Brian Thorne’s metaphor (‘A collision of worlds’, Therapy Today, May 2009) describing statutory regulation as like putting ballet dancers under the direction of a regimental sergeant major helps us to conceptualise some of the current confusion within the therapy profession – is therapy an art or a science (or both)? Can it be defined within a medical framework of symptomatology and measured outcomes or not? Is there ever a need for strong direction so that ballet dancers work together for maximum creativity? How much room is there for individualistic interpretation?

Two issues – the political NHS costs agenda and the current debate over ‘proven’ therapies is in danger of being fused. The tail is wagging the dog. The debate on models has become politicised because CBT is arguably quicker and cheaper to learn and shows measurable short-term outcomes. We have to find ways to explain how we know that relational depth creates long-term change and healing. It can be expensive; it is sometimes quite subtle and hard to measure – but we know that it can transform. Many of us, including myself, have benefited from skilled practitioners using these methods. Maybe we need to talk more about this.

We cannot resist the regulation of our profession. For too long we have sat in our separate sects. Our priority has to be the best interests of the public who are confused by the plethora of acronyms and titles. We must, however, be proactive to resist counselling and psychotherapy becoming controlled like social work and teaching. We must fight for an inclusive methodology. Brian Thorne is right and so are the behaviourists. Surely all future therapists will require both a substantial training to work in relational depth and some CBT skills to manage urgent presenting symptoms such as anger management, assertiveness, drug or alcohol dependency and negative thought patterns.

Penny Spearman