RESPONSE

A Note on `Core Professions'

David Black

Anyone interested in the development of psychotherapy in the UK must be grateful toJonathan Pedder for his excellent summary of the recent history and current situation inCourses in Psychotherapy: Evolution and Current Trends (1989). It is splendidly lucidand informative.

I should like, however, to pick out one theme from his paper which I think needs verycareful attention. It is the suggestion that `entry to the practice and profession ofpsychotherapy should be via the core professions'. By core professions he means: `obviously' medicine, clinical psychology and social work; apparently less obviously, `nursing, occupational therapy, educational backgrounds and so forth'.

This suggestion, he says, `I first thought rather conservative but am coming round tothink is perhaps right'.

As a first point, let me comment on the word conservative. The reality is that the greatmajority of the existing psychotherapy trainings have no tradition of regarding medicine,etc, as `core professions' in the sense that there is any necessity to enter the training by wayof them. Even Dr Pedder's own organisation, the British Psychoanalytical Society, acceptspeople from other backgrounds quite readily, and I am not aware that they are regarded inany way as less equipped, having done the training, than the medics and others. Of all thetrainings, the only ones whose tradition would be `conserved' by this (in fact) radicalinnovation would be the adult training of the Tavistock Clinic, certainly an excellent bodybut unique because of its special relation with the NHS, and perhaps some of the universitydiploma courses.

Dyne and Figlio (1989), responding on behalf of the 'independents', make a secondimportant point: that many excellent therapists come to training in middle life and withoutsuch backgrounds. It would be pointless and counter-productive to require them to domassive preliminary trainings of such limited relevance to their mature goals.

In the Question of Lay Analysis, Freud's detailed and (I would say) conclusivestatement on this topic, central points of principle are addressed. Here is one of hissummaries (Freud 1926, pp. 244-245):

For the patient, then, it is a matter of indifference whether the analyst is a doctor or not, providedonly that the danger of his condition being misunderstood is excluded by the necessary medicalreport before the treatment begins and on some possible occasions during the course of it. For himit is incomparably more important that the analyst should possess personal qualities that make himtrustworthy, and that he should have acquired the knowledge and understanding as well as theexperience which alone can make it possible for him to fulfil his task. It might be thought that itwould damage an analyst's authority if the patient knows that he is not a doctor and cannot insome situations do without a doctor's support. We have, of course, never omitted to informpatients of their analyst's qualification, and we have been able to convince ourselves thatprofessional prejudices find no echo in them

David Black is a psychotherapist, training as a psycho-analyst. Address for correspondence: 30Cholmley Gardens, London, NW6 1AG.

British Journal of Psychotherapy, Vol. 6(4), 1990© The author

David Black 459

and that they are ready to accept a cure from whatever direction it is offered them - which,incidentally, the medical profession discovered long ago to its deep mortification. Nor are the layanalysts today any chance collection of riff-raff, but people of academic education, doctors ofphilosophy, educationalists, together with a few women of great experience in life and outstandingpersonality.

Nowadays, of course, for `a few women' we would have to read `many women''including many professional women, and for `doctor' we could read `member of a "coreprofession".' Otherwise, Freud's paragraph is as true today as it was in 1926.

Moreover, one should say `self-styled core professions'. It is by no means clear thatmedicine or clinical psychology are at the `core' of psychotherapy, and there is no reason tothink that doctors, say, are better at it than any other category of professionals. If we are toconsider what skill is central in psychotherapy, rather than medical knowledge, it isprobably a great sensitivity to language.

This proposal of 'core professions' is especially concerning because we have theexample, of the American history in which the medical profession attempted, for manyyears successfully, to keep a monopoly of 'psycho-analysis'. (Perhaps their nearidolatry ofFreud was reparation for their guilt at flouting his express wishes!) Recently, they werethreatened with legal action by other bodies for `restraint of trade' (i.e. for establishing anillegitimate monopoly). Faced with having to argue the case in public, they wiselyabandoned their claim.

The question of who does or does not have a right to `trade' as a psychotherapist is ofcourse very important. It links with a further point, more subtle but equally crucial.

What happened in America during the years of medical domination of psychoanalysiswas a brief flowering followed by an authoritarian deadening. Psychoanalysis lost much ofits prestige. This is not an accident. Psychoanalytic thinking cannot be done in anauthoritarian environment. It depends above all on a freedom in relation to formulations,an ability in its practitioners to be open to very varied ways of seeing experience, a certain`playfulness', a contact with alternative languages. A monolithic profession cannot abidethis: like a dominant religion, it expels heretics and learns from no-one.

It has been a strength (although I have certain criticisms) that in England the BritishPsychoanalytic Society has been divided into three groups. The necessity for each group tomaintain at least the semblance of respect for the others has in practice meant that all threegroups have evolved, retained some humility and moved towards a degree of flexibility. Itis similar to the generally pluralistic scene of the current psychotherapy trainings, althoughunfortunately (in my view) the resolutely 'empirical' cast of English thinking has banishedmany views from serious consideration. A satisfactory outcome to the deliberations of theUKSCP will not be to create a 'monolith', however impressive to polititians, withdesignated 'core professions' other than psychoanalytic psychotherapy itself. (Even thatwould be questioned by some members.) It will be (and this is a far more difficultachievement) to establish a structure in which mutual respect for difference is possible,and dialogue continues.

References

Dyne, D. & Figlio, K. (1989) A comment on J. Pedder's `Courses in Psychotherapy': A future fortraining in psychotherapy. In British Journal of Psychotherapy, 6(2), pp. 222-226.

Freud, S. (1926) The question of lay analysis. In Standard Edition, 20. London: Hogarth Press.Pedder, J. (1989) Courses in psychotherapy: evolution and current trends. In British Journal of

Psychotherapy. 6(2), pp. 203-221.