment and self-selection of practitioner categories, and the stool of imposed criteria for the category of psychotherapist imported from the UK Standing Conference for Psychotherapy. These criteria are not only imposed, they also appear to be restrictive and out-moded, implying a total separation – within a closed, hierarchical professional enclave – of psychodynamics from socio-political dynamics. It is all very unhealthy, and looks as though humanistic practitioners are incongruently choosing a form of professionalization quite at odds with the interrelated values of self-realization and social transformation which have so far distinguished humanistic psychology.
Foster, J. G. (1971) Enquiry into the Practice and Effects of Scientology, London, House of Commons Report.