Are state policies designed to prevent terrorism and sexual abuse counterproductive for the psychological therapies and hence our societies?

Therapy used to be the place, outside the confessional, where one could talk about sex, dreams, violence and disturbing fantasies. Is it still? Can we still appropriately respond to, for example: The man who when dropping his daughter off at university fancies her friend and worries he is a paedophile; the female patient who can’t give up the narcissist because the sex is better; the client who fantasies about bottling his opponents; the ‘abused’ wife who feels helplessly trapped by her minority culture’s traditions; or, the young person who is not sure whether to join a gang, etc.?

What then are the personal, cultural and economic factors that influence here our abilities as psychological therapists? This and the following questions were considered at a Universities Psychotherapy and Counselling Association conference ‘Working with sex, violence and sex and violence: real or imagined’ held in London November 2016: Do government policies for psychotherapy, such as ‘Safeguarding’ and ‘Prevent’, together with the increased use of manualisation, remove issues of sex and violence from the consulting room with the danger that they are acted out rather than worked through? Can we assume that there is still a need for at least some psychological therapists and counsellors who can enable their clients to work through such experiences, real or imagined? As psychological therapists, can we hear issues of sex and violence in our clients, if we haven’t explored these in ourselves?

How then, if at all, can we work with such policies as the UK’s Prevent (Home Office, 2011) and Safeguarding (Charity Commission for England and Wales, 2017; Office of the Public Guardian, 2015)? The British Government has introduced two policies: ‘Safeguarding’ which requires psychological therapists to regard keeping children and vulnerable adults from abuse as an overriding professional duty; and, ‘Prevent’ which sets out the responsibilities for psychological therapists to identify vulnerable individuals at risk of radicalisation and refer them to regional Prevent teams for what is termed ‘support’. It may appear insensitive to question such policies when there have been so many terrorist attacks. But it is argued here that, this is the very time that they should be reappraised. We are currently in a world that appears increasingly unstable, where the West with decreasing economic and political powers is having to face the ascendency of the East. This can be seen to give rise to leaders who are empowered to be omnipotent and the only ones who can tell the ‘truth’. Such moves towards greater totalitarianism can be seen with the advent of Trump in America and ‘Brexit’ in the UK. Here, there is a nostalgic attempt to return to a situation that probably for many never existed. For example, ‘Let’s make America great again’, where any negative news is regarded as ‘fake news’; and, where if one was to still suggest an alternative to Brexit one could be regarded as a ‘traitor’ and ‘not carrying out the will of the people’. This has affected the consulting room. Previously many therapists told their clients at the commencement of therapy that they would have to report them if they considered them a danger to themselves or others. Whilst not necessarily advocating this, it seems more helpful to the individual and society than the mandatory requirements of Safeguarding and Prevent.

Coline Covington (2017) argues that what happens here is that leader and people become one, the leader negates loss and frustration, instead all await the great day to arrive. Anyone who attacks this group must be hounded down. The result is paranoia where the source of corruption is seen as always coming from without. It is the comfort of this illusion that leads to dictatorship. For as Hannah Arendt has pointed out ‘evil is banal because it is disconnected from thought’ (Arendt, 2006). What then happens in such societies to the psychological therapies? It would appear that they also become thoughtless with neither therapist or client encouraged to allow thoughts to come to them. Therapists are increasingly trained in a manualized way that does not encourage thoughtful practice. It could be argued that the therapies have always been in danger of being over technologised/theorised. But, we are now in a worse era with, for example, the UK government’s counselling roll-out programme Improving Access to Psychological Therapies (IAPT) with its extraordinarily narrow notions of so-called evidence based practice and where there is little chance of finding therapists who having explored their own concerns about their sexuality and violence which could then help them hear others thoughts about such issues. Thus, the young person who is wondering whether to join a gang could well be stupid to talk to a counsellor who is required to report this. Similarly, the person who is concerned about being sexually interested in young people underage, or the erotic touch of a baby, would be taking a great risk of being reported to the authorities if he or she was to talk of this to a psychological therapist. So whilst it is cheaper to manually train therapists; and, perhaps we are in a country that feels it is too great a risk to provide psychological therapies where people can allow thoughts to come to them that may not be allowed in the mainstream culture, these policies are counterproductive, potentially leading to far more terrorism and sexual abuse as those who are worried about such thoughts may be reported to the state. Yet in Germany, which perhaps significantly is one of the few places in the West where it might be argued is not experiencing economic decline, there are adverts on primetime television aimed at those concerned about their feelings towards children encouraging them to have confidential counselling (Connolly, 2015).

If we were able to allow more people to access thoughtful therapy so there was less chance of them acting it out, we would need to train far more psychological therapists and supervisors to be able to think about their own sexuality and violence so they can hear others. Instead, the system of training we are increasingly developing is better described by what Letiche (1990, p. 230) entitled Five Postmodern Aphorisms. I will conclude this part of the editorial by revisiting and adapting these five aphorisms with specific reference to training in the psychological therapies:

(1)	‘An examination of what is said reveals the banality of the text’ (even though messages may seem to be communicated). ‘Anything can be aesthetic, can belong to a look; nothing really means … In a society lacking in proscriptive authority these aesthetic signs of authority however empty they may be, will be grabbed and exploited for all they are worth’. To what extent is this happening with therapeutic labels where, for example, some counsellors now call themselves ‘psychotherapists’ and some ‘psychotherapists’ call themselves psychoanalysts and the public is unlikely to know whether the therapist has had a 2 or 4 year training with or without any of the ever decreasing requirements for personal therapy?
(2)	Choice is at the very best half-choice: ‘… if the system breaks down and people really try to choose, violence surfaces’. Can psychological therapists resist both the pressure to provide therapy as a means of social control and the pressure to cease really offering psychological therapies where they increase individual and group awareness of people’s pain and suffering?
(3)	By improving the interaction with patients, one lessens the level of individual action. One imprisons the patient in his or her own narcissism. ‘The person might be made content, effective and even creative. The individual receives the image that s/he, in turn, projects outwards’. There is no place for example for alterity (Levinas, 1969).
(4)	‘Deliver us from thought’. Where the psychological therapist and her/his organisation stops and the patient starts is not clear. Hence, it is as if the possibilities for consciousness are determined: this could lead to no acknowledgement of imagination, no unconsciousness, and no tacit dimension?
(5)	Doubt not … catastrophe is inevitable … Does psychological therapeutic knowledge contain its own negation? How often does psychological therapeutic training like other ‘… training tells what is to be done, it does not reveal how to doubt’ (Letiche, 1990, p. 238). How many trainings genuinely teach students how to doubt their psychological therapeutic gurus, let alone question such aspects as the training organisation’s approach to such state regulation as Safeguarding and Prevent?

Hence, we are no longer training most psychological therapists to be able to work with sex, dreams, violence and disturbing fantasies and therefore for most potential clients there is less possibility of finding a places on the edge of society which are safe for such explorations. Isn’t this very dangerous?

Now to the papers themselves. In the first paper, ‘Rethinking the scientist-practitioner model: On the necessary complementarity of the natural and human science dimensions’, Paul Healy unpacks and reconceptualises the scientist- practitioner model. Tackling what may be considered a tricky and contentious aspect of psychology, Healy makes salient, thought- provoking points relevant to the field.

‘More focused attention upon relationship; another call for paradigm shift in Psychiatry’, our second paper addresses the importance of the therapeutic relationship between clinician and patient. Hugh Middleton opens the debate as to why emotional distress has evolved into a medicalised model and highlights the long-standing need for rethinking the current medical model’s views on emotional difficulties.

Our third paper, ‘Walk and Talk Therapy: A descriptive phenomenological study’ by Stephanie Revell and John McLeod, researches the views of practitioners on the value of walking and talking in therapy and draws out the implications for counselling and psychotherapy practice. A significant piece of work that adds to the relatively sparse literature on how Ecotherapy within a psychotherapy or counselling tradition actually ‘works’.

‘Stories of family caregivers of people with dementia in Greece: Implications for Counselling’ is our fourth paper in which the authors Philia Issari and Christina Tsaliki explore the lived experiences of dementia family caregivers within the Greek socio-cultural context. A timely and relevant paper that contributes to an area lacking in research.

The final paper, ‘A healing relationship: Clients’ experiences of the long-term relational significance of the horse in horse assisted psychotherapy’ by Joakim Norberg, Marianne Tuuvas and Jan Carlsson adds value to the literature on the human-horse relationship in mental/behavioural health treatment. Rich in content, the paper successfully fills a gap in the research whilst also helping with our knowledge of the more immediate effects of equine therapy.

The last article was on the human-horse relationship, but to return to the subject of this editorial, what is the long term human-human relational significance for psychological therapists of policies such as ‘Safeguarding’ and ‘Prevent’ ? They may fill a gap in our need for others to think for us but they can too readily take away the possibilities for us and our societies to allow thoughts to come to us and the therapist taking responsibility for judgements and timings of interventions in terms of the therapy to the potential benefit of all.

Del Loewenthal
Department of Psychology, University of Roehampton, London, UK
[email protected]