My latest realisation will probably be old news to anyone who is involved with social media: It has come to my attention that Twitter is something of an echo chamber. That is to say, I have found that my views about issues pertaining to counselling and psychotherapy have been almost completely affirmed by the therapists I have engaged with on Twitter, and somewhat naively, this has lulled me into the false assumption that most therapists in the UK are in accord, particularly when it comes to the issue of statutory regulation of the profession.
My views on regulation of counselling and psychotherapy in the UK have been touched upon in this blog before. I believe that the current situation does not do enough to protect vulnerable clients, and affords too many freedoms to anyone who fancies calling themselves a psychotherapist. I think there is an assumption of accountability which simply does not exist when a therapist in private practice chooses not to be a member of a professional body. For the dissatisfied or abused client, there is nobody to complain to, and nobody to turn to. To me, this is completely unacceptable, and by allowing the status quo, I feel we as a profession are failing in our collective duty of non-maleficence to clients.
So anyway, back to my naive assumption that most therapists think along these lines. Recently, on a closed internet forum, I have been engaging with therapists who are overwhelmingly against statutory regulation. In fact, I believe I have been the sole voice in favour on some of the forum discussions. So much for pottering around my comfortable corner of the twittersphere!
So why the divide? Why is there seemingly this silent split in the profession? And how do we constructively bring these these sides of the debate together for meaningful dialogue?
I do want to say that I think many of the anti-regulation arguments are actually valid concerns that need to be addressed. How, for example, do we ensure that regulation does not lead to homogenisation of the profession? I think it’s very important that any move towards regulation is respectful of the diversity and evolutionary development of psychotherapeutic practice in this country, and does not seek to standardise or snip at the edges of the relational tapestry.
Recently, several professional bodies have come together to work on a framework of competencies for counselling and psychotherapy. I find this encouraging and concerning in equal measure. On the one hand, it seems like common sense that the public should have clarity about what therapy entails, and crucially (to my mind) what the minimum requirements for qualification are. On the other hand, its development has hardly been inclusive; not all professional bodies have been invited to take part (read here for the NCS’s open letter in response to the framework) and membership consultation has been invisible as far as I am aware. I think, if we want to move towards regulation, we need to think carefully about whom we want to do the regulating, and how we ensure that we properly represent the needs of the practitioners who will be impacted by it, as well as their clients.
I have heard a (kind of) compromise suggested, whereby the titles of counsellor, psychotherapist, psychoanalyst etc, become legally protected titles, and anybody wishing to practice under these titles must join a register, justifying their use of the title and stating which professional body they will maintain membership of, adhering to their chosen body’s ethical framework and being accountable to them in the event of complaints. To me this sounds like a promising compromise, avoiding the need for non-expert interference from state regulators, reducing the risk of homogenisation, and also safeguarding clients. While a lot of work would be necessary to realise such an ambitious project, I think it has mileage, and should not be discounted. It has to be preferable to division and mudslinging, which, sadly, I am beginning to feel exists, in pockets, on both sides of the current debate.
From the perspective of a client, I know how a no-regulation system can disenfranchise and disempower. I say this with caution, as I am aware that my own experiences could be used to attempt to invalidate my perspective. I would argue that there is no objective voice in this debate because everybody with investment in the regulatory process brings their own perspectives. So I will say this. My first therapist claimed to be a member of the BACP; this was a lie. Several unethical actions later, I would have liked to have had the opportunity to make a complaint. Of course, this was not possible; there was nobody to complain to. If this individual chooses to practice again, they are free to do so. I have found this set of circumstances extremely difficult to accept, and I sought further therapy, in part to come to terms with this injustice.
I have heard it argued that there are such a small number of these types of cases (I’m not sure how we would know) that mitigating this risk is not worth the risk to the wider profession. I feel that, if there is an identified risk to clients that we can mitigate, then we need to mitigate that risk. If any clients at all face this avoidable situation, we are failing them.
I am still confident that we can find some common ground. That we can work together to achieve something positive. I don’t want a split in the profession, and I don’t think anybody really wants a split in the profession. It will take hard work and respectful dialogue from all sides, but I see no reason why we can’t develop a way forward which both protects clients, and protects psychotherapy, in all of its diverse and creative forms.
A Client First 
There is nothing that a statutory framework of counselling based on protected tiles could do that can’t be done with the existing statutory framework of counselling based on accredited registers.
I take it you would like anyone practicing counselling or psychotherapy to be compelled to sign up to appropriate regulation, but, as the Council for Healthcare Regulatory Excellence has said in the past:
“Protected titles create a boundary for professional practice, in that titles are reserved for registrants, and cannot legally be used by non-registrants. However, this does not stop people from practising in an unregulated way. There are examples of practitioners, including some who have been struck-off by a former regulator, who use non-protected titles. They may even state correctly that they are trained in a field of practice, and offer services to the public, without using a protected title. ”
[Council for Healthcare Regulatory Excellence , February 2010, “Protecting the public from unregistered practitioners: Tackling misuse of protected title.”]
If “Counsellor” and “Psychotherapist” were made protected titles tomorrow an unregulated practitioner could just change her stationary and carry on regardless, which is exactly what happened when “Podiatrist” and “Physiotherapist” became protected: unregulated practitioners just rebranded themselves “Foot Health Practitioner” or “Sports Injury Therapist” and most people didn’t know the difference [Health and Care Professionals Council, July 2007, “Evaluating public awareness concepts.”].
As it stands the existing statutorily accredited register based system for regulation isn’t particularly effective for much the same reason, the public don’t know that Accredited Register exists. They could be made to work, but it would take a massive publicity drive to make the work of the Professional Standards Authority so that it becomes public knowledge that you need to check that any health or social care professional you consult is on an Accredited Register.
In short, all the legal tools are already in place for effective statutory regulation of counselling and psychotherapy, now it’s down to the difficult job of getting them working properly.
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Hi Patrick, thanks for your comment. I understand the argument that unscrupulous practitioners could continue practicing under some other title, and I agree. But most people seeking counselling and psychotherapy will look for a counsellor or psychotherapist. They will look for someone specifically practicing under that title. To me, even if this action will not restrict “emotional guides” etc from practicing, it still will safeguard those who look specifically for a counsellor. Just because it doesn’t fix all the problems, doesn’t mean it can’t help with some of them. I hear a lot about publicity and education when it comes to the PSA registered bodies, but I don’t think that’s enough. I don’t think it helps the potential client who has heard about counselling from an acquaintance and simply types “counsellor” and their local area into Google. I know it’s not a perfect solution, but it would stop unaccountable practitioners from advertising themselves as counsellors and psychotherapists and I believe that’s a good start.
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“I don’t think it helps the potential client who has heard about counselling from an acquaintance and simply types “counsellor” and their local area into Google.”
Neither would protected titles help them, I just tried typing “Podiatrist” (a protected title) and my local area and alongside the statutorily regulated podiatrists and chiropodists Google told me about several “Foot Health Professionals”.
Protected titles haven’t stopped unaccountable “Foot Health Professionals” advertising themselves in a way that makes them indistinguishable from regulated Podiatrists to many people, if it didn’t work then what is your reason for believing it would work for “Counsellor”?
People looking for help will look for practitioners that appear to offer the help they want regardless of the title they happen to use. If a potential client’s friend says “Jane Blogs really helped me with my anxiety” he’s going to think of Jane Blogs as a counsellor even if she calls herself a “Humanistic Practitioner”.
If your ultimate goal is effective regulation of counselling to protect clients then the Accredited Registers are at least as good start as protected titles. They are both kitemark schemes that are only as good as the general public’s understanding of them, only suitably regulated practitioners are allowed to use the relevant kitemark so if people know what to look for they are protected by them. From the public’s point of view the only difference between accredited registers and protected title’s is the kitemark they need to look for.
Protected titles without considerable follow up investment in publicity would leave us with a marginally better ineffective regulatory framework than the one we have today. Protected tiles with considerable follow up investment in publicity would improve regulations, but it wouldn’t achieve anything that couldn’t be achieved by similarly adequate investment in the current system of Accredited Registers.
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I appreciate your perspective Patrick. I tend to think there are significant differences in how people approach looking for a footcare specialist and mental health practitioner. But I do take your perspective on board and I thank you for engaging with my blog.
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Hi Erin, just wanted to let you know that the NCS link in this post is no longer valid – I think the web pages which have position statements and policy news are continually updated to show only the most recent information, which means that you can’t bookmark anything specific.
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Ah thank you, yeah, that’s annoying that I seemingly can’t link directly to the article I’m referring to. I appreciate you letting me know about it.
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