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Plan B on Psychotherapy Regulation
Posted Monday 18 April 2011
This is a guest post from mental health nurse and blogger, Zarathustra (of the former Mental Nurse blog).
Despite the complex work they do with very vulnerable people, counsellors and psychotherapists are surprisingly under-regulated. Anyone can call themselves a psychotherapist, and there is no obligation to belong to a professional association. This can increase the risk of abuse and make it harder to make a complaint. Government plans to regulate the industry are sadly being watered down by the Coalition.
The lack of regulation was illustrated by the case of Derek Gale, an arts therapist struck off by the Health Professions Council (HPC) for physically, sexually and financially abusing his clients. The HPC regulates arts therapists, as well as occupational therapists, radiographers and other healthcare professions. Psychotherapists, however, are regulated by nobody, so Gale could continue practising by himself retitling himself as a psychotherapist.
The previous government planned to make "counsellor" and "psychotherapist" protected titles, to be regulated by the HPC, which has a robust complaints system to deal with fitness-to-practice issues. Sadly, the new coalition has opted for a weaker plan B approach.
Under plan B, statutory regulation will be replaced by "assured voluntary regulation". The HPC will be allowed to set up a voluntary register which counsellors and psychotherapists can join. In addition, existing psychotherapy organisations can apply to have their complaints procedures accredited by the Council for Healthcare Regulatory Excellence (CHRE), to be renamed the Professional Standards Authority for Health and Social Care.
Some of these organisations would find it easier than others to gain accreditation from the Professional Standards Authority. The British Association for Counselling and Psychotherapy, for example, has an excellent code of ethics and complaints procedure, and would probably have little difficulty being accredited. At the other end of the scale, some therapy organisations do not have lay members for complaint hearings, so the therapist is judged by his or her own colleagues. Some require complaints to be proven to the criminal standard of "beyond reasonable doubt." The College of Psychoanalysts UK even expects people to pay costs if their complaint is rejected! (Click on the link and see Part 5 1.2.1) Such organisations may well need to reform if they want to be accredited.
Effectively, the government is creating a "marketplace of regulators" with the HPC and accredited organisations in competition with each other. There is no obligation for a therapist to join one of these regulators, though quite likely they'd be unlikely to get any work from the NHS, social services or schools and colleges without doing so. However, critics have pointed out that "counsellor" and "psychotherapist" will still not be protected titles, and this will still leave the professions with no nationally-agreed set of standards or ethics.
The new proposals are at least an improvement on the current situation. Even so, they do not go far enough to protect the vulnerable from abusive psychotherapists. People who use these services need proper statutory regulation.
Zarathustra
19 Comments
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The advantages and disadvantages of statutory regulation for psychotherapy and counselling have been debated back and forth for years, without resolution. The Coalition Government has spoken at last, and they seem to be much less keen on regulation by the state than Zarathustra. The UK Council for Psychotherapy (UKCP) will be working to improve our professional regulation within the new Plan B policy environment. We have been operating a national register for many years, and we will work to make ‘assured’ (voluntary) registration work.
Zarathustra comes up with an interesting example to support the case for statutory regulation. He uses the example of Derek Gale, who abused his clients for years, even though he was regulated by the Health Professions Council! This man was also a UKCP psychotherapist, and UKCP struck him off promptly once the HPC has concluded its disciplinary case. His clients weren’t protected very well by either form of regulation.
Wouldn’t it be nice if we could pass new laws saying that nasty things won’t happen anymore? Regulation is a difficult business, and Zarathustra’s post helps us understand how we need to try to make the new registration systems work to protect clients.
David Pink, UKCP
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I thank Mr Pink for his reply. However, I must take issue with his statement that,
"He uses the example of Derek Gale, who abused his clients for years, even though he was regulated by the Health Professions Council!"
No regulator can prevent abuse entirely. The General Medical Council did not stop Dr Harold Shipman, and the Nursing and Midwifery Council did not stop Beverley Allitt. This is not a reflection on those regulators, merely a statement that abusive individuals are out there in all professions.
What matters is how these regulators respond when a complaint is made. I have spoken with the complainants in the Derek Gale case. They were very impressed by the robust and fair way that the HPC investigated the issue. They were also impressed by the way in which complainants were supported by the HPC during proceedings.
As for their opinion on how their complaints were dealt with by the UK Association for Humanistic Psychology Practitioners (the UKCP-affiliated organisation to which Gale belonged)....Well, this is a family blog so I had best not repeat how they expressed their opinion.
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Zarathustra
Professional regulation is not about being for or against mass murderers. That's a matter for the police, not regulators.And the blog discussion should not be about trading clever exaggerations and wild insults - yours or mine.
It is good that you have briefed people through the MIND website about the change in Government policy. I hope MIND and service users will want to work with professional bodies like UKCP to improve the regulation of psychotherapy and counselling. And a bit of support from the Governement wouldn't go amiss either.
David Pink, UKCP
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This new Coalition Government has a completely different view, but Joanna, Zarathustra, and many many UKCP members are very upset, and still want the Government to introduce state regulation of psychotherapy. These are sincere and passionate views, that deserve respect.
UKCP is producing information for our members analysing and assessing the new Government's policies. We have sent email briefings to 6000 therapist members of UKCP, and the materials are openly available on our website under 'news' (www.UKCP.org.UK). A top priority is to assess the new scheme for kite-marked 'officially-assured' voluntary registers, so we can decide the way forward for psychotherapy regulation. We need to know what the rules are for 'assured' professional registers, and what all this will mean for the public.
Visitors to the MIND blog can and should make their own assessment of the new Government policy on regulation of health and social care professionals. UKCP will continue to try to improve the regulation of psychotherapy, whether under centralising Labour, or the deregulatory Coalition. I would welcome the views of genuine service users about the new policy. Surely regulation is something that is done for service users, and the debate should not be monopolised by 'players' from within the professions (like me, and all the other people who have posts above!).
David Pink, UKCP
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The whole debate really misses the point. The UKCP, amongst other regulatory bodies, is largely composed of organisations that practice so-called psychodynamic therapies - what one of our most esteemed scientists Peter Medawar once described as being perhaps the greatest confidence trick of the 20th Century. It has even got to the point where the UKCP licences snake oil salesmen like the following on their website:
Neuro Linguistic Psychotherapy Counselling Association NLPtCA
National College of Hypnosis and Psychotherapy NCHP
How about some proper evidence based psychological therapies instead of the people who for the most part ignored childhood sexual abuse for 50 years and then made a living out of "recovered memories" when that became fashionable.
Not regulation - informed consumerism!
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I would love to see them regulated. I have had a lot of bad experiences with them in the past and on going and it upsets me greatly that when you feel they are not doing their job properly there is nothing you can do about it. There needs to be a stop to professionals abusing their position and giving vulnerable people the run around when they are needed most.
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All NHS & Non-NHS Mental Health Services/Providers Should Be Regulated & So Should All Psychotherapists Be Regulated Too :)
All Psychotherapists Be Regulated, Wheather Working In The NHS, Non-NHS, Private Hospitals Or Charities, Or As An Volunteer.
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I once meant an homphobic volunteer Counsellor for City & Hackney MIND,
The complaint fell on deaf hears with City & Hackney MIND,
So I as found out She was an so called Consultant Psychologist,
I was able to complain to BACP http://www.bacp.co.uk Although they looked in to the complaint more than City & Hackney MIND,
They weren't able to do much & It was Me word against Hers & Hard to prove,
My advice is always tape record a few sessions with an one to one counsellor digitally & I've Done this once or twice since.
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The subject of regulation of the psychotherapy profession is discussed on two pages of the Dramatis Personae web site. Some quotes from the Mental Nurse blog by zarathustra (before the domain was pinched) are included in the text.
The existence of INTEGRITY though is a positive development, not least because the UKCP and other professional bodies have been promoting, sometimes actively engaged in promoting, one of psychotherapies most contentious issues.
The key pages on the Dramatis site that might be of interest, are;
http://www.dramatis.hostcell.net/SRA/RAINS3/rains3.html - Dr. Valerie Sinason & David Icke - RAINS Part three
http://www.dramatis.hostcell.net/SRA/RAINS4/rains4.html - Dr. Valerie Sinason & David Icke - RAINS Part Four
The pages are concerned with the 'modern' (that might not be the best term) belief in satanic ritual abuse (the SRA Myth) in British psychotherapy and other professions (other pages deal with the US equivalent). The pages are part of a history of the SRA Myth in the British Isles from 1988 to the present day.
The regulation of psychotherapy in the UK is discussed at http://www.dramatis.hostcell.net/SRA/RAINS3/rains3.html#regulation
The last-but-two section of the pages (http://www.dramatis.hostcell.net/SRA/RAINS4/rains4.html#bowlby) is concerned with the devaluing and trashing of Sir John Bowlby's legacy that has taken place in recent years. This was contributed to the site by a Royal College of Psychiatrists member. The next section after that investigates the most recent 2011 publication from Karnac Books in the UK, in support of the SRA Myth, bringing the history of the SRA Myth bang-up-to-date.
Although the site receives contributions from psychiatrists and psychologists, we have only ever received one contribution from a psychotherapist (an anonymous member of The Bowlby Centre staff). Any corrections, criticisms, suggested amendments or contributions are always welcome and can be made anonymously if preferred.
Rachel
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Astonished by the stuff about SRA abuse above. And following on from reading that blog they also seem to have some fairly scuzzy attitudes towards the LGBT community.
The problem is that I see and hear very little about this debate outside of specialist blogs. Can I suggest a campaign along the lines of what happens when the firemen go on strike, that is an internet version of "if you support us honk!"
Anyone who wants to see the UKCP and their ilk bought to account (and reality) simply tags any sumission to any blog with a hyperlink to Mental Nurse's relevant pages (if he doen't mind, and once resurrected) with a simple message like "regulate psychotherapy".
If you can't regulate them then make a start on destroying their commercial viability, see how quickly they fall in line.
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With reference to the case of Derek Gale it is well known that there were years of pain and dissatisfaction from complainants before the Health Professions Council (HPC) finally took the situation in hand. The convenors of INTEGRITY: Social Responsibility in Psychological Therapies, are experienced in child protection and safeguarding which is crucial when considering matters of regulation. At present without statutory regulation anyone can have individual and intimate access to vulnerable children and adults without training, qualifications, CRB checks, codes of ethics or conduct, a theoretical framework, a philosophical base, professional registration, any complaints procedures or accountability of any kind whatsoever. Literally anyone can simply rent a room and invite people in, practising anything they like in the name of psychotherapy and counselling. Integrity suggests this situation is unacceptable when potentially one in five of the population may seek some form of psychological support over a lifetime.
We are convinced that all resistance to statutory regulation needs to be investigated critically. INTEGRITY welcomes the position statement from MIND on regulation in the interests of service users. The public need access to transparent and accountable information in order to fulfil a duty of care and social responsibility. The Health and Social Care Bill (2011) makes it clear that this government wants both the HPC and the CHRE to undertake an impact assessment of the regulatory needs of those professions currently unregulated. A regulatory impact assessment will be essential for psychotherapy and counselling to determine whether this field needs statutory regulation. As the MIND survey suggests, statutory regulation is The Protection We Deserve and it is most concerning that this is not yet being listened to or heard by everyone at every level. Why are the professional associations not campaigning alongside?
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INTEGRITY suggests that statutory regulation would have substantial beneficial impact on future training, qualifications and service delivery, providing quality assurance for both students in education as well as those seeking psychological help. Counselling and Psychotherapy students seeking education and training provision can be extremely vulnerable people themselves. They can suffer as much from the potential for emotional, financial or sexual exploitation and abuse of power as anyone else. It is commonplace to require extensive therapy as integral to training for many years. This can go on for over a decade without transparent or accountable criteria for assessment, appropriate student rights or positive outcomes. Some training can be notoriously lengthy and expensive whilst others can be awarded the same qualification in a very short time with additional titles added at random. Training Institutes and educational organisations can be set up in much the same way as an individual practice without university validation, independent scrutiny, assessment or accreditation.
Everyone accessing psychotherapy or counselling in the context of training or life crisis is a ‘genuine’ service user who requires equal opportunity with reference to professional standards, safeguarding and accountability. INTEGRITY would like to promote service delivery of psychotherapy and counselling but until appropriate statutory regulation is in place we are faced with a serious moral and ethical dilemma in that we do not have confidence in the current systems, standards and procedures that are in place for the protection of the public.
Joanna North and Jocelyne Quennell on behalf of INTEGRITY
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@beanpole111
Thanks for your links to stuff on SRA, which I found quite interesting.
I've done a brief response to your articles here: http://madosphere.com/2011/04/25/when-satanists-attack/
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It’s notable that UKCP suggest that it would be nice if laws could take away 'nasty things'. It is highly unlikely that any law or regulation has ever entirely prevented the problems they were put in place to deal with; and no-one has ever suggested that statutory regulation for professionals actually halts misconduct in its tracks, just as making particular forms of behaviour criminal does not produce a panacea.
Rather statutory regulation provides a social contract between the public and the professions: misconduct and incompetence is investigated by an independent body in an open and transparent way. Statutory regulation means that people found to have caused harm to their clients are held to account, and by a single body, not the 70-plus that UKCP currently have on their books. It will be interesting to watch developments as UKCP discuss the issues with CHRE; given that UKCP member organisations have had their second opportunity to sign up to a single central complaints process for the last year, and very few have done so, on what basis would CHRE agree to accredit a register? A register? Or 70 different ones?
Here at the Clinic we continue to take calls every week from people who have been subject to secret conduct processes, often made up on the hoof, with no lay involvement, no clear outcome, little in the way of sanctions, no publically accessible information and no way for other clients to know what has happened. With these groups it is often a major challenge simply to get hold of their complaints procedures or codes of ethics. Imagine asking for the NHS Complaints procedure and being told ‘You’ll have to put in writing what the problem is, and then we’ll see if we can send you the complaints policy’, or being managed into a ‘mediation’ session, with the therapist's close colleagues, against a practitioner who has so undermined your self esteem that you have come to think that you are worthless.
Jonathan Coe & Dawn Devereux -
Imagine reporting a concern about a therapist's behaviour and being told that you will have to run your own case against a barrister or pay upwards of £10,000 for legal representation, whilst the therapist is provided with a barrister by his insurance company. During the complaint hearing you may well find yourself, and the substance of the complaint, subject to psycho-analysis by the people responsible for investigating, and who may see the individual as responsible for everything that happens to them, and that the client themselves must therefore have engendered any and all behaviour in the therapist, no matter how aberrant. If you lose (as you are likely to with the odds stacked against you) a body will then permit membership organisations to require you to pay the ethics panel’s costs, which are likely be several thousand pounds. Does anyone know of any other professional conduct process that is so stacked against the client?
Jonathan Coe & Dawn Devereux -
I am a UKCP Fellow and member of the UKCP’s Psychotherapy Council. I am writing here in a personal capacity but I know that my views are shared by a number of senior members of UKCP.
I have been involved in developing the regulatory frameworks of UKCP since its beginning in 1992. This includes developing training standards, assessing and monitoring training institutes, and dealing with complaints. Like most of my colleagues who are in favour of statutory regulation I have seen over the years that voluntary self-regulation does not work.
The less serious matters can be well-handled by the training organisations at a local level – and this would continue whatever form of regulation was in place. This includes grievances or disagreements that lend themselves to alternative dispute resolution or mediation. But when it comes to serious complaints such as allegations of exploitation, abuse or misconduct, even with the best will in the world we do not have the independent personnel, the finances or the expertise to provide fair and effective regulation. Handling complaints is mainly undertaken by volunteers, usually without training. These volunteers are often colleagues, ex-trainers or supervisors of the practitioner being complained against.
However while I believe this government is kicking the issues of public protection into the long grass, I accept that they have decided in principle against statutory regulation in favour of ‘assured voluntary regulation’ for the time-being. They have called for an ‘impact assessment into the regulatory needs’ of the profession to be undertaken by the CHRE and the HPC (Health and Social Care Bill 2011 Part 7: 212 and 213). This will include consultation with service-users and employers as well as the profession. I welcome this. As far as I am aware none of the professional bodies has ever looked at regulation from the clients’ perspectives. -
The recommendations from these assessments will enable the government to make a final decision about voluntary or statutory regulation (Hansard 29.03.2011 page 41).
Meanwhile the Health and Social Care Bill and the Command paper are clear that there would be two routes to voluntary regulation. One is a system whereby the CHRE would ‘quality assure’ the large number of existing self-regulating bodies and monitoring their registers. This route may be better than the current system but still does not provide the consistency and coherence in the professional field that I think the public need and deserve.
The other is for the Health Professions Council to set up a voluntary register for psychotherapists. This second option in the absence of statutory regulation would be a better option in my view. The HPC is an independent regulator with the resources and experience to undertake the job. It has spent the last two years consulting widely with the profession ironing out some of our internal disagreements. Because they are independent of the profession I believe this would be a more effective and ethical route, even though still a voluntary route. It would give the public coherent standards for psychotherapy and a consistent unitary ethical framework and complaints procedure.
What concerns me is that the UKCP leadership has prematurely tried to shut down this option. They have made public policy statements calling for the government to withdraw the powers given to the HPC to set up a voluntary register and circulated to all the UKCP membership an advisory paper to the Board of Trustees also closing down this option. This policy has been rushed through without any consultation at any level with the membership. -
Speaking from experience, taking up a course of therapy offered by NHS has subsequently had the worst impact on my mental health than any other adverse life experience I have had. It left me with much, much worse mental distress than prior to therapy and I suffered a severe breakdown as a result. I see this as due to the unshakable push by the therapist to get the client to change to fit their personised construct of the client's mental 'difficulties'. Prior to enrolling on the course, I believed that a therapist would allow me to freely and non-judgementally talk about difficult experiences and things I had 'bottled up', also I hoped he/she would offer a degree of emphathy. This definitely was not the case, the therapist would listen in silence and ask questions but most damaging was their 'synopsis' of your 'problems', / way your mind works and their subsequent push of their ideas on you. It is only after 4 years and a huge amount of mental distress and loss of employment/quality of life that I have come to realise that their views that I took to be authority were based on little understanding. I do not believe that Psychotherapists/ CBT therapists have the nessesary experience to deal with severe mental conditions yet they have the self belief to proport they do. I owe my recovery to other people that have experienced mental health difficulties and MInds pages that deal with 'caring for oneself'. Having studied Psychology at college, I realised there is still very little depth of knowledge in this area as compared to other disciplines yet threrapists in their failure to acknowledge this, mean they freely supersede their clients views with that of their own readings. This arrogance coupled with the clients vunerability can and does cause silent suffering. Feedback forms to the client after the therapy has finished desperately need to be implimented, this information will allow for regulation of therapists but also so that the therapist can they themselves grow.
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Dear Scott, I’m so sorry to read that you had this bad experience with a counsellor at a local Mind and I’m sorry that you feel it was ignored with your local Mind. If you’d like to talk about this more, please email webmaster@mind.org.uk. Take care, Taryn from Mind
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