Leading Article: Therapy that women can do without

WOMEN have long suffered the medicalisation of their mental problems. In Victorian times, psychiatry and the oppression of women walked hand in hand as practitioners such as Henry Maudsley linked mental illness with unhealthy female defiance of sexual stereotypes. The asylums filled as men defined and treated women's psychopathology. As recently as the Seventies, a standard British psychiatric textbook recommended psychosurgery for a depressed woman 'who may owe her illness to a psychopathic husband who cannot change and will not accept treatment'.

A more sympathetic approach might have been expected from psychotherapy, which specialises in listening and understanding, rather than reducing women's problems to illness. Yet women received a raw deal even from Freud, who denied the reality of sexual abuse his female patients said had occurred in childhood.

So it is shocking, but hardly surprising, to learn from a survey by the British Psychological Society that 40 out of 1,000 NHS psychologists have sexually abused their clients. One in four has a patient who has had an affair with a previous therapist. 'Sexual abuse' is the only suitable term: when a therapist has a sexual relationship with a client, he is abusing power and taking advantage of a psychologically vulnerable person. Most psychotherapists are not psychiatrists, who in any case are regulated by the General Medical Council. The problem lies with psychologists working as psychotherapists, who are subject to little professional control; and with growing numbers of lay counsellors, who are a law unto themselves.

Many women go to therapists because they have been abused, sexually or emotionally, frequently by men who have had power over them. A central feature of psychoanalysis is the notion of repetition compulsion. Patients tend to repeat in the relationship with a therapist the early important experiences in their lives. That repetition must be interpreted and remain imaginary for a healthy recovery to be achieved. Since these are often sexual traumas, sexuality inevitably becomes the central issue in psychotherapy. A therapist finds himself in a position of authority. Unless he understands his own psychopathology or has been well trained, he might well take advantage of the client.

If nothing is done to outlaw such abuse, women can rightly claim that Freud's injustice is being repeated. Critics of psychotherapy complain that the technique has been dominated by men whose theories have reduced women's problems to a reflection of sexual need. The misconduct of some therapists further reduces women to sexual objects. These charlatans are interested not in helping their patients, but in seducing them.

The British Psychological Society is right to call for legislation registering psychologists and psychotherapists. Like doctors, they should be struck off and prevented from practising if they have affairs with patients. Therapists involved in sexual relationships with former patients should also have to prove they are not exploiting their power. Virginia Bottomley, the Secretary of State for Health, has given the nod to the regulation of osteopaths. She should also support protection for the equally vulnerable patients of therapists.