#15 The colonisation of psychotherapy.

History as a form of spellcasting // AHPRA's Code of Conduct

“To tell a story about things that have happened is to weave a spell about reality.” Gordon White

History is a form of spell casting. I recently encountered this idea while piecing my way through

Gordon

White’s Time Magic course via his online magic school, Rune Soup. I think it has interesting implications for the world of psychotherapy, and clinical psychology in particular. The ways that we form stories about reality, and which stories get picked up and recorded as the truth, have profound implications for what happens next and what becomes possible in the world. Many therapy frameworks—narrative, cognitive, and psychoanalytic, for a start—adopt this spellcraft as a means of healing by focussing on how patients’ stories about themselves and their lives might be amended to create room for new possibilities. At a meta-level though, there is also the question of how the story of healing itself has been told over time.

The Enlightenment, the intellectual and cultural movement that emerged in the 17th and 18th centuries, shepherded in a new dominant paradigm emphasising reason, science, and the individual over religious, communal, or mystical ways of meaning-making. As Gordon points out, this dramatic shift in collective thinking was possible only with a spell that first said:

Everything that came before was superstition.

This spell opened the gates for everything subsequent to be framed as “enlightened”. Science and reason could be positioned as the only valid ways of knowing. While the Enlightenment championed ideas of liberty, progress, and human rights, it also provided the ideological tools of colonisation. Indigenous knowledge—complex, place-based understandings developed over generations of lived experience, observation and tradition—was recast as primitive folklore, leaving scientific empiricism newly positioned as a uniquely enlightened and universally relevant means of discovering the “real truth.” Clinical psychology is a product of this lineage, and the "scientist-practitioner model" is a modern incarnation of this spell. It maintains its power through colonial means, adopting a rhetoric that says, “Those others didn’t know, but we know now.”

Photographer: Jacob Sutton (via Pinterest)

The clinical archive

As Gordon points out, history is held in archives. The archetypal archive is an expression of what is deemed real and important by the governing powers of a particular time. Clinical psychology, like modern medicine, utilises the academic journal as a dominant archive, and thus adopts the procedure of academic publishing as a determinant of legitimacy. In other words, these publications, and in particular, the much revered-randomised control trial, become the “evidence” of our “evidence-based practice.” While there are undoubtedly important advantages to this kind of research in principle, the powerful enchantment of this type of language glazes over many problems:

• Bias. Research outcomes are deeply affected by corporate interests (especially from pharmaceutical companies, but sometimes even academic institutions themselves) as well as the particular lens of individual researchers.

• Exclusion. An archive is not only a “positive” body of information - it wields great power in everything it does not include. This exclusion doesn’t only extend to types of wisdom and intervention deemed unscientific. Research trials demonstrating that an intervention has no effect, or an unexpected effect, are often left out of the archive. This occurs especially if said trials are funded by companies or research institutions who are heavily disincentivised to share the knowledge that their treatments don’t work.

• The Buzzfeed-ification of published data. Once something is published, it is often quickly reduced to a punchline summary basically saying “it works!” without any exploration of details like effect size (how well something works), durability and relapse (how long the benefits of an intervention actually last), and the nature of outcome measures (what actually counts as an “improvement”).

• What can’t be measured within the confides of empirical research but still exists?

A deeper dive into each of these is beyond the scope of this particular rant, but what I mean to say is that when we are under a spell that pre-determines legitimacy, and then uses institutional power to reinforce that legitimacy, not only are we not connected to the truth, but we’re not even engaging in the very scientific practice so glorified by the rhetoric of our profession.

Colonisation and the Code of Conduct

The deployment of a powerful archive is not the only colonial strategy utilised by clinical psychology to maintain its own power and legitimacy. Highly competitive, exclusive training pathways to licensure reinforce elitism and institutional power, while excluding many types of people from entering the field. Behaviours, rituals, and beliefs outside of Western norms are categorised as symptoms of disorder; for example, spiritual or ancestral communication may be diagnosed as psychosis or dissociation. Similarly, cultural values like silence and collectivism can be pathologised as avoidance or enmeshment. Clinical psychology also extracts knowledge from non-Western traditions (e.g. meditation and mindfulness practices, yoga, storytelling), stripping them of their cultural context and commodifying them for deployment in Western brands of therapy. It largely assumes a universal model of the human psyche founded in Western individualism, and underpinned by capitalist aspirations of continuous productivity and self-improvement.

The new AHPRA Code of Conduct for psychologists, scheduled to replace the APS Code of Ethics on 1 December, appears to be the next step in this colonisation process for psychology in Australia. With this change, the set of guiding ethical principles (of respect, propriety, and integrity) that has governed the practice of psychology in Australia since 2007 (and in various iterations since the formation of the Australian Psychological Society in 1949) is replaced with a compliance-based model, focussed much more on minimum standards for acceptable conduct with reference to specific behaviours. While I thought this type of document might at least appeal to those seeking more directive rules to assuage psychologists’ collective chief neurotic pre-occupation—not getting in trouble—in fact, the over-utilisation of vague terms like “safe”, “effective”, “boundaries”, and “evidence-based” without the articulation of an actual ethical framework do little to provide even that.

The Code also insinuates the Psychology Board into numerous aspects of the psychologist’s pre-existing personal life, including recommendations about the personal health, wellbeing and medical treatment of the clinician, and mandates that all psychologists participate in efforts to promote the psychological wellbeing of the community. While these ideas might seem innocent enough, they reflect a deepening overreach in clinical governance, a kind of moral surveillance over the psychologist’s private life that has implications for their individuality, authenticity, and freedom of thought and behaviour outside the consulting room¹. These are all hallmarks of colonisation. Ironically, the new Code actually requires that psychologists “recognise colonisation” in order to practice in a “culturally safe way”. So I guess you can claim reading this as PD?

Some of the more severe of these new restrictions are rules imposed on public comments of any kind made by psychologists. The Code states (in section 8.4):

Psychologists recognise that they have an obligation to enhance and protect the profession’s reputation by refraining from practice and personal behaviour that might bring the profession into disrepute and/or reflect on their ability to practise as psychologists.

Psychologists should be aware that statements intended to be private could become public and can affect the public standing of the profession.

When making public statements of any kind, including on social media, professional behaviour includes that you:

a. use respectful language, respect the privacy of others and maintain proper boundaries, and
b. make informed comments using contemporary, peer-reviewed research findings and/or your demonstrated experience and expertise.

This section exemplifies much of the new document. It is almost indecipherably vague — for example, what is “disrepute”? What are “proper boundaries”? Allusion is made to the characteristics of “professional behaviour”, but is professional behaviour required by psychologists in all areas of their public personal life? This is hinted at, but not made explicit. The requirement that a psychologist making public statements “make informed comments using contemporary, peer-reviewed research findings” borders on absurd. Does that mean exclusively? Is a psychologist ever allowed to speak in public about anything other than peer-reviewed research? Depending on one’s reading, it could be suggested that come December, under these guidelines, I would no longer be able to write this newsletter.

These kinds of ominous rules put undue stress on practitioners, but they also fail at their supposed task. While they can be easily weaponised in the policing of psychologists in their professional work and personal lives, they are at the same time, too vague to actually inform or inspire meaningful ethical decision-making. Practitioners who are content to use whatever rules are handed down from the institution as a framework for what it means to be a psychologist will be largely unaffected. But psychologists in pursuit of the kind of creative and individualised work that often requires a type of thoughtful risk-taking previously defensible within the outgoing Code of Ethics, or those who wish to retain sovereignty over their lives outside the profession, should have great cause for concern. It is this kind of institutional power grab, disguised as an innocent update to protect the safety of patients, that perpetuates fear and burn out in many of my good colleagues, who are trying to offer ethical, useful psychotherapy to their patients without losing their own right to be human under ever expanding colonial rule.

1. Arnold Goldberg explored this topic at length in his book, Moral Stealth:

Goldberg, A. (2007). Moral stealth: How "correct behavior" insinuates itself into psychotherapeutic practice. University of Chicago Press