Monday, 28 October 2013


I recently initiated an exchange on the Independent Practitioners yahoo group around the growing concerns as to the impact of our diminishing skills base on our professional survival. I have for the interest of those who are not able to access the yahoo exchange copied here the question I set and my response to the replies that followed.

Dear All,
I heard in the news recently that in order to build the newly proposed nuclear power station we have to employ the French and Chinese. The eradication of our industrial base in this country means as we no longer have the skills to undertake this as purely a British project.

It has increasingly been on my mind that we are in a similar position. The down grading of our clinical expertise within the training programmes and the absence of opportunities for therapists to practise once trained will inevitably impact on the pool of skills over time even for those who opt for Independent Practise.

It is a worrying fact that once those of us who were more thoroughly clinically trained and have years of therapeutic expertise under our belt begin to disappear/retire our skills will go with us.Using myself as a benchmark I figure we have about another 10 to 15 years.
I believe this elephant in the room needs to be addressed very urgently at all levels. What do others think?


The following is my response to my colleagues replies. 

Dear All,
I think we need a moratorium on this issue because I believe the underlying reasons that are conspiring towards our potential demise are multi layered and complex.
Here are some of my thoughts as to how this awful situation has evolved
1. We are a young profession and as a result we were/are still getting to grips with some basic principles with regard to what we do and how we go about it. Unlike the medical profession for instance that has had several hundreds of years to establish itself and its core paradigms,  we were/are still in the stage of getting our heads around what we do. This has put us at a distinct disadvantage as we have not yet developed a way of clearly articulating our work which is why I believe so many of us, who despite the intuitive feeling about the benefits of our work, find it so hard to describe what we are doing and how it is happening. Which isn't wrong it is a natural progression. However within the storm of NHS reform over the last 20 years, we have allowed ourselves to be persuaded into believing this is a fault of ours, an indication of our poor competence and our therapeutic ineffectiveness.
2. We have because of these external forces unfortunately fallen in with the false belief that a scientific methodology and more to the point one particular brand of scientific methodology is the one and only way of delineating and exploring the effectiveness of our work. Most of us know instinctively this is a false premise which it is. However many of us don't have the real understanding as to why this is so, which is not our fault because in the normal course of events we would have time to explore all methodologies and choose the ones that best suit our needs.
3. We have as a result of the impact of factors stated in 1 & 2 not as yet sufficiently established a confident belief or I would even say understanding of our therapeutic process. The tools we have really needed to do this have been locked away from us and any attempt to employ such approaches has left those of us who try, with a strong feeling of the cold wind as we stand outside the door of the cosy quarters of the "research community".
4. Sadly the rise of this 'materialistic' scientific approach as a primary tool, came simultaneously with the changes in the NHS and needless to say the new Captains were only too keen to jump upon any research that supposedly proved we were ineffective. The fact that the methodology was questionable was not of interest. Anything to suggest we could be replaced by untrained unskilled personal would meet the new NHS agenda i.e. cutting back on money was inevitably accepted with ease and without question.

5. Even sadder was the compliance of many of our leaders. However I believe this was as a result of their sheer lack of clinical experience and ergo were easily persuaded by what they saw as a superior modus operandus

6. As a result was borne the ghastly Consultative Model the final nail in our coffin. The worst thing about this has been its enforced acceptance and with that a virtual professional collapse in our ability to argue it out of court. This despite the fact that its credentials even from a scientific prospective are so poor that one would not need a whole brain to see why.

7. The politics and economics of the NHS have becoming increasingly founded in and dependent upon the perpetuation of the belief in the Consultative Model. So powerful has this been that even many therapists believe in their hearts that the consultative model is just as effective as direct therapy as do the institutions that train them. But who can blame them when they have had no opportunity to practise their craft and make their own minds up.

8. And finally which is where we are now service providers have via the acceptance of the Consultative Model carte-blanche to cut back services and remove therapy from the picture completely and this has been with our blessing.
The resolution of this dreadful mess requires as far as I can see a major rethink from top to bottom and needs a whole profession approach.
Id be interested to hear what others think.