Medics often brand themselves as illness specialists: we suffer because we’re ill; a bit of us is broken, we’ll fix that by cutting something off or adding a pill; if you’re lucky, you’ll be cured. I polarise, of course, and many medics such as Joanna Moncrieff and David Zigmond (see his blog post in the BMJ) are highly attentive to these issues. Psychologists often take a critical approach too these days, rejecting such reductionism and fundamentalism in favour of context and the biopsychosocial. This proves problematic in the NHS though, a system where patients and other professionals are socialised to demand of the psychologist ‘what’s wrong with me?’ and ‘how are you going to make it better?’
While my career has led me to become a trainer in counselling psychology, my training was in clinical psychology. My colleagues and I had rarely encountered counselling psychologists, apart from the occasional supervisor or office mate on placement. It seemed hard to work out the difference between us. The best we could come up with where the observables: we got paid to train, did psychometrics and CBT and finished in three years. They worked for free, had mandatory therapy, did counselling and seemed to take ages to qualify. After training though, they seemed to do the same as us.
Counselling psychologists that I supervise tell me that image is a problem. They feel subordinate, misunderstood, and out of place. When I ask ‘what makes you unique as a counselling psychologist?’ they either don’t know or say the same things that I say as a clinical psychologist. I have the same problem, I say. I am a clinical psychologist, training as a psychoanalyst. I tried to bring these together by working as a trainer in counselling psychology. It just got messier!
Clinical psychologists were once specialists in brains and behaviour: their branding was as psychometricians and behaviour modifiers. Hardly surprising given the profession was born alongside psychiatrists in the asylum, where assessment and evaluation, categorisation and medical intervention was the order of the day. Not for nothing did we attract the label of ‘handmaidens if psychiatry’. When the training became doctoral, clinical psychologists labelled up as experts in mental health research. Where to go with once there are no asylums; behaviour and other therapy is routinely carried out by inexperienced, barely trained, cheaper graduates; and psychological research is only permitted if it confirms with the ‘evidence base’. Other forms of therapy, particular those dealing with the complexities of human relationships and their, often unconscious, underlying processes, are treated with suspicion and contempt.
So what place for the counselling psychologist in this? What is its brand? Not medicine. Counselling? Counsellors do that. Psychological therapy? Clinical psychologists do that. Research? Not many counselling psychologists are really into that (see my post on this). Pluralism? Clinical psychologists. Relational approach? Psychoanalysts. Humanism? Counsellors. A mix of them all? Fine, but eclecticism really isn’t in vogue. Where’s the evidence for it? …
In her article in the New York Times, Lori Gottlieb discusses ‘branding’ herself to generate referrals to her practice. Do counselling psychologists need to do the same? More importantly, can they? I’d love to hear your thoughts and comments; and if you want supervision on these issues, get in touch!
Dr Russel Ayling