Harm in therapy: the question of regulation

^{Featured photo credit: Franck V.}

By: Lucia Sarmiento Verano

The current push for the regulation of our profession in the UK seems to come (from what I’ve seen online) from the idea that it will protect the public from harm. More precisely it will protect potential clients from charlatans, people who practice without the right qualifications, lie about their knowledge and skills and harm others. Now, these cases do exist. However, focusing solely on the figure of the rogue therapist considerably invisibilises the massive amount of harm that happens all the time by practitioners who do hold the appropriate qualifications and memberships and who are deemed perfectly fit to practice.

To me, the figure of the rogue therapist has become somewhat of a scapegoat, the single location of disturbance that also serves a purpose. The group or the collective that refuses to honestly look at the systemic aspects of the problem can locate it in the individual thus avoiding to look at the problem as something held and enabled by the collective. An individual that can later be punished and expelled from said collective, creating the illusion of a solution. The problem is not in the group anymore; therefore, the group is made “good” again, and there is no need to question the current system.

For those who have been reflecting on issues of oppression and harm from a collective lens, it’s relatively simple to see why this approach is problematic. We know that is not how the dynamics of harm and power work. The misuse of power and may be enacted by a person at a given time, but they are always collectively enabled through systems that individualise issues and are not prepared to foster accountability.

What would really give me hope and faith in the movement for regulation would be to see a willingness to question the structure that enables harm as well as the focus on harmful practitioners, instead of only the later. For this, we need to be willing to look at our profession as a collective and consider what currently enables harm. The following is a non-exhaustive list of what could potentially be explored:

1/ Attachment to the “good” image, both individually and collectively as a profession

This attachment comes with an incapacity to tolerate deviations from this image that gives us worth, creating a collective that demands constant goodness of its members too. An unhelpful good/bad binary, a colonial perspective, shapes how we see ourselves as professionals and thus, how we practice and how we expect others to practice. It often leaves little room for mistakes, and little consideration for all aspect of our humanity, notably the ones deemed unsavory (ones we all carry). We may then consider there is a defensive splitting of the “bad”, the not good enough, that becomes invisible in us, and is projected onto the figure of the rogue therapist. We learn the need to surveil ourselves and others, and hide those “bad” parts from everyone, including at times ourselves. With a little luck we have developed the capacity to privately admit to those in therapy or supervision. Collectively, the “bad” practitioners constitute an unbearable contamination of the collective “good” triggering incredibly unhelpful ways of dealing with harm and complaints that may end up being even more harmful for clients.

2/ A culture of punishment and silencing

A direct consequence of what I described previously is that the culture and thus, the systems in place, revolve around punishing and potentially expulsing the “bad” therapist. Alternatively, it can also function on the basis of silencing complaints, dealing with them as discreetly as possible, lest the world knows we are “bad”, before all returns to “normal” and the perpetrator of harm continues to practice without accountability or repair possible. Indeed, we see so many complaints dismissed or partially resolved, offering no sense of justice or healing for the person harmed. Needing to hide or expel the “bad” in order to remain “good” prevents a culture of accountability. Fear of punishment is pervasive in many professions. It creates an environment where people will not admit a mistake, or will hesitate to explore their limitations as practitioners. Therapists go unchecked until greater boundaries are crossed and people are seriously harmed. This issue is not automatically solved when professions are more regulated. In fact, we could argue that higher regulation may mean higher consequences for practitioners. Some may see this as a good thing, but the more you learn about carceral systems and abolitionism, the more you understand harsher punishments only serve for misdeeds to be buried deeper under the surface. Accountability becomes even harder to achieve.

3/ A profession built around power and prestige

Let’s say it how it is, being in a profession, no matter how much it may feel like a vocation, is still about navigating an economic system, getting access to resources, money, paying bills, sustaining our life, etc. Like most structures in this society, there is a reliance on position, status and prestige. These may open doors to more security, both material and psychological, or alternatively, close those very same doors and leave us alone and vulnerable. Naturally, in a system like this, ownership and possession of resources (and their accumulation) are encouraged, creating situations where particular people hold significant power to shape the profession, materially and intellectually. Moreover, mirroring western academic and intellectual production, our whole theories and practices are often based around people who hold central positions and their ideas. Admiration for certain individuals is encouraged to the detriment of alternative perspectives (and of the entire teams of people who actually participate in knowledge production while one person takes credit). Celebrity culture, submission and deference to the big name “expert” are widely practiced between us professionals. It is also taught in our trainings which often circle around few big-name theories, instead of generative thinking, or fostering collegiate spaces that welcome the knowledge we can all produce from our own experiences and positionalities.

4/ Additional considerations:

Harm within highly regulated professions also exist in great numbers. Especially harm coming from people who hold significant power. These cases are often accompanied by absolute impunity due to the level of power certain people and institutions have. They may retaliate against people who speak up, or could even hold power to excommunicate members and threaten their livelihood. Higher regulations also often mean a higher barrier of entry into the profession making it even more exclusive. Pathways to entry become more complex and often more expensive, preventing the entry of marginalised communities into the spaces that need them the most. People who are well positioned to understand and advocate for vulnerable clients will be unable to do so, leaving many unprotected. Privilege concentrates in the space, so does power and potential for harm with impunity.

I will end this blog here. I wouldn’t like this piece to be read as a condemnation of our profession. I am merely describing what I have observed. Like I said, I am not against regulation per se, perhaps in some ways it can be a way forward. However, I haven’t yet seen any advocate for regulation seriously considering these problems. This is concerning for me, as simply regulating the profession will not address these particular points which are, I believe, at the core of a system that continues to enable harm. I hope this text reads like a sincere invitation for my colleagues to consider the issues I have described, and recognise that addressing them is a key part of the effort to mitigate harm in therapy.