Vulnerability and power are two dynamics at play behind the closed doors of a psychotherapist’s room. In the wrong hands, the potential for such engagements to go awry is clear.

“What happens in this emotional, cognitive field between two people, when things get close and when things get intense, it’s very powerful. That’s why they call it ‘a dangerous method’,” says the general secretary of the European Association for Psychotherapy (EAP), Tom Warnecke. A 2011 film of that name, set in the early days of psychoanalysis at the start of the 20th century, centres on how psychiatrist Carl Jung crossed professional boundaries to have a love affair with a patient, Sabina Spielrein. (She went on to become a pioneering psychoanalyst herself before being killed by the Nazis in 1942.)

Warnecke quotes the words of Sigmund Freud: “We don’t ban chemists from handling explosives. We just train them well.”

Just how well psychotherapists of the future in Ireland might be trained is a matter of ongoing dispute between practising professionals and the multi-profession health regulator CORU.

Currently, anyone in Ireland can call themselves “a psychotherapist”, which is why accredited members of the profession have for years been calling for State regulation. But the statutory regulations now proposed by CORU are “dangerous” in their own way, argues the Irish Council for Psychotherapy (ICP), because they dilute the standards upheld voluntarily. This claim is strongly rejected by CORU, which, incidentally, is not an acronym but a name originating from the Irish word cóir, meaning fair, just and proper.

The lack of a specified training time frame, or any requirement for trainees to undergo personal therapy, or for ongoing clinical supervision, make the proposed regulations far from “just and proper”, in the opinion of the ICP. It points, instead, to European-wide standards for education and training in the field, devised over the years by professional associations in EAP’s 43 member countries.

To date, four-year continuous training has been the absolute norm here, says ICP chair Belinda Moller, who describes the absence of a specified time frame in the proposed standards as “shocking on two fronts”.

Firstly, “there’s no recognition of the time needed for the formation of a psychotherapist; the ethical maturity that one has to have in order to meet the many challenges that the psychotherapist is going to meet. The idea that a trainee psychotherapist, after a nine-month academic training, would sit with somebody who’s in a state of torment is just dangerous for the trainee and, of course, dangerous for the public.”

The lack of a time frame will also open the door to inconsistent durations of training, she says. “We’re just so opposed to the idea of fast-tracking training of any kind because of the work involved, which involves sitting with suffering, sitting with confusion, with early childhood experiences that the client isn’t able to speak about yet.”

Claims that CORU is lowering standards are simply wrong, says the regulator in a statement to The Irish Times. “They fundamentally misrepresent CORU’s proposals by conflating voluntary professional guidelines with statutory regulation. CORU is introducing legally enforceable minimum standards for the first time, ensuring that all registered practitioners meet consistent requirements and providing greater assurance and stronger protections for the public.”

Psychotherapy regulator cited ‘wider implications’ in rejecting personal therapy proposal

The gulf between the two sides will be a dominant topic at the ICP’s annual conference in Co Dublin on September 26th, at which Warnecke will be the keynote speaker. He will be addressing a room of mainly fellow professionals, but the message will be very much for the general public, he tells The Irish Times in advance of his visit.

“Safeguarding the patients, the clients, this is really what this is all about,” he says, citing three practitioners who have been through the courts for sexual violations of boundaries in recent times, one in the US and two in the UK where there is no statutory regulation of psychotherapists.

“There are bad apples. We cannot eradicate them but, by having good standards, we can keep the ‘barn door closed’ as much as we can.” There are at least a dozen countries where psychotherapy is state regulated at the level of the EAP, he says.

“We have credibility throughout Europe,” says Wernecke, who is “passionate” about the need for appropriate safeguards. “I have worked with someone who was raped by a therapist in practice. I know a lot about it, unfortunately. I’d rather not.”

The issue is not just about sexual violations but also the risk of retraumatisation during therapy.

“The only thing that makes this safe is to have the skills and the qualification and the awareness … and good supervision, which is also something CORU wants to dismiss.”

In many European countries, ongoing supervision is required for practising psychotherapists. “It’s not a policing,” he says, but rather a supportive system for therapists and, in turn, their patients. “I’m in supervision,” he points out, saying it is essential even for senior practitioners, who also need to reaccredit every five years.

Sexual assault cases are at the extreme end of psychotherapeutic transgressions. But even the most well-meaning practitioner brings elements of their own past into the room.

A therapist needs to have already engaged with any “hidden hurts” and found a way forward, says Warnecke, so as not to put the patient at risk. That is why there is dismay that the incoming regulations do not mandate trainee therapists to undergo therapy themselves or require clinical supervision throughout training and early practice.

Personal therapy helps trainees to manage and recognise their own personal responses in complex situations, says Moller. While CORU is suggesting alternative methods for self-reflection, “we would argue that nothing replaces the deep emotional learning that is involved in personal therapy”.

It is not CORU’s role to dictate how these are taught or assessed; education providers have the flexibility to design their own curriculum and choose suitable assessment methods, which may include personal therapy, among others

Coru

There is the danger, for instance, that in a psychotherapeutic setting a therapist would be unaware of their own need for power “because they haven’t had the training to recognise their own motivations or impulses”.

Among the general public, says Wernecke, “I don’t believe everybody has to be in therapy. I think that’s nonsense.”

He dismisses a notion, popular in the US, that “if you’re not in therapy and you never have been, then there’s something really wrong with you”.

But it’s different for those who want to work in the field.

CORU maintains that it has set standards for skills such as reflecting on therapeutic boundaries, managing dynamics in the therapeutic process, and handling personal emotional responses. “It is not CORU’s role to dictate how these are taught or assessed; education providers have the flexibility to design their own curriculum and choose suitable assessment methods, which may include personal therapy, among others.”

CORU’s position “is not that personal therapy lacks value, but that public protection is achieved by regulating competence, education, continuing professional development, ethics and fitness to practise rather than mandating one specific training requirement across the entire profession”.

Bad therapy: ‘After some of our sessions I couldn’t go into work the next day’

The ICP, which is the national umbrella body representing more than 2,100 psychotherapists across 10 professional associations, had hoped a meeting with the Minister for Health, Jennifer Carroll MacNeill, last March might lead to changes in CORU’s plans.

However, a follow-up letter from the Department of Health, seen by The Irish Times, backs CORU’s approach and confirms the process to regulate counsellors and psychotherapists will continue as proposed.

“The Minister is of the view that any delay to the introduction of regulation of counsellors and psychotherapists presents a clear patient risk as there is currently no mandatory education, no code of practice, and no minimum standards of clinical experience for these professions,” the letter adds.

The question of personal therapy is addressed in an appendix to the letter, which states there is no consistent empirical evidence demonstrating that compulsory therapy enhances therapeutic competence or improves client outcomes. “While personal therapy may offer individual benefits,” it adds, “research has shown that mandated participation can also lead to negative experiences for some trainees, including emotional burden and financial pressure, particularly when participation is a condition of qualification.”

It is not possible to provide a definitive date for the opening of the register for counsellors and psychotherapists, a department spokesman tells The Irish Times. But the department and CORU “will continue to engage with all stakeholders as progress is made towards the regulation of these professions”.

Warnecke says he would be happy to talk to any politician or relevant expert in Ireland about what is at stake. Meanwhile he hopes to boost morale among Irish psychotherapists, as it can be quite dispiriting, he points out, to have your expertise rejected.

It would be nice, he adds, to see more openness and concern among policymakers because “when patients come to therapy, they are really in a vulnerable place and they deserve top-class service”.