General practice counselling amidst the ‘audit culture’: History, dynamics and subversion of/in the hypermodern National Health Service

Abstract

This paper takes an explicitly political perspective in examining some of the key arguments which General Practice (GP) counsellors, struggling to make sense of working in a milieu that contradicts their value system, are currently needing to address. Beginning with a brief contextualising of the ‘audit culture’ as a ‘hypermodern’ cultural phenomenon, challenges to the author's previous published writings on GP counselling are then invoked to open up key arguments that are confronting GP counsellors in their work. It is argued that there are major difficulties of values-incongruence for any non-Cognitive Behaviour Therapy (CBT) counsellor now working in an NHS GP milieu, and that for practitioners to find an authentic-enough stance for their client work, resistance, subversion and even organised principled non-compliance might be a necessity for practitioners wishing to stay true-enough to their core beliefs and professional identity. The nature of the National Health Service’s (NHS) current attitude to the psychological therapies could mean that practitioners have to make the stark choice between incongruent compliance, values-congruent subversion, or outright rejection of what they are asked to do (with resignation or even redundancy being one possible outcome). A variety of strategies will no doubt be pursued by different practitioners at different times, and the courage that practitioners are able to garner in this paradigmatic struggle for the ‘soul’ of our work can contribute towards a longer-term, much-needed sea-change in the state's attitude to counselling and psychotherapy as modern healing practices.