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Psychotherapy Bill [H.L.]

5 p.m

Lord Alderdice: My Lords, I beg to move that the House do now resolve itself into Committee on this Bill.

Moved, That the House do now resolve itself into Committee.--(Lord Alderdice.)

On Question, Motion agreed to.

House in Committee accordingly.

[THE DEPUTY CHAIRMAN OF COMMITTEES (Lord Skelmersdale) in the Chair.]

Clauses 1 to 10 agreed to.

Clause 11 [The Education Committee]:

Lord Alderdice moved Amendment No. 1:

("(5) The Education Committee shall establish sub-committees to give authoritative advice on the educational, training and continuing professional development requirements of the various modalities of psychotherapy.
(6) At the outset, sub-committees shall be established in the following modalities--
(a) Psychoanalytic Psychotherapy, Psychoanalysis and Analytical Psychology,
(b) Cognitive and Behavioural Psychotherapy,
(c) Family and Systemic Psychotherapy,
(d) Group Psychotherapy,
(e) Humanistic and Integrative Psychotherapy,
(f) Experiential Constructivist Psychotherapy,
(g) Hypno-psychotherapy,
and other sub-committees may be established as the Council deems appropriate.
(7) The Education Committee may, with the agreement of the sub-committees, modify the system of sub-committees set out in subsection (6)(a) to (g) above.").

The noble Lord said: At Second Reading we addressed, at some length, the principle of regulation of the profession of psychotherapy. There was a gratifying welcome in your Lordships' House for the principle of regulation of psychotherapy, but with regret and concern it was noted by a number of noble Lords that this process had failed to reach fruition some 30 years after the publication of the Foster report, which had been such a crucial early marker.

One reason for the failure has been the diversity of therapeutic approaches that fall within the bailiwick of psychotherapy. During the past couple of years, much of my endeavour has been directed towards persuading the various psychotherapy organisation and representatives to accept a relatively limited but coherent list of modalities. Indeed, one of the reasons why the wording in this amendment was not included in the Bill when it was first presented to your

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Lordships' House is that discussions have continued up until the last week or two to try to reach an agreement.

The amendment, which sets down a number of modalities, does not permit or require registration by modality. The notion of modality is imported by way of sub-committees into the area of education and training and the purpose is to recognise the different requirements of education, training and continuing professional development of the different approaches to psychological treatment. Here I have taken on board the valid concern raised at Second Reading by the noble Lord, Lord Hodgson of Astley Abbotts, that education is not the same as training and that continuing education is now a proper requirement of all professions. By inserting subsection (5) into Clause 11, the amendment emphasises those three important components of professional education, professional training and continuing professional development.

The advice that the sub-committees would be required to give is described as "authoritative". While to a lawyer, like my noble friend Lord Wedderburn of Charlton, that description may appear something of a hostage to fortune, its purpose is to emphasise the view of professional groups that the advice tendered by their modality sub-committees should be taken seriously. I know it would be their wish that within the confines of their modality, the advice tendered should be regarded by the education committee and the council pretty much as the authoritative word.

Returning to the main burden of the amendment--the setting down of modalities--I emphasise that, despite the amendment, registration would not be by modality. The Bill gives legal protection to the title "psychotherapist", and with the exception of those already registered with the GMC, would require those who wanted to used the title "psychotherapist" to register with the General Psychotherapy Council. However, I repeat, as there has been some misunderstanding about it, that the indicative registration, as the Bill stands--I cannot say what may happen in the future--is not for the different modalities but for the title "psychotherapist" itself.

The modalities described in the amendment are psychoanalytic psychotherapy, psychoanalysis and analytical psychology; cognitive and behavioural psychotherapy; family and systemic psychotherapy; group psychotherapy; humanistic and integrative psychotherapy; experiential constructivist psychotherapy and hypno-psychotherapy.

I want to make it clear that I do not regard that list as being complete for all time, nor as satisfying the wishes of all therapists. The amendment gives the committees a substantial position--in some ways a starting position--but it clearly leaves open the possibility of the merging or de-merging of the sub-committees and of adding others. I believe that the flexibility for the development of new ways of working is important indeed. This Bill is not intended to create stagnation or rigidity but to create regulation. However, even as matters stand, I fully admit that some problems remain. We shall come to Amendment No. 2 and I shall want to make some remarks about it.

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At Second Reading, a number of noble Lords expressed concerns about the position of analytical psychology. I advised the House that I was aware of the problem and that I would try to address it specifically. I have met and corresponded with a substantial number of representatives of that and other traditions and it seems clear that unions--that is, practitioners of analytical psychology--are somewhat divided on the question. Some want to be separated into a separate modality, as proposed in the amendment standing in the name of the noble Earl, Lord Caithness, and the noble Lord, Lord Clinton-Davis, but others do not want to be divided from their colleagues. At least, that appears to be the current position. Although what we have is not perfect, it may be the best that we can have at present. More work needs to be done in that regard, but we shall deal with it later.

There are those who would suggest that the semi-federal nature of my model would be directed better if it were described in the form of a collegiate structure rather than a modality arrangement. I have no doctrinal difficulty with that. I adopted a modality approach because of the substantial problem of using the current organisations as a basis for a collegiate structure. Many of the current organisations compete and overlap with each other and, try as I might, I have yet to see a model of how a collegiate structure might be put into a workable form.

More difficult still, I have yet to understand how it can be constructed in a way which does not conflict with the European Convention on Human Rights because there are smaller organisations--some of which are established on the principle that they do not like organisation and are particularly opposed to regulation--which yet might well be able to claim coverage under the European convention.

For those reasons, I have focused on the registration of individuals rather than the recognition of organisations or of colleges. But I remain, as I trust the Minister does, open minded about which model might work. If propositions are put which are workable and reasonable, and which conform to the proper legal regard, I shall happily embrace them. Neither the instrument of legislation nor the model for regulation is one to which I have a doctrinal attachment. I simply want something which will work and be proper.

In summary, the amendment comes out of my discussions with the various organisations. To some outsiders, the disputes and divisions within the psychological world may appear as esoteric and quaint as do the procedures of your Lordships' House to the uninitiated, but they are all based on matters of substance--sometimes of history and relationships, broken or otherwise, and sometimes of genuine intellectual debate. Overcoming them is no easy matter and this amendment does not claim to be a perfect

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instrument. However, it is the best I have been able to achieve to date and at this point is substantially better than the alternatives. I beg to move.

The Earl of Caithness moved, as an amendment to Amendment No. 1, Amendment No. 2:

    Line 8, leave out ("and Analytical Psychology") and insert--

("( ) Analytical Psychology,").

The noble Earl said: Sadly, I was unable to take part in the Second Reading debate so I shall take this opportunity to congratulate the noble Lord, Lord Alderdice, on bringing forward the Bill. When one is trying to help and to do good, it is always difficult to be buffeted around on all sides. I apologise to him for that but I am one of those people who are trying to make the Bill a little better. I certainly do not want to deter the noble Lord from pursuing the Bill in his discussions.

It gives me particular pleasure to have my amendment supported by the noble Lord, Lord Clinton-Davis. For years, we were on opposite sides of the Dispatch Box hammering away at each other and it makes a pleasant change to be on the same side for once.

I turn first to Amendment No. 1 which is a welcome step forward and a significant improvement to the Bill as it was at Second Reading. However, I believe that the amendment can be improved upon. My amendment seeks to make a separate modality for analytical psychologists who are the followers of Jung. We now start to enter what may be a very difficult and complicated area, and I shall try to keep it simple. Although I may err, I believe that it will be simpler for everybody to understand.

It is common knowledge that Freud and Jung parted acrimoniously in 1913 and went their separate ways to form completely different theoretical bases for their approaches to analytical work. Jung moved away from Freud's biological determinism, as did Adler and Rank. But Jung transcended the theory of these biological forces and that led him to consider other forms of energy, apart from the sexual energy on which Freud focused, including power, nutrition and other forces. He looked at many metaphysical concepts and studied many cultures. His views accepted and embraced the complexity of human behaviour but not in the limited way that he believed Freud saw it. He also moved dream analysis into a different league. Perhaps a summary of his goals is best seen in the autobiographical Memories, Dreams and Reflections. Jung is not alone but his contribution is fundamental and unique.

It is quite natural that out of the two different theories of Freud and Jung have evolved different techniques and institutions worldwide. At Second Reading the noble Lord, Lord Burlison, when talking about analytical psychology, said:

    "That is a branch of psychotherapy with a distinct and different training".--[Official Report, 19/1/01; col. 1354.]

To force the followers of Freud and Jung some 80 years later to cohabit in the same modality is, I believe, unworkable and a recipe for disaster. If we look at the

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UK alone, the BCP and UKCP voluntarily split in 1992, only some nine years ago. I also say to the noble Lord, Lord Alderdice, that to lump them together in the same modality will create confusion in the mind of the public, who increasingly see analytical psychology and psychoanalysis as two discrete modalities, and that confusion will militate against the Bill's aim to protect and educate the public.

I move away from the UK and look at the international scene for a moment. There are two international bodies: the International Psychoanalytical Association and the International Association for Analytical Psychology. To support my contention that these should be split in the UK, I quote the current International Journal of Psychoanalysis:

    "For the International Psychoanalytical Association: the term 'psychoanalysis' refers to a theory of personality structure and function and to a specific psychotherapeutic technique ... based on and derived from ... Sigmund Freud".

That is not what the followers of Jung believe, and that is why they deserve and should have independent recognition. The noble Lord, Lord Alderdice, himself recognised that at Second Reading. He acknowledged at col. 1334 that the two disciplines were a divided profession. Referring to analytical psychology, at col. 1356 he said he appreciated that,

    "it would not help matters for it to be 'muddled in' with other things".

I believe that there is a very strong case for keeping these two specialist modalities separate. They are different and should remain so. Given the huge differences in philosophy, education, training and therapy, surely what the followers of Jung and Freud have put asunder the noble Lord, Lord Alderdice, should not join together. I beg to move.

5.15 p.m.

Lord Clinton-Davis: I am delighted to speak in support of the amendment moved by the noble Earl, Lord Caithness. He is right that we have not always agreed--I welcome him to the cause of progress--but I am genuinely delighted to be on the same side today. Although we have a difference with the noble Lord, Lord Alderdice, that does not mean that we do not want to come to a rapprochement with him; of course we do. The noble Lord has given me an assurance--I believe that the same applies to the noble Earl, Lord Caithness--that between now and the enactment, we hope, of a Bill such as this, he will enter into further dialogue with everyone concerned with this difficult matter.

It is true that all the therapeutic modalities under the proposed umbrella see themselves as members of a healing profession and have its integrity and the interests of their patients at heart. With that, I suppose, there will be no dissent whatsoever.

The Bill encompasses many diverse means towards the aim of mental and emotional healing. It is extremely important that they are all recognised and acknowledged in their own right. The proposed amendment seeks to do exactly that. It acknowledges and supports the wish of the practitioners of analytical psychology--the Jungians--to be a separate entity

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and not to be subsumed into a grouping together with the psychoanalysts and the psychoanalytic psychotherapists, whose theory, practice and training differs fundamentally from their own.

The analytical psychologists are smaller in number, albeit world-wide. They do not feel that their interests or those of their patients would be best served in cohabitation with much larger numbers of practitioners who are not on the same wavelength.

I make no value judgments in supporting the amendment; neither does my noble friend, on this occasion, Lord Caithness. I merely uphold the right of an important branch of the profession who perceive themselves to be different and who have a very different approach from psychoanalytic practitioners, to be recognised as such in the mind of the public--their potential clients--by according them an independent identity within a modality in their own right.

I hope that the further discussions which the noble Lord, Lord Alderdice, has described will prove to be constructive and that the outcome will be helpful, because a rapprochement between the different sectors in this particular field is of the utmost importance. If it does not occur, the Government will tell the noble Lord, Lord Alderdice, where he can get off. Of course they will. I want to see the Bill, or something like it, eventually enacted, as does my noble friend, on this occasion, Lord Caithness.

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