
I want to take a brief detour from the longer series of posts I’m writing on concept of the virtual to ask about an odd paradox in health professional education that’s puzzled me for some time.
As always, I’d love to know your thoughts and experiences.
So here are my questions: do you need to have had a mental illness to become a psychotherapist? And why isn’t the same true of all health professions?
More broadly, why do some health professional training programs require students to have some first-hand experience of their future profession, and others don’t?
A lot of psychotherapy and counselling courses won’t let people into their programs unless they have experience of their own personal supervision and have been mental health service users.
Most other programs make no such demand.
In the psychotherapy team I managed a while back, there were strong opinions about this. There was a belief that future psychotherapists should have some cause for mental health support, and that their experience of this would make them better practitioners in the future.
I can see the sense in that.
But I haven’t really come across this in any other disciplines. I’ve never known a midwifery program insist that students should have given birth, or a occupational therapy course insist that the candidate be disabled.
In fact, in many other courses its the exact opposite.
In physiotherapy, there’s been a longstanding exclusion of disabled candidates. It’s better these days, but for the longest time, the physiotherapy profession was made up of people who were entirely able-bodied (or at least very good at hiding their disabilities).
Setting aside the discriminatory nature of this, I think it’s interesting that one program believes prior experience can help someone become a more rounded practitioner, and the other argue the exact opposite.
One of the concepts at the heart of the psychotherapy training program was the concept of the self. At every stage of their training, student would be asked to lay bare their own inner thoughts and experiences.
In their early clinical encounters with clients, student’s interactions would be pored over with an educator and they would be repeatedly asked why they questioned the client in this way; what from their own experience had prompted them to ask this question and not another? This analysis would then form the basis of rounds of more personal therapy as the student came to terms with their unconscious and its impact on their practice.
This kind of thing was never done in physiotherapy. I’ve never known a student physiotherapist to be asked whether they’d steered their patient assessment in the direction of their own prior experience of injury or illness. But, of course, they always do.
So, maybe our students should follow psychotherapy’s lead and be conversant with particular kinds of illness experience in order to enter a particular kind of profession?
But the objections are obvious. How far would you go, for instance? Would you have to have emphysema to work in respiratory care? A stroke as a condition of entry into neurological rehabilitation? Wouldn’t you be too sick to work if you had to be a victim of everything a nurse has to confront?
Clearly, we are asking our students to care for people who come with a wide and varied set of health problems, and empathy shouldn’t be disease-specific. So why would psychotherapy argue that mental health is an exception?
I think this is because it sees the mind not only as intrinsic to the problem but also the process of therapy. The two are intrinsically linked. Other professions don’t make such a strong link. The body is not seen as the seat of the soul, but rather as corrupt matter, indifferent to thought and feeling.
You can engage with the body as a machine and leave all of your personal thoughts and experiences at home.
But I know this isn’t true.
It still astonishes me the kinds of things I see our physiotherapy students and practitioners confront every day without any of the grounding in their own self-expression and experience that our psychotherapy colleagues enjoy.
To that end, I’ve written a lot in the past about how the inclusion of just transference and counter-transference might transform physiotherapy training.
But I see very little appetite for this, which does make me wonder if we’re not doing a terrible disservice to our health professionals, and perpetuating the kinds of Cartesian dualism that has so beset Western healthcare in the past.
Interesting question. Keep on such questening
This makes complete sense to me, as someone highly experienced in getting injured! I've had plenty of physio over the years as a result of footballing injuries, and the results vary. However, what became very clear to me in ageing, is that I never really understood what I was being asked to do, and why. The instructions were usually about the technicalities of the injury (ruptured tendon, ligament, meniscus etc), and the exercises that would help, and the program of exercise. However, there was nothing about the feeling of the injury, and nothing about the feeling of normality (once healed). I walked with a limp, through habit, for a long time (despite still playing football!), because it was never pointed out to me that I was compensating for a previously broken leg now healed. It wasn't until I did some Alexander method "lessons" that I really got what I was doing wrong, and learned to fully pay attention to my body and catch myself in poor form.
That said, I'm not suggesting that physios had to have experienced a broken bone or torn ligament. It does strike me that the ones I so, though, had no particular connection to their body, no lived awareness. Neither was it their passion, which I think is probably more key. Like me in my dreary office work, when a subject becomes professionalised, process driven, systematised and simplified, I expect many just walk through it, and follow the steps and motions and instructions required of the job - they see it as a job. There's no philosophy, no deep thought, no revision and study, simply that abstract notion that jobs give us - it pays the bills. Perhaps that's why psychotherapists are required to "mental health" themselves. To ensure that they have that depth of thought, and continued curiosity. I suspect that psychotherapy tends toward the philosophical and depth of thought, compared to the technical and scientific of physiotherapy. Or, at least, you can likely spend an entire career in physiotherapy concentrating solely on the technical and scientific side of things (ignoring things like the placebo effect, the effect that stress can play in injuries and healing and other such things).
Anyway, I'm rambling, hope you get me. I'm just a guy who has been injured a lot, and who enjoys reading your blogs (not quite sure who they sneaked up on me if I'm honest!).