Fit to Practice? The Experience of State Registration from the perspective of an art therapist

by Kevin Jones on October 9, 2009

Art therapy as a profession has never critically reflected upon the effects of state regulation on its teaching and practice. There is  no evidence that state regulation has improved either protection of the public or standards of training compared with self regulation by the British Association of Art Therapists (BAAT).  Without this collective, considered and researched reflection I think that it is it is extremely difficult for counsellors and psychotherapists to find reassurance from our experience as art therapists.

I voted for the state regulation of art therapy in 1997 believing that this was a step forward for the protection of the public and for the professional development of art therapy. My experience, however,  of being a state regulated art therapist, working as a full time lecturer in art therapy in a university setting and my subsequent training as a psychoanalytic psychotherapist, has lead me to oppose state regulation for counsellors and psychotherapists. Engaging with this debate the second time around has allowed me to reflect upon the ethics, politics  and values of my clinical practice and has made it clear that there are alternative ethical frameworks and forms of accountability that more accurately reflect my therapeutic values.

This short contribution indicates ways in which future Health Professions Council (HPC) regulation might affect counselling and psychotherapy. The lack of evidence on public protection suggests to me that the policy of ‘protecting the public’ in art therapy has functioned mainly as a threat, a disciplinary measure hanging over individuals and their professional organizations. My impression is that the professional response is to adopt defensive practice to avoid litigation rather than  engage with an ethical frame for practice.

Whilst the state regulation of art therapy has provided professional recognition and development and arguably improved pay and conditions within the National Health Service (NHS), recently there has also been an increase in job losses through redundancies.  My experience is that state recognition within the NHS has steered professional development in directions that run counter to the core values of both professional training as an art therapist and psychoanalytic psychotherapist. In the NHS the purchasing of treatments through the guidelines provided by the National Institute of Clinical  Excellence (NICE) based upon particular standards of Evidence Based Practice (EBP) has seen art therapy increasingly only being offered for the treatment of specific, medically defined conditions.   There is also pressure toward shorter term work focused around cognitively based and solution focused outcomes, rather than longer term open ended psychodynamic work. There has also been an increase in art therapists providing generic mental health services rather than art therapy. Within the NHS there has also been the loss of distinct art therapy studio space in favor of multifunctional generic use, eroding a key site of professional identity and development.

Counsellors and psychotherapists already working within or seeking to gain validation from universities will find their teaching shaped by the material constraints and the ideologies that support and promote education within the market place. My experience of teaching the MA Art Psychotherapy at Goldsmiths College, University of London suggests that state regulation influences the teaching of theory and practice. Staff and trainees are influenced by the HPC related Standards of Proficiency and Practice and the Standards of Education and Training so that teaching and practice can become defensively orientated toward the standards rather than engagement with the therapeutic relationship. Re-reading the art therapy Standards of Proficiency recently I believe that they are so simplistic that they can be taken to mean almost anything. They also contain inappropriate medical and diagnostic terminology that then has to be used when we ‘map’ our standards of education and practice onto learning outcomes for trainees and for peridoc review by the HPC and the university.

These agendas combine to increase bureaucracy and the micromanagement of a workload focused on regulatory procedures and the packaging of educational and therapeutic work into instructional and therapeutic commodities. As this model is internalized by practitioners, students and clients are increasingly related to as consumers of goods and services. It suggests that state regulation is one aspect of the marketization and regulation of education and public services.

The ‘crisis of the university’ means that the MA Art therapy course has seen the student staff ratio increase, a reduction in pay for associate staff and an increase in centralized models of education delivery antithetical to the experiential and psychodynamic teaching of our course. The pressure to provide research that is relevant to the local economy and which can demonstrate positive economic impact sits uneasily with the clinical concerns of psychodynamic practice which does not involve the realization of profit.

The British Association of Art Therapists (BAAT) has been enormously important in the development of art therapy. Now that State registration is not dependent upon individuals belonging to a particular member organization there has been a change in the relationship between the professional association and its members. As Ian Parker and Simone Revelli have written, one effect of regulation by the state is that the link between the individual practitioner and their training and member organization is broken and practitioners are instead offered an individualized relationship with the state (Parker & Revelli 2009).

The effect of this change is that BAAT has been left in search of a purpose. My experience as an art therapy educator is that as the professional association seeks to find a new role in the regulatory environment, BAAT is in danger of situating itself alongside HPC as a disciplinary body and increasingly relating to it members through business models, management techniques and an emphasis on legalized procedures, rather than focusing on the democratic participation of the membership in its activities.

Art therapy has always had a strong commitment to public sector provision, offering a form of psychotherapy to clients who would not normally be considered suitable for   psychodynamic therapy. Here, art therapy had a strong link to anti psychiatry practices that questioned relationships of power between the individual and the state, promoting horizontal rather than hierarchical relationships between individuals and organizations.  The critical potential for psychodynamic work to highlight the importance of individual and group relationships in human distress rather than the individualizing and de-humanizing models of organic and medical psychiatry is increasingly eroded. The democratic values which linked art therapy to anti psychiatry and broader social struggles for democracy, have been reduced to market principles of accountability, choice and efficiency, explicitly enforced by hierarchical management structures backed by institutional governance and legal force.

Counsellors and psychotherapists beware the experience of art psychotherapy! When considering a response to government proposals for state regulation look to your core therapeutic, political and philosophical values as the most important basis for your decision.

Kevin Jones

Reference

Parker, I., Reevelli, S. (eds) (2008) Psychoanalytic Practice and State Regulation. London. Karnac.