The practice of Counselling is a social movement which has developed in momentum and strength in the 1970s. Like other movements, it is observed by many and understood by few. It is acclaimed by those who see in it the possibility of at least alleviating human problems, at best as an aid to enable individuals to make the most of their potential in a highly complex world which at one and the same time is full of choice and opportunity and of confusion, frustration and insecurity.

The Approval Exercise in which psychiatric hospitals and units are approved for general professional training has recently completed the first round of visits to general psychiatric units. The present phase includes a continuing review of both fully and provisionally approved hospitals and first visits to subspecialty units in mental handicap, child and adolescent psychiatry, and forensic psychiatry. The announcement of an impending visit is likely to engender apprehension rather than a feeling of empathy with the task of the Convenor and his panel, but a description of the Convenor's role should dispel any misconception that it consists of a frolicsome succession of expense-accounted jaunts.

The history of Broadmoor involves the management of mentally abnormal offenders, or ‘criminal lunatics’ as they were called, over the last 180 years (Partridge 1953; Walker and McCabe 1973; Allderidge 1977). Before 1800 there were no special facilities for such patients, and they were incarcerated in local prisons where, John Howard wrote, the conditions were ‘crowded and offensive because the rooms which were designed for prisoners are occupied by the insane. Where these are not kept separate they disturb and terrify other prisoners. No care is taken of them although it is probable that by medicines and proper regimen some of them might be restored to their senses and usefulness in life’.

The Report of the Professions Joint Working Party (1978) raises a number of questions. The first of these springs from the composition of the Working Party. Five of the organizations are overtly in business to train and certify practitioners of psychotherapy along psychodynamic lines, but though the Report speaks collectively of ‘seven organizations representing practitioners of psychotherapy’ neither the British Association for Behaviour Psychotherapy nor the Royal College of Psychiatrists can be categorized in the same way. Each of these organizations raises issues of a different order.

[At the Autumn Quarterly Meeting in 1978, the College passed a Resolution in which it reiterated ‘its concern over the abuse of psychiatry for the suppression of the dissent in the Soviet Union’ and also expressed its ‘admiration and support’ for, among others, Dr Alexander Voloshanovich ‘whose clinical reports have been invaluable for the brave work in Moscow of the Working Commission to Investigate the Use of Psychiatry for Political Purposes' (Bulletin, January 1979, p. 6–7).

A psychiatric ward, like any organization, must be capable of changing to meet new demands. Undue conservatism has repeatedly been blamed for serious short-comings. Yet change can be dangerous, especially if it is rapid. Such a hiatus of experience may occur that disorganization results, or so much energy is diverted to those parts of the system being changed that vital routine tasks are neglected. Laudable endeavours in community psychiatry have got into difficulties when wards have quickly been depleted of experienced staff who have moved into community care, for which they have much enthusiasm but little experience.

Community psychiatric nursing has developed rapidly in recent years and there is a great variation between services and in operational policies. It seemed appropriate that there should be some discussion within the College as to the role of the community psychiatric nurse, lines of responsibility and communication and relationship with other professional groups.

For some years my colleagues and I have been teaching counselling skills to undergraduate medical students and to postgraduate trainees in medicine, social work, nursing, clinical psychology and occupational therapy. We started teaching these skills to postgraduates (particularly family planning clinic doctors and nurses) at the request of the Family Planning Training committee of the West Midlands Regional Health Authority. At first we concentrated on teaching simple psychosexual counselling skills but latterly, as a result of consumer demand, we have extended the number of topics. We have also begun to apply the lessons we have learnt in postgraduate teaching to the teaching of medical undergraduates.

‘Between 1846 and 1879 the produce of a penny income tax has risen from £750,000 to £1,750,000, notwithstanding a much greater exemption; and the inhabited house duty has advanced in about a similar ratio; leaving little doubt that a considerable increase in the paying capabilities of the middle classes has been diffused throughout the country.

The title chosen by the Association of University Teachers of Psychiatry for their meeting was ‘Improving Higher Psychiatric Training—Roles and Responsibilities’. This title implies firstly that higher training needs to be improved and secondly that someone must take responsibility for doing so. The Joint Committee on Higher Psychiatric Training officially holds this responsibility, but the AUTP is obviously concerned to critically review the progress so far made.

Pre-Membership training tends to concentrate on the acquisition of knowledge and gaining clinical experience, especially in the assessment of patients. In postgraduate training the learning of various management skills, the development of special interests and filling gaps in previous training are the primary tasks. Theoretical learning through books and journals alone is insufficient in these areas. Opportunities must be available for the senior registrar to use his clinical time to achieve satisfactory training. If the senior registrar's position is largely supernumerary this is easily achieved; however, this happy situation is a rarity.

If medical students are to be effective in clinical practice they must acquire the skills needed to put patients with psychiatric problems at ease, to promote trust and confidence, and to elicit an accurate and relevant history. Unfortunately, there is considerable evidence that traditional methods of medical training fail to equip them with these essential skills.