"The problems with therapy"

This article by Lucy Bannerman was originally published in The Times and can be viewed here.

“Think of a happy place and ask yourself this: does it take more skill to heal the body or heal the mind? Few would entrust their physical health to anyone who was professionally unqualified, unaccountable and under no professional obligation to try to make you better. Which is why, if you seek help from a podiatrist, chiropodist, or several other health professions, you are protected by statutory regulation. If a physiotherapist gets too familiar, for example, you can complain to a government watchdog, which will decide whether to strike him or her off a national register. Those falsely claiming to be such professionals can be prosecuted or fined.

With matters of the mind, however, no such conditions apply. Anyone can put up a brass plate and call him or herself a psychotherapist or counsellor, and those looking for expert guidance through their most intimate issues must rely on trust, often at a time when they are most vulnerable. Rest assured, though, nobody will mess with your feet.

This week, the Health Professions Council (HPC), the regulator chosen to correct this anomaly, will make its formal recommendations to the Government on how best to control the psychotherapy and counselling industry. “It will,” promised Marc Seale, the HPC’s chief executive, at the time of the watchdog’s appointment, “for the first time, create a legal framework that will allow for the removal of rogues and charlatans from practising and potentially harming the public.”

Ranks are split between therapists who grudgingly accept a need for regulation by a watchdog with teeth, and purists who argue the process of therapy should not be subject to the same biomedical codes of conduct that already govern, say, paramedics and X-ray technicians. The spectre of state intervention has also highlighted issues as old as Freud — namely, how do you regulate psychotherapy when no one can agree on what it is, and how do you find the right rulebook if, as some claim, there are as many different types of therapy as there are ways of talking.

The experience of Shona Fleming, 24, from Doncaster, who underwent therapy offered by an organisation with extreme religious views, underscores some of the difficulties. Three years ago, she was struggling with bulimia, self-harm and suicidal thoughts. Then she heard through her church about a free counselling service that promised to help. Mercy Ministries UK — motto: “Lives transformed, hope restored” — describes itself as a “distinctly Christian organisation dedicated to helping girls and young women — ages 18 to 28 — who specifically seek our care for a variety of addictions and hurts”.

Fleming checked into its residential counselling programme at a house in the village of Oxenhope, Yorkshire. Minimum stay is six months and contact with friends and family is limited. She found the experience so distressing, she calls it “Mercy Miseries”.

The group, founded by Nancy Alcorn, an American Christian evangelist who blames psychiatric illnesses and homosexuality on “demonic activity”, has homes in the US, Canada, New Zealand and Australia. It claims it has helped more than 2,500 girls worldwide to overcome depression, eating disorders, addiction and other “life-controlling issues”. It is believed that about 20 young women are now in care in the UK home, which opened in 2006.

Fleming claims that her nine-month treatment — involving intense study of “demonic oppression” — left her deeply disturbed. And she also says the in-house solution to bulimia was 45 minutes of “couch time” after every meal, during which girls were forbidden to go to the lavatory unaccompanied. Group counselling revolved around study of a bizarre “hellfire and brimstone”-style self-help manual, Restoring the Foundations, seen by The Times. Exercises include “Sins of their Fathers”, which links patients’ conditions to any “iniquities” in their family history, such as abortion or homosexuality. The final chapter, “Demonic Oppression”, instructs how to “cast out demons” through “deliverance” and include charts linking demons to everything from cancer, anorexia, Aids and rock‘n’roll.

During her one-to-one counselling, Fleming claims that her counsellor blamed a “little girl demon” for her depression and eating disorder. “If sessions got too intense, she would break out in prayer or start speaking in tongues.” She was encouraged to stay in the programme by her family, who are committed members of Abundant Life, an US-style “charismatic” church in Bradford, with strong links to Mercy Ministries. Feeling confused and increasingly introverted, Fleming recalls being called into the main office by three senior members of staff.

“They said I wasn’t moving on with my issues and had to confront the ‘little girl demon’ inside me. They told me to walk around the room, and started walking around me, praying, speaking in tongues. It was getting louder and louder. They were saying, ‘Talk to the little girl, tell her she’s got to go. Tell her she’s got to leave’. I was freaked out.”

She believes that what took place was an exorcism. “I look back on it now and it seems crazy. I should have worked it out, but I felt vulnerable.” Now a confident woman, Fleming feels that she has overcome her problems — despite counselling, not because of it. “I really did come out worse than when I went in,” she says.

Arianna Walker, executive director of Mercy Ministries UK, says that dozens of girls who have been through the UK programme thanked Mercy for improving their life. One such example is Joy, 21, a former self-harmer from Bedfordshire, who joined in 2007. “I probably wouldn’t be alive today without Mercy,” she says. “I never thought I could exist without feeling desperately low, but I decided to go to Mercy Ministries for one more attempt at life. I found an abundant life that is not like anything I’ve ever known.”

Joy has joined the Abundant Life Church, where she pays to attend its “leadership academy”. She says that, unlike Fleming, she found study of “demonic oppression” therapeutic.

Walker says: “Unfortunately, as with any organisation dedicated to helping those in need, there are occasionally those who express frustration with some aspect of the care they have received. MMUK takes such complaints very seriously.” She denies exorcisms are performed, and says that study of “Restoring the Foundations” was discontinued in June 2008: “Our emphasis is on the power of God’s grace and unconditional love to help hurting young women overcome addictions and past hurts.”

She adds that, although the charity supported proposals for government regulation, the Tennessee-based organisation will be changing the title of its staff from “counsellors” to “facilitators”, once new legislation comes into place — “so that our approach to supporting young women is more accurately described according to UK terminology, instead of American.”

Mercy Ministries is one of an estimated 100,000 organisations believed to be offering counselling or psychotherapy in the UK. The NHS is investing more than ever in “talking therapies”, with £173 million earmarked to increase the number of cognitive behavioural therapists throughout England by 2010/11.

However, hundreds of practitioners — from Jungian analysts and well-woman workers to student counsellors and bereavement experts — have signed a petition, declaring a “stance of principled non-compliance” with proposed regulation. They argue that in therapy, unlike other medical professions, there is no specific “cure” to be assessed: just a fuzzy and unsatisfying response to the question: do you feel better?

“Misconduct is misconduct,” says Professor Andrew Samuels, of the Alliance for Counselling and Psychotherapy, which leads the hardcore of resistance. He believes that the HPC system is too costly and bureaucratic and wants an alternative regulator more attuned to what psychotherapists do. “Psychotherapy is not riddled with thousands of unqualified and evil people,” says Samuels, who believes the unscrupulous few are already dealt with adequately by “the law of the land”.

He warns even those struck off the register could still reappear, working as life coaches, while “the [innocent] therapist could end up with a huge bill, a ruined reputation and still be cleared”.

Which begs the question: whose interests are at stake here — those of the public or the professionals?

For Dawn Devereux, a psychotherapist from St Albans, an industry overhaul cannot come quickly enough. She wants to see a new HPC-regulated system that will protect others from having to go through the bizarre, closed-door complaints procedure that she had to face.

As is common, she underwent therapy during her own training. Sessions began inconsistently — “at times, he would act as a classical Freudian therapist, typically silent. Then, he’d spend the whole session talking about himself and his marital problems, or shout, and go purple with anger.” Her therapy ended with an alleged sexual advance. “I was confused and made to feel the problem was me.”

Devereux finally complained to his professional body, but found herself in the “surreal” position of complaining to a panel on which her therapist used to be a senior member. “I felt treated like a troublemaker. I thought that they would want to know about someone like this. Instead they seemed to close ranks.” The therapist continues to practise. “It’s appalling. I’ve done everything I could do, but vulnerable people will still put their confidence in him.”

Now running her own practice, Devereux estimates that about half of her regular clients have had similar, traumatic experiences. She believes that the good name of her profession is being damaged, not just by cases of misconduct, but also accepted practices, such as encouraging clients to attend more therapy sessios than they need.

“As a therapist you’re meant to be helping people, not making them dependent on you. When the power relationship is exploited, it becomes an institutionalised form of abuse. It encourages and fosters a culture of dependency when you’re supposed to be doing the opposite.”

One solution is to extend the powers of the scores of existing professional bodies.

Urban Bliss is an oasis of calm among the boutiques of Portobello Road, West London. The clinic offers techniques across the spectrum of the therapy rainbow. There are healers specialising in shamanism, angel readings and “theta healing”. And also naturopaths, reiki masters, clairvoyants and aura cleansers.

Abigail Peters is a psychotherapist based here. She is a member of the British Association of Counsellors and Psychotherapists, and the UK Council of Psychotherapy, and believes more regulation by the HPC would be at odds with the work they do.

“It would mean a lot of these people” — gesturing to naturopaths and hypnotherapists next door — “and all these amazing techniques that focus on people’s ‘uniqueness’ would be banished. I don’t believe the few rotten apples justify that.”

Peters describes herself as a “transpersonal integrative psychotherapist” specialising in “timeline therapy” and “eye movement desensitisation reprocessing” for trauma victims. “We all want to know that our field is being protected,” she says, “but when you’re looking at wellbeing, there’s a lot of intuition involved. It’s subjective.”

Human complexities cannot be reduced to a box-ticking process, says Peters, who is concerned that therapists might be unfairly held to account if they fail to achieve holistic healing of mind, body and soul. “When it comes to counselling, lots of people are coming for a quick fix. But as you go deeper, it is possible they will come out of sessions feeling worse.”

That does not necessarily mean that the counsellor is not doing his or her job, she says. Perhaps, the greatest problem is this: psychotherapy boils down to a conversation between two people, freely entered upon. And how do you regulate that?”

Written By Mercy Survivors

Support for survivors of Mercy Ministries