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Psychotherapy needs regulating to protect the public
Posted Thursday 10 December 2009
A guest post by Zarathustra of the Mental Nurse blog.
Imagine you're a professional working with vulnerable people -say, a doctor, social worker, nurse or arts therapist. Suppose you then got struck off, maybe for breaching confidentiality, or for taking drugs in front of your clients, or crossing professional boundaries, or financially exploiting and verbally abusing them.
Or, if you happen to be arts therapist Derek Gale, for doing all of the above and promptly being struck off by the Health Professions Council as a result. One minute you're a successful professional, running something more resembling a religious cult than a therapeutic practice, merrily charging people large sums of money to financially, sexually and emotionally exploit them. The next you're off the HPC register and your lucrative income has been taken away from you. What's a poor abusive therapist to do, eh?
Luckily for Derek - though less so for the rest of us - there was a handy little loophole. All he had to do was call himself a psychotherapist and counsellor, and he could just carry on practicing as though nothing had happened. He could do it because "arts therapist" is a protected title, but "psychotherapist" and "counsellor" are not.
A protected title means precisely that - a job title that is protected by law from being used by any con artist, quack or yahoo. Doctor, nurse, occupational therapist, dietitian...these are all protected titles and you can be prosecuted if you use them without being registered with the appropriate professional body.
Treat somebody's veruccas while pretending to be a chiropodist, and you can be fined up to £5000. But when it comes to sitting in a room with somebody who may have mental health problems or been terribly traumatised, and have them pay you to explore the deepest, most volatile parts of their psyche - anyone is allowed to do that.
It's worth remembering that the history of psychotherapy has examples of abuse by psychotherapists going right back to the foundations of the profession. Both Freud and Jung engaged in acts towards their patients that would be considered serious misconduct. Freud invented his entire Seduction Theory in order to dismiss his patients' accounts of sexual abuse as mere fantasies. Jung had a long-running sexual relationship with one of his patients, Sabina Spielrein.
It's also worth remembering that psychotherapists, particularly psychoanalysts, have at times had a reputation for cliquey, even slightly cultish behaviour - a good read of Jeffrey Masson's Final Analysis provides some shocking illustrations of this. Without proper regulation, there's plenty of scope for an abusive therapist to do a lot of damage to already damaged people.
Psychotherapy isn't entirely a unregulated free-for-all. Professional bodies do exist. Over 70 of them are listed by the umbrella organisation, the UK Council for Psychotherapy (UKCP). They tend to have rather Judean People's Front names - Association for Group and Individual Psychotherapy, Institute of Group Analysis, Forum for Independent Psychotherapists, Association for Family Therapy, Institute of Family Therapy and so on. Each of these organisations have their own members register, and you can make a complaint against a member.
Complaints procedures vary from organisation to organisation, but these procedures often fall far short of what one might expect if complaining, say, against a doctor to the General Medical Council, or against a nurse to the Nursing and Midwifery Council.
Depending on which organisation your psychotherapist belongs to, you may find that the complaints are resolved behind closed doors, with little or no accountability. You may be expected to provide your own counsel. You may find yourself expected to enter into a process of "negotiation and mediation" with the psychotherapist you complained against.
Such organisations tend to claim that the use of negotiation and mediation is to resolve any transference issues that might be the cause of the complaint, and to help resolve disputes informally. A more cynical individual (such as me) might suggest that they could be used in order to bully somebody into dropping the complaint.
Assuming that a complaint is successful and a psychotherapist is struck off by their member organisation, there's absolutely nothing to stop them simply going off and registering with one of the others; or indeed, not bothering to register with any of them.
Fortunately, this sorry state of affairs may soon come to an end. Moves are underway to make psychotherapists and counsellors protected titles, and for these professions to join their arts therapist colleagues on the Health Professions Council register. This needs to happen, preferably sooner rather than later. Only by doing so can individuals like Derek Gale be kept out of the psychotherapy profession, and members of the public can have the reassurance of knowing that when they pay for therapy, they're paying somebody who is accountable for their actions.
Zarathustra, Mental Nurse
25 Comments
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It's good to see this topic in a more mainstream mental health setting. I hope it will bring further awareness to the issue. It is scary to think how unregulated the therapy industry is. Even more so when you think about the people they are working with, people who are clearly vulnerable.
One would think compulsory CRB checks would at least be a minimum expected, but I am guessing that you can practice without even having a clear CRB under your belt!
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Patients are obviously abused and exploited in state run facilities as well , we know they are , but most mental health patients have no faith in the NHS complaints process and just before it was abolished the Healthcare Commission reported that there was little evidence that Mental Health Trusts were using the NHS complaints procedures to resolve patients complaints at all , they were simply embroilling patients in months if not years of evasive bureaucracy .
Is this the sort of system you want in place for psychotherapists?
With psychotherapists at least patients have a choice if something goes wrong whereas the NHS runs a monopoly ,and if patients get on the wrong side of management or staff that's it, they can end up being hounded out of services altogether .
Recently, the Care Quality Commission , the Healthcare Commission's successor , reported that a large number of patients do not feel safe on NHS MH wards so instead of criticising psychotherapists perhaps NHS management and staff should focus on putting their own house in order.
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@Dave
Your concerns about NHS complaints procedures are valid, but this is more an issue of individual competence rather than organisational issues.
If you want to make a complaint against an individual nurse, doctor or occupational therapist, you have the right to do so to the Nursing and Midwifery Council, the General Medical Council or the Health Professions Council respectively. You can do so directly without having to go through NHS complaints procedures. If that professional is found to be unfit to practice, they can be struck off, suspended or placed on a supervision order.
All I'm suggesting is that psychotherapists should be accountable for their conduct in the same way as doctors, nurses and OTs.
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Dear Mind,
In my work I come across many service users who pay privately for psychotherapy out of their benefits and DLA - or low wages. It is a lifeline especially where a background of trauma or abuse has produced a mental health diagnosis including depression. Psychotherapy allows a service user to choose their therapist, choose the gender and also to have long term consistent support towards healing and recovery that the NHS refuses to provide. Go to any service user run group and ask them about this. Within the NHS, a service user cannot choose who they see or the quality of service, nor are most social workers, nor CPN's in a post for longer than 6 months. The constant revolving door of stressed out staff means the service user has to build up trust again.....and again.....and again....having a well trained consistent psychotherapist is the sucess behind many a stable service user.
If the plans to remove DLA are put in place, pressure on services because of service users loosing their long term psythotherapy support and healing will be quite a serious blow to both service users and budgets.The over reliance on NHS funded CBT does not acknowledge the hidden issue of service users going to psychotherapy.
I acknowledge that regulation of any sphere that provides treatment for vulnerable poeple is necessary. -
I was abused by a NHS psychologist he got away with it by saying I was 'delusional'
His professional body the British Psychological Society didnt uphold my complaint (it was his word against mine)
Ten years later Im still trying to piece my fractured psyche back together
I can no longer trust health professionals due to what he did to me and I feel incredibly sad that I have lost so much in terms of faith in men
He continues to work for the Healthcare Trust has gone on to work with vulnerable children he married a psychologist who works at the same NHS Healthcare Trust and the pair of them wrote about me in a textbook 'delusional client'
I didnt know if I should laugh or cry -talk about adding insult to injury
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MIND is at present doing a survey on therapy and psychological treatments. Perhaps they should look at what is going to happen soon on a large scale.
CBT Cognitive behaviour therapy in job centres
There is potential for a huge amount of damage to be done to individuals when thousands of partly trained CBT therapists are let lose on the unemployed and mentally ill to push a neo liberal false political ideology onto people about work being the only way for mentally ill people to get better and to get out of poverty.
Perhaps the people that have signed up on this policy should have CBT to change their beliefs. that includes employers politicians and the DBC that are involvied in the welfare reform
agenda. Incidentally how many of the CEO of charities suffer from the disabilities themselves and how many are paid at least £100 thousand pound a year?Paul Hereford
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@Fiona
It might interest you to know that practitioner psychologists have recently become HPC-regulated.
Were your complaint to have been heard today, it would have been by the Health Professions Council and not the British Psychological Society.
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I think maybe the answer is 'mandatory personal therapy' for psychotherapists,many of them have had very little experience of personal therapy and because of that they find it difficult/impossible to manage their countertransference and distinguish their own issues from their clients issues
The psychologist who mistreated me was 'enacting' in our psychotherapy sessions and I think his behaviour towards me was probably a direct reflection of how he himself was treated as a child.He had a lot of unresolved personal issues and denied conflicts and his lack of insight made him vulnerable,I think he mistreated me as a way of feeling in control and powerful ,I dont think he was fully aware that he needed to abuse me in order to feel good about himself
The most distressing aspect was his unfair scapegoating of me & the cover up process (in a case study in a text book) he labelled me as "delusional"
He has repeatedly refused to take any responsibility and acknowledge his wrongdoing -his sick pride and his ego was his main concern
Many therapists are wounded healers and are actually attracted to jobs where they can interact with others from a position of power and authority (Im Ok you're not Ok)
Mandatory therapy for psychotherapists has been suggested by Andrew Grimmer (in the Handbook of Professional and Ethical Practice For Psychologists Psychotherapists and Counsellors)
I think it would be a very good idea because therapists with anti social/narcissistic tendencies will never submit their wills to regulation they are too pathological
If therapists are required/forced to undergo their own substantial psychotherapy perhaps the bad apples can be identified before they do damage? -
It's ironic seeing this on the Mind site as Mind have been very vocal about regulating the therapists, yet has no overall complaints procedure itself and as far as I can tell Mind workers are unregulated (unless through some other body). It's all down to local Mind branches to devise their own inhouse complaints systems. No independent bodies. I found one Mind branch whose policy says that if there's any chance a complaint could lead to a claim for damages, the complainant will be handled by their insurer. Not excactly patient friendly is it? I know people who've worked with Mind, so I know that risky stuff does goes on. Perhaps that's inevitable given the nature of the field, but all this finger pointing at the counsellors and psychotherapists looks like projection to me."It's not us, it's them!". Of course there are a few notorious cases, but a quick scoot round the user forums will turn up plenty of instances of NHS iffy practice by supposedly 'regulated' psychiatrists and nurses, and patients either not complaining or getting no joy when they do.Also re the post here about the government's CBT programme, therapists in jobcentres etc.?These CBTers mostly have very little training and would not be regulated under the proposed law (yet) because the NHS calls them 'wellbeing practitioners'. They wouldn't qualify for BACP, UKCP or one of the big therapy bodies. Again, scoot round some forums and you can see some are already complaining of being forced by management to take huge caseloads and work without supervision to hit targets, thus putting their clients at risk.I always think the thing is to look at what people DO rather than what they SAY. And I reckon the government is doing some pretty dodgy things right now when it comes to 'therapy'. Of course they will make it look good on paper, they always do, but from what I hear on the ground things are not always so hunky dory at all.
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Thanks for your comment, mel. We do believe that all therapists should be regulated, whether they work for Mind or not. It's also important to remember that Mind is not one big charity - each local Mind association (the groups that provide services) is an independent charity, so we can't have an overall complaints procedure. Mind (the national association) has a complaints procedure you can find here http://www.mind.org.uk/assets/0000/0175/Complaints_procedure.pdf and it's a requirement that each local Mind has its own robust complaints procedure in order to be affiliated. Mind is committed to ensuring the highest possible standards of service and if local complaint procedures are not being followed properly we would certainly want to know - contact@mind.org.uk
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I am a former Vice Chair of a LMA
Myself and the Executive Officer resigned because the complaints procedure wasnt being followed properly
Two seperate formal complaints were made by service users against the Chair for inappropriate conduct
Both complaints were basically just swept under the carpet-it was suggested the complainants were mentally unwell and trouble makers and the Chairman even suggested that one of the complainants should be banned from using services
Myself and the Exec Officer did raise concerns with National MInd (and the local NHS Trust) but they did not want to intervene
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@Fiona,
We can't go into the details here, but Mind did get involved with this complaint and investigated the matter thoroughly. We were satisfied with the response from the local Mind association in this case.
As this is a confidential matter I don't think we can continue this discussion here. But if you'd like to contact me directly I'd be happy to discuss this further - p.nicholls@mind.org.uk
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Zarathustra replied on 15 Dec 2009 at 09:37
@Fiona
It might interest you to know that practitioner psychologists have recently become HPC-regulated.
Were your complaint to have been heard today, it would have been by the Health Professions Council and not the British Psychological Society
Thanks for that Zarathustra
I wrote to them a few days ago asking them to investigate the piece he wrote about me in the text book because its pure breach of confidentiality he didnt mention my name gender etc but its a blow by blow account of the BPS and NHS complaints proceduresIts also highly amoral imo because effectively he is using his status to 'set the record straight' (yet more abuse of his 'professional' power) and where is the voice of the service user (me) in the highly subjective (self serving) account of his??
He has written about "delusional transference" (how convenient) also he has written about clients complaining as a way of "attention seeking" and clients who seek out "powerful men" to destroy LOL I did laugh at the grandiosity and pomposity of his viewpoint
I think Its very wrong when therapists can use publications and books to 'cover up' their mistakes & restore their lost professional credibility and lie the man truly has no moral compass or honour
I just hope and pray he hasnt harmed other people although after speaking to case workers at Prevention of Professional Abuse Network statistically its very likely he has
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In one sense I think your decentralized locally based complaints policy is probably quite commendable, though I'd be interested to see some figues on how often it is invoked and how users feel about it, given that everything is done 'in house'.Do Mind publish anything like that? I know some organizations such as BACP do, I would hope that Mind would do too.
Fiona in her post says:
"Myself and the Executive Officer resigned because the complaints procedure wasnt being followed properly
Two seperate formal complaints were made by service users against the Chair for inappropriate conduct
Both complaints were basically just swept under the carpet-it was suggested the complainants were mentally unwell and trouble makers and the Chairman even suggested that one of the complainants should be banned from using services."The Mind response: " Mind did get involved with this complaint and investigated the matter thoroughly. We were satisfied with the response from the local Mind association in this case."
Case closed, despite the resignations.Yet Fiona, ex vice chair of the association in question clearly still feels something was amiss. What gives? Was there any independent oversight of the conclusions Mind reached about the conduct of its own officers?
Anyway, I assume the Mind system is based on some kind of idea about keeping things at 'grass roots level' etc. and I sort of agree with that. In which case what I don't understand is why Mind is championing a system for psychotherapists (HPC) which is the antithesis of your own, i.e. centralized, bureaucratic and involving lawyers and the like. It's intimidating enough to complain already. Also I've used a lot of third sector services myself, (nothing suitable available on the NHS) it looks to me that my freedom of choice will be badly damaged by what HPC are up to. Those pushing for it seem to think a masters degree is some guarantee of character and integrity or something. What planet are they on? I suspect planet 'vested interest'.
Fiona's story about the psychologist sounds like a truly horrible experience. My guess is that people like that will sail through the system, as they always do, they are very good at manipulation. I like the idea of personal therapy for therapists. I reckon it should be considered as important as their qualifications, or made a mandatory part of it. It is for most psychotherapy courses already but not I think for psychologists who seem to have quite a bit of power. The thought of some people I've met with psychology degrees 'doing therapy' gives me nightmares.
Why don't Mind campaign for a change in the criminal law so that serious professional abuse (sexual/financial etc) when it happens gets taken as seriously as it ought to be? All these new quangos and the like strike me as just bureaucratic tinkering at the edges so that those in positions of power can look as if they're doing something for the 'clients' while they rig the market. Meanwhile for the 'service users' its the same old same old.
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@Mel
In relation to the regulation of local Mind associations, we can't comment further on this case, but you're welcome to contact Pete (see above).
Mind has been very clear about what it is campaigning for: protection from abuse for vulnerable service users. We believe that this protection should be provided whether a profession works at a grass roots level or not.
We agree with you that the current complaints process is intimidating and service users tell us that this is mainly because complaints must be made to counsellors and psychotherapists directly. Without an independent authority, service users fear that they may be unfairly treated. This is why we believe that independent regulation will actually make the process less intimidating.
Mind campaigns for service users to get the widest choice of talking therapies possible. Statutory regulation will not lessen this choice. It aims to ensure safe practice but the Health Professions Council (HPC) will not prescribe which therapies should and should not be practiced.
Regarding the threshold standards that a counsellor or psychotherapist would need to have in order to practice, the current proposals are still being drafted by the HPC in consultation with the professions. However, although it may be proposed that psychotherapists need to attain a Masters level or equivalent (in line with most professional psychotherapy bodies who already require this level for professional membership), the threshold standard for counsellors would be much lower.
Finally, you suggest that Mind campaign for a change in the criminal law. Technically, service users already have the right to use the criminal courts in order to prosecute professionals. However, even if a professional is found guilty of abuse by criminal law, there is nothing to stop that person from continuing to practice once they are back in society. It is exactly this problem that statutory regulation would begin to address.
Mind is and will continue to campaign for independent and statutory regulation to help protect vulnerable service users from abusive practitioners. However, we will also campaign to ensure that regulation is as simple as possible, not bureaucratic and does not limit choice.
For more information please read our policy statement on this subject:
http://www.mind.org.uk/campaigns_and_issues/report_and_resources/2611_regulation_of_psychotherapists_and_counsellors -
@Mariam,
Thanks for taking the trouble to reply. I think we are in different universes though. You see experts and 'professionals' on the one hand and 'vulnerable service users' on the other. I know some people may identify with the term, but I don't consider myself a 'vulnerable service user' despite having needed and made use of psychotherapy. In fact for all sorts of reasons, identifying with that label would be a symptom of sickness rather than health in my case. Psychotherapy is such a larger world (at the moment) than you seem to be aware of. In your post you said "Statutory regulation will not lessen this choice".How do you know that? You just say it like you know it's true. I think of course the kind of regulation proposed will limit choice. How could it not? If I want to see a counsellor I will have to see someone who has passed an approved course and who conforms to the the 'standards' and the 'mindset' layed down by the central body. Choice is already being limited in many areas to CBT which would have been useless for me. The people at Mind may think they know what's best for everyone else, but I don't believe anyone has the right to decide that on my behalf. I find it really patronizing to be honest. Perhaps you are on the right track for the NHS where patients may be more 'vulnerable', but to try and impose this on everyone else sounds to me like the 'we know best' authoritarian attitude which is part of the problem, not the solution. I've had enough of that, and putting up with it for years very much fuelled my own depression. I think you are also mistaken that people always have to complain direct to the therapist. Maybe that's true in the NHS, but if I had a complaint about my counsellor I could go to the agency that employs her or directly to her professional body. I'm also really worried that HPC take complaints from third parties such as family members. I can see how this might be appropriate for some people, but to be honest if i thought there was a chance that a family member might complain over my head I'd have probably avoided therapy altogether.
I still say toughen up the criminal law, probably tighten things up in the NHS and above all educate people as to what is and is not acceptable.
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I think that the positive work that psychotherapists’ do is largely unacknowledged. I am an art therapist who is also employed by mind. I have also used mental health services a long time ago and I have also worked for NHS MH.
Under these circumstances, I feel that I can see things from all perspectives. It is true that the psychotherapist is in a position of power but if it is used correctly that power can be supportive nurturing and life changing for the client. I had psychotherapy through my art therapy training and I continue to have therapy. It is useful to acknowledge your own issues in order to be more effective in clinical practice. I am aware that the most reputable training has personal therapy as a mandatory requirement.
It is true; there are people who abuse power among therapists as there are in every profession. However, I feel it is wrong to say that a lot of therapists that are “wounded healers” become therapist for negative reasons. I am aware that being a “wounded healer” may give me the compassion, empathy and insight to help others who were in my situation.I feel saddened by the unfortunate events that Felicia has experienced. Ideally, the psychologist concerned should have gained their clients permission before writing anything that was about the clinical situation. There should have been regulations in place and I am personally glad that I am part of the HPC so that I can maintain a good enough practice for my clients.
It is important to be able to trust the people whose care we are under. My continued therapy has enabled me to become more assertive and developed my interpersonal skills. It has been at times my only support when I have had life challenging difficulties. These professional regulations are vital so that the clients using these services can gain some of the most vital of things-trust and security. -
Remi,
I am glad you have had therapy yourself and I think the 'wounded healer' can be a very positive image and definitely have those good qualities you describe.
I'm confused why you say "I am part of HPC so that I can maintain a good enough practice". This Gale character was part of HPC too. It didn't make his practice 'good enough' obviously. In fact isn't it just as possible his endorsement by the powers that be encouraged his clients to lower their guard, thus contributing to the abuse?Ok, they made a big noise about striking him off, but that's a bit rich given they'd given him the nod in the first place. But they are not there to make things actually safe, only to appear to do so. Why that is, is a big subject.
I trust my own therapist because of my cumulative experience with her, not because someone in an office somewhere has told me not to worry, I'm safe, go to sleep. Genuine trust , as opposed to the highly conditional and hypnotic 'make believe' kind beloved of some therapists, must be earned, nurtured, lost and found, built between people, it cannot ever be bestowed from above or outside. Predators are very skillful at invoking and manipulating power anyway, including any kind of authority, I see no reason why they will not do the same thing with this body, just like Shipman, those two psychiatrists whose names I can't remember and all the other nightmare stories. In my opinion, what's needed is to encourage people's innate powers of discernment, rather than imply they should put their faith in some quango to rescue them.But the state will not encourage that, because an undiscerning populace is a compliant one that doesn't ask authority awkward questions. I think there is something very unhealthy about a culture that needs to try and pretend that things are safe and neat like this. And it is a game of lets pretend. Look at what's going on in the world. It's not nice. People who we are told we can trust, lie and cheat and manipulate and sometimes kill people in their thousands in the pursuit of an abstact idea such as God or Democracy. It's the society that has the pathology, far more than the individual, but so much therapy encourages us to look the other way, to deny and internalize our ever present horror at the brutality of power. Taken to it's logical conclusion, some of the kind of thinking expressed here would mean locking up anyone with a serious mental health problem, just because a a tiny few pose a risk to the public. You can't be too careful.Surely that's the kind of thinking Mind is against isn't it?
I do wonder if this particular regulation process might be more about reassuring the professionals (and the politicians), not the clients, so they can say to themselves 'Yes, I am a safe person, I am good, my patients should trust me". I imagine quite a few might feel attached to that kind of fantasy image of themselves.
They do say the road to hell is paved with good intentions.
Here's a link to a clip from a brilliant film called Network which seems timely: http://www.youtube.com/watch?v=WINDtlPXmmE -
@mariam,
I looked at your national Miind complaints policy, thank you for the link, it is similar to those run by local LMAs. I guess the LMAs base theirs on the national Mind policy.
I see there are 3 stages in making a complaint against a Mind worker: 1: "Speak to the individual(s) concerned or their line manager and try to resolve the
complaint informally" (Could be a bit scary?)
2: "Outline the details of your complaint by letter, fax, email, or audio tape and send it to
the Chief Executive" who makes a decision.
And 3, the Appeal stage "If you are not satisfied with the response to your complaint then outline the reasons
for your dissatisfaction by letter, fax, email, or audio tape within seven working days .....An Appeals Panel, normally of three members, including a trustee, will be convened
to consider your appeal."
This panel's decision is final, stage 4 the policy says is only "a review of the complaints handling
process, not a further investigation of the complaint."So everything is done in house. Where is the independent input here? And where do Mind publish details of complaints received, how they have been resolved etc., as do for instance BACP and for that matter HPC? Is it Mind policy that voluntary workers, befrienders, advocates etc, who work closely with people with serious mental health issues, should be subject to independent statutory regulation and training standards?
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There are some truly exceptional psychologists and psychiatrists currently working in the NHS but they are VERY few
They tend not to rise in the ranks because they are perceived as 'boat rockers' (my God that boat needs rocking doesnt it?!)
Most of the candidates for NHS posts have never had experience of suffering mental distress and tend to come from backgrounds that are significantly different from those of patients/service users they tend to be academic high flyers with 'technical' competence but they lack real life experience have led relatively sheltered lives and cant properly relate to their
clients.People with mental distress dont need learnt techniques or methods they need authentic affirmation by mature 'real' health professionals not the condescending pseudo affirmation of adult acting psychiatrists and psychologists etc
There is also a very pronounced 'us versus them' dynamic in the health service Ingroup=health professionals Outgroup=service users/patients,a presumed superior-inferior relationship and this allows them to excuse their own when they abuse 'them'
The basic us-them dynamic is often described as group fitness.This is the tendency of members of an in group to value themselves more highly than they value non members and turn off their empathy
I experienced the closing of ranks when I reported my abusive therapist/psychologist and it disgusted me and left me even more traumatised disillusioned, shocked & with an exacerbated feeling of victimisation it felt like psychological and emotional rape
He got away with what he did to me (and others) and continues to have access to vulnerable people.His word took precedence over mine he was believed and I was not even though I was speaking truth and he was lying
As a survivor of prolonged child abuse this had an absolutely devastating impact on my life
I was referred to a man who, I believe, deliberately sought out a position of therapeutic power in order to abuse and he also sought peer support in what he did by unfairly pathologising me and denigrating me when I complained about him
It has been virtually impossible for me to get my case across because the universal tendency is to believe the 'professional' and most people arent even aware of issues surrounding power imbalances and fail to recognize emotional illiteracy in therapists
As a child I was humiliated,brushed aside,intimidated,laughed at treated like an object and he did exactly the same and got away with it because he was part of the 'ingroup' and I was one of 'them'
I have now reported him to the HPC but once again its 'my word against his'...I have no hard evidence so basically Ive got no chance of justice have I......
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@Fiona,
What a dreadful experience. What comes over in your post is that you have a very deep understanding of the cultural and power issues involved in therapy, unlike a lot of professionals. I agree with you, not only are many, especially those in mainstream institutions, unaware of these dynamics, they positively reinforce them. I haven't had an experience as unpleasant as yours, but I've certainly come across a few therpists who seemed quite screwed up to me, yet totally unaware.
I really hope you do get some redress, maybe HPC will do something. I am personally skeptical of the kind of regulation HPC use working for therapy, because it implicitly reinforces the us/them, in/out, top/bottom dynamic through it's implementing of academic standards etc. This is far more problematic in psychotherapy than in medicine. Too many medically/psychiatrically orientated people just don't understand that at all, and worse still they pour scrorn on those that disagree with them, as if their view of the world is the only valid one. Some very good therapists have had issues themselves, and many years of life experience but no formal qualifications; the HPC system will quickly squeeze them out in favour of 'professionals' with the right credentials, but possibly little empathy or understanding of real distress. It will also reinforce the medicalizing and pathologizing of emotional and mental distress, thus making it easier for abusive professionals to turn things back against any patients who challenge them, as happened to you.Unintended consequences, but likely in my opinion.Of course the regulators won't know this is going on because it is part of the subjective experience of the patient, and not objectively measurable. Good therapists will try to make the best of it. Some of my friends are teachers or social workers, they tell me that similar things have happened with Ofsted.
Ofsted says everythings great and getting better, but the real world is totally different, lots of demoralized and scared teachers and social workers. Some of them want to retire early, they've had enough.At the same time, the existing voluntary systems seem to have been less than effective too and there is an obvious conflict of interest. I think we badly need some 'out of the box' thinking, but I can't see the department of health or HPC coming up with much of that when they don't even really understand the problem and have too much vested interest in simply tweaking the status quo to make it look more user friendly. They are not in any sense independent either.
There are of course as you say some great people inside the system too, but it can be made very hard for them if they are seen as rocking the boat, I've seen this happen.
Thank you for sharing on this blog. Your experience shows how complex these issues are, and that they cannot be swept under the carpet with simplistic approaches. I wish you the very best with everything, you deserve it.
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Did you know that the philosopher Friedrich Nietzsche, author of Thus Spoke Zarathustra (1883-5), was a critic of the reasoning behind organisations like the HPC?
He argued that modern societies have an irrational faith in the power of reason to produce a good society. It is irrational, because there is often no evidence that the rational systems that we come up with actually work, or are free of costs. The original posting provides no evidence that the HPC will raise standards. The fact that, because Zarathustra as a mental health nurse is regulated, others should also be regulated, is not a strong argument. The fact that some therapists behave badly is also not a strong argument. There is no evidence that inspection and monitoring has raised standards in schools, hospitals, universities or banks. It costs a lot of money, and creates bureaucracy. Where are the benefits?
I think that Zarathustra should reconsider. Is more and more regulation really the answer to our problems? It almost sounds like a modern equivalent of snake oil or witch trials, since you can never show that the “cure” does not work. There seems no end to what additional regulation is needed.
Here is a short quote from Nietzsche, courtesy of the Wikipedia. This suggests that the real problem is the moralising drive for improvement in all modern institutions which never live up to their promises. Maybe it is time to do things differently. We could make a start by reducing unnecessary regulation:
“Zarathustra was the first to consider the fight of good and evil the very wheel in the machinery of things…Zarathustra created this most calamitous error morality…His doctrine, and his alone, posits truthfulness as the highest virtue; this means the opposite of the cowardice of the ‘idealist’ who flees from reality…Am I understood? The self-overcoming of morality, out of truthfulness; the self-overcoming of the moralist, into his opposite – into me –that is what the name of Zarathustra means in my mouth”.
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Max,
I agree with many of your observations. Although the systems operated by HPC, Ofsted etc. are very attractive to those who irrationally put their faith in 'pure reason', there may be an emerging trend away from the centralized and relatively unresponsive regulation of this kind. Systems such as these seem to almost invariably produce unintended consequences which far outweigh the benefit of occassionaly identifying a problem (usually after it has happened). Although as you point out, reason cannot solve every problem, it can sometimes improve things by degrees if we are prepared to heed it's findings rather than listen to our fears and prejudices. There is evidence emerging to back up an alternative approach. A few quotes:
"Research conducted by King’s College London and Royal Holloway, University of London, has found that regulation may distract NHS professionals and organisations from providing safe and effective patient care. The research raises questions about the future regulation of psychotherapists and counsellors by the Health Professions Council. The study "Statutory Regulation and the Future of Professional Practice in Psychotherapy and Counselling: Evidence from the field", funded by the General Medical Council and the Economic and Social Research Council (ESRC) Public Services Programme, examined the way that NHS doctors and therapists, including those in an Improving Access to Psychological Therapies (IAPT) service, said that current forms of regulation affected their clinical work.
Dr Gerry McGivern, Lecturer in Work and Organisations in the Department of Management and lead author at King’s, explains, ‘The experience of doctors and therapists highlights a number of unintended effects of regulation which adversely affect patient care. Responding to high-profile media spectacles and expanding bureaucracy has created a regulatory climate obsessed with blame, which doctors describe this as “hell” and “reminiscent of the Inquisition”, undermining professional practice, patient safety and care.’Dr Michael Fischer, Research Fellow in Healthcare Management in the Department of Management, at King’s added: ‘Our research in an IAPT service also highlights the risks of expanding bureaucracy more focused on outcome measures than actual patient care. It suggests that rather than remote, quasi-legal regulation, interpersonal processes such as clinical supervision and local professional engagement appear key to protecting the public and ensuring safe and effective practice.’
One of the recommendations: "Professional engagement is essential to making regulation work so mandatory professional regulation may be a more effective means of improving patient care and protecting the public than imposing statutory regulation on reluctant professionals who cannot see its benefits in practice. "
(the full story here: http://www.kcl.ac.uk/news/news_details.php?news_id=1190&year=2009)
Mandatory professional regulation would mean therapists having to sign up to a professional body with a robust ethical code and a complaints process. The law would act as an umbrella to ensure the complaints and ethics codes were actually up to scratch and doing the job effectively. At a recent conference Dr Michael Fischer delivered an excellent presentation on this report. Mark Seale, chief exec of HPC was there but seemed unmoved. I spoke with Mark, who seems a very nice man whose intentions are good. However Mark and his organization continue to ignore the findings of the report, which was submitted to them, presumably because it does not fit with their agenda of regulating and collecting fees from another 50,000 therapists.
Bodies like HPC and Ofsted are in some ways behind the times, the dinosaurs of the regulatory world. They recently 'struck off' an occupational therapist because he was a convicted child rapist. This is spun by HPC as the system working, yet he was convicted a year before he registered with HPC, and took several years before anyone realized his history, during which time he was working with vulnerable people in the NHS. The hospital said "We followed all the procedures". So that's alright then. (http://www.mirror.co.uk/news/top-stories/2009/10/07/nhs-man-is-child-rapist-115875-21728983/ )
If HPC is clumsy in it's regulation of 'health professionals' it may prove disastrous for therapy. The example of Art Therapy, already HPC regulated, is oft quoted to imply otherwise. In fact the vast majority of art therapists work in the NHS.They are thus a self selecting group with a particular way of working, and their practice is very different to most counsellors and psychotherapists, especially those outside the public sector. The only way now to be an arts therapist is through an HPC approved course at post graduate level. So much for diversity. Arts therapy is now an elite 'profession' inaccessible to those without the funds or the right connections to get training.
The unintended consequences of the wrong kind of regulation may include making counselling less safe and less accessible for clients, probably those least able to afford any alternative. I am a trained and qualified counsellor, potentially eligible for the proposed registration, however many like me may decide not to practice as voluntary or low cost counsellors under the HPC system. I would consider it ethically dubious to practice, because HPC's inappropriate complaints system destroys the safety and confidentiality of the therapeutic space for some of the most vulnerable client groups and threatens to drag both practitioner and client through a damaging and adverserial public trial if a disgruntled or malicious third party (they do exist) makes a complaint. For what? I don't need the money, luckily I have other options. No doubt the no win no fee lawyers are already salivating at the prospect of pursuing more third party complaints against 'mental health professionals'.What could perhaps offer a genuine improvment is a flatter, less heirarchical and more responsive system based on peer supervision and accountabilty.Systems with these characteristics are emerging amongst groups of therapists working in the private/charity sector, not perfect (there is no perfect) but a positive step. ( see http://i-p-n.org/pdfs/ipnleaflet.pdf) . Large inherently heirarchical bureacracies such as the NHS are a tougher nut to crack.
Some groups such as Alcoholics Anonymous have been using non heirarchical self regulating systems for decades. Everyone keeps everyone else in line. A very basic version of the flat, peer to peer accountabilty model has emerged on the net through sites like Ebay, where buyers and sellers constantly monitor each other on a peer to peer basis. It might seem odd to make such a comparison, but I suspect something working with some of these principles would pick up problems much faster. Instead we are reliant on remote management 'following procedures', and the honesty of someone who perhaps is incapable of being honest. We then have to wait years for somone to notice so that the regulator can do something(or not). The ineffectiveness of centralized regulation at actually preventing harm has repeatedly shown itself in all sorts of areas, social work, mental health, finance,the stories are familiar now. "How could this have happened?" people ask, "why didn't anyone say anything" and there is a call for more rules and more monitoring, a more powerful parent figure, ignoring the fact that the perpetrators are usually already regulated in some way and in any case quite adept at manipulating any system. Meanwhile good professionals may tend to close ranks and keep their heads down in an atmosphere of fear and recrimination. The stereotypical 'rogue outsider' is in reality a rare phenomena, and by it's very nature, probably can never be eliminated completely by rational systems. That's unfortunately the nature of living, occasionaly bad things happen and cannot be prevented. The present regulatory fever about health professionals started with Shipman and a few other high profile cases, all in the NHS incidentally. The idea that imposing more regulation on the private sector will somehow prevent the widespead problems in the NHS seems to be pure fantasy, totally without evidence. Which is odd considering the Department of Health is so keen on 'evidence based practice'. They expect everyone else to be evidence based, but it's apparently OK for them to proceed on the basis of nothing more than anecdote, fantasy, projection and a bit of box ticking. Other groups seem to buy into this, either because it suits their own interest (possibly certain professional factions are in favour of HPC because it will exclude other views and orientations and guarantee their share of the public sector psychotherapy pie), or because it appears (but only appears) to offer a solution for legitimate concerns, as in the case of Mind and other user groups.But nobody offers any evidence for how it will protect the publc, just repeatedly asserts that it will. CBT therapists call this cognitive error 'emotional reasoning'; the belief that if we feel something to be true, then it must in fact be so. 'Reflective practice', questioning our assumptions and notions of 'common sense', is what therapists are supposed to be about, at least that's what my training taught me.
The current plans are naive and contradicted by the evidence base. Both clients and practitioners, the vast majority of whom are ethical and not at all abusive, deserve better. -
If I were Jennifer's client I would feel reassured that she has no illusions regarding the shortcomings of centralised regulatory systems such as the Health Professions Council, which mainly (70%) function to administer employer initiated disciplinary processes and regularly show evidence of untreatable deafness and myopia. The public are better served by practitioners like her who are obviously capable of "reflective practice and prepared to take responsibility for each other's work within local and flat structures.
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Jennifer obviously feels strongly (!) about this topic. I for one think as a general rule, leaving regulation up to the industry being regulated is asking for trouble.
I don't think anyone is suggesting pointless bureaucracy or focusing on punishment instead of patient care. If some kind of regulation is needed, and everyone here seems to agree that there ought to be oversight of some kind, it should be as minimal as it can be to be effective. And effective in this case has to mean providing high quality care across the board and protecting vulnerable adults.
Commenting is now closed.