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
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