31 December 2016

A framework for New Years Resolutions?

I wonder how many people are setting themselves some resolutions this year? What is the drive behind the choices they make? Are people attempting to make changes because they are critical of themselves? "I'm too (insert word here)", "I'm not (insert word here) enough", "I should/shouldn't be (insert word here)"?

How about a framework for making resolutions?           

How about basing the choices you make on something fundamentally meaningful?

I propose that Bronnie Ware's famous list of "Top 5 Regrets of the Dying" could be a great way of defining resolutions that will ultimately make a difference to the quality of our lives. Bonnie has shared what she discovered as a nurse in palliative care. Her findings, which she has extended into a book on the subject, are as follows:

1. I wish I’d had the courage to live a life true to myself, not the life others expected of me.
This was the most common regret of all. When people realise that their life is almost over and look back clearly on it, it is easy to see how many dreams have gone unfulfilled. Most people had not honoured even a half of their dreams and had to die knowing that it was due to choices they had made, or not made.
It is very important to try and honour at least some of your dreams along the way. From the moment that you lose your health, it is too late. Health brings a freedom very few realise, until they no longer have it.
2. I wish I didn’t work so hard.
This came from every male patient that I nursed. They missed their children’s youth and their partner’s companionship. Women also spoke of this regret. But as most were from an older generation, many of the female patients had not been breadwinners. All of the men I nursed deeply regretted spending so much of their lives on the treadmill of a work existence.
By simplifying your lifestyle and making conscious choices along the way, it is possible to not need the income that you think you do. And by creating more space in your life, you become happier and more open to new opportunities, ones more suited to your new lifestyle.
3. I wish I’d had the courage to express my feelings.
Many people suppressed their feelings in order to keep peace with others. As a result, they settled for a mediocre existence and never became who they were truly capable of becoming. Many developed illnesses relating to the bitterness and resentment they carried as a result.
We cannot control the reactions of others. However, although people may initially react when you change the way you are by speaking honestly, in the end it raises the relationship to a whole new and healthier level. Either that or it releases the unhealthy relationship from your life. Either way, you win.
4. I wish I had stayed in touch with my friends.
Often they would not truly realise the full benefits of old friends until their dying weeks and it was not always possible to track them down. Many had become so caught up in their own lives that they had let golden friendships slip by over the years. There were many deep regrets about not giving friendships the time and effort that they deserved. Everyone misses their friends when they are dying.
5. I wish that I had let myself be happier.
This is a surprisingly common one. Many did not realise until the end that happiness is a choice. They had stayed stuck in old patterns and habits. The so-called ‘comfort’ of familiarity overflowed into their emotions, as well as their physical lives. Fear of change had them pretending to others, and to their selves, that they were content. When deep within, they longed to laugh properly and have silliness in their life again.
(NB This list is taken from Bronnie Ware's site)
So how might a list of resolutions look using this as a framework?
1) Make a list of things you want to do in life and plan roughly when those things can be achieved. Make one of those things happen this year.
2) Find a better work/life balance. Try a session or two with a counsellor or life coach or read a book on the subject. Watch some Alan Watts lectures. Here's a great one.
3) Find a way to be able to express your feelings. Confide in friends. If you struggle to express yourself then try some sessions with a counsellor to learn how to express your feelings. We all have them. We haven't all had the opportunity to learn how to express them.
4) Dig out your old address book and make contact with people you stopped sending Christmas cards to years ago. Or look at those that you send a quick one-liner to and write an actual letter. Arrange to meet up with at least one old friend this year.
5) Allow yourself to experience happiness. If guilt or shame are getting in the way then find a therapist to work through those feelings. Everyone is entitled to feel joy. Find something joyful that you can do this year. Join a group, buy yourself something silly but fun. This doesn't have to be expensive. I got a lot of joy out of buying an old copy of Ladybird Cinderella which I absolutely loved as a kid. It was a few pounds on eBay. I still drool over the three frocks she got to wear in that edition.
Final note
I do not want to make light of the real struggles that some people face and loss, poverty and ill health as well as discrimination can have a very negative impact on our experience of life. This article is meant to highlight those things that we potentially do have a choice in, although not all of us will be able to make those choices. I remain sensitive to that.

30 December 2016

Top 5 Lifestyle Tips - Things to do Alongside Counselling

(Originally published 7th August 2013)

Counselling is usually for one hour, once a week, for a set duration. That leaves a lot of time spent outside of the counselling room, with the issues that brought a client there perhaps not changing an awful lot between sessions. So I sometimes advise on what steps a client can take to assist the counselling work and help them achieve their goal of overcoming grief, depression, unwanted patterns of behaviour or relationship issues.

1. Take up Meditation

The West is catching up with what the East have known for millenia. Meditation is good for the mind, body and soul. Pretty much everybody has heard of meditation but in the past it has had an air of hippiness or religiousness about it, but even the NHS has caught onto the benefits with the Western-friendly concept of mindfulness (click here for an interesting post exploring the differences/overlaps between meditation and mindfulness).

Here is a short video done by a chap called davidji who succinctly and quite persuasively explains some of the benefits of meditation in this short (2:15min) video (click here if it does not show up on your device):

If you need any more persuasion, try this link from The New York Times regarding research in meditation and how it effects the brain. 

You can start off by trying a guided meditation CD or looking on YouTube for a taster. 

2. Keep a Journal

Keeping a personal journal was a requirement of my training. We had to bring in our journals from time to time to show the tutor that we were writing in them regularly. I really learnt the benefits firsthand of writing down parts of my process. There are a few reasons for why it was so useful:

  • Expressing frustrations without offending anybody
  • Consolidating work done in personal therapy (another requirement of my training)
  • Being able to look back and chart personal growth
  • For visual learners - reinforcing what you have learnt 

Some of my clients keep a journal and write reflectively in between sessions. Sometimes, they might bring some of their thoughts to the next session. There are no rules about what's right or wrong in this respect - each person is different. What I can say though, is that those that keep journals tend to need less sessions overall. This is a hard thing to quantify, but it seems to me that the work is more "efficient" and it keeps us more on track if the client does this work between sessions.

Making a note of any dreams can create fruitful work too. It is quite common for clients to have a highly symbolic and powerful dream the night before a session.

3. Take up some aerobic exercise 

Exercise raises endorphin levels in the brain. Endorphins contribute to our sense of well being, as well as being natural painkillers. Regular exercise will help you to feel fitter and help you get into shape, to feel healthier and better about yourself. Read this NHS article for more information on the relationship between exercise and depression. I wouldn't go so far as to say that exercise can cure depression, but it can help alleviate the symptoms by letting the body access it's natural, feel good hormones.

Aerobic exercise is the kind that gets you out of breath, so walking would need to be to the point that you struggle to speak and get sweaty. Swimming would need to be pushing your limits. Running and strenuous sports such as tennis and squash would count as aerobic exercise, as well as many cardio-based gym classes.

4. Take up yoga, pilates or martial arts

Although these are also described as exercises, I have separated them from aerobic exercise because the benefits are different (although strenuous yoga or martial arts will yield cardio benefits too). The benefits of these forms of exercise are that they strengthen the mind and body connection. These activities require a lot of learning, so the challenge is mental as well as physical. By doing these kinds of activities you can create the space to make changes in areas of your life where you are struggling. It is easier to break old habits if you harness your brain's ability to reshape it's neuronal networks by contunued learning. Joe Dispenza writes extensively about this in his book Evolve Your Brain, which I write about here, along with the reasons why I began to learn a martial art.

5. Pay attention to diet

I am not a nutritionist but I have long been interested in dietary matters. I believe that many people would feel a lot better if they had a dietary overhaul. Sometimes, I enquire about food habits with clients as a poor diet can lead to mood swings, difficulties with sleeping and the worsening of the symptoms of depression, anxiety, the menopause and pre-menstrual tension.

I have had a few clients give up caffeine, or at least cut down, because caffeine can induce anxiety in some people, and cause insomnia in others. Alcohol can lead to depression and anxiety the day following consumption. Many people do not realise the connection between what they eat and their subsequent mood. A food diary can help.

An interesting book to read on the subject is Patrick Holford's The Optimum Nutrition Bible. If you can get half way to eating the way he suggests you'll probably feel a whole lot better.

Amanda Williamson is  BACP Registered Senior Accredited private counsellor and coach working in Exeter, Devon. 


10 November 2016

Alain de Botton's response to post USA election fallout

Whether you were for Trump, Clinton, other or no one, there is no doubt that the recent USA election has had a profound impact on many individuals and on our collective psyche. The post-Brexit fallout was certainly something tangible in my therapy room and post US-election angst is, unsurprisingly, cropping up this week.

On a general note I have noticed this general state of unease can make us feel incredibly vulnerable and we can go into a more child like state. Our historical psychological tendencies might pop out during these precarious times. This can be seen all over social media with people exchanging either Critical Parent or Adapted Child responses rather than retaining an adult position. I have found myself drawn into it and it's sometimes a challenge to keep the frontal lobe switched on and calm down the amygdala before responding to an inflammatory comment.

Amongst the Facebook responses to the election I saw the following post by Alain de Botton, author and co-founder of The School of Life, which I found some comfort in. I found comfort in his belief that facing reality is the only way to navigate reality, in his assertion that optimism is not always healthy, helpful or appropriate and in his vision for us to engage our frontal lobes and think longterm.

As a therapist with a distinctly existential edge...actually as a person with a distinctly existential edge, I wanted to share those words and hope that others also find similar, authentic comfort.

With kind thanks to Alain de Botton for permitting me to share directly on this site.

It is an enormous and very rare privilege to have lived in the days of good government. Across nations and centuries, few people have ever done so. By a rare bit of luck, certain groups in a few corners of the globe tasted decades of this remarkable, anomalous blessing. They might, foolishly (especially if they travelled little, seldom read history books or had a very high estimation of their own populations) even have started to assume it was a natural or god-given norm. Yet the default state of almost all nations is quite other, it is authoritarianism, bullying, demagoguery, corruption, monopoly, racial segregation and state sponsored aggression and murder. We will not now, it seems, be living in dramatically unusual times; it was the years before that will be remembered as unusual: a daring bet against the facts of our nature. We aren’t sliding into a new age of darkness, we are reverting to a mean. Civilization was always, simply, an unlikely concept.
Those who are afraid are typically reassured by optimism: all will, eventually, be well, the kindly tell them. But we need stiffer and darker counsel. We should explore not what might ideally happen (which leaves us oscillating painfully between hope and despair), but what will happen if the worst comes to pass. We need to make ourselves entirely at home with catastrophe, looking it squarely in the eye - so as not to keep catching glimpses of it here and there and so taking fright anew every time. We stand to see that whatever comes to pass will, in a desperately reduced and pitiful form, still be survivable. A home could be built among the ruins. There might be some sort of life to be led, despite everything. Nothing is ever properly unbearable, not least because we always retain access to the best escape route. The Stoic philosophers of Ancient Rome, those pour souls agitated beyond compare by the the antics of their hysterical, thin-skinned murderous Emperors, were known to calm themselves down by holding up their veins to the light and calling out ‘Freedom!’ - knowing it could, if it came to that, all be over in minutes. 

We shouldn’t be surprised by our fellow citizens. That is what the human animal is really like: very sweet at points from close up, usually generous to small children and the elderly, hard-working, but highly prone to delusion, tribal, offended by strangers, uninclined to rational analysis and with a fondness for slaughter and reckless messianic plans. The elite, routinely derided as ‘out of touch’ are not so on the basis of forgetting how much milk or the rent costs, rather on the basis of forgetting how dark and fragile human nature is.
There’s a natural longing to do something quickly and angrily. There’s an equal longing to give up and hide, the counsel of quietism. Neither feels right; neither endurance nor explosion. The only true avenue is to commit ourselves to years of careful, adroit plotting to bring about a renewal of that now ever more implausible dream: a land governed for a little while longer by a spirit of wisdom and love.

7 September 2016

Revisiting the Accreditation Confusion

Back in February 2015 I wrote an article entitled "Accredited This, Accredited That" in an attempt to address the confusion in our profession about the use of the word Accreditation to describe counsellors and psychotherapists. We have therapists accredited by the BACP, therapists accredited by the National Counselling Society involving a quite different set of criteria and we have therapists who are on an Accredited Register who may or may not have accredited status. 

In that article I questioned the Professional Standards Authority and they offered the following:

"The Professional Standards Authority is aware of the potential for confusion in the different uses of the word ‘accredited’. We are working closely with the Accredited Registers to prevent this confusion by providing clear information to the public. This will include a guide to different types and levels of qualifications in health and care, which we will publish in the coming months."

Counsellor and Psychotherapist Accreditation

The British Association for Counselling and Psychotherapy (the BACP, at that time the BAC) introduced the concept of accredited membership back in 1983 and for a number of years it has been used to separate a tier of members who have been through their accreditation application process involving set criteria above and beyond the basic membership. The criteria is currently as follows(1):

To apply for BACP accreditation, you must: 

Be a Registered Member of BACP 
Have successfully completed a BACP-accredited or other appropriate professional training of at least 450 hours
Have been in practice for at least three years and completed a minimum of 450 supervised practice hours 
Have an ongoing supervision arrangement in place for 1.5 hours per month
Be covered by professional indemnity insurance

You will need to complete an in-depth application providing evidence of your training, practice and supervision. This includes a reflective practice section, asking you to write about your understanding of what you do, using examples from your practice. 

In contrast we have the National Counselling Society (NCS) accredited membership level which requires the following (2):

Accredited Membership is awarded to a member who has successfully completed one of the following:

A National Counselling Society Accredited Course at Ofqual Regulated Qualifications Framework (RQF) Level 4 or Ofqual RQF/Framework for Higher Education Qualifications(FHEQ) Level 5 or equivalent
A full qualification in counselling or psychotherapy practice atOfqual RQF Level 4 or Ofqual RQF/FHEQ Level 5 or equivalent which complies with the Society's currently published standards of training

There is also the facility to apply for membership without these requirements based via a complex committee.

The accredited status of these two professional bodies for counselling and psychotherapy is clearly different. Added to that we have had, since 2012, the existence of the PSA's Accredited Registers adding a further type of accreditation into the mix.

The confusion has been the source of ongoing confusion within the profession and not just amongst service users. I have participated and observed many online discussion on counselling forums with what sometimes amounts to petty spats and resentment between BACP and NCS members.

I asked Phil Doré , author of the blog Unsafe Spaces what he thinks about this issue:

Looking at all the differences in types of registration and accreditation - I'm a mental health nurse, I have an interest in psychological therapies, I read and write about the different professional bodies - and these differences make my head spin trying to make sense of it. So if it does that to me, what does it do to a lay person? Would a lay person even know that there's a difference between BACP Registered, or BACP Accredited? Or between BACP Accredited and NCS Accredited? Let alone know what those differences are. Also it's important to bear in mind that when people are accessing counselling or psychotherapy, they're often experiencing a mental health condition, often at a period of crisis in their life. It's simply not a time when they should be expected to parse information that's as clear as mud to begin with.

This is pretty much how I feel about it too.

The PSA, BACP and NCS's responses to this issue

I wrote the following to the PSA:

I wrote a blog post in February 2015 where I asked the PSA for their response to the fact that there is a lot of confusion around the word accreditation in the counselling and psychotherapy profession. There is a substantial amount of confusion amongst professionals too would appear from various online discussion groups. 

I was told by the PSA back in Feb 2015 that they would be working on clearing up the confusion and I would like to have an update on this as it still an issue. I have been involved in a discussion only today on a counselling practitioner's forum.

They responded within 5 days:

Thank you for your enquiry regarding usage of the term ‘accreditation’. Since your blog post of February 2015, we have updated one of our Standards, specifically Standard 9e, which states that the organisation must ‘make its education and training standards explicit and easily accessible to the public to enable all those using the register to make informed decisions’. The assessment of this additional Standard started in April 2016 for both new applicants and existing Accredited Registers submitting their annual review of accreditation.

When registers are first accredited, we provide them with a communications toolkit with clear guidance on how to share information on their new accreditation status with the public. In this, we ask that they make it clear that it is they, the organisation, which is accredited and not their individual members (which distinguishes it from the BACP’s system of accreditation, for example).

We are aware that the terms ‘accredited’ and ‘accreditation’ are both widely used in healthcare as well as many other professional and public sectors. We addressed this in our original formal consultation and it was agreed that this was still the best descriptor for the programme.

I then wrote the the BACP and the NCS as follows:

When I applied for BACP Accredited status 2 years ago I was unsure about whether it was worth it with the ARs in place although decided to proceed for the professional development and personal validation that the process entails i.e. the self-reflective essays and defining of my approach. BACP Accreditation has also been nationally recognised as a mark of a particular level of experience (3yrs post qualifying and 450+ hours)

There is much confusion between therapists about the value of BACP Accredited member status. Added to that we have the National Counselling Society's Accredited member status that, as far as I can, requires significantly less experience and written work to apply for. I have seen numerous arguments on therapist forums where some believe that NCS Accred status is the same thing as BACP Accred status. NCS therapists seem to express concern that BACP therapists think that they are somehow better than NCS therapists if they point out the difference in criteria and BACP therapists are perturbed by the perception that their Accredited status is potentially being devalued in some way by it being stated that they are like for like. I can appreciate both view points.

This is all secondary though to the main issue, whichever emotions are provoked within (and without) the profession, which is that since the creation of the Accredited Registers we now have a confusing situation around the use of the word accredited which as far as I am aware, is not being addressed by the BACP, NCS or PSA.

I wrote to the BACP on 1st June and after some chasing up I received an apology for the delay in replying along with a response on 19th July from Helen Coles, Head of Professional Standards:

We agree that there is confusion as the same or similar titles are used for professional counsellors/psychotherapists in different contexts by different organisations.  To some extent such confusion is inevitable given the small number of words to indicate similar professional statuses. `Accreditation’ and `Registration’ are not protected titles.  What this means in practice is that any organisation can use them as a descriptor.  As well as BACP  and NCS there is UKCP’s registered status (as distinct from being on UKCP’s PSA Register) and NCP and BABCP use their own terminologies.  Perhaps I should also point out that counselling is not the only industry (accountancy is another) served by a number of professional bodies.

BACP is working more closely with other therapy bodies, including UKCP, which provide fora for addressing such confusions.  We also have regular contact with the PSA and were heavily involved in discussions about setting up the Registers.  However it is important to recognise that other therapy bodies and the PSA are all independent organisations, making independent choices about the choice of titles to reflect different statuses and in the case of the PSA, using the word ‘accredited’ to describe the Register programme.  BACP is always willing to meet other bodies and discuss such issues, while recognising it can influence, but not order.

As BACP it isn’t appropriate for us to comment on the quality (or not) of the schemes of other therapy bodies.  The requirements for PSA registers are well publicised, enabling people to make their own judgment on quality.  We would never encourage members (accredited or otherwise) to imply that members of some other professional counselling/psychotherapy bodies are of a different standard, but that does not negate our pride in our Accredited Members.

We are proud of the quality of BACP’s Accredited members and the BACP Accreditation scheme. A well-established, longstanding scheme, its quality is recognised by therapists, government, the NHS, employee assistance programmes and a wide range of counselling employers.  The requirements of the scheme are well publicised, as is guidance on making applications, allowing all to form their own judgment about its worth.  The demand for accreditation by counsellors and psychotherapists is steady.  Because of this wide recognition as a quality kitemark we would be reluctant to have no current plans to  change the title.

I wrote to the NCS somewhat later on 1st August and received a response from their interim CEO, Jenny Parker on 16th August:

Thank you for your email and apologies for the delay getting back to you. The Society is restructuring our membership grades at the moment, and the standards of registration and accreditation will change in 2017.  Accordingly there is little point in our answering your queries until these changes have taken effect.

This is a new and interesting development and I do wonder whether they will be looking to bring their level of accredited status more in line with the requirements of the BACP.

Further opinions

Roslyn Byfield, a BACP Accredited counsellor working in Central London, also has concerns around the use of the word accreditation in the profession:

The BACP Ethical Framework is clear that adherents must not misrepresent themselves or their qualifications - a no-brainer, you could think, as this would constitute dishonesty, the opposite of what counselling and therapy stand for.

But unintentionally or otherwise, this could be happening due to widespread confusion about qualifications terminology. It could be argued that professional and standards bodies have been short-sighted in not anticipating the confusion which could arise between being an accredited member of an organisation and being on an accredited register (but not personally accredited). Since it’s well-known that there is still public confusion as to the roles of and differences between a psychotherapist, psychologist and psychiatrist, it follows that there is potential for more confusion when it comes down to the detail of levels of qualification.

Recent exchanges on counselling forums have shown that some practitioners are suggesting they are ‘accredited’ when, in fact, some are on the BACP register (accredited by the Professional Standards Authority) as a registrant or they are ‘accredited’ by the relatively new body, the National Counselling Society, the requirements of which are not comparable with BACP accreditation. Understandably, those who have gone through the rigours of BACP accreditation do not wish their qualification to be confused with one which is not comparable in terms of work, learning and reflection required. In addition some Senior Accredited BACP practitioners are aggrieved that the register icons, which since March 2016 must be included in practitioners’ websites and literature, do not include one for the senior accredited category (the two are for BACP registered and BACP registered and accredited).

This situation could easily result in some practitioners telling clients and potential employers that they are ‘accredited’, when in fact that is not the BACP accreditation which would be assumed by many.

To make the provisions of the Ethical Framework meaningful, BACP and other relevant organisations including the NCS should take steps to clarify this situation and issue advice to members and the public to prevent such confusion arising. BACP could also produce a third icon, which Senior Accredited practitioners could use in their marketing materials. If this situation continues unaddressed, it risks bringing the Ethical Framework and the profession into disrepute.

And finally, I requested some input from peer Patrick Killeen, a philosopher trained in counselling skills who has contributed to this blog before.

The British Association of Counselling and Psychotherapy (BACP) has a strange quirk in the way it uses the word “accredited” that can be summed up in one sentence.  You don’t have to be an “Accredited Member” of the BACP to be an accredited member of the BACP.  This anomaly stems from the difference between the standard English meaning of “accredited” and the jargonistic way that word is used within the BACP.

According to Google “accredit” means to “give authority or sanction to (someone or something) when recognized standards have been met”. The BACP have a register of counsellors and psychotherapists which they say is “a public record of therapists who have met our standards for registration” [http://www.bacpregister.org.uk]. So by including someone on their register the BACP are literally accrediting them.

However, they don’t include Registered Membership in their so-call “accreditation” programme, instead they refer only to “Accredited Membership” and “Senior Accredited Membership”.  They clarify the situation by saying “BACP accreditation is a quality standard for the mature, experienced practitioner who can demonstrate high standards of competent and ethical practice” (my emphasis) [http://www.bacp.co.uk/accreditation/Individual%20Practitioners].  So “Registered Membership” accredits all counsellors including the newly qualified, while “Accredited Membership” and “Senior Accredited Membership” only accredits experienced counsellors.

This idiosyncratic use of the word “accredit” has become an issue recently because the BACP’s register has itself been accredited by another organisations, the Professional Standards Authority (PSA), and so anyone on the BACP register can now say that they are a member of the BACP’s Accredited Register, even though they may not be an Accredited Member of the BACP.  A state of affairs that some might find more than a little confusing (even though the underlying situation is quite straight forward: registered members are accredited by the BACP and the BACP’s register is in turn accredited by the PSA).  

The BACP could clear this up by renaming the membership categories to make their use of the word “accredited” more consistent with standard English, for example by renaming “Accredited Member” as “Accredited Experienced Member”; but that would stir up a lot of trouble among their members.  For years there has been a strong cultural expectation within the BACP to become an “Accredited Member” as soon as possible after joining.  They never had a rule saying you must do so, but by withholding the word “accredited” and the public acknowledgement that goes with it they were able to get a high uptake of their “accreditation” scheme without the messy business of making and enforcing official rules.  There’s no way for the BACP to resolve the “accreditation” ambiguity without admitting explicitly that (although it is worth it for its own sake) members don’t, and never did, actually have to become “Accredited Members”.

If you have any comments regarding this please comment below. These things get discussed on Twitter and Facebook forums and the arguments therefore get strewn about. The organisations mentioned above will read the comments here so please comment here if you want to be heard.

(2) http://www.nationalcounsellingsociety.org/join/criteria/levels/  
(NB This link no longer work as checked on January 2024)

22 August 2016

The Ongoing Battle of Protecting Clients from Struck off Therapists

Someone recently sent me an email following a series of Tweets I made requesting that Torbay and South Devon NHS Trust stop signposting to Palace Gate Counselling Service, an Exeter based counselling agency struck off by the BACPThe email contained the following words:

"Do you ever feel like it's an ongoing battle for an appreciation of the seriousness of what you and others endure? Without people like you persevering and getting the message out there publicly where would things be?"

Well yes. It absolutely feels like an ongoing battle. I first tried to ensure that the NHS stopped signposting patients to the Palace Gate Service over two years ago via my local Medical Committee as it had been brought to my attention that various NHS locations were continuing to signpost to Palace Gate Counselling. On their advice I sent the following email to the British Medical Association in October 2014:

Dear Sir or Madam

I am writing to you at the suggestion of Devon Local Medical Committee who felt unable to assist me. They were originally considering publishing an article for their newsletter after I raised concerned about local GP surgeries continuing to refer NHS patients to an Exeter based counselling agency who had BACP membership removed twice for unethical behaviour  under two separate complaints. They decided that it was not the correct forum and suggested I try higher up.

I heard just a few weeks ago that ISCA Medical Practice in Exeter were still sending clients to the struck off agency. My own (GP) practice manager had no awareness of the issues. Yet Devon Primary Care Trust had sent this message to their Depression and Anxiety Service staff:

No further signposting or referrals to Palace Gate Counselling Services

We would like to inform all staff that counselling services run by Palace Gate Counselling have recently been investigated by the British Association of Counsellors and Psychotherapists (BACP) due to alleged improprieties.
The BACP Professional Conduct Committee found that the company were in breach of their ethical framework on thirty counts. This has resulted in their membership of the BACP being withdrawn.
The findings of the report can be found here.
This is a serious situation and as a result the Trust cannot support signposting or referral of people accessing our service to Palace Gate Counselling. This will cease with immediate effect.
Please note that this notice does not include CRUSE who are also based at Palace Gate.

Surely somebody is responsible for ensuring that GP's stop sending clients for therapy with therapists that have no accountability and have been removed from a professional register (twice)? 

I have done pretty much everything in my power to try and highlight this situation. I am campaigning for the statutory regulation of counselling and psychotherapy which won't happen for years, if ever. In the meantime we have a situation where many NHS patients are seeking counselling outside of the NHS. The NHS choices page on counselling does not mention to patients that counselling is unregulated and that the onus is on them to check the credentials of their therapist. I believe that it is unethical to promote counselling as a treatment but not advise patients that they could end up seeing somebody who is unqualified and unregulated. I believe it to be irresponsible to have GPs refer patients to a service that has been proven to act unethically.(1)

I would very much appreciate somebody looking into this matter.

I received the following response:

As you may know, the BMA is a professional association and trade union for doctors in the UK.  We are neither a clinical nor regulatory body, and as such we don't have a role in advising practices about local referral policies.  
However you might like to contact NHS England for further advice - they could direct you to the relevant local Area Team.  Similarly, the local Clinical Commissioning Group (CCG) would be another useful source of information regarding local referral policy in your area:

NHS England: Tel: 0300 311 22 33; Web: http://www.england.nhs.uk/

  • NHS Northern, Eastern and Western Devon CCG:  Tel: 01392 205 205; Web: http://www.newdevonccg.nhs.uk/
  • NHS South Devon And Torbay CCG: Tel: 01803 652500; Web: http://www.southdevonandtorbayccg.nhs.uk/Pages/default.aspx

Finally, you could raise your more general concerns about the way in which the counselling profession is regulated with the Government, and your local MP might be a good starting point for this.  

While we are unable to advise directly, I hope this information is helpful.  

As it happens I had already written the same email to NHS England who responded as follows:

Thank you for your email to NHS England.

I advise that NHS counselling services are not commissioned by NHS England, rather they are commissioned by local Clinical Commissioning Groups (CCGs). If you wanted to raise a concern about counselling services commissioned by the NHS in your local area, I would recommend that you contact your local CCG NHS Northern, Eastern and Western Devon CCG.

However, I also understand that you are concerned about GPs in your area referring patients for private counselling services that both you and the BACP have considered to be substandard. I have highlighted your concerns with the Primary Care Commissioning team at your local NHS England Area Team, as they are responsible for commissioning GP services in your local area.

Regarding professional regulation, you may find this document (now broken link Jan 24) produced by the Law Commission useful. I would recommend that you discuss any suggestions regarding changes to health and social care legislation with the Department of Health, or highlight your concerns with the Professional Standards Authority.

I hope that this information is useful to you.

I followed the advice within and sent the same details to my local Clinical Commissioning Group who responded thus:

Thank you for your email, as GP’s within Devon are commissioning by NHS England I have forwarded your email to their Local Area Team and they should be in contact with you directly.

I didn't hear anything following this. Fast forward some 20 months to June 2016 and it is brought to my attention by a journalist that NHS Torbay and South Devon Trust have continued to signpost patients to Palace Gate Counselling Service via an online document which was updated only a month before. So I sent a further email to my local Clinical Commissioning Group:

You sent me this message around 18 months ago and I have still not been contacted by anyone regarding this matter. I have today been notified by a journalist that a Devon NHS trust is still advertising the services of the counselling agency on an online resource updated just a few months ago. Basically, the NHS is endorsing a proven unsafe counselling agency. I am not prepared to let this go on.

And guess what? I received no response. Which is why I eventually Tweeted as Tweeting does seem to be an effective way of getting organisations to listen. Lo and behold, my Tweet led to the following email being sent to me by the department at NHS Torbay and South Devon Trust responsible for the leaflet in question the day after they saw my Tweet:

One of my colleagues has forwarded me your message on Twitter regarding Palace Gate Counselling Service.  As BACP have found the service guilty of serious professional misconduct we have now removed details about it from our information.  We weren’t unfortunately aware of this before, otherwise we would have removed the details earlier.

So finally, I have managed to get yet another source of referrals to this struck off agency removed. I have also had to contact the Citizens Advice Bureau and a local Church to ask them to stop referring, even though they had both received a statement from a large group of local counsellors. 

And yet despite all this the organisation continues to operate. The counsellors working there receive their supervision from the two directors who's behaviour got the agency struck off. Clapham and Talbott carry on practising. They can continue to sing their own praises and attract clients via the Palace Gate Counselling Service Twitter and Facebook pages. This is totally legal.

Why do I have to work so hard at making sure that the NHS are not signposting patients to this struck off service? Why do I bother? I bother because I have a duty of care. I bother because I receive messages from alarmed people who see me as a point of contact, as the person who will alert the appropriate organisations. On occasion I have become quite resentful that people don't seem to be prepared to do it themselves but would rather send me an email and leave it with me to sort out. What about other people's duty of care? What about the NHS' duty of care? Why do I feel like I am shouting into the void much of the time? 

Even after all this and Tweets being sent direct to Exeter Sessional GPs they continue to list Palace Gate Counselling Service in their online resource pack.

Should I give up? Is it a waste of time? And let's not forget that I have received various legal threats from the directors of Palace Gate Counselling that I will be sued if I go public with the complaints.

And so we return to the words sent to me recently:

"Do you ever feel like it's an ongoing battle for an appreciation of the seriousness of what you and others endure? Without people like you persevering and getting the message out there publicly where would things be?"

Without people like me nothing would change and many more people would be at risk of the abusive behaviour that I and others have challenged. Sometimes I really want to give up. Except I take the safety of clients in therapy very seriously. 

(1) I am pleased to say that the NHS web page on counselling does now mention the Professional Standards Authority Accredited Registers. I do have huge doubts about the efficacy of the AR's as a way of protecting clients/patients but it is a step in the right direction.

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