A Crusade to liberate therapy

	Book review on In, against and beyond therapy: critical essays towards a ‘post-professional era’ by Richard House (2010) Reviewed by Isabel Clarke, 2011 published in Network Review No 106
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In traditional societies, most people do not need to agonise about their role in life and their place in society. It was determined for them by birth; they follow the family's occupation, marry the individual chosen for them and generally fit into their allotted place. It has never been that simple for everyone. Some people inevitably fall through society's cracks. The younger sons of the fairy tales are sent out into the dark forest, inadequately equipped, to seek their fortune. The individual unwilling to be constrained by the limits imposed seeks to transcend them by initiative - the heroes and misfits common to all ages. Our society is different.  We are all heroes, misfits or have dropped through the cracks, as the containment offered in past ages has all but evaporated, and we are on our own; lonely individuals inventing themselves. And yet, there is always the drive to recreate containment, security, institutions that will temper this harsh fate. And there are therapists to help us find our way, whether seriously lost or just in need of direction. This is the context of Richard House's volume of collected essays.

The volume clearly documents House's crusade, over decades, against the professionalisation and state regulation of therapy, in favour of a more intuitive, right brain, postmodern, understanding of the practice. The book starts with a very helpful account of House's personal experience of enculturation into the world of therapy; disillusionment with creeping professionalisation, and making common cause with the alternative body, the Independent Practitioners' Network.  Richard Mowbray's manifesto of this movement, and Ian Parker's work of deconstruction of diagnosis figure prominently in all that follows - namely a somewhat miscellaneous collection of book reviews and critical essays, delineating House's position on various linked topics. These include, individual therapy, the regulation of the profession, professional training and research (where he advocates narrative and participatory approaches).

As a call to arms for the independent and alternative practitioner, this book is a powerful resource. The work's ability to reach out beyond the bunker towards a more general audience is somewhat limited by House's relentlessly polemical approach. Even when expressing his abundant admiration for Georg Groddeck's embodied thinking, for instance, he is constantly swiping at Cognitive Behaviour Therapy (CBT).

This is a pity, as there are important arguments buried amid the flying missiles. The balance between art and science in the practice of therapy. Therapy as spiritual activity.  The tension between vested interests and creative practice. Critique of the medicalising and pathologising of reaction to life's adversities represented by Ian Parker's work on deconstructing psychopathology and  Bracken and Thomas's critique of the medicalisation of trauma.

The partisanship goes along with the book's role as a manifesto and rallying cry for a beleaguered faction. In the true spirit of postmodern contextualisation, I must declare my own position as a representative of the (by House) derided CBT; a practitioner embedded in the NHS, so equipped with official certifications galore.

In other respects we are not so far apart.  Both critics of the status quo, we share a passion to dismantle  medicalisation  and unmask the hollowness of diagnosis as applied to mental distress (Clarke,I  2009).  We both respect the spiritual; the other 'way of knowing' (Clarke,C. 2005 - much cited in the volume under review). While House criticises from the outside, I operate from within, because I work with those at the sharp end of the mental health spectrum. There are hardy souls who choose to work in isolation with profoundly disturbed and risky individuals, but I am not one of them - I value the safety of everyone concerned too much.

The real difference between us concerns logic.  Human beings are stuck, by our very constitution,  uncomfortably between two contradictory logics. House champions the intuitive; the dominant paradigm is the scientific. In reality we need both.  I explore the roots of this eternal balancing act in the way our brains are wired up (Clarke 2008, 2010). Such ambiguity sits uneasily with the steamroller of polemic. The intuitive and the rational need each other. Pursuit of the intuitive and non rational, if not constantly rebalanced with reference to the rational, can lead into dangerous territory. A spurious certainty, a fundamentalism can creep in. House himself quotes George Steiner's reference to the 'drug of truth'. 

This is not to say that the need for balance is never noted in this long and diverse volume. There is partial recognition of the  paradox of arguing against the need for regulation to prevent abuse, while acknowledging that therapists do not really know what they are doing as they operate within the obscurity  of human relating. The chapter by service users on the dangers inherent in being a therapy client because of the power gradient, also sits uneasily with opposition to all regulation. 

The reality is that the Health Profession's Council has taken on the regulation of the professions of counselling and psychotherapy whether we like it or not (and most us do not like it one bit!) I would agree that the human potential movement should not become swept up in this. I would argue for a distinction between practitioners operating within the orbit of the NHS  and providing therapy to those whose everyday functioning is temporarily impaired, and those providing a private service of self exploration. After all, it is reasonable to demand  accountability where public money is being spent.

In conclusion, this book is a resource and a compendium of important issues.  The central message is well summarised by C.G. Jung: 'learn your theories as well as you can, but put them aside when you touch the miracle of the living soul' (quoted by House,P.279) - a both-and if ever there was.

Clarke, I. (Ed.)  (2010) Psychosis and Spirituality:  consolidating the new paradigm.  Chichester: Wiley

Clarke, I. (2009) 'Coping with Crisis and Overwhelming Affect: Employing Coping Mechanisms in the Acute Inpatient Context'. In A.M. Columbus Ed. 'Coping Mechanisms: Strategies and Outcomes'. Advances in Psychology Research Vol.63.Huntington NY State:Nova Science Publishers Inc.

Clarke, I. ( 2008) Madness, Mystery and the Survival of God. Winchester: OBooks.

Clarke, C. (Ed). (2005) Ways of Knowing: science and mysticism today.  Exeter: Imprint Academic.

Isabel Clarke is a consultant clinical psychologist working in acute care in the NHS. She is editor of  CBT for Acute Inpatient Mental Health Units (Routledge, 2008; with Hannah Wilson), Psychosis and Spirituality; consolidating the new paradigm (Wiley, 2010) and author of Madness, Mystery and the Survival of God (O Books, 2008).

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