Choosing a Psychotherapist

James Baxter


If you were considering psychotherapy, whether for yourself or for someone you know, how would you go about it? I guess many people would look for someone trained, qualified and accredited. Thus they would hope to ensure that the prospective client will not be exploited - financially, physically or emotionally: that there will be no attempt to persuade them, for example, that the condition for which they need help is more serious and requires more intense or prolonged treatment than they thought; that they will not be discouraged from seeking additional help and thus become emotionally over-dependent on the therapist; that promises will be kept and private information will remain confidential; or that they will continue to be offered help if their condition deteriorates.

These are but some of the less obvious risks. Instances of sexual exploitation and 'recovered', but false, memories that achieve publicity are the tip of the iceberg. It is hardly surprising that psychotherapy is sometimes compared to a religious cult; yet many people assume that, because professionals know best, therapists who are accredited by their fellows are more reliable than those who are not.

Perhaps we should enquire more deeply. The codes of ethics that members of the professional associations are expected to abide by offer clients no more protection in fact than they can expect from any supplier of services. There is no way of assessing whether the proportion of association-accredited therapists who prey upon clients is smaller or greater than the proportion of those who are not accredited. Indeed, accreditation by an association can have the opposite effect to the one claimed, by confering on its members spurious credentials that actually make it easier for them to exploit credulity.

Most clients would probably confirm the findings of research that the effectiveness of psychotherapy (or 'counselling' as it is sometimes called) depends largely on their personal experience of the therapist as a person who is honest, trustworthy, genuinely open-minded, flexible in approach and dedicated to their joint purpose. Also that s/he understands and accepts them for what they are rather than as others regard them. Finally, that, while being tutored in the art of making their lives more fulfilling, they are encouraged to challenge the therapist's views, without jeopardising the emotional support s/he offers. The techniques that some 'schools' of psychotherapy claim as key factors, such as psycho-analytical interpretations, desensitisation exercises, dream interpretation, guided imagery, hypnosis, role-playing and biofeedback are in fact ancillary.

On the face of it, we might suppose that the courses of instruction often deemed essential to accreditation are a reliable indication of high standards. But are they? As someone who has had considerable experience of such courses, I can vouch for them as a means of learning more about oneself and one's relationships to others. But I also know that they are not, and indeed cannot be, a valid measure either of proficiency or probity. In its truest sense, training involves the objective measurement of clearly defined skills against generally accepted standards, so that what constitutes proficiency is hardly in doubt - as in the training of a fighter pilot, say, or in that of an infant who seeks to graduate from dependence on nappies.

The skills, values, knowledge and attitude needed for safe and effective psychotherapy are indeed special; but only because they are so sparse in society as a whole. Claims that it depends on a body of specialised, differentiated knowledge and skill are unsubstantiated. The qualities required are more likely to be acquired over a long period of time by people who are sufficiently self-aware and dedicated than inculcated by courses of instruction.

Indeed, the kind of 'training' cherished by the professional associations cannot provide their members with the most important item they need in their armamentarium: the interpersonal, or 'people', skills that may follow from practical experience of dealing with and understanding people from diverse backgrounds. It is perhaps not surprising, therefore, to come across research revealing that 'untrained' practitioners have in some instances proved more effective than those who are 'trained' and 'qualified'. I doubt if I am the only one to have discovered that many of the latter appear unable to understand what some of us struggle to put into words.

By declaring that 'anyone can call himself a psychotherapist', professional associations can subtly imply that their members maintain higher standards. But there is no evidence of this. Some years ago, a task force appointed by the Department of Trade and Industry set out to establish standards for psychotherapy, only to discover there were none that could be objectively measured, or even adequately defined. So, in the absence of such standards, can anyone who practises psychotherapy truthfully claim to be appropriately trained or qualified?

Some of the professional associations also insist on their members being supervised by other members. This may give the impression that the supervisors accept ultimate responsibility for clients' welfare. But, in psychotherapy and counselling, as in academic research, that is not the case. In psychotherapy, supervision is a means of support and/or challenge to the therapist's thoughts and feelings. Depending on the kind of relationship between supervisor and supervised, this may or may not improve the quality of the service the client receives. The only people truly capable of assessing the value of the service are its clients.

Because extreme distress can make us more vulnerable than usual to being exploited, those seeking help from psychotherapy or counselling need to be particularly wary of charlatans. Can the professional associations - whose primary purpose is to serve the interests of their members - offer the kind of protection needed? 'Who will protect us from our protectors?' queried the Roman poet Juvenal. Whether we like it or not, the only real protection against professional misconduct is caveat emptor: 'the client must be wary'.

If the exploitation of clients is to be minimised, the first step will have to be increased understanding of the true nature of psychotherapy; because it is not - as we are sometimes encouraged to believe - a recondite, para-medical treatment, administered exclusively by members of an elite, but a particular form of education that helps clients improve their ability to help themselves.


[The author has been practising psychotherapy since 1983]