 We demystify what goes on behind the therapy room door. Join us on this voyage of discovery and co-creative conversations. This is The Therapy Show, behind closed doors podcast, with Bob Cook and Jackie Jones. Next one. Welcome back to episode 95 of The Therapy Show, behind closed doors with the wonderful... I need to come up with some new words, Bob. I'm fed up with wonderful. You're not wonderful anymore. Well, we'll have to come up with something else. Bob Cook and myself, Jackie Jones. And in this podcast episode, we're going to be looking at Is Therapy a Middle Class profession? I love this title. It's a great title. And just before we go that direction, we've only got five more podcasts. That's five more weeks before we land on the landmark of 100. I know. Do you remember what you said you were going to do? Being some champagne in it. Yes. So on the last one, I'm sure that people listening to can't taste the champagne, but at least I can describe what the champagne tastes like. It's an achievement once we get to a hundred episodes, Bob. That's a hundred weeks of doing this podcast and it's an achievement. Oh, it's a wonderful landmark to celebrate. So I'm looking forward to that. Now, is is Psychotherapy a Middle Class profession? So what do you think, Jackie, before I go into my sort of my own thoughts about this? Yes and no is my answer to that one. I think it can be. Yeah, I think it can be seen as that. I did think that before I became a psychotherapist myself. I'm certainly not middle class. But I did think you needed to be at the upper echelons in order to be a successful psychotherapist. Yes. What do you mean by upper echelons? Not somebody like me. Is like echelons. You mean upper what? Well, it's more intelligent. I can remember on the training course that I was on that they'd all, you know, most of them had already got a degree or they'd been to university or, you know, they were I would class as very intelligent people. I left school with no qualifications at all. Yeah, that's what you mean by upper echelons. Yes, you had. I think your background was it being a you were a nurse, were you a nursery nurse? I worked in schools and I was a nurse in a foster care. Yeah, that's right. So you had a very good background in terms of helping professions and in terms of back in the day back there, of course, that, you know, that was enough to get people psychotherapy courses. So I was just a really good student. But, you know, it's an interesting what you're talking about from that frame to, you know, 1985. When I started my psychotherapy training, yeah, in Metanoa in London, still going, by the way, it was nowhere near the same requirements that you need now. But one thing that has stayed very constant, and many things have changed is it was very expensive. Yeah. So if you look at psychotherapy training now, it's still expensive. Yeah. If you compare 80s to where we are now, you know, psychotherapy training has stayed expensive. So does that make it by definition only open? To put in the phrase middle class, because when you start defining what middle class is, when parameters is money. Yeah. Does that take it out of the reach of, say, the working class, working class people, for example, if we're going to move in our class within society, does it only put it really into the reach of. Potentially, yeah. That's one aspect. Yeah. Another one is the one you touched on, which is to be a psychotherapy, especially I was thinking of. The if the training is often is through the UK CP, or she's a regulating crediting body. The training is is by definition postgraduate. It's a postgraduate level seven training. So that means that most people will have university degrees or stroke and, which is where you came in, professions which like nurses, like mental health professionals, social workers, they've all, you know, have those qualifications. Because nowadays more than ever, there's a huge academic part training where you have research components. And if people haven't got the capacity for academic exercise, for example, they may struggle in the training. Yeah. Make them definitely good therapists. No, it might to write an essay to have the capacity to research. Does that make them good therapists? Not particularly for me. However, that is certainly where training has gone to. Yeah. My opinion to academically. That was the part that I struggled with more than anything because I'd never had to do that before. Do you know what I mean? The referencing and the way it was structured and all that sort of stuff. I just never done it before. So that was a difficult part for me. Yeah. I recently went to my daughter's graduation, well, two or three years ago. And that's my experience for me in the sense of very proud of my daughter. I think I was with it. What is interesting though is that the graduation is similar to when I went to Holy University 50 years ago. But if we go back 50 years ago, far less people went to university. Yeah. Nowadays, many, many, many kids go on to universities. Yeah. From different classes, for example. So that's an interesting one. But if we look at money, we look at education. So when I read somewhere, I think probably when I was doing my training, the average psychotherapist, the cost of their training is probably about £30,000. I can tell you what it is now. I nearly fell through the floor when I read that. Well, it's interesting, isn't it? Because I don't know if it's that much. The average training at the Manchester University for psychotherapy, the training weekends here. Yeah. £3,700 a year. Yeah. So that takes us four years. That's going to take us to about £15,000, isn't it? Yeah, yeah. Can't do the maths off the top of my head, but it's probably about that for the training. Yeah. That's right, isn't it? £446,000 is a bit off that. So we'll say 148 or something. We'll say 15 convenience maths, right? Now, where you get to a higher figure, probably, is to be a psychotherapist, you have to do your own therapy. Yeah. And if it's a UK CP accredited training course, you have to do, basically, you have to be a therapist before the training. And therapists charge, let's say, an average £50. And you have to have a qualified therapist. They're certainly going to be £50, so that's £200 a month. Yeah. So, you know, multiply that 12, that's 2,400. Multiply that by four years, we're into, you know, about 14,000 there, aren't we? Yeah. So that takes us near, you're probably right now. It's getting us into the land of 30,000. Yeah. Counting the books you have to buy. Well, that's it. And being a member of the, you know, the bodies that you have to be a member of in the books and, you know, all that sort of stuff. Yeah. And you don't get any, start getting any money back, really, until you start seeing clients. And that won't be until probably the end of, you know, beginning of the fourth year. Yeah. And even when you do get money back and seeing clients, so, you know, a lot of that money goes into supervision. Yeah. And there's other things. It's an expensive training. It is. And I think this is one of the things that clients don't often see is the stuff that goes on behind the scenes, you know, if you need to rent a room or, you know, hire a room to see the clients and the insurance that you need to take out in order to, you know, public liability and all those sorts of things. And, you know, your continuous professional development and your supervision and the list goes on and on and on. It costs lots of money. It does. And when you interview people going into this profession, often they say, is there a job afterwards? Yeah. The answer is yes. Now, interviewing this time around, when people ask me the same question, I'll say yes and the next question is, is there a piece so popular? So, you know, I still think there's a career to be made out of it. And if we're going to mark money as a criteria in this, you know, what class a person comes from, then to be able to afford it, to have the university education, they're all parameters of middle class. Yeah. See, when I think about that, one of the stumbling blocks for me or the things that I kind of think about is that, is there a disconnect in the therapy room if you've got lots of middle class therapists and not necessarily middle class clients, do you know what I mean? And is that where the waiting list comes from, you know, to see people on the NHS because they can't afford to go private and there's not that many working for the NHS so then the waiting list is longer, whereas if you can pay for it, you get in quicker and all that sort of stuff. No, no. Yeah. Yes. And I think there's an assumption at the beginning there which I don't agree with. Okay. And I think therapy is so expensive that therapy is starting off with 50 pounds to 70 pounds an hour. So the people that can afford that are usually the middle class. Yeah. So you usually get middle class therapists and middle class people as clients. Okay. Yeah. Now, because I wanted to try and address that, I have adopted a low-cost clinic for people with low incomes. Yeah. And it's very successful. Yeah. It's very successful. So I've tried to address that and I don't know how many low-cost client clinics there are, but there's not many. No. No. So a lot of the clients who afford 50 to 70 pounds an hour or 250 pounds a month or whatever we're talking about will be people who have money. Yeah. Who have money may often come from the working. There's a nether parameter or criteria for middle class definition. Yeah. Yeah. Of course, sometimes people, you know, it doesn't always have to be a criteria for money or education. I was thinking people can maybe work in class. You said in the earth, very interestingly, you said that you came from a working class background and you afforded the training and you are where you are today. So you are, in fact, you started the whole podcast when I asked the question, is it a middle class profession? You said yes and no. Yeah. And I think you probably said yes and no because of your own experience maybe. Yeah. Definitely. I can remember being shocked when I found out how much the average person pays. And I think one of the things with the institute that I liked was that it wasn't like you had to pay for everything up front. I wouldn't have been able to access it had that been the case. Yeah. So I think that's why I said, I think by definition, if we have the criteria to do with money and education, it is probably put on in middle class. Now, I know there was attempts to move away from that in terms of discounts, that was giving discounts and low cost clinics and bursaries for training and all the things we're talking about here. So there are movements to help move away from that middle class process. But I still think is therapy is predominantly a middle class profession. Yeah. At least that's where I would argue. Yeah. The next bit then, is there anything wrong with it? Is there anything wrong with it? I didn't ask this in the blog and I answered that. Is there anything wrong with psych therapy being predominantly middle class? In my book, yes. Yeah. Because it denies access to mental health services for so many people. Yeah. He certainly doesn't sit right with me at all. So you are right. So what happens then, is people go to the NHS. So what happens then is you, I think, I don't know, a decade ago, I don't know which government brought in improving access to mental health services. And so, you know, there's CBT therapists and there's therapists and there's NHS and people can get, you know, but albeit CBT, they can get 12 sessions or six sessions or maybe 18 sessions on the NHS. That's where people go because they can't afford private. Yeah. Yeah. So I think, I'm glad the NHS has taken on board improving access to, you know, mental health services. Certainly not enough for me, but at least they have. Yeah. Yeah. I struggle with certain parts of this as a career, you know, purely and simply because of a lot of the bureaucracy and a lot of the costs that I have to pay that then has to be, you know, picked up by the clients at some points. You know, I've got a mortgage and I've got bills to pay and, you know, those sort of things. It is quite difficult, but then I have people messaging me saying that, you know, they've tried to get on the waiting list to see somebody and they've been told it will be at least six months. Certainly the NHS. You know, so then they're having to turn to private and knowing that it's an expense that they can't always cover. I find it difficult sometimes. Yeah. That's why a lot of therapists have sliding scales. Yeah. Yeah. So I think therapists do feel the way you are and they do their bit. I think a large majority to help people. And I think psychotherapy training should be cheaper, for example, so that we can attract different. That's why I do bursaries, for example. Yeah. In my trainings. Do you think doing therapy, delivering therapy in different ways, waters it down somehow? What do you mean? As in, like some psychotherapists will see groups and they offer them lower if you're in a group rather than, you know, one-to-one in a session. Yeah. Or, you know, doing it online or, you know, offering it in different ways at different pay scales, waters the therapy down somehow. I hope not. Okay. What do you think? I personally do it in different ways. Do you know what I mean? I do support based on therapeutic principles at a much lower level than I would do one-to-one psychotherapy in a group. And that's my way of kind of allowing greater access to certain people to my skills. Because I'm still the same in either room. It's not like I've forgotten anything when I go in one room and I suddenly become more intelligent in another room. But I just wonder what your thoughts were on it. Well, I like to think it doesn't water, you know, what you're talking about doesn't water down the therapy. I like to think that anyway. I'd like to think, you know, people give discounts to their clients because they haven't got that type of money. I'd like to think that the therapist still gives their best services to the client. And I'd like to think that online therapists also give their best services to the client. And I'd like to think that the group psychotherapists also give their best services to their clients. That's why I said I hope not. Yeah. But it is a minefield out there and the amount of people now that are on waiting lists for some sort of mental health support is phenomenal. And yes, maybe there should be more ways to access training and it be subsidised or it's like the same with the nurses. There's not enough nurses now so they're trying to recruit more. If there was more psychotherapists then maybe the waiting list wouldn't be quite as long as what they are. That's right. I like my regulating body which is the UK CP is doing and that's giving bursaries same as my own institute but the UK CP itself the regulating body gives bursaries out to trainees who can't to train a psychotherapist. So there's a push in our regulating body to address the problem we're talking about here. Which is I'm pleased about. On average how many psychotherapists do you get through your doors in an average year at the institute for being qualified? You mean people want to go into this profession? How can you go through the training? How many qualified psychotherapists come out of the institute every year? Well to do the four years training I haven't looked at the figures but a high amount. People then who go on and want to get accredited by the major regulating body I think it's a lower amount but we encourage people to get accredited by the UK CP the major regulating body after training rather than just leave after four years with us. I think it's a difficult training. The other thing is that to be I got very confused with this when I was training I'm trained in transactional analysis so I can call myself a transactional analysis psychotherapist. You can call yourself a transactional analyst, yeah. But the training goes on and on after you leave the institute. It's like eight, ten years old tolls, yeah. So there's a lot in it we now go back to the point you brought a lot earlier on in this podcast is that when you spend £30,000 on a training you want to get it back in some way. Yeah. Hopefully. So often you keep so often the therapy charges are quite high to get back some of the money you've spent. And then again that's a barrier to clients coming through. Yeah. It's interesting isn't it? It is, it is and it's a half a dozen of one and six of the other what do you do? You're kind of not getting that many clients because your prices need to be as high as they are but yeah if you put them lower then you're not recuperating the money that you kind of spent. And again it was a topic that you suggested was talking about at some point was marketing. We market ourselves as psychotherapists which I think would be a really good podcast to do. Well we are, it's on the list. Yeah, yeah definitely. Yeah. So I think for my sense quite a lot of therapists try to do their own bit by sliding scales discounts, all those sorts of openings to people who haven't got so much money. Nothing the UKCP does its bit to give bursaries and XXX and you know having a psychotherapy training at a postgraduate level having a psychotherapy training which is getting on to four thousand pounds a year and in London more like seven thousand pounds a year inhibits I think people from other classes. Yeah. So it's a conundrum it's a whole issue I think psychotherapy world struggles with. Yeah. There's also something else I can remember in part of my training me thinking me being a people pleaser and all that sort of stuff you know I'd give therapy free to so many people you know once if people could afford it they'd pay me and then I would give psychotherapy free to other people and it was like well no you don't there has to be an exchange of monetary value in a psychotherapy situation ethically and morally and everything we can't just do it for nothing no and I think there's a great problem for people who attempt to do that even though I can understand it might come from a generous spirit. Yeah. Yeah. A sliding scale or a process which is comfortable for both parties. Yeah yeah because it's like everything if we give it away for free it's not valued and you know yeah it's ethically not right as a practicing psychotherapist to do that. Certainly not we do have a mental health crisis in this country and we have an NHS which we know by reading the papers we know now how totally underfunded the NHS is how mental services and the NHS are totally underfunded and recognised and I don't want to make this a political podcast but I think politics has a big part to play in funding and I think there could be improvements in that area just let's put it that way. Yeah yeah definitely and without a lot of charities that are out there do you know what I mean then there'd be a lot of more people in worse situations than what they are right now yeah You know my daughter and her husband they started a whole process called revolutionary youth where they help people with and sure teenagers in many different ways and that's wonderful because the teenagers can start to improve their mental health that's free that's free for the youth to come into the different parts of the community and I think there are many different charities many different projects many different wonderful people who help address this balance and reduce the mental health crisis in this country and I think independent therapists do their own bits and I still think we need to think more about how we can help people in different classes if you like to have access to improve their mental health it's a good topic Bob it's a big topic and I know we have to end and I hope it wasn't too heavy for people listening but I think it's important to think about yeah it's different from our number one podcast but I think it's a so important things to reflect on I think we cover a lot of important topics that aren't necessarily what people think we might talk about and I love that about this you know and again whether you're listening to this on the podcast or whether you're watching it on YouTube if you've got any topics that you would like us to talk about we're open to more things aren't we Bob? Yeah we're zooming into our 100th podcast and I know I've sent you probably another 30 titles so that takes 230 podcasts and the more titles the better Yes the next episode we're going to be looking at hope and dread in the therapy process oh I hope that's okay unfortunately I can't make a pun about it dread about the next podcast because I enjoy them so much but they're certainly two really important parts of the therapeutic process but I'll stop because we can go into the podcast Okay Bob until next time See you next week Bye bye