Monday, 10 May 2010

Managing the Urge to Professionalise

The urge towards professionalism builds up a rigid bureaucracy. Bureaucratic rules become a substitute for sound judgment.
Carl Rogers

When I was a student nurse on night duty there was an elderly man who was blind and hallucinating. He was distressed and spent much of the night yelling “Hold me tight, for Gawds sake!” We would go over and hold his hand and it wouldn’t make much difference, he’d just up the noise, begging for reassurance and containment. In the end he was prescribed sedation which brought him much closer to death but kept him quiet. One night, the registrar came on to the ward as the sedation was wearing off and the elderly man began his painful wailing. The Registrar went over to him, held his hand and asked, “What can I do for you?” “Hold me tight!” said the old man. So the registrar pulled back the covers, got into bed and shifted the old man to recline between his legs, back to chest, and held him tight. A good nights sleep was had by all. Now of course, he’d never consider doing something like this and would be disciplined if he did.

When I first began working with young girls who had been subjected to dreadful abuse and were considered dangerous, one or two of them needed to negotiate physical contact. The rooms we met in had beanbags and some of them sat on the floor cuddled up to me as we lay back, experiencing safe intimacy and basic human connection without which we all go mad. Now of course, I’d never consider doing something like this and would be disciplined if I did.

Chaplaincy is undergoing a process of professionalisation that will result in very well qualified chaplains and no certainty of high-quality work. The only positive result of professionalisation is that it’s easier to fire someone when they work outside of professional boundaries.

Time and again, history demonstrates that when a vocational group enters into the process of professionalisation what actually happens is gross standardisation and a parallel requirement for the individual to stop thinking for themselves. Employers, who may know and care nothing about the internal dialogue within a group of people sharing the same job title, begin to demand that employees have professional qualifications and a very vicious cycle is set up. Creativity is stunted, peer review becomes meaningless, relationship becomes defunct in preference to saying the right thing.

Here in the UK, this means that the most qualified, experienced but not accredited on principle psychotherapist is not as attractive to an employer as someone who has been qualified for 3 years if they are accredited. The less experienced psychotherapist has ticked some boxes, written the right words, perhaps made a few up and paid her money to the British Association of Counsellors and Psychotherapists. Sound research demonstrates that BACP accredited therapists are more likely to have complaints made and upheld against them (1) but employers don’t care and neither do therapists who correctly perceive accreditation to be what employers (rather than clients) want. Two issues become plain here: employers want to reduce their feelings of risk of liability and people who feel strongly about being part of a professional group are likely to be status-led rather than client-led.

Chaplaincy is deep into the process of becoming professionalised. US hospital chaplains are required to have a Masters of Theology which demonstrates that they at least have an interest and background in their own belief systems. This requirement equips the chaplain with the theology she needs to serve her clients in terms of the relationship between deity and person. But a theology qualification doesn’t cover the ethics of the relationship between the chaplain and the patient, or the patient and chaplain with the institution. Various chaplaincy professional bodies are beginning to address these situations as an aside to the process of gaining professional recognition. To me, that phrase ‘gaining professional recognition’ is very telling: we want to be seen rather than ignored by important people. We want to join those important people as peers.

The model we have to guide us is a Christian one, and I have a lot of time for it. Christ was a very ordinary person who chose not to be a priest or to join the Jewish hierarchy or to work for the Roman hierarchy where he could have gained a great deal of power and influence. He visited the sick to bring them comfort rather than to offer an integrated holistic approach to healthcare and related to people as people rather than the relationship being dependent on which social group they were part of.

Meeting with administrators and chief executives is part of the work of the chaplain, as is report writing and collecting statistics. Studying the experience of other chaplains is vital, so that we can learn from their mistakes without having to repeat them and build on their successes. But desiring professional recognition - not because it allows us to deepen relationships, but because it highlights status – moves us away from humility, away from the position of liminality that is central to being a chaplain, and away from empathising with the vulnerable in preference to empathising with shareholders who need prestige to advertise their hospital.

The professionalisation of chaplaincy is inevitable. As we move through it, we would be well served to maintain a private store of cynicism, a way of being that isn’t fashionably sweetness- filled but which protects us from believing everything we’re told, in this case about how important professional status is. ‘Professional’ is very different from ‘accountable’ and the more professionally qualified a person is the more they are trusted to be left alone with vulnerable people: that equation alone should give us pause. The sad cliché of the pedophile masquerading as a Scout Master demonstrates that processes which bestow status facilitate people who want to abuse power.

ps - looking for a picture to illustrate this post I searched 'professional priest' and 'professional'. Google for yourself what comes up for 'professional': young, arms folded, mildly sexually alluring but essentially challenging. It's what we expect from the title, and aspire to.

1 Khele.S, Symons.C, &Wheeler. S. An analysis of complaints to the British Association for Counselling and Psychotherapy 1996-2006. Counselling and psychotherapy research CPR) 8 (2) 2008: p127

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