Category Archives: Richard House

SCoPEd Consultation: Methodologically Challenged

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Richard House Ph.D., former Senior Lecturer in Psychotherapy, Counselling and Psychology at the University of Roehampton, subjects the SCoPEd framework consultation exercise to critical analysis.


Introduction and Context

In this commentary I wish to deconstruct, and subject to critical analysis, the apparent methodology used by the psy sponsor organisations in their recent SCoPEd consultation process. In precipitating a process that could end up having major implications for the practice of many thousands of psy practitioners, organisations surely have a grave responsibility to ensure that, as far as possible, any research that is carried out is methodologically robust, and transparently fair and unbiased. In the case of the SCoPEd consultation, I will show below that this is, alas, very far from being the case – which, in turn, places substantial doubt on the reliability of the initial findings as recently announced.

A Fair Consultation?

The first observation to make about the consultation process is that the most important question of all wasn’t even posed – i.e. “Do you think that it is necessary and appropriate for the psy organisations to develop an explicit written framework for competent practice in the therapy field?”.

Rather, the need for a competency framework is merely asserted and assumed by “organisational fiat”, as a background given; and only then do respondents answer the questions posed, having already tacitly and implicitly agreed to the need for such a framework by the way the consultation has positioned them, and by the very act of them completing the consultation.

It should by no means be tacitly or casually assumed that everyone who completed the consultation necessarily agrees that such a framework is necessary; yet there is no mechanism within the consultation as implemented to discover this vital information. One has to ask whether this was an oversight, or a quite deliberate “positioning” by those conducting the process.

So one has to ask, further, why were members not asked, first and foremost, to give their view on whether a generic framework is necessary and appropriate? Although of course this has to be speculative, it might conceivably be because by doing this, it would then have been far more difficult to position members into accepting the principle of a framework per se without any debate. And as mentioned above, the very “democratic” act of completing the consultation can easily be read as giving tacit legitimacy to that which, at the outset, should have been open to discussion and possible refutation, rather than merely assumed as an uncontested datum.

Thus, a fair and proportionate consultation that was genuinely aiming to find out members’ views – as opposed to one merely seeking rubber-stamping legitimation for a pre-decided view – would have sent all potential respondents both the proposed framework and a document of equal length critiquing the need for a proposed framework. This would then have left members free to make up their own minds, “un-nudged”, with an accompanying, genuinely open-ended set of consultation questions.

As it is, a methodological “coach-and-horses” can be driven through this whole process, as anyone with any expertise in research methodology will know. (I can just imagine what a group of sharp, methodology-savvy Roehampton PsychD research students would have made of this! – and it wouldn’t have been pretty…)

It’s therefore extremely disappointing to this commentator, at least, that this consultation wasn’t far better informed methodologically. Moreover, this in turn is, at the very least, consistent with the suspicions of organisations like the Alliance for Counselling and Psychotherapy that this is yet another choreographed, top-down power move by our field’s psy organisations, still intent on importing the dead hand of state regulation into our work.

An “Independent” Research Company?

We read in the rubric from the organisational sponsors of “[t]he consultation exercise, which was run by an independent research company on behalf of BACP, the British Psychoanalytic Council (BPC) and the UK Council for Psychotherapy (UKCP), … [and that] … More than 3,000 members and stakeholders submitted a comment as part of the consultation process. These are currently being analysed by the independent research company for the key themes, which will be published in the summer.” (my emphasis)

The phrase “was run by” needs to be carefully interrogated and unpacked. It is indeed potentially reassuring to be told that the research company “running” the consultation process was “independent”; but such cosy reassurance is of no substance unless respondents are told in detail what the term “running” actually means in practice. For example, to have any methodological confidence in the consultation’s reported findings, the public needs to know what written remit the “independent research company” was given by the sponsoring organisations prior to the consultation exercise. This is critical, because it needs to be totally transparent to what extent the research company is, indeed, genuinely “independent” – e.g. merely in the sense that they carried out the data-collecting exercise, or in the sense that they themselves decided on the questions to be asked in it, and how those questions were framed.

Moreover, regarding the analysis of the comments received, we also need to know what, if any, guidance was given to the “independent” company by the sponsoring organisations, in terms of how the company analyses and presents the qualitative findings. If this information is not completely transparent, respondents will have no way of knowing whether the presentation of the results is a fair and representative depiction of the actual feedback which respondents gave in their thousands.

The Questions Themselves

Regarding the actual questions posed in the consultation procedure: first, respondents were asked, “Q1a – How will the framework affect clients or patients being able to find the right kind of help to meet their needs?” (my italics).

First, note that the tell-tale word “will” is used here, rather than “would”. If this were a genuinely open-minded consultation that hadn’t already pre-decided the desired outcome, the word “will” would most certainly not have been used in this question. Rather, the hypothetical “would” should and would have been used.

This is by no means a minor, semantics-oriented issue – for the way these questions are worded will have a major impact in creating the background “mood-music” to ease the driving through of any required institutional agenda. Those composing the wording of these survey questions will have been well aware of this (and if the sponsoring organisations weren’t, for any reason, then any reputable “research company” worth its salt certainly would have been).

In my view, and strictly speaking, respondents who were expecting a fair and open consultation which was not already positioning them by the way the questions were posed should have refused to answer this question. A much fairer and objective wording for this question would have been something like the following:

Q1aWould a framework like the one suggested have any impact, negative or positive, on clients/patients being able to find the right kind of help to meet their needs; and if so, how?”.

The key point here is that such a question might well have yielded significantly different results from the question that was actually posed (on which, see below).

Indeed, all four consultation questions commit this elementary methodological error in using the weasel word “will”. So, in relation to question 1b, a fair, more objective wording would have been as follows:

Q1b – Would a framework like the one suggested have any effect, negative or positive, on employers being able to establish which counsellors and psychotherapists to employ in their service; and if so, how?”

And for question 1c:

“Q1c – Would a framework like the one suggested have any effect, negative or positive, on trainees in their understanding of the pathways open to them for core training with adults; and if so, what and how?”

And finally for 1d:

“Q1d – Would a framework like the one suggested have any effect on professional bodies being able to promote the skills and services of their members; and if so, how?”

If the employed research company wished to test the reliability of the first reported consultation results, they could quite easily carry out a much smaller survey of practitioners who did not complete the first survey, using these alternatively worded questions. The results of such a survey would then provide clear evidence on the extent to which the original survey results are reliable and representative, or otherwise. Without doing such a follow-up, the reliability of the original survey results must remain in question.

Finally, regarding the raw presented statistical results, it’s clear that even when we ignore the multiple biasing effects of the way in which the whole consultation process was conducted (referred to in detail above), around 25 per cent of respondents – a considerable minority – were not happy with the proposed framework. If I were one of the psy organisations wishing to see this framework implemented, I certainly wouldn’t be feeling at all triumphant about these initial results.

In Conclusion

I have raised a number of core methodological issues in this commentary, and I ask the sponsoring organisations to reply to the concerns I have raised here in adequate detail.

If there is no full response, the silence will be deafening, and the many thousands of concerned practitioners will no doubt reach their own conclusions.

 

Dr Richard House, C.Psychol., AFBPsS, Cert.Couns.

Former Senior Lecturer in Psychotherapy, Counselling and Psychology, University of Roehampton; former PsychD research supervisor; former counsellor and psychotherapist in General Practice (1990–2007); author of Therapy Beyond Modernity (2003) and co-editor (with Del Loewenthal) of Against and For CBT (2008).

richardahouse@hotmail.com

 

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‘Welfare Reforms and Mental Health – Resisting Sanctions, Assessments and Psychological Coercion’. Conference Report – Part Two

In part two of our conference report, Richard House reflects on an historic event


Psy Users and Professionals Join in Common Activist Cause: a report on a one-day conference in Bermondsey, London, 5 March 2016

An historic event

This historic conference, entitled ‘Welfare Reforms and Mental Health – Resisting Sanctions, Assessments and Psychological Coercion’, was jointly organised by the Mental Health Resistance Network (MHRN) and the Alliance for Counselling and Psychotherapy, with the aim of bringing together activists and campaigners, both mental health and claimant activists and psy professionals, with a view to resisting punitive Conservative Government’s welfare reforms.

We use the term ‘historic’ advisedly, because to our knowledge this is one of the first (if not the first) occasion/s where service users, survivors, clients, psy professionals and academics have come together without the usual, often stultifying ‘expert’/‘client’ hierarchies of power. Indeed, it has rapidly become evident to members of the Alliance in recent months that when it comes to activism, we professionals have a huge amount to learn from the users and survivors of the services that professionals provide. So there was a really tangible sense of equality between everyone present at this gathering – the kind of thing that over-professionalised elements of the therapy world would no doubt be appalled by, and would construct allegedly sound, self-serving theoretical rationales as to why such equality wouldn’t be good for users/clients! Our response to such balderdash probably isn’t printable in a public document of this kind; but we warmly welcome this, the latest foray into what an exciting ‘post-professional’ psy world might begin to look like.

The conference

The conference was ably introduced and chaired by Paula Peters of DPAC (Disabled People Against Cuts), and Paula introduced us to two magnificent and inspiring speakers: Paul Atkinson of the Alliance, and Denise McKenna of MHRN (both addresses are to be reproduced in the Humanistic Psychology journal Self & Society later this year; also see Denise’s address here).

“the politics of austerity and neoliberalism, and their noxious effects on those most susceptible to psychological distress and fragility in society”

Paul and Denise spoke incredibly movingly about the backdrop to just why we were all assembled here, each striking an admirable balance between ‘diagnosing’ the problem and the issues, and calls for action and effective mobilisation and resistance. The main focus was on the politics of austerity and neoliberalism, and their noxious effects on those most susceptible to psychological distress and fragility in society, especially poor and disabled people. Indeed, the state as abuser was a recurrent motif that ran through the whole event.

We then broke for a series of inspiring and richly diverse workshops – something for everyone – the only drawback seeming to be that everyone wanted to go to all of them! The following workshops comprised the event:

  • Welfare reform and psychological coercion – with Rob Stearn and Jay Watts
  • Recovery In The Bin (RITB) – 19 Principles
  • Organising to tackle professional bodies, charities, and DWP staff – with Paul Atkinson
  • Campaigning Priorities – with the Mental Health Resistance Network
  • Emotional support for Survivors and Activists
  • The Mental Wealth Foundation – with Roy Bard
  • Direct Action – with Andy Greene

It’s quite impossible to do justice in this short review to the range of vital themes identified and explored on the day. To name just a few raised in one of the workshops I attended:

  • the issue of how we might step up campaigning around the collusion of professional organisations and charities with the Department of Work and Pensions (DWP) and Work and Health initiatives on welfare to work;
  • the theme of why psychology and psychotherapy are being used by government-funded agencies to legitimate oppression;
  • Improving Access to Psychological Therapies (IAPT) promoting a CBT agenda designed to coerce people into being productive consumers rather than offering care; examples of how survivors and mental health workers organised together to opposing the cutting of a successful peer-led project in Liverpool;
  • how community psychologists are organising campaigns in Brighton and elsewhere in the country;
  • how we might use the local press alongside social media to by-pass the bias of official national media.

Each participant was able to attend two workshops in all and my sense was that the discussions were wide-ranging, with the synergy of users, psy professionals and academics producing a quality of discussion and sharing which was far more than the sum of its parts. This surely has to be just the start of something new, exciting and vitally important in the world of psy.

The evening social

As if the rich fare of the day wasn’t sufficient for us all, we were then treated in the evening to a stunningly excellent artistic cabaret of talented musicians and poets, with the likes of Edgar Broughton (he of the legendary 1970s prog rock Edgar Broughton Band), the amazing iconoclastic singer-songwriter Dave Russell, and the radical performance poet, Woman Of Bones Tara Fleur.

Two particular highlights were Dave Russell’s extraordinary cover of the Sex Pistols’ ‘Pretty Vacant’ (‘Beefheart meets Stockhausen’, as someone remarked at the time) and Tara Fleur’s poem ‘I.D.S.I.O.T’., in which she searingly exposes the outrage that is the government’s back-to-work regime for those with mental health issues; a poem that brings humour and hilarity, visceral passion, outrage and tragedy – all wrapped into one breathtaking bravura performance. A ‘John Cooper Clarke moment’, as one poster expressed it on YouTube. This 12-minute, must-watch poem is indeed now on YouTube – and we strongly urge all our supporters to circulate this link to all of their contacts – a poem that will hopefully become a key ideological port of call in the struggle against the appallingly iatrogenic back-to-work regime. It was certainly good to be reminded that talking-shops do have their limits, and that brilliant agitprop and political art can reach places that nothing else can.

And what next?

All in all, then, this conference was a crucial and necessary staging-post on the way towards creating a critical mass in and around psy that can effectively resist the flagrant class attacks on poor and disabled people that the current government is perpetrating. The hope was also expressed that these events might become on ongoing forum of support for those working in and around ‘psy and the state’ – so watch this oppositional space! Certainly, as we write some strong post-conference initiatives are already underway. A dozen activist therapy and service user organisations are currently preparing an open letter to the main professional organisations, calling them out on their tacit support for the DWP’s welfare to work policies. A working group will be meeting to develop the Mental Wealth Foundation, an umbrella for radical mental health activism. We are developing groups of support and advocacy for people facing Work Capability Assessments. The working group for the next conference is forming. The day was also filmed, including face-to-face interviews with some key psy ‘movers and shakers’; and a film is currently being made which will soon be available on the Alliance, DPAC and MHRN websites.

And finally, we’d like to offer our heart-felt thanks to Gary, Mandy and Ilona at Wade Hall, Dickens Estate, Parker’s Row, Bermondsey for providing such a great venue for this event, for coping so wonderfully with the mushrooming number of attendees and for the wonderfully generous catering.

And once more to Paul Atkinson and Roy Bard for the tremendous work they put into organising this stunningly successful event.


See part three of our conference report here.

Go back to part one here.