An Article on Professional Ethics: International Review of Sociology 16:2 (July 2006), pp. 175-189

SOCIALLY RESPONSIBLE ROLES OF PROFESSIONAL ETHICS: INCLUSIVITY, PSYCHOTHERAPY AND ‘THE PROTECTION OF THE PUBLIC’

ABSTRACT

The remit of the apparatus of professional ethics in the field of psychotherapy can be appropriately expanded so as to make the profession more socially responsible and thereby contribute to the ‘protection of the public’ that is said to be the main purpose of statutory regulation. Using ideas culled from the sociology of the professions, political theory and ethical discourse, it is proposed that ethical psychotherapy cannot take place if the overall social framework is itself profoundly unethical. Inclusivity and diversity are reframed as ethical professional practices. Questions of wealth, gender, sexuality and ethnicity are not only ‘social’ or ‘political’ – they are also part of a morally imaginative expansion of what we mean by professional ethics. Attention is paid to the dangers of self-righteousness and moral tyranny.

KEY WORDS : diversity, inclusivity, pluralism, professional ethics, psychotherapy, social responsibility,

INTRODUCTION

At the time of writing, the British Government is taking an interest in the regulation by law of the profession of psychotherapy. Whilst considerable progress has been made towards the voluntary evolution of consensual training standards and codes of professional ethics, it is nevertheless still the case that anyone in Britain can call themselves a psychotherapist. Hence, psychotherapy may be regarded as a ‘semi-profession, as defined by Etzioni (1969). One of the main reasons given for the Government’s interest is that what is at stake is the ‘protection of the public’. As Lewis and Maude pointed out as long ago as 1952, there is a three way tension between protecting the interests of the professional, those of the client, and those of the wider society (p. 59). In terms of psychotherapy, this means protecting the public from un- or under trained practitioners over whom no professional body seems to have adequate disciplinary control. In the profession itself, there is considerable debate over the best way to co-operate with the Government and a range of views exist including the cynical notion that psychotherapists – whatever their true beliefs about statutory regulation – might be the major beneficiaries. At the least, those psychotherapists likely to be acknowledged as legitimately qualified may gain considerable advantages over the others.

In spite of the foregoing, the warning issued by Witz (1992, p.5) that we should be careful not to think only of generic professions but also of ‘professional projects’ with their own context in historical time is manifestly applicable to the special case of psychotherapy.

In this paper, I take a fresh look at what it might mean to ‘protect the public’. I do so by exploring the socially responsible impact of codes of professional ethics in the psychotherapy field in terms of increasing the degree of inclusivity in the field. The term ‘inclusivity’ has found favour recently as articulating the goal of affirmative action or positive discrimination. In terms of psychotherapy, this would mean making entrance to the profession more inclusive and – equally important – making access to the services of psychotherapists a more inclusive process. In this quest, my thinking has been informed by ideas from the sociology of the professions, politics, philosophy and religion. Succinctly, I seek to reframe what the public interest might be with respect to the profession of psychotherapy and – equally – to expand what is usually taken as the remit of codes of professional ethics and the apparatus they spawn. The politics of this project reflect the need to avoid or at least manage what Kaye (1999, pp.27ff) calls the ‘colonialism’ of psychotherapy and its pull towards ‘regulatory praxis’.

The public should surely be concerned with the composition of the profession of psychotherapy, which means with the matter of who is admitted to training courses as students and trainees, and, hence, with those who are excluded. Similarly, the public should surely be concerned with the matter of which of its members will obtain psychotherapy, and, hence, with those who are excluded. These issues clearly have a lot to do with money and resources but, as I shall argue, there is more involved than those bottom-line aspects. What is taught on courses in terms of practice and theory as well as the overall ideology and values of psychotherapy will determine its attractiveness to applicants for training and for potential clients. In this respect, psychotherapy lacks what Freidson (1994) refers to as an ‘adequate method of conceptualising knowledge itself’ (p. 43).

In the paper, I argue that it is a reasonable proposition that these are ethical matters as well as political ones. If this is so, then there is a key collective role (cf. Lawrence, 1999, pp.236-7) for professional ethics in the protection of the public in the sense I am defining that elusive goal – as a greater level of inclusivity. Those concerns that are usually understood as political – the diversity agenda, equal opportunities, non-discrimination on grounds of race, religion or culture, and so on – deserve to be revisioned as profoundly ethical concerns. Of course, they remain social and political issues, but the ethical dimension should be granted some legroom. In fact, as Aristotle pointed out, you cannot really divorce ethics from politics and, probably, one should not seek to do so. For both concern the well-lived life and what communities need for the humans within them to flourish. In many ways, this is a belief shared by all the religious traditions as well: you cannot live an uncontaminated ethical life in an environment that is itself unethical and contaminated.

If we continue to probe this morally imaginative expansion of what we mean by ‘ethics’ and by ‘protecting the public’, we reach an incitement to ethics committees in the field of psychotherapy (and maybe this could be generalised to other professions too) to redefine what they do and alter their conception of their remit. The ethics committee, whatever it is formally called, would start to function as the socially responsible element in the constitution of professional bodies in the field of psychotherapy. (See Heta and Matti, 1994, pp.137,140-1 for a discussion of the connection between professional obligation and social responsibility.)

The need to assert this proposition is underscored by the apparent absence in virtually all texts of professional psychotherapy ethics of an apperception of the social role of ethics (Palmer Barnes, 1998; Palmer Barnes and Murdin, 2001; Solomon and Twyman, 2003. An exception is Aveline, 2001). It is true that most ethics codes contain clauses outlawing discrimination, and this is commonplace, but the purview of the ethics committee does not include a proactive stance with respect to such issues. Indeed, questions of admission to training, content of training courses and the key matter of access to psychotherapy seem deliberately omitted from ethical discourse. Perhaps this is because of a totally understandable fear of a psychotherapy ‘thought police’. But, as I shall try to show, the present situation is much more likely to lend itself to hidden policing and other restrictive developments than would one in which the overlap of professional ethics and public interest questions in the inclusivity area is accepted and worked with.

My various attempts, on the ground, to constructively elide the difference between the ethical agenda and the inclusivity agenda have produced some amusing but highly significant results. For what we have here are two communities or sub-groups within psychotherapy that could not be more different in term of personal or group style (using the word ‘style’ in its broadest and most serious sense). The ‘ethicists’ are the ‘suits’ of the psychotherapy world, chosen or self-selected because of their track records as sober and responsible inhabitants of the village of psychotherapy. They will tend to be conservative and highly respectful of tradition. They must attend to the letter of the law as well as its spirit, so that all parties in ethical processes and disputes are protected. In a sense, they will resemble judges. The ‘inclusivists’, on the other hand are the rebels of the field, the ones who get called permanent adolescents by the rest, under-dogs and champions of underdogs. They are the radicals in the village, the reforming and sometimes the revolutionary party. In my view, a professional field that is shorn of dialogue between these two groupings is unlikely to flourish in the sense of adapting to changing circumstances. Nor will such a profession be able to make its fullest contribution to the public good, however that might be defined. And, without a clear vision of the possibility of making such a contribution, why should any group be granted the freedoms and privileges of a profession by the rest of society?

I mentioned earlier that these perspectives owed something to religion. In the First Epistle to the Corinthians, Chapter 13, Verses 1-3, Paul write:

Though I speak with the tongues of men and of angels, and have not charity, I am become as sounding brass, or a tinkling cymbal. And though I have the gift of prophecy, and understand all mysteries, and all knowledge: and though I have all faith, so that I could remove mountains, and have not charity, it profiteth me nothing.

For ‘charity’ (or love) read ‘inclusivity’. My point is that it is not enough for professional codes of ethics in the psychotherapy field to achieve their short-term goal of banishing improper behaviours, such as sexual misconduct or financial exploitation, if the overall field still radiates a certain immorality and lack of ethics by virtue of its having too little inclusivity. If the diversity agenda is excluded from the ethics agenda, then psychotherapists of the highest probity and honour are as sounding brass or tinkling cymbal – in the words of English street language, all ‘piss and wind’.

The social dimension of ethics is by no means a superficial matter. In many respects, psychotherapists already know at some level that, in our world in the West, what is ‘deep’ is hidden on the surface. The textures, noises, smells and experiences of daily life are what psychotherapy clients worry about and bring to their psychotherapy sessions. I have spent the past thirty years arguing (Samuels, 1989, 1993, 2001) that one cannot divorce psychotherapy from social and political pressures. I have also been careful to avoid the on-high position whereby the politics of the psychotherapy profession are somehow excluded from the discourse at the interface of psychotherapy and society (Samuels, 1997a, 1997b).

We could develop this point about the overlap of psychotherapy and politics a bit more by reminding ourselves that the social world in which people live today is, and always has been, redolent of the very themes that present in a psychotherapy consultation. For example, the management of aggression and violence is both a psychotherapeutic and a political matter. Sexuality – in the sense of issues to do with same-sex unions and also the seeming vulnerability of long-term heterosexual relationships – is also a thematic that occurs in both a political and a psychotherapeutic world view. The rising tide of seemingly ethnically-derived discord reflects, amongst many other things, a set of problems in terms of an encounter with difference, with an Other. These, too, are the regular themes of psychotherapy in which questions of transcultural or intercultural practice are on the table. In a way, as I have argued (2005), all psychotherapy is transcultural therapy.

INCLUSIVITY AND METHODOLOGY

As stated briefly, this term refers to the ground covered by equal opportunities, positive discrimination and affirmative action. It is therefore a practice as much as an attitude and, I suggest, the ethical overlay applies to both practice and attitude. What follows is an attempt to sketch a methodology to assess the social state of inclusivity in British psychotherapy today, which, as will by now be apparent, is also an assessment of its ethical state. And, in turn, the project also extends to the question of protecting the public with which the paper began.

The essential feature would be to research and study the field to see who is presently excluded and who is included, either deliberately or inadvertently. It was such study that led a group of British psychotherapists, including myself, to determine, in the mid-1990s, that there was discrimination against members of sexual minorities applying for training programmes in psychoanalysis and psychoanalytic psychotherapy. The training bodies concerned denied that they were discriminatory and pointed out that, in fact, they had not refused admission to anyone from a sexual minority. The research discovered that homosexual applicants were discouraged sufficiently early in the process for them to be excluded from the statistics. As no formal application for training had been made, it was therefore not the case that any rejection had taken place, whether on discriminatory or any other grounds. Verbatim testimony of those who had been told there was no point in applying for training was assembled and this formed an important part of a successful campaign involving Government departments and ministers to get such discrimination ruled improper and, via the drafting of relevant documents, unethical as well.

In spite of this optimistic tale, psychotherapy in Britain still has a problem of exclusivity in relation to economically disadvantaged people, members of ethnic minority communities, those who are physically or cognitively challenged – and, as I shall demonstrate shortly – on a different level from that of outright discrimination to lesbian/gay/bisexual/transgendered/transsexual people.

Additionally, there is a huge problem with respect to inclusivity in that, after forty years of feminist endeavour in the field, many of the ideas and practices of psychotherapy are not satisfactory from women’s points of view. An equally tense development is the realisation that, as those of us who have challenged the shibboleths of male psychology know, psychotherapy does not seem authentically inclusive for increasing numbers of men either.

The next stage in mapping out a methodology by which inclusivity might be assessed and evolved is to consider what, if any, actions to take to remedy injustices, imbalances and prejudices against people who come from these identifiable groupings, whether as potential students or potential clients. The main objection put forward in the British psychotherapy field against affirmative action or positive discrimination is that these practices lead to a lowering of standards. If entry to the profession is made too ‘easy’, so the argument goes, the advances towards higher levels of professionalism will be put at risk.

This is where the new social role for the ethics committees that I am proposing will have its impact. For it would become the responsibility of the ethics committee to explain to the public that it is manifestly important that, given the heterogeneity of the pool of potential psychotherapy clients, there be a commensurate heterogeneity in the groups of people accepted for training programmes. Ethics committees would announce the precise circumstances in which existing training standards (for example, educational qualifications) could be varied and – more important, perhaps – those reasons why this is desirable from the point of view of public well-being. For example, the need to develop a psychotherapy profession containing individuals from all conceivable ethnic and economic backgrounds is, if presented appropriately, a very strong argument in favour of acts that lead to an increase in inclusivity.

It has been put to me that even to discuss the question of ‘standards’ is risky and, here again, I turn to an ethical perspective to underscore the need to be frank about these matters. The ethics committee, which also possesses knowledge of and expertise in psychotherapy, can make it clear to relevant public authorities and to the media that psychotherapy is and always has been a profession in which the need for technical and theoretical knowledge is tempered by the realisation that there are human qualities and characteristics that go into the making of a good or good-enough psychotherapist that have very little to do with educational qualifications. In Jung’s words, ‘therapy is an encounter, a discussion between two psychic wholes in which knowledge is used only as a tool’ (1946, p.229). Arguably, this is true of other professions as well, but it is manifestly the case that psychotherapy is closer to a craft or even to an art than many professions. It would be wrong – so the ethical argument would go – to deprive the community of skilled psychotherapists able to work on the basis of cultural affinity with many of the most deprived and dispossessed elements in it on spurious ‘educational’ grounds.

Continuing to discuss a methodology for inclusivity, and thinking in terms of the public good, of public ethics, the decision of the US Supreme Court in June 2002 concerning affirmative action is of great importance. The court ruled that such action was lawful provided it was done on a general and not on a statistical (quota) basis. The precise circumstance was the admissions policy of the Department of Law at the University of Michigan. A special feature of the ruling was the proposition that, via affirmative action, the majority benefit as well as the minority or minorities in question.

If one scans this argument, one can see how the ethical thread runs through it. For example, businesses benefit from the acquisition of skills that can only be developed through exposure to widely diverse people, cultures, ideas and viewpoints. National security requires a highly qualified, ethnically diverse officer corps. From an admittedly paradoxical ethical point of view, treating some people unjustly can help to produce a more just, as well as a more productive and safer society. Of course, there are contrary viewpoints, in which the dangers of inclusivity-positive actions are highlighted, not only in connection with ‘standards’ but also in connection with the risk of ideological tyranny. However, it would be accepted by all in the British psychotherapy world that such things have not been attempted in their field as yet. In other words, whilst the dangers of such solutions are abstract, the problems to be addressed are anything but. Moreover, the impact of inclusivity-positive actions is huge as can be seen from what happens when they are rendered illegal. According to statistics put out by the African-Latino Society of the University of California at Berkeley, their university admitted 61% fewer members of minorities in 1998 – the year in which the state first implemented its ban on affirmative action.

Any consideration of inclusivity in psychotherapy (or any other profession) should not shy away from a critique of the idea. It is not mockery of psychotherapy that leads to the question being raised of the desirability of ‘everyone’ being involved in it, whether as practitioner or as client. Psychotherapy is a controversial practice and claims that it is ineffective are still made in spite of much evidence to the contrary. Then we have to consider the Eurocentric nature of psychotherapy which, in spite of its global reach, is primarily a text written by and, it may be suggested, for white Westerners. There is simply no point in trying to make it more accessible for others. The argument would continue so as to dispute that the ethical flow would be all in a positive direction, for psychotherapy has the potential to ‘colonise’ others, making them conform to heteronormative and other conventional standards. The response to this argument is to point out that no-one proposes making therapy compulsory and that the present situation wherein members of ethnic minorities are often simply not offered psychotherapy because they are deemed ‘unsuitable’ is far worse.

It could be claimed that there are real dangers in assembling a list of the excluded for, by so doing, people are corralled and typecast, their individuality lost – a betrayal of a key value of psychotherapy as well as a key ethical value. However, we are referring here to actual injustices with a long history, particularly with respect to the treatment (in all senses) of homosexuality by psychoanalysis. From a psychological as well as an ethical view, it is wrong to deny such a history.

One question that often arises in psychotherapy circles is how ‘representative’ the slate of speakers at a conference should be. As far as I know, there has never been ethical input into such discussions which remain on a purely pragmatic and public relations basis, thus leading to accusations of political correctness when representation is being considered. Is it ethically right to look for a ‘lesbian speaker’? Or to seek a balance between the sexes with regard to presenters? Or to look for an Afro-Caribbean participant when none has offered a paper?

Psychotherapists are or seem to be a markedly ‘liberal’ group of people and are hence very likely to wish to say that they ‘treat everyone in the same way’. This would mean, for example, that they have no special judgemental ideas about homosexuals as opposed to heterosexuals. Or that they are, in the dreadful expression, ‘colour blind’. There is no need to labour this point but it is interesting how often the well-meaning members of the profession stymie acts designed to promote inclusivity. The irony – and this, too, is an ethical phenomenon – is that unconscious motives of a shadow kind are fully accepted with respect to all other areas of life than this one. It means that the role of liberal values in promoting self-interest is repressed, denied, disavowed.

As far as liberal attitudes in the psychotherapy world in Britain towards sexual minorities are concerned, a profoundly unethical state of affairs has arisen in which there is a division into what Denman has called ‘good gays’ and ‘bad gays’ (personal communication, 1999). Good gays may be admitted to training programmes because, in salient respects, they resemble idealised heterosexuals. That is, they seem to be involved in long-term relationships and to have adopted a bourgeois life style.

In general, were ethics committees to take the inclusivity agenda seriously as part of their general remit, they will be able to generate awareness of the manner in which belongings and professional identity are generated by exclusion. In other words, how the actual life of the psychotherapy organisation, its corporate and collective spirit, is underpinned by exclusion. The new ethics remit I am proposing would engage directly and in a socially responsible way with questions of power in the profession, educational and otherwise. It would be essentially emancipatory in the sense of making available for challenge the underlying assumptions and purposes of psychotherapy. Above all, the new ethics remit would recognise and express the provisional, immature and tentative nature of knowledge in the field of psychotherapy.

MONEY, ETHICS AND INCLUSIVITY

Clearly, issues of finance cannot be avoided. Most psychotherapy trainings are expensive and this restricts who can become psychotherapists. Many psychotherapists charge a lot of money and this restricts who can see them. What can be done about these problems, in terms both of ethics and of inclusivity?

It seems plausible to me that one function of an ethics committee could be to promote deep and searching enquiry into the nature of what the profession professes about itself. If this self-reflexive task were carried out, then a possible discovery might be that the psychotherapy profession has opted for an inappropriate socio-economic and cultural location. Have psychotherapists allowed themselves to self-identify along the lines of doctors? Might this not be too ambitious a location? Perhaps some sort of equivalence with teachers or nurses would be more appropriate. I am aware that history is not kind to the notion of a deliberate downgrading of an entire professional group but, if the lines along which I am arguing are valid in some way, this is the ethically suggestive proposal to face. In many ways, psychotherapists are quite well equipped to consider the voluntary reduction of income levels to which they aspire. For much of their theoretical literature concerns questions of greed, though this is often at a psychological or even metaphorical level. But what if psychotherapists are, literally, greedy? Should the public not be protected from that? And isn’t that an ethical concern? I do not want to tightly predict the outcome of explorations like this but I think it is fair to say that they have not yet happened in British psychotherapy.

A related issue is the question of the marketing of psychotherapy. When I began to practice in the early 1970s, there was an absolute ban on advertising. The present situation in Britain could not be more different and the Internet has made it inevitable that psychotherapists would enter the world of self-promotion. However, this understandable development needs to be looked at alongside some observations about how psychotherapy is marketed, in the sense of actually practised as a business in Britain today. Here, we have to admit that a degree of ‘pyramid selling’ is involved. What I mean by this is that the more senior a practitioner in psychotherapy becomes, the more likely he or she is to be involved in the training of others. Here, one of the strengths of psychotherapy is also a palpable weakness. It is a requirement in all psychotherapy organisations that professional training involves the student experiencing personal psychotherapy (or, at very least, some sort of germane self-development process, but usually it is psychotherapy). Who is to provide this ‘training therapy’? The answer, of course, is that the senior psychotherapists provide it and a significant proportion of their practice, and hence of their income, is made up of training work. If we add to this, the effects of the analogous requirement to obtain clinical supervision, and note that this, too, is provided by senior practitioners, then the conditions for a profoundly unethical meta-organisation of the profession do, arguably, exist. Again, I am not aware of much if any discussion about this situation, whether ethical or otherwise.

A further example of a form of professional practice in psychotherapy that has deleterious results from the point of view of inclusivity concerns the psychoanalytic preoccupation with numbers of sessions of treatment given per week. Sometimes, the desirable number is stated to be daily treatment (five times), sometimes three or four. But many have argued that there is little evidence that such a high frequency of treatment is necessary. It may be more of a ritual or magical practice. Whatever the truth of these criticisms, the fact remains that the financial implications of such high levels of treatment are critical both in terms of who can train (for the training analysis must be at the stated frequency) and who can seek such treatment. Unthinking adherence to an unreasonably high number of sessions of treatment per week may (paradoxically) place that segment of the psychotherapy world that considers itself de luxe firmly in the ‘lower hemisphere’ of professional activity as defined by Freidson (1994, pp. 205-6). He means professional activity conducted without thought for the well-being of the client and exclusively for the benefit of the professional.

I want to ask: could training, or the delivery of a psychotherapy session, be so organised that the financial delimiters were kept as non-intrusive as possible? One suggestion is that the profession needs to move to a model of individualised training via portfolio acquisition so that training can proceed, not only according to the personal needs of the what would be an ethically viable way of addressing these issues? How could a psychotherapy student, but also according to his or her financial resources. Is there any rationale for the year-by-year approach in psychotherapy training? I believe that there is a need for ethical input in connection with such a proposal.

One last point in this section on economic factors and professional ethics. It s ac commonplace that many psychotherapists overwork and suffer from poor work/life balance. The collective symptom of the profession is exhaustion. Although many ethics code do refer to the importance of the personal health of the practitioner, this is usually drafted with very serious illness, perhaps of a psychological or cognition-damaging kind, in mind. This would be different from a concern for a decent work/life balance with the consequent financial implications.

DIVERSITY IN PSYCHOTHERAPY

My approach to the question of diversity and inclusivity in psychotherapy will be divided into three sections: ethnicity, sexuality, and a pluralistic approach to training. The intention is to render into terms that are applicable to psychotherapy the point made by Johnson (1989, p. 45) that, in the context of a profession, the ‘producer’ imposes a new uniformity upon the ‘consumer’.

Ethnicity:

In a widely acclaimed recent paper on racism and psychotherapy, a moving moment occurred when the Black client confronted her own racism to be set alongside the admitted racism of the White therapist. Although this was, as I say, moving, I was troubled by the narrative. How is it politically transformative to lead a Black client to her own racism? The aim seemed to be a liberal, universal one: to establish we are all ‘racist’, all equally guilty, all in it together. Now, if I say that this is an unethical approach, I do not mean that the therapist has offended any conceivable code of ethics or professional conduct. Nor am I saying that the line of exploration this therapeutic dyad undertook was wrong. But there is still an ethical dilemma at the very least with the implicit suggestion that it is the client’s internal discoveries that should be privileged rather than her exploration (still internal) of her lifelong receipt of racial prejudice, including from her therapist.

Moving the discussion in a wider direction, there is still a huge ethical as well as a practical or intellectual need to challenge the Eurocentrism of much psychotherapeutic theorising especially those ideas that depend on the components of the family, whether external family or internal family. Freud’s theory of the Oedipus complex assumes a universal triangulation within the family and, whilst allowing for the possible ubiquity of jealousy as an emotion, the heterosexist and somewhat predictable lines of Freud’s account are culture-bound. This far, probably most would agree. But the argument goes on that to maintain Oedipus without question is of dubious ethicality.

Many psychotherapists are excited about the possibility of doing transcultural or intercultural work. Doing therapy with ‘the Other’ is inspiring and interesting. But it, too, throws up ethical dilemmas. Should a therapist read up and study the culture of the Other? Or simply do what she or he has been trained to do and see what happens? One way to proceed that strikes me as more ethical, in the sense of more democratic and transparent, is to admit ignorance and think in terms of co-discovery and even of the co-creation of new models of the mind and new clinical methods with clients who are somehow ‘different’.

In spite of changes in consciousness and improvements in practice, the lack of an ethical perspective on the ethnicity/inclusivity theme means that psychotherapy – certainly in Britain – is effectively excluding many clients from successful participation in treatment. It is a kind of institutional racism.

An ethical approach suggests that we consider how much an individual learns from working with an Other. I believe that learning is different from idealising traditional methods of spiritual and psychological healing such as Shamanism. It is possible to avoid a kind of transcultural tourism and work towards ad hoc syntheses via bootstrapping. For example, traditional healers stress the role of ancestors in the construction of current impasses in the individual’s life. Isn’t this compatible with, though obviously different in emphasis from the psychic determinism of Freudian theory in which parental influences are decisive?

There is a further, very penetrative, role for an ethics committee in connection with psychotherapy’s typical linguistic tropes. Here, we see an assumption of an equivalence between ‘dark’ and whatever is bad, inferior, problematic. The best example of this is the Jungian notion of the ‘shadow’ which, whilst very useful in brining us face-to-face with the ineluctable destructiveness of humanity, does tend to elide that with whatever is ‘dark’.

Sexuality:

Earlier, I mentioned the campaign to end discrimination against sexual minorities with respect to admissions for psychoanalytic training in Britain. Partly as a result of the Government’s intervention, anti-discrimination clauses had to be inserted in the literature of several prestigious psychoanalytic training institutions in both the private and public sectors. However, if one is honest about it, the changes that have been made are perhaps little more than superficial. For it is still the case that few lesbians and gay men apply for psychoanalytic trainings in Britain. In part, this is because what they will still hear things about themselves will be distinctly unpalatable. For example, that homosexuals have an excess of the death drive. This is because (so the argument goes) they cannot have children and so are cut off from the life drive(s). Or, it is alleged, homosexuals will have trouble in imaging their parents in productive and fertile heterosexual intercourse, due to their own personal lack of such experience. The stupidity of such arguments is best brought out merely by repeating them. But if the image of the combined parents in intercourse is stated to be a requirement for a degree of mental health, then the implications for homosexuals could not be more serious. The existence of such theories is, therefore, an ethical as a well as a clinical dilemma.

What I am saying in this paper is that there is justification for an ethics committee examining the functioning of the training organisation in terms of what is actually taught so as to see if there is in fact adherence to the principles that may be enshrined in the code of ethics. Specifically, there are a number of common practices, which few in the psychotherapy world seriously question, that, from an ethical viewpoint, deserve scrutiny and discussion. For example, we see inappropriate mention of a patient’s sexual orientation in clinical papers and presentations. Sexuality is presented in a defining and foundational way: ‘that patient was a 45 year old lesbian who had never been married’. Then there is the issue of ‘good gays’ and ‘bad gays’ that I mentioned earlier: ‘she had never maintained a permanent relationship’.

More serious, perhaps, from an ethical point of view is the widespread belief that homosexuality has ‘causes’. As if, in the world of psychotherapy, anything other than a bad thing has a cause! Positive things are never assigned causes. For example, it is still often asserted that there is a ‘homosexogenic family’, that causes homosexuality in males, on which there is a suffocating, possessive mother and a cold, absent, critical father (as if this didn’t apply to the families of numerous heterosexuals). Similarly, it is often stated that homosexuals do not have a clear sense of gender identity whereas, in fact, as many homosexuals as heterosexuals know that they are male or female.

In addition to asking for detailed justification of ideas like those I have just outlined, an ethics committee would want to ask if sufficient attention is being paid in the training programme to special issues that are relevant go sexual minorities, mainly to do with coming out and with internalised self-loathing.

Finally, and most controversially, psychotherapists often lose their ethical position and fall into Western culture’s moral panic over what has been called the ‘homosexual lifestyle’. For gay men, this means extreme promiscuity (known in Britain as ‘cottaging’). Now, there is no point in denying that cottaging happens, though there are many reasons for it. But there are heterosexual equivalents (lapdancing, striptease, prostitution, pornography, trafficking) and we do not find heterosexuality being equated with them or stigmatised on the basis of their existence. Behind the liberal value of tolerance, we see that the spectre of cottaging is manoeuvred into place to continue to smear and stigmatise homosexual men.

From the female angle, the equivalent equation is that lesbianism means, inevitably, ‘bed death’. The proposition is that, after an initial flurry, lesbian relationships lose their sexual excitement and physical contact ceases. Again, of course, this can happen, just as it can happen in heterosexual marriages. What is unethical is the way in which the standing of lesbianism is somehow undermined.

Another moral panic that psychotherapists join in with concerns the alleged bad effects on a child or children of growing up in families headed by two adult women. This prejudice is widespread in the psychotherapy world and, of course, ignores the way in which children of heterosexual marriages are damaged by them. Indeed, what little research there is seems to suggest that there are no inevitable psychological consequences of growing up in a lesbian household.

A pluralistic approach to training:

In this section, I argue that the ethics committee of a psychotherapy training organisation can only fulfil its part of the job of ‘protecting the public’ if it seeks to ensure that the training programme is sufficiently pluralistic in nature. The basic connection that I am assuming to exist is between the ideas and practices that are taught on the programme and the utility to patients and clients from a wide range of backgrounds of those ideas and practices. Again, the ethical goal is to make sure that the high-sounding statements of principle are actually translated into everyday practices on the ground.

The training standards of the United Kingdom Council for Psychotherapy require all registered psychotherapists to have attained proficiency in at least two modalities of psychotherapy. With some exceptions, this requirement is simply not adhered to. There are reasons for this beyond the tribalism and conformity of the psychotherapy world that have to do with the absence of an adequate ethos to facilitate such a pluralistic set-up.

Pluralism is an attitude to difference developed initially in the political world. As I have suggested (1989), its hallmarks are competition, bargaining and a conversation that has mutual understanding as its goal rather than agreement. As A.N. Whitehead put it, ‘ a clash of doctrines is not a disaster, it is an opportunity’. Pluralism is intended to be the opposite of fanaticism or fundamentalism, though pluralists can often be fanatics for pluralism and risk being accused of believing in nothing at all.

I would like to take this notion of pluralism and, so to speak, ethicise it. I do this by turning once again to religion – this time to Islam – for inspiration. The turn to Islam is part of a wider theme in my current work in which Islam is understood as the significant other of the West and, sometimes, as its ‘therapist’ – particularly with respect to a critique of the shallow materialism and lack of spirituality in much of Western social organisation. I hope it will be understood that I do not seek to idealise Islam, which certainly breeds its own cruel fundamentalisms and injustices. Dependence on a Book is not always a good thing (Torah, New Testament, Freud, Jung). Dependence on a book, coupled with possession of power in general and military power in particular, is a disaster, no matter who has the instruments of violence and destruction.

In the Koran, we meet the concept of Ta’Aruf – ‘that you might come to know one another’. As the Koran says, ‘O Mankind, we have created of you male and female, and have made you peoples and tribes, that you might come to know one another’. Now this is a very interesting take on difference and diversity that gives the whole inclusivity agenda in a professional field such as psychotherapy a pronounced ethical twist. You lose something by knowing only your own tradition, seems to be the message of the Koran here. So the creation of difference and diversity is for humanity’s benefit. And the more you know about the Other with his or her difference, the more likely you are to work out your own difference in a through and imaginative way in response.

Considerations like these are an amalgam of religion and morality and would need translation into pragmatics and detailed organisation. But, as the Jewish saying goes, ‘God is in the details’. (The British say ‘the devil is in the details’!) Ta’Aruf means that difference and diversity are valued in a new way. There is no disaster of the Tower of Babel. Nor is there only one way to salvation, for example, via Christ. Ta’Aruf resembles the statement of the physicist Nils Bohr: ‘The opposite of a correct statement is a false statement. But the opposite of a profound truth may well be another profound truth.’

CONCLUDING REFLECTIONS

The main risk of a profession such as psychotherapy following the line laid out in this paper is the growth of a self-righteousness that would be persecutory for practitioners and of dubious benefit to consumers (cf. Lawrence, 1999, pp.221ff). Savonarola came to a fiery end, after all. I would not want to replace one tyranny with another. Here, W.B. Yeats’s poem ‘The Great Day’ comes to mind:

Hurrah for revolution and more cannon shot!

A beggar upon horseback lashes a beggar on foot.

Hurrah for revolution and cannon come again!

The beggars have changed places, but the lash goes on.

Finally, I want to turn to the third Abrahamic faith – Judaism – for some concluding reflections. Jewish liturgical and religious tradition is often castigated unfairly as a source of a rather rigid morality, an eye for an eye and a tooth for a tooth sort of morality. This is partly true. But there is something more, and this can offset the potential for sanctimony that attaches to the project of making inclusivity an ethical matter.

The night before the Day of Atonement (Yom Kippur), the Kol Nidre service is held. This service begins with a particularly beautiful prayer which, in most congregations, is regarded as being so important that it is actually recited three times:

All vows, bonds, oaths, devotions, promises, penalties and obligations, wherewith we have vowed, sworn, devoted and bound ourselves, from this Day of Atonement until the next Day of Atonement. Lo, all these we repent us in them. They shall be absolved, released, annulled, made void, and of null effect. They shall not be binding, nor shall they have any power. Our vows shall not be vows, our bonds shall not be bonds, and or oaths shall not be oaths.

‘Our vows shall not eb vows’ – at the heart of the Jewish liturgy? What is going on? The Rabbis, who are of course the original model for the incorrigible disputativeness of psychotherapy, tell us that there are no less than three possible meanings for this prayer. (1) Do not aim too high in the future lest failure disappoint. It is better to annul your vows before it is too late. (2) You will have slipped up morally in the past, so backdate an annulment of your vows as a precaution. (3) Never mind about paltry moral contracts with human beings; the only important ones are with God.

Whichever interpretation appeals, what is placed firmly on the table at Kol Nidre is failure. Failure in the social realm is always present and this will be the case with regard to the matter of inclusivity in psychotherapy. But perhaps we have to learn to ‘fail better’, as Samuel Beckett put it, and that ‘failure is the key to the kingdom’, in the words of the Sufi poet Rumi.

REFERENCES

Aveline, Mark (2001) Complexities of practice: psychotherapy in the real world. In Values and Ethics in the Practice of Psychotherapy and Counselling. Eds Fiona Palmer Barnes and Lesley Murdin. Buckingham: Open University Press, pp. 128-143.

Etzioni, Amitai (1969) The Semi-Professions and Their Organization: Teachers, Nurses, Social Workers. New York: Free Press.

Freidson, Eliot (1994) Professionalism Reborn: Theory, Prophecy and Policy. Cambridge, UK: Polity Press.

Hayry, Heta and Hayry, Matti (1994) The nature and role of professional codes in modern society. In Ethics and the Professions, Ed. Ruth Chadwick. Aldershot: Avebury, pp. 136-144.

Johnson, Terence (1989) Professions and Power. Basingstoke: Macmillan.

Jung, C.G. (1946) The Psychology of the Transference. London: Routledge and Kegan Paul; Princeton, NJ: Princeton University Press (1965).

Kaye, John (1999) Towards a non-regulative praxis. In Deconstructing Psychotherapy, Ed. Ian Parker. London: Sage, pp. 19-38.

Lawrence, John (1999). Argument for Action: Ethics and Professional Conduct. Aldershot: Ashgate.

Lewis, Roy and Maude, Angus (1952) Professional People. London: Phoenix House.

Palmer Barnes, Fiona (1998) Complaints and Grievances in Psychotherapy: A Handbook of Ethical Practice. London: Routledge.

Palmer Barnes, Fiona and Murdin, Lesley (2001) (Eds) Values and Ethics in the Practice of Psychotherapy and Counselling. Buckingham: Open University Press.

Samuels, Andrew (1989) The Plural Psyche: Personality, Morality and the Father. London and New York: Routledge.

Samuels, Andrew (1993) The Political Psyche. London and New York: Routledge.

Samuels, Andrew (1997a) Pluralism and the future of psychotherapy. In The Future of Counselling and Psychotherapy, Eds Palmer, Stephen and Varma, Ved. London: Sage, 1997.

Samuels, Andrew (1997b) Pluralism and psychotherapy: what is a good training’. In Implausible Professions: Arguments for Pluralism and Autonomy in Psychotherapy and Counselling, Eds House, Richard and Totton, Nick. Ross-on-Wye: PCSS Books.

Samuels, Andrew (2001) Politics on the Couch: Citizenship and the Internal Life. London: Profile Books; New York: Other Press.

Solomon, Hester and Twyman, Mary (2003) (Eds) The Ethical Attitude in Analytic Practice. London: Free Association Books.

Witz, Anne (1992) Professions and Patriarchy. London: Routledge.

SOCIALLY RESPONSIBLE ROLES OF PROFESSIONAL ETHICS: INCLUSIVITY, PSYCHOTHERAPY AND ‘THE PROTECTION OF THE PUBLIC’

Andrew Samuels

BIOGRAPHY: Andrew Samuels is Professor of Analytical Psychology at the University of Essex, Visiting Professor of Psychoanalytic Studies, Goldsmiths College, University of London, and Honorary Professor of Psychology and Therapeutic Studies at Roehampton University. He is a Training Analyst of the Society of Analytical Psychology, in private clinical practice in London. He was the founder of Psychotherapists and Counsellors for Social Responsibility. His many books have been translated into 19 languages and include The Plural Psyche (1989), The Political Psyche (1993) and Politics on the Couch: Citizenship and the Internal Life (2001).

ABSTRACT

The remit of the apparatus of professional ethics in the field of psychotherapy can be appropriately expanded so as to make the profession more socially responsible and thereby contribute to the ‘protection of the public’ that is said to be the main purpose of statutory regulation. Using ideas culled from the sociology of the professions, political theory and ethical discourse, it is proposed that ethical psychotherapy cannot take place if the overall social framework is itself profoundly unethical. Inclusivity and diversity are reframed as ethical professional practices. Questions of wealth, gender, sexuality and ethnicity are not only ‘social’ or ‘political’ – they are also part of a morally imaginative expansion of what we mean by professional ethics. Attention is paid to the dangers of self-righteousness and moral tyranny.

KEY WORDS : diversity, inclusivity, pluralism, professional ethics, psychotherapy, social responsibility,

INTRODUCTION

At the time of writing, the British Government is taking an interest in the regulation by law of the profession of psychotherapy. Whilst considerable progress has been made towards the voluntary evolution of consensual training standards and codes of professional ethics, it is nevertheless still the case that anyone in Britain can call themselves a psychotherapist. Hence, psychotherapy may be regarded as a ‘semi-profession, as defined by Etzioni (1969). One of the main reasons given for the Government’s interest is that what is at stake is the ‘protection of the public’. As Lewis and Maude pointed out as long ago as 1952, there is a three way tension between protecting the interests of the professional, those of the client, and those of the wider society (p. 59). In terms of psychotherapy, this means protecting the public from un- or under trained practitioners over whom no professional body seems to have adequate disciplinary control. In the profession itself, there is considerable debate over the best way to co-operate with the Government and a range of views exist including the cynical notion that psychotherapists – whatever their true beliefs about statutory regulation – might be the major beneficiaries. At the least, those psychotherapists likely to be acknowledged as legitimately qualified may gain considerable advantages over the others.

In spite of the foregoing, the warning issued by Witz (1992, p.5) that we should be careful not to think only of generic professions but also of ‘professional projects’ with their own context in historical time is manifestly applicable to the special case of psychotherapy.

In this paper, I take a fresh look at what it might mean to ‘protect the public’. I do so by exploring the socially responsible impact of codes of professional ethics in the psychotherapy field in terms of increasing the degree of inclusivity in the field. The term ‘inclusivity’ has found favour recently as articulating the goal of affirmative action or positive discrimination. In terms of psychotherapy, this would mean making entrance to the profession more inclusive and – equally important – making access to the services of psychotherapists a more inclusive process. In this quest, my thinking has been informed by ideas from the sociology of the professions, politics, philosophy and religion. Succinctly, I seek to reframe what the public interest might be with respect to the profession of psychotherapy and – equally – to expand what is usually taken as the remit of codes of professional ethics and the apparatus they spawn. The politics of this project reflect the need to avoid or at least manage what Kaye (1999, pp.27ff) calls the ‘colonialism’ of psychotherapy and its pull towards ‘regulatory praxis’.

The public should surely be concerned with the composition of the profession of psychotherapy, which means with the matter of who is admitted to training courses as students and trainees, and, hence, with those who are excluded. Similarly, the public should surely be concerned with the matter of which of its members will obtain psychotherapy, and, hence, with those who are excluded. These issues clearly have a lot to do with money and resources but, as I shall argue, there is more involved than those bottom-line aspects. What is taught on courses in terms of practice and theory as well as the overall ideology and values of psychotherapy will determine its attractiveness to applicants for training and for potential clients. In this respect, psychotherapy lacks what Freidson (1994) refers to as an ‘adequate method of conceptualising knowledge itself’ (p. 43).

In the paper, I argue that it is a reasonable proposition that these are ethical matters as well as political ones. If this is so, then there is a key collective role (cf. Lawrence, 1999, pp.236-7) for professional ethics in the protection of the public in the sense I am defining that elusive goal – as a greater level of inclusivity. Those concerns that are usually understood as political – the diversity agenda, equal opportunities, non-discrimination on grounds of race, religion or culture, and so on – deserve to be revisioned as profoundly ethical concerns. Of course, they remain social and political issues, but the ethical dimension should be granted some legroom. In fact, as Aristotle pointed out, you cannot really divorce ethics from politics and, probably, one should not seek to do so. For both concern the well-lived life and what communities need for the humans within them to flourish. In many ways, this is a belief shared by all the religious traditions as well: you cannot live an uncontaminated ethical life in an environment that is itself unethical and contaminated.

If we continue to probe this morally imaginative expansion of what we mean by ‘ethics’ and by ‘protecting the public’, we reach an incitement to ethics committees in the field of psychotherapy (and maybe this could be generalised to other professions too) to redefine what they do and alter their conception of their remit. The ethics committee, whatever it is formally called, would start to function as the socially responsible element in the constitution of professional bodies in the field of psychotherapy. (See Heta and Matti, 1994, pp.137,140-1 for a discussion of the connection between professional obligation and social responsibility.)

The need to assert this proposition is underscored by the apparent absence in virtually all texts of professional psychotherapy ethics of an apperception of the social role of ethics (Palmer Barnes, 1998; Palmer Barnes and Murdin, 2001; Solomon and Twyman, 2003. An exception is Aveline, 2001). It is true that most ethics codes contain clauses outlawing discrimination, and this is commonplace, but the purview of the ethics committee does not include a proactive stance with respect to such issues. Indeed, questions of admission to training, content of training courses and the key matter of access to psychotherapy seem deliberately omitted from ethical discourse. Perhaps this is because of a totally understandable fear of a psychotherapy ‘thought police’. But, as I shall try to show, the present situation is much more likely to lend itself to hidden policing and other restrictive developments than would one in which the overlap of professional ethics and public interest questions in the inclusivity area is accepted and worked with.

My various attempts, on the ground, to constructively elide the difference between the ethical agenda and the inclusivity agenda have produced some amusing but highly significant results. For what we have here are two communities or sub-groups within psychotherapy that could not be more different in term of personal or group style (using the word ‘style’ in its broadest and most serious sense). The ‘ethicists’ are the ‘suits’ of the psychotherapy world, chosen or self-selected because of their track records as sober and responsible inhabitants of the village of psychotherapy. They will tend to be conservative and highly respectful of tradition. They must attend to the letter of the law as well as its spirit, so that all parties in ethical processes and disputes are protected. In a sense, they will resemble judges. The ‘inclusivists’, on the other hand are the rebels of the field, the ones who get called permanent adolescents by the rest, under-dogs and champions of underdogs. They are the radicals in the village, the reforming and sometimes the revolutionary party. In my view, a professional field that is shorn of dialogue between these two groupings is unlikely to flourish in the sense of adapting to changing circumstances. Nor will such a profession be able to make its fullest contribution to the public good, however that might be defined. And, without a clear vision of the possibility of making such a contribution, why should any group be granted the freedoms and privileges of a profession by the rest of society?

I mentioned earlier that these perspectives owed something to religion. In the First Epistle to the Corinthians, Chapter 13, Verses 1-3, Paul write:

Though I speak with the tongues of men and of angels, and have not charity, I am become as sounding brass, or a tinkling cymbal. And though I have the gift of prophecy, and understand all mysteries, and all knowledge: and though I have all faith, so that I could remove mountains, and have not charity, it profiteth me nothing.

For ‘charity’ (or love) read ‘inclusivity’. My point is that it is not enough for professional codes of ethics in the psychotherapy field to achieve their short-term goal of banishing improper behaviours, such as sexual misconduct or financial exploitation, if the overall field still radiates a certain immorality and lack of ethics by virtue of its having too little inclusivity. If the diversity agenda is excluded from the ethics agenda, then psychotherapists of the highest probity and honour are as sounding brass or tinkling cymbal – in the words of English street language, all ‘piss and wind’.

The social dimension of ethics is by no means a superficial matter. In many respects, psychotherapists already know at some level that, in our world in the West, what is ‘deep’ is hidden on the surface. The textures, noises, smells and experiences of daily life are what psychotherapy clients worry about and bring to their psychotherapy sessions. I have spent the past thirty years arguing (Samuels, 1989, 1993, 2001) that one cannot divorce psychotherapy from social and political pressures. I have also been careful to avoid the on-high position whereby the politics of the psychotherapy profession are somehow excluded from the discourse at the interface of psychotherapy and society (Samuels, 1997a, 1997b).

We could develop this point about the overlap of psychotherapy and politics a bit more by reminding ourselves that the social world in which people live today is, and always has been, redolent of the very themes that present in a psychotherapy consultation. For example, the management of aggression and violence is both a psychotherapeutic and a political matter. Sexuality – in the sense of issues to do with same-sex unions and also the seeming vulnerability of long-term heterosexual relationships – is also a thematic that occurs in both a political and a psychotherapeutic world view. The rising tide of seemingly ethnically-derived discord reflects, amongst many other things, a set of problems in terms of an encounter with difference, with an Other. These, too, are the regular themes of psychotherapy in which questions of transcultural or intercultural practice are on the table. In a way, as I have argued (2005), all psychotherapy is transcultural therapy.

INCLUSIVITY AND METHODOLOGY

As stated briefly, this term refers to the ground covered by equal opportunities, positive discrimination and affirmative action. It is therefore a practice as much as an attitude and, I suggest, the ethical overlay applies to both practice and attitude. What follows is an attempt to sketch a methodology to assess the social state of inclusivity in British psychotherapy today, which, as will by now be apparent, is also an assessment of its ethical state. And, in turn, the project also extends to the question of protecting the public with which the paper began.

The essential feature would be to research and study the field to see who is presently excluded and who is included, either deliberately or inadvertently. It was such study that led a group of British psychotherapists, including myself, to determine, in the mid-1990s, that there was discrimination against members of sexual minorities applying for training programmes in psychoanalysis and psychoanalytic psychotherapy. The training bodies concerned denied that they were discriminatory and pointed out that, in fact, they had not refused admission to anyone from a sexual minority. The research discovered that homosexual applicants were discouraged sufficiently early in the process for them to be excluded from the statistics. As no formal application for training had been made, it was therefore not the case that any rejection had taken place, whether on discriminatory or any other grounds. Verbatim testimony of those who had been told there was no point in applying for training was assembled and this formed an important part of a successful campaign involving Government departments and ministers to get such discrimination ruled improper and, via the drafting of relevant documents, unethical as well.

In spite of this optimistic tale, psychotherapy in Britain still has a problem of exclusivity in relation to economically disadvantaged people, members of ethnic minority communities, those who are physically or cognitively challenged – and, as I shall demonstrate shortly – on a different level from that of outright discrimination to lesbian/gay/bisexual/transgendered/transsexual people.

Additionally, there is a huge problem with respect to inclusivity in that, after forty years of feminist endeavour in the field, many of the ideas and practices of psychotherapy are not satisfactory from women’s points of view. An equally tense development is the realisation that, as those of us who have challenged the shibboleths of male psychology know, psychotherapy does not seem authentically inclusive for increasing numbers of men either.

The next stage in mapping out a methodology by which inclusivity might be assessed and evolved is to consider what, if any, actions to take to remedy injustices, imbalances and prejudices against people who come from these identifiable groupings, whether as potential students or potential clients. The main objection put forward in the British psychotherapy field against affirmative action or positive discrimination is that these practices lead to a lowering of standards. If entry to the profession is made too ‘easy’, so the argument goes, the advances towards higher levels of professionalism will be put at risk.

This is where the new social role for the ethics committees that I am proposing will have its impact. For it would become the responsibility of the ethics committee to explain to the public that it is manifestly important that, given the heterogeneity of the pool of potential psychotherapy clients, there be a commensurate heterogeneity in the groups of people accepted for training programmes. Ethics committees would announce the precise circumstances in which existing training standards (for example, educational qualifications) could be varied and – more important, perhaps – those reasons why this is desirable from the point of view of public well-being. For example, the need to develop a psychotherapy profession containing individuals from all conceivable ethnic and economic backgrounds is, if presented appropriately, a very strong argument in favour of acts that lead to an increase in inclusivity.

It has been put to me that even to discuss the question of ‘standards’ is risky and, here again, I turn to an ethical perspective to underscore the need to be frank about these matters. The ethics committee, which also possesses knowledge of and expertise in psychotherapy, can make it clear to relevant public authorities and to the media that psychotherapy is and always has been a profession in which the need for technical and theoretical knowledge is tempered by the realisation that there are human qualities and characteristics that go into the making of a good or good-enough psychotherapist that have very little to do with educational qualifications. In Jung’s words, ‘therapy is an encounter, a discussion between two psychic wholes in which knowledge is used only as a tool’ (1946, p.229). Arguably, this is true of other professions as well, but it is manifestly the case that psychotherapy is closer to a craft or even to an art than many professions. It would be wrong – so the ethical argument would go – to deprive the community of skilled psychotherapists able to work on the basis of cultural affinity with many of the most deprived and dispossessed elements in it on spurious ‘educational’ grounds.

Continuing to discuss a methodology for inclusivity, and thinking in terms of the public good, of public ethics, the decision of the US Supreme Court in June 2002 concerning affirmative action is of great importance. The court ruled that such action was lawful provided it was done on a general and not on a statistical (quota) basis. The precise circumstance was the admissions policy of the Department of Law at the University of Michigan. A special feature of the ruling was the proposition that, via affirmative action, the majority benefit as well as the minority or minorities in question.

If one scans this argument, one can see how the ethical thread runs through it. For example, businesses benefit from the acquisition of skills that can only be developed through exposure to widely diverse people, cultures, ideas and viewpoints. National security requires a highly qualified, ethnically diverse officer corps. From an admittedly paradoxical ethical point of view, treating some people unjustly can help to produce a more just, as well as a more productive and safer society. Of course, there are contrary viewpoints, in which the dangers of inclusivity-positive actions are highlighted, not only in connection with ‘standards’ but also in connection with the risk of ideological tyranny. However, it would be accepted by all in the British psychotherapy world that such things have not been attempted in their field as yet. In other words, whilst the dangers of such solutions are abstract, the problems to be addressed are anything but. Moreover, the impact of inclusivity-positive actions is huge as can be seen from what happens when they are rendered illegal. According to statistics put out by the African-Latino Society of the University of California at Berkeley, their university admitted 61% fewer members of minorities in 1998 – the year in which the state first implemented its ban on affirmative action.

Any consideration of inclusivity in psychotherapy (or any other profession) should not shy away from a critique of the idea. It is not mockery of psychotherapy that leads to the question being raised of the desirability of ‘everyone’ being involved in it, whether as practitioner or as client. Psychotherapy is a controversial practice and claims that it is ineffective are still made in spite of much evidence to the contrary. Then we have to consider the Eurocentric nature of psychotherapy which, in spite of its global reach, is primarily a text written by and, it may be suggested, for white Westerners. There is simply no point in trying to make it more accessible for others. The argument would continue so as to dispute that the ethical flow would be all in a positive direction, for psychotherapy has the potential to ‘colonise’ others, making them conform to heteronormative and other conventional standards. The response to this argument is to point out that no-one proposes making therapy compulsory and that the present situation wherein members of ethnic minorities are often simply not offered psychotherapy because they are deemed ‘unsuitable’ is far worse.

It could be claimed that there are real dangers in assembling a list of the excluded for, by so doing, people are corralled and typecast, their individuality lost – a betrayal of a key value of psychotherapy as well as a key ethical value. However, we are referring here to actual injustices with a long history, particularly with respect to the treatment (in all senses) of homosexuality by psychoanalysis. From a psychological as well as an ethical view, it is wrong to deny such a history.

One question that often arises in psychotherapy circles is how ‘representative’ the slate of speakers at a conference should be. As far as I know, there has never been ethical input into such discussions which remain on a purely pragmatic and public relations basis, thus leading to accusations of political correctness when representation is being considered. Is it ethically right to look for a ‘lesbian speaker’? Or to seek a balance between the sexes with regard to presenters? Or to look for an Afro-Caribbean participant when none has offered a paper?

Psychotherapists are or seem to be a markedly ‘liberal’ group of people and are hence very likely to wish to say that they ‘treat everyone in the same way’. This would mean, for example, that they have no special judgemental ideas about homosexuals as opposed to heterosexuals. Or that they are, in the dreadful expression, ‘colour blind’. There is no need to labour this point but it is interesting how often the well-meaning members of the profession stymie acts designed to promote inclusivity. The irony – and this, too, is an ethical phenomenon – is that unconscious motives of a shadow kind are fully accepted with respect to all other areas of life than this one. It means that the role of liberal values in promoting self-interest is repressed, denied, disavowed.

As far as liberal attitudes in the psychotherapy world in Britain towards sexual minorities are concerned, a profoundly unethical state of affairs has arisen in which there is a division into what Denman has called ‘good gays’ and ‘bad gays’ (personal communication, 1999). Good gays may be admitted to training programmes because, in salient respects, they resemble idealised heterosexuals. That is, they seem to be involved in long-term relationships and to have adopted a bourgeois life style.

In general, were ethics committees to take the inclusivity agenda seriously as part of their general remit, they will be able to generate awareness of the manner in which belongings and professional identity are generated by exclusion. In other words, how the actual life of the psychotherapy organisation, its corporate and collective spirit, is underpinned by exclusion. The new ethics remit I am proposing would engage directly and in a socially responsible way with questions of power in the profession, educational and otherwise. It would be essentially emancipatory in the sense of making available for challenge the underlying assumptions and purposes of psychotherapy. Above all, the new ethics remit would recognise and express the provisional, immature and tentative nature of knowledge in the field of psychotherapy.

MONEY, ETHICS AND INCLUSIVITY

Clearly, issues of finance cannot be avoided. Most psychotherapy trainings are expensive and this restricts who can become psychotherapists. Many psychotherapists charge a lot of money and this restricts who can see them. What can be done about these problems, in terms both of ethics and of inclusivity?

It seems plausible to me that one function of an ethics committee could be to promote deep and searching enquiry into the nature of what the profession professes about itself. If this self-reflexive task were carried out, then a possible discovery might be that the psychotherapy profession has opted for an inappropriate socio-economic and cultural location. Have psychotherapists allowed themselves to self-identify along the lines of doctors? Might this not be too ambitious a location? Perhaps some sort of equivalence with teachers or nurses would be more appropriate. I am aware that history is not kind to the notion of a deliberate downgrading of an entire professional group but, if the lines along which I am arguing are valid in some way, this is the ethically suggestive proposal to face. In many ways, psychotherapists are quite well equipped to consider the voluntary reduction of income levels to which they aspire. For much of their theoretical literature concerns questions of greed, though this is often at a psychological or even metaphorical level. But what if psychotherapists are, literally, greedy? Should the public not be protected from that? And isn’t that an ethical concern? I do not want to tightly predict the outcome of explorations like this but I think it is fair to say that they have not yet happened in British psychotherapy.

A related issue is the question of the marketing of psychotherapy. When I began to practice in the early 1970s, there was an absolute ban on advertising. The present situation in Britain could not be more different and the Internet has made it inevitable that psychotherapists would enter the world of self-promotion. However, this understandable development needs to be looked at alongside some observations about how psychotherapy is marketed, in the sense of actually practised as a business in Britain today. Here, we have to admit that a degree of ‘pyramid selling’ is involved. What I mean by this is that the more senior a practitioner in psychotherapy becomes, the more likely he or she is to be involved in the training of others. Here, one of the strengths of psychotherapy is also a palpable weakness. It is a requirement in all psychotherapy organisations that professional training involves the student experiencing personal psychotherapy (or, at very least, some sort of germane self-development process, but usually it is psychotherapy). Who is to provide this ‘training therapy’? The answer, of course, is that the senior psychotherapists provide it and a significant proportion of their practice, and hence of their income, is made up of training work. If we add to this, the effects of the analogous requirement to obtain clinical supervision, and note that this, too, is provided by senior practitioners, then the conditions for a profoundly unethical meta-organisation of the profession do, arguably, exist. Again, I am not aware of much if any discussion about this situation, whether ethical or otherwise.

A further example of a form of professional practice in psychotherapy that has deleterious results from the point of view of inclusivity concerns the psychoanalytic preoccupation with numbers of sessions of treatment given per week. Sometimes, the desirable number is stated to be daily treatment (five times), sometimes three or four. But many have argued that there is little evidence that such a high frequency of treatment is necessary. It may be more of a ritual or magical practice. Whatever the truth of these criticisms, the fact remains that the financial implications of such high levels of treatment are critical both in terms of who can train (for the training analysis must be at the stated frequency) and who can seek such treatment. Unthinking adherence to an unreasonably high number of sessions of treatment per week may (paradoxically) place that segment of the psychotherapy world that considers itself de luxe firmly in the ‘lower hemisphere’ of professional activity as defined by Freidson (1994, pp. 205-6). He means professional activity conducted without thought for the well-being of the client and exclusively for the benefit of the professional.

I want to ask: could training, or the delivery of a psychotherapy session, be so organised that the financial delimiters were kept as non-intrusive as possible? One suggestion is that the profession needs to move to a model of individualised training via portfolio acquisition so that training can proceed, not only according to the personal needs of the what would be an ethically viable way of addressing these issues? How could a psychotherapy student, but also according to his or her financial resources. Is there any rationale for the year-by-year approach in psychotherapy training? I believe that there is a need for ethical input in connection with such a proposal.

One last point in this section on economic factors and professional ethics. It s ac commonplace that many psychotherapists overwork and suffer from poor work/life balance. The collective symptom of the profession is exhaustion. Although many ethics code do refer to the importance of the personal health of the practitioner, this is usually drafted with very serious illness, perhaps of a psychological or cognition-damaging kind, in mind. This would be different from a concern for a decent work/life balance with the consequent financial implications.

DIVERSITY IN PSYCHOTHERAPY

My approach to the question of diversity and inclusivity in psychotherapy will be divided into three sections: ethnicity, sexuality, and a pluralistic approach to training. The intention is to render into terms that are applicable to psychotherapy the point made by Johnson (1989, p. 45) that, in the context of a profession, the ‘producer’ imposes a new uniformity upon the ‘consumer’.

Ethnicity:

In a widely acclaimed recent paper on racism and psychotherapy, a moving moment occurred when the Black client confronted her own racism to be set alongside the admitted racism of the White therapist. Although this was, as I say, moving, I was troubled by the narrative. How is it politically transformative to lead a Black client to her own racism? The aim seemed to be a liberal, universal one: to establish we are all ‘racist’, all equally guilty, all in it together. Now, if I say that this is an unethical approach, I do not mean that the therapist has offended any conceivable code of ethics or professional conduct. Nor am I saying that the line of exploration this therapeutic dyad undertook was wrong. But there is still an ethical dilemma at the very least with the implicit suggestion that it is the client’s internal discoveries that should be privileged rather than her exploration (still internal) of her lifelong receipt of racial prejudice, including from her therapist.

Moving the discussion in a wider direction, there is still a huge ethical as well as a practical or intellectual need to challenge the Eurocentrism of much psychotherapeutic theorising especially those ideas that depend on the components of the family, whether external family or internal family. Freud’s theory of the Oedipus complex assumes a universal triangulation within the family and, whilst allowing for the possible ubiquity of jealousy as an emotion, the heterosexist and somewhat predictable lines of Freud’s account are culture-bound. This far, probably most would agree. But the argument goes on that to maintain Oedipus without question is of dubious ethicality.

Many psychotherapists are excited about the possibility of doing transcultural or intercultural work. Doing therapy with ‘the Other’ is inspiring and interesting. But it, too, throws up ethical dilemmas. Should a therapist read up and study the culture of the Other? Or simply do what she or he has been trained to do and see what happens? One way to proceed that strikes me as more ethical, in the sense of more democratic and transparent, is to admit ignorance and think in terms of co-discovery and even of the co-creation of new models of the mind and new clinical methods with clients who are somehow ‘different’.

In spite of changes in consciousness and improvements in practice, the lack of an ethical perspective on the ethnicity/inclusivity theme means that psychotherapy – certainly in Britain – is effectively excluding many clients from successful participation in treatment. It is a kind of institutional racism.

An ethical approach suggests that we consider how much an individual learns from working with an Other. I believe that learning is different from idealising traditional methods of spiritual and psychological healing such as Shamanism. It is possible to avoid a kind of transcultural tourism and work towards ad hoc syntheses via bootstrapping. For example, traditional healers stress the role of ancestors in the construction of current impasses in the individual’s life. Isn’t this compatible with, though obviously different in emphasis from the psychic determinism of Freudian theory in which parental influences are decisive?

There is a further, very penetrative, role for an ethics committee in connection with psychotherapy’s typical linguistic tropes. Here, we see an assumption of an equivalence between ‘dark’ and whatever is bad, inferior, problematic. The best example of this is the Jungian notion of the ‘shadow’ which, whilst very useful in brining us face-to-face with the ineluctable destructiveness of humanity, does tend to elide that with whatever is ‘dark’.

Sexuality:

Earlier, I mentioned the campaign to end discrimination against sexual minorities with respect to admissions for psychoanalytic training in Britain. Partly as a result of the Government’s intervention, anti-discrimination clauses had to be inserted in the literature of several prestigious psychoanalytic training institutions in both the private and public sectors. However, if one is honest about it, the changes that have been made are perhaps little more than superficial. For it is still the case that few lesbians and gay men apply for psychoanalytic trainings in Britain. In part, this is because what they will still hear things about themselves will be distinctly unpalatable. For example, that homosexuals have an excess of the death drive. This is because (so the argument goes) they cannot have children and so are cut off from the life drive(s). Or, it is alleged, homosexuals will have trouble in imaging their parents in productive and fertile heterosexual intercourse, due to their own personal lack of such experience. The stupidity of such arguments is best brought out merely by repeating them. But if the image of the combined parents in intercourse is stated to be a requirement for a degree of mental health, then the implications for homosexuals could not be more serious. The existence of such theories is, therefore, an ethical as a well as a clinical dilemma.

What I am saying in this paper is that there is justification for an ethics committee examining the functioning of the training organisation in terms of what is actually taught so as to see if there is in fact adherence to the principles that may be enshrined in the code of ethics. Specifically, there are a number of common practices, which few in the psychotherapy world seriously question, that, from an ethical viewpoint, deserve scrutiny and discussion. For example, we see inappropriate mention of a patient’s sexual orientation in clinical papers and presentations. Sexuality is presented in a defining and foundational way: ‘that patient was a 45 year old lesbian who had never been married’. Then there is the issue of ‘good gays’ and ‘bad gays’ that I mentioned earlier: ‘she had never maintained a permanent relationship’.

More serious, perhaps, from an ethical point of view is the widespread belief that homosexuality has ‘causes’. As if, in the world of psychotherapy, anything other than a bad thing has a cause! Positive things are never assigned causes. For example, it is still often asserted that there is a ‘homosexogenic family’, that causes homosexuality in males, on which there is a suffocating, possessive mother and a cold, absent, critical father (as if this didn’t apply to the families of numerous heterosexuals). Similarly, it is often stated that homosexuals do not have a clear sense of gender identity whereas, in fact, as many homosexuals as heterosexuals know that they are male or female.

In addition to asking for detailed justification of ideas like those I have just outlined, an ethics committee would want to ask if sufficient attention is being paid in the training programme to special issues that are relevant go sexual minorities, mainly to do with coming out and with internalised self-loathing.

Finally, and most controversially, psychotherapists often lose their ethical position and fall into Western culture’s moral panic over what has been called the ‘homosexual lifestyle’. For gay men, this means extreme promiscuity (known in Britain as ‘cottaging’). Now, there is no point in denying that cottaging happens, though there are many reasons for it. But there are heterosexual equivalents (lapdancing, striptease, prostitution, pornography, trafficking) and we do not find heterosexuality being equated with them or stigmatised on the basis of their existence. Behind the liberal value of tolerance, we see that the spectre of cottaging is manoeuvred into place to continue to smear and stigmatise homosexual men.

From the female angle, the equivalent equation is that lesbianism means, inevitably, ‘bed death’. The proposition is that, after an initial flurry, lesbian relationships lose their sexual excitement and physical contact ceases. Again, of course, this can happen, just as it can happen in heterosexual marriages. What is unethical is the way in which the standing of lesbianism is somehow undermined.

Another moral panic that psychotherapists join in with concerns the alleged bad effects on a child or children of growing up in families headed by two adult women. This prejudice is widespread in the psychotherapy world and, of course, ignores the way in which children of heterosexual marriages are damaged by them. Indeed, what little research there is seems to suggest that there are no inevitable psychological consequences of growing up in a lesbian household.

A pluralistic approach to training:

In this section, I argue that the ethics committee of a psychotherapy training organisation can only fulfil its part of the job of ‘protecting the public’ if it seeks to ensure that the training programme is sufficiently pluralistic in nature. The basic connection that I am assuming to exist is between the ideas and practices that are taught on the programme and the utility to patients and clients from a wide range of backgrounds of those ideas and practices. Again, the ethical goal is to make sure that the high-sounding statements of principle are actually translated into everyday practices on the ground.

The training standards of the United Kingdom Council for Psychotherapy require all registered psychotherapists to have attained proficiency in at least two modalities of psychotherapy. With some exceptions, this requirement is simply not adhered to. There are reasons for this beyond the tribalism and conformity of the psychotherapy world that have to do with the absence of an adequate ethos to facilitate such a pluralistic set-up.

Pluralism is an attitude to difference developed initially in the political world. As I have suggested (1989), its hallmarks are competition, bargaining and a conversation that has mutual understanding as its goal rather than agreement. As A.N. Whitehead put it, ‘ a clash of doctrines is not a disaster, it is an opportunity’. Pluralism is intended to be the opposite of fanaticism or fundamentalism, though pluralists can often be fanatics for pluralism and risk being accused of believing in nothing at all.

I would like to take this notion of pluralism and, so to speak, ethicise it. I do this by turning once again to religion – this time to Islam – for inspiration. The turn to Islam is part of a wider theme in my current work in which Islam is understood as the significant other of the West and, sometimes, as its ‘therapist’ – particularly with respect to a critique of the shallow materialism and lack of spirituality in much of Western social organisation. I hope it will be understood that I do not seek to idealise Islam, which certainly breeds its own cruel fundamentalisms and injustices. Dependence on a Book is not always a good thing (Torah, New Testament, Freud, Jung). Dependence on a book, coupled with possession of power in general and military power in particular, is a disaster, no matter who has the instruments of violence and destruction.

In the Koran, we meet the concept of Ta’Aruf – ‘that you might come to know one another’. As the Koran says, ‘O Mankind, we have created of you male and female, and have made you peoples and tribes, that you might come to know one another’. Now this is a very interesting take on difference and diversity that gives the whole inclusivity agenda in a professional field such as psychotherapy a pronounced ethical twist. You lose something by knowing only your own tradition, seems to be the message of the Koran here. So the creation of difference and diversity is for humanity’s benefit. And the more you know about the Other with his or her difference, the more likely you are to work out your own difference in a through and imaginative way in response.

Considerations like these are an amalgam of religion and morality and would need translation into pragmatics and detailed organisation. But, as the Jewish saying goes, ‘God is in the details’. (The British say ‘the devil is in the details’!) Ta’Aruf means that difference and diversity are valued in a new way. There is no disaster of the Tower of Babel. Nor is there only one way to salvation, for example, via Christ. Ta’Aruf resembles the statement of the physicist Nils Bohr: ‘The opposite of a correct statement is a false statement. But the opposite of a profound truth may well be another profound truth.’

CONCLUDING REFLECTIONS

The main risk of a profession such as psychotherapy following the line laid out in this paper is the growth of a self-righteousness that would be persecutory for practitioners and of dubious benefit to consumers (cf. Lawrence, 1999, pp.221ff). Savonarola came to a fiery end, after all. I would not want to replace one tyranny with another. Here, W.B. Yeats’s poem ‘The Great Day’ comes to mind:

Hurrah for revolution and more cannon shot!

A beggar upon horseback lashes a beggar on foot.

Hurrah for revolution and cannon come again!

The beggars have changed places, but the lash goes on.

Finally, I want to turn to the third Abrahamic faith – Judaism – for some concluding reflections. Jewish liturgical and religious tradition is often castigated unfairly as a source of a rather rigid morality, an eye for an eye and a tooth for a tooth sort of morality. This is partly true. But there is something more, and this can offset the potential for sanctimony that attaches to the project of making inclusivity an ethical matter.

The night before the Day of Atonement (Yom Kippur), the Kol Nidre service is held. This service begins with a particularly beautiful prayer which, in most congregations, is regarded as being so important that it is actually recited three times:

All vows, bonds, oaths, devotions, promises, penalties and obligations, wherewith we have vowed, sworn, devoted and bound ourselves, from this Day of Atonement until the next Day of Atonement. Lo, all these we repent us in them. They shall be absolved, released, annulled, made void, and of null effect. They shall not be binding, nor shall they have any power. Our vows shall not be vows, our bonds shall not be bonds, and or oaths shall not be oaths.

‘Our vows shall not eb vows’ – at the heart of the Jewish liturgy? What is going on? The Rabbis, who are of course the original model for the incorrigible disputativeness of psychotherapy, tell us that there are no less than three possible meanings for this prayer. (1) Do not aim too high in the future lest failure disappoint. It is better to annul your vows before it is too late. (2) You will have slipped up morally in the past, so backdate an annulment of your vows as a precaution. (3) Never mind about paltry moral contracts with human beings; the only important ones are with God.

Whichever interpretation appeals, what is placed firmly on the table at Kol Nidre is failure. Failure in the social realm is always present and this will be the case with regard to the matter of inclusivity in psychotherapy. But perhaps we have to learn to ‘fail better’, as Samuel Beckett put it, and that ‘failure is the key to the kingdom’, in the words of the Sufi poet Rumi.

REFERENCES

Aveline, Mark (2001) Complexities of practice: psychotherapy in the real world. In Values and Ethics in the Practice of Psychotherapy and Counselling. Eds Fiona Palmer Barnes and Lesley Murdin. Buckingham: Open University Press, pp. 128-143.

Etzioni, Amitai (1969) The Semi-Professions and Their Organization: Teachers, Nurses, Social Workers. New York: Free Press.

Freidson, Eliot (1994) Professionalism Reborn: Theory, Prophecy and Policy. Cambridge, UK: Polity Press.

Hayry, Heta and Hayry, Matti (1994) The nature and role of professional codes in modern society. In Ethics and the Professions, Ed. Ruth Chadwick. Aldershot: Avebury, pp. 136-144.

Johnson, Terence (1989) Professions and Power. Basingstoke: Macmillan.

Jung, C.G. (1946) The Psychology of the Transference. London: Routledge and Kegan Paul; Princeton, NJ: Princeton University Press (1965).

Kaye, John (1999) Towards a non-regulative praxis. In Deconstructing Psychotherapy, Ed. Ian Parker. London: Sage, pp. 19-38.

Lawrence, John (1999). Argument for Action: Ethics and Professional Conduct. Aldershot: Ashgate.

Lewis, Roy and Maude, Angus (1952) Professional People. London: Phoenix House.

Palmer Barnes, Fiona (1998) Complaints and Grievances in Psychotherapy: A Handbook of Ethical Practice. London: Routledge.

Palmer Barnes, Fiona and Murdin, Lesley (2001) (Eds) Values and Ethics in the Practice of Psychotherapy and Counselling. Buckingham: Open University Press.

Samuels, Andrew (1989) The Plural Psyche: Personality, Morality and the Father. London and New York: Routledge.

Samuels, Andrew (1993) The Political Psyche. London and New York: Routledge.

Samuels, Andrew (1997a) Pluralism and the future of psychotherapy. In The Future of Counselling and Psychotherapy, Eds Palmer, Stephen and Varma, Ved. London: Sage, 1997.

Samuels, Andrew (1997b) Pluralism and psychotherapy: what is a good training’. In Implausible Professions: Arguments for Pluralism and Autonomy in Psychotherapy and Counselling, Eds House, Richard and Totton, Nick. Ross-on-Wye: PCSS Books.

Samuels, Andrew (2001) Politics on the Couch: Citizenship and the Internal Life. London: Profile Books; New York: Other Press.

Solomon, Hester and Twyman, Mary (2003) (Eds) The Ethical Attitude in Analytic Practice. London: Free Association Books.

Witz, Anne (1992) Professions and Patriarchy. London: Routledge.

 

Andrew Samuels

BIOGRAPHY: Andrew Samuels is Professor of Analytical Psychology at the University of Essex, Visiting Professor of Psychoanalytic Studies, Goldsmiths College, University of London, and Honorary Professor of Psychology and Therapeutic Studies at Roehampton University. He is a Training Analyst of the Society of Analytical Psychology, in private clinical practice in London. He was the founder of Psychotherapists and Counsellors for Social Responsibility. His many books have been translated into 19 languages and include The Plural Psyche (1989), The Political Psyche (1993) and Politics on the Couch: Citizenship and the Internal Life (2001).

Andrew Samuels

BIOGRAPHY: Andrew Samuels is Professor of Analytical Psychology at the University of Essex, Visiting Professor of Psychoanalytic Studies, Goldsmiths College, University of London, and Honorary Professor of Psychology and Therapeutic Studies at Roehampton University. He is a Training Analyst of the Society of Analytical Psychology, in private clinical practice in London. He was the founder of Psychotherapists and Counsellors for Social Responsibility. His many books have been translated into 19 languages and include The Plural Psyche (1989), The Political Psyche (1993) and Politics on the Couch: Citizenship and the Internal Life (2001).

Andrew Samuels

BIOGRAPHY: Andrew Samuels is Professor of Analytical Psychology at the University of Essex, Visiting Professor of Psychoanalytic Studies, Goldsmiths College, University of London, and Honorary Professor of Psychology and Therapeutic Studies at Roehampton University. He is a Training Analyst of the Society of Analytical Psychology, in private clinical practice in London. He was the founder of Psychotherapists and Counsellors for Social Responsibility. His many books have been translated into 19 languages and include The Plural Psyche (1989), The Political Psyche (1993) and Politics on the Couch: Citizenship and the Internal Life (2001).

Andrew Samuels

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