Are psychotherapists et al even less fit for purpose?

‘I find touching a baby’s skin so erotic.’

‘I dreamt of having sex with my daughter and being terrified but then in my dream I thought it horribly no longer mattered as I had done it so many times previously’.

‘When I was sixteen I was well developed. My father unexpectedly left home but use to sometimes open the door of the hairdresser’s where I worked and just shout at me.’

‘On my way here today I saw a couple of girls, whom I think were about fourteen, at the top of your road and I’m very worried I found them sexually attractive.’

‘When I dropped my daughter off at Uni for the first time there was a girl standing next to her in the queue and I felt attracted to her – am I a paedo?’

‘My wife put our baby on my chest when I was lying in bed and I to my horror felt some stirrings – I do so very much hope I’m not one of them!’

The first quote is from a woman on a short course for health service professionals, where I subsequently had to spend too much of the programme protecting her from verbal attacks from her fellow students. The others could be from the consulting room. But are too many psychotherapists increasingly unable to explore with their clients what might not be uncommon concerns?

In a forthcoming issue of the European Journal of Psychotherapy and Counselling, the case is presented of a client who was addicted to child pornography from when he was very young and had a history of an aggressive attitude (Grossmark, in press). The successful therapy included the therapist acting like a midwife, helping the client change his baby son’s nappy, involving showing him how to clean around the baby’s private parts. Whilst one might not expect most therapists to assist in changing nappies, what percentage of current therapists would have reported the client on the birth of his son to Safeguarding (UK Government, 2021)? Would 90% of psychological therapists be too high or too low?

In the United Kingdom, as in many countries, psychotherapists are encouraged, and more often required, to report such situations in the name of Safeguarding. There is clearly too much historical evidence of a horrendous lack of Safeguarding. However, can current procedures lead more to the Safeguarding of agencies and therapists at horrendous, thoughtless expense for clients and others? One result of this could be that the therapist might appear to be in a win-win situation, greatly reducing responsibility including the chances of blame, possibly with legal proceedings. However, for the client they are likely to be referred to another professional who is very unlikely to have had any personal therapy. Furthermore, the chances are that this client and his family will be demonised (from outside and from within) and the child could rightly, but also wrongly, be taken into care. However, it is not only this referred to professional who takes over from the therapist who is likely to not have had any personal therapy. All the well-known professional counselling, psychotherapy and psychoanalytical bodies, at least in the United Kingdom, have reduced at least some of their requirements for personal therapy with an ever-increasing number of so-called qualified therapists having had no one-to-one personal therapy at all.

Furthermore, regarding even those who have had psychotherapy, to what extent would their psychotherapists, and indeed supervisors, have been able to hear the client mentioned above? For these psychotherapists and supervisors in turn may not have been able to explore their own sexualities and violence in their own therapy and supervision (Loewenthal, 2015)? Similarly, for even currently experienced trained psychotherapists and supervisors: where could they take their dreams now without fear of being reported? How many psychotherapists today would be able to hear a dream of a client having sexual fantasies about someone who is under-age according to the country or state that the psychotherapist is working from? Now hopefully many, if not most, readers would agree that what is often important is in the telling rather than what is told and how as therapists we experience the client? But, if the therapist has not worked through their own unexplored minefields then such nuances will not come to the forefront.

Yet, all this is difficult to consider thoughtfully when not only are more and more horrendous cases coming to light when safeguarding has been woefully inadequate but also that for the psychotherapist to stay with such issues can too easily lead to aggressive scapegoating from others who are even more terrified to explore their sexualities.

In the title of this editorial are the words “psychotherapists et al“ for perhaps it is not just psychotherapists that are so afflicted to the detriment of their clients. (Perhaps instead of ‘psychotherapists’ I should have used ‘psychological therapists’). However, it is suggested that the ‘et al’ might not only include counsellors, psychoanalysts, psychologists and arts and play therapists but all in the helping professions including psychiatrists. Perhaps what I have written so far is just the tip of an iceberg of an international deluding socialisation process whereby young people who are interested in others go to study psychology and psychiatry. Here they can be seen to learn very little about others or themselves but are too frequently armed and personally disarmed by an alienating training. How many psychiatrists are in a similar situation as described to me of having only minutes with a distressed patient with the only options of a prescription pad and the distant hope of persuading their hospital to offer their first patient support group (on weight loss)? There have previously been important criticisms of psychotherapy training (for example, Kernberg, 1996) but at least then there was in-depth training and lengthy intense training analyses. Yet nowadays one can also just train for one day a week for 2 years without one to one personal therapy and advertise as a therapist of an apparent reputable professional body with the general public being none the wiser.

Layard et al. (2007) was very able in persuading successive UK governments to prioritise talking therapies over drug therapies. Interestingly, it is perhaps CBT therapists working to take their clients minds off their problems who may be best trained, as there is an argument that they do not need personal therapy to do this. However, for those therapists to work with clients who wish to work things through, so that they can allow thoughts to again come to them, these therapists would appear to be increasingly ill-equipped. This may mean that none of us can be sure we can take our dreams and potentially dark thoughts to therapy.

Psychological therapists seem to increasingly hope to be part of society and not on the edge of it, but do not they need to be able to think and speak of that which might ordinarily be repressed or suppressed? To do this it is advocated that they need a training of sufficient length and depth together with training therapists and supervisors who are also able to personally go where others may not. The danger is that instead a professionalisation process (increasingly technologised) evolves as a defence against anxiety which can lead to the therapist not realising they are out of their depth and it is their role and the therapy rather than them as a person that the client is responding to giving them authority. (It is also suggested that this can lead to further deficiencies in the lives of the people who are therapists and their relationships with their partners, children and indeed everyone.) It would appear reinforced that the greatest resistance to a successful therapy lies within the therapist. For to what extent is it credible to consider that as psychological therapists we are increasingly becoming like too many psychologists and psychiatrists pretending to offer a service that increasingly does not exist? The danger for clients of psychological therapists maybe the more so in that we might be offering a trusting relationship which should not be trusted.

Turning to the papers of this general issue. I would first like particularly to thank the following people for their help with this issue: Orit Badouk Epstein, Christian Buckland, Anne Edwards, Jodie Fellows, Penny Forster, Francesca Maria Freda, Allan Keith, Miranda Kersley, Victoria Leach, David Maree, Anthony McSherry, Arielle Schwartz and Luca Tateo. I would also like to take this opportunity to thank the translators of this issue of our journal and very belatedly thank our translators for all journal issues over our last 25 years. Our translators are currently: Betty Bertrand (French), Nicole Fisher (German), Patricia Talens (Spanish), Anna Milona (Greek) and Carmine Parrella (Italian).

Our papers for this issue come from Australia, England, Italy, Ireland, Scotland and the first from the United States. It is ‘On the use of profane language in psychotherapy and counselling: A brief summary of studies over the last six decades’ by Izaak Williams and Michael Uebel. Here is another area that psychological therapists might usefully personally explore to their client’s benefit. The authors in questioning through a literature review on profanity what they take to be a categorically taboo subject matter in present-day counselling provide a useful basis for future practices and research.

Our next paper ‘When the past becomes the present’ is by Helma Mair. This interpretative phenomenological analysis, with rich case examples, suggests that clients’ previous traumatic experiences can resurface during a session in the form of memory fragments, physical sensations and nervous system activation to produce feelings of unsafety that psychotherapists need to be able to recognise and know how to respond.

Our third paper is ‘Metapsychology of borders: structures, operations and semiotic dynamics’ by Raffaele De Luca Picione. Taking into account several border-focused models from psychoanalysis, psychology and semiotics, the author identifies and discusses eight operations carried out by borders: Distinction, Differentiation, Separation, Containment, Protection, Mediation, Transformation and Regulation. The paper can be seen to provide a metatheoretical review of the concept of borders in clinical and dynamic psychology with an interesting fertilisation with cultural psychology.

The following paper ‘Healing attachment trauma in adult psychotherapy: the role of limited reparenting’ is by Panoraia Andriopoulou. The focus is on limited reparenting, an attachment informed approach employed in the context of schema therapy. The author comprehensively explores its potential in producing beneficial therapeutic outcomes by meeting the client’s attachment needs and thus reconstructing their relational schemas.

Our penultimate paper by Archana Waller, Chiara Paganini, Katrina Andrews and Vicki Hutton is “Trust and a sense of safety in the group: the benefits of professionally led support groups in eating disorders”. The overall findings of this review suggest that professionally led support groups increased social networks, learning coping strategies, reduction in psychological symptoms, and increased perceptions of the well-being of people living with eating disorders. It can be difficult to evaluate the reasons why professional led groups are beneficial and this paper usefully helps to emphasise their importance for future research.

Our final paper is by Julia McLeod, Sally Lumsdaine and Kate Smith and is entitled: ‘Equipping students to be resourceful practitioners in community settings: a realist analysis’. The authors make the case that training for non-medical community-based counselling work is an under-researched area and are able to offer data from ten years on the course they teach to fill that gap. They valuably employ Pawson and Tilley realistic evaluation approach.

This last paper is one of the too rare papers that explore the effectiveness of psychotherapy trainings. This editorial has been written on the training assumption, which seems increasingly to only be given lip service, that in order for therapists to thoughtfully consider with a client what a culture regards as a taboo they first need to be able to think about it through their own psychotherapist and supervisor with regards to themselves. We need to be in a position to be able to help our clients distinguish what are the vital very simple pleasures of life from the intentionality of inappropriate perversity.

Otherwise as psychotherapists et al we may not be able to listen and think before acting.

Disclosure statement

No potential conflict of interest was reported by the author(s).