22 June 2013

Regulation of Counselling and Psychotherapy - What the Public Want



5TH MAY 2016: PLEASE READ THIS POST REGARDING THE PAPER DEMONSTRATING THE NEED FOR REGULATION: http://www.amandawilliamsoncounselling.co.uk/2016/05/regulation-of-counselling-and.html

As many followers of my Facebook/Twitter/blog are aware, the issue of the regulation of counselling and psychotherapy is close to my heart. I have always seen the sense in being part of a body such as the BACP (the British Association for Counselling and Psychotherapy) in order to support my practice and for the opportunity of support for my clients. During my training I attended a BACP Accredited Course at the Iron Mill Institute in Exeter which is known for being a highly professional and ethical training establishment. The advantages of the safety net of regulation was clearly explained to us and underpinned our learning.
As far as I’m concerned, regulation seems to be an obvious requirement for those working with clients who are going through emotionally difficult and more often than not, painful processes. Unfortunately, as in every profession, there are a few rotten apples. Equally, there are some that make genuine errors of judgment (therapists are human beings after all) and an external perspective is required sometimes, first and foremost for the protection of clients,  but also for the professional development of therapists and for the protection of the profession as a whole.

However, the counselling and psychotherapy professions are not currently regulated by law. Currently there only exists voluntary regulation; counsellors and psychotherapists can elect to be a member of  a professional organisation such as the BACP or the UKCP.  
Recently there has been a new register launched by the BACP which is accredited under a new scheme set up by the Department of Health, and administered by the Professional Standards Authority. A peer, Rinske Goettsch has written a post on this register here. Hopefully, if publicised enough, this will assist in the decision making process for those looking for a private counsellor. It does not, however, afford the same protection as that of statutory (compulsory) regulation. As the Professional Standards Authority website states:

"The main purpose of the scheme is to enhance public protection and raise professional standards. The Authority sets high standards for organisations holding voluntary registers and accredited registers require their registrants to meet high standards of personal behaviour, technical competence and where applicable, business practice. This requirement will enhance public protection but it does not have the power to bar people from working in the same way that statutory regulation can."

There are a number of therapists who strongly oppose regulation. Some of them are worried that regulation will impede creativity within therapy. I struggle to see this viewpoint. I suppose the problem here is the definition of the word regulation, or the interpretation of the word, and also what shape the actual regulation takes. As a therapist who chooses voluntary regulation with the BACP, my experience of regulation within that context is that I can practice in my own unique way, with some parameters and expectations (correlating nicely with my favourite Sartre quote: "Freedom is what you do with what you've been given"). I commit to continuing professional development (minimum requirement is 30 hours a year - always exceeded), regular supervision (I exceed the minimum requirement, sometimes double it up when going through difficult times) and choose to be accountable for unethical practice. How hard can this be? I also commit to adhering to the BACP Ethical Framework for Good Practice in Counselling - a very well written document that allows the freedom of creativity within the work, whilst holding some clear boundaries about what is and what isn't okay to do as a therapist. 

Why do I care so much?

Now, I am all fired up and passionate about this issue because I have fallen victim to what I consider to be unethical practice by a therapist. He isn't a member of a regulatory organisation and unfortunately, there are several other women of whom I am aware who are also claiming that he has conducted himself inappropriately. I can imagine why this man is anti-regulation.  I am also aware that I may have a skewed perspective on what I think is right for everyone. Having been stung by my negative experience, and simply from being self-aware, I know how easy it is to see the world through one's own eyes. It is much more difficult to see the bigger picture, when you have you're own little realm of experience that impacts deeply on your perspective.

I need to know more!

So I have been mulling over doing some research, much like that I did last year on client's autonomy in deciding the frequency of sessions. Earlier this month I attended a marvellous workshop on Relational Depth, held by Mick Cooper at Exeter Cathedral. Mick Cooper co-wrote a book that was very influential on my second year of training, when I was honing my approach (Working at Relational Depth, by Mick Cooper and Dave Mearns). I have blogged about the workshop separately as it deserves it's own post. During the workshop, Mick told us to approach him at break times if we wanted to ask him about anything. I was wondering whether to do a poll at the Exeter Respect Festival the following day, and I was musing as to whether it would be useful to do one to find out the public's stance on regulation. Part of Mick's talk was about how we, as therapists, could look at extrapolating our therapeutic approach to our relationship with the profession, not just our relationship with our clients. A truly person-centred way of viewing the profession would be to ask people what they want, and what they think will be helpful, rather than assuming what works. This is an humanistic honouring of our uniqueness (clients and therapists!). This is about the philosophy of pluralism and in fact, Mick wrote a book with John McLeod on Pluralistic Counselling and Psychotherapy.

So during the lunch break I approached Mick and asked if I could get his thoughts on the regulation of the industry. He generously invited me to sit outside whilst he ate and we discussed what I had in mind. I told him that it was a topic close to my heart due to a challenging situation regarding my ex-therapist, but that I wanted to get a broader view of the topic. Mick made a very important point, which seems so obvious now that I've heard it. He pointed out that there are groups of therapists arguing about this topic but that what really should matter is what the public, the clients, actually want. Mick said that he "sat on the Psychotherapy and Counselling Professional Liaison Group, which was drawing up a proposal for regulation of the field by the HPC – which was never accepted by the government in the end. There was a lot of criticism of the group by people opposed to statutory regulation".

This takes me back to August 2012, when I was in contact with somebody closely associated with the Derek Gale case. He told me that it took four years to bring the rogue therapist to any kind of justice. More can be read about the case here. He was struck off the UKCP and HCP (now HCPC) registers (although the UKCP took 3 years to do so), but this does not prevent him from being able to continue as a psychotherapist if he so chooses. The person I spoke to pushed for statutory regulation at the time but became jaded after receiving hostility and intimidation from those fiercely against regulation. This hostility amongst the therapeutic community saddens me. The charity MIND wrote a short piece on Gale and the problems of regulation here. Nothing much has changed in almost 4 years, and the new voluntary BACP register doesn't mean much if the UK public don't know anything about it.

Howard Martin, one of the complainants in the Derek Gale case orginally campaigned for statutory regulation but was jaded by the process:

"I was the original complainant in the Gale case, however while I support a charity that works with survivors of abusive therapeutic relationships and other toxic groups I no longer overtly campaign for the legislation of psychotherapy. I found that the depth of corrupt practise within all disciplines so ingrained and at such a high level that for outsiders like myself it was just too time consuming and emotionally draining. "

The charity Howard refers to is Catalyst Counselling, run by Graham Baldwin who specialises in helping people disengage from abusive relationships such as cults or abusive therapists.

The research

The decision was made; this year's Respect Festival poll would be to discover what the public think about statutory regulation. Do they feel the same as me? Do they care either way? I came up with the following way of posing the question to the public:

Should Counselling and Psychotherapy be regulated professions?

Therapists have been in debate regarding this issue for many years. Some are
staunchly for regulation, some are staunchly against.

I would like to ask THE PUBLIC their opinion, to help inform therapists.

Q: How important is the statutory (compulsory) regulation of counsellors and psychotherapists to you?

                            1 I am strongly against statutory regulation
                            2 I am slightly against statutory regulation
                            3 I don’t care either way
                            4 I am slightly for statutory regulation
                            5 I am strongly for statutory regulation

Finally, are you aware that Counselling and Psychotherapy are currently unregulated professions in theUK?

I was accompanied for the day by Tina Welch, a colleague with whom I work closely, and who's work I value greatly. I believe that Tina works very ethically. Tina is very much with me on wanting to raise awareness and in seeing what it is the public actually want. 

We asked a total of 117 adults to rate the importance of statutory regulation according to the above scale. 40 were male, 77 were female. 5 people were therapists and 2 described themselves as having a background in mental health.

The findings

The answer to our first question gives what I believe to be a very clear message about what the public want. 

In answer to the question asking whether they were aware that counselling and psychotherapy are currently unregulated professions in the UK, 75 people were not aware of this fact and 41 said they were aware. 1 person was unsure whether they knew or not. 

Of those that didn't know, many expressed surprise at this fact and assumed that they are regulated professions (I would like to collect data on that specific issue next time - how many people assumed the professions are regulated and/or are surprised to discover they are not?)

A number of people said that there should be more polling of public opinion on this matter. 2 of the people that expressed this were personally strongly against statutory regulation, but welcomed this research being done.

So not only do the majority of people we asked want regulation, but many assumed it was already in place.

Seal of approval

I passed on the details thus far to professor Mick Cooper and was delighted to receive very positive feedback about this piece. He added the following for me to include in this post:

"The views of the public and of service users are incredibly important when considering issues like regulation and accreditation. So its great to see people asking the public what they think. Really rigorous research here will be critical in helping us ensure that our systems are best suited to our clients' want and needs."

Opinions from other stakeholders

I decided to ask a number of people, whose opinions I respect, their stance in response to my findings and the issue of regulation as a whole. These include a number of therapists with varying opinions, two companies that deal with the fallout of therapist abuse (Catalyst Counselling and The Clinic for Boundaries Studies) and a service user.

Duncan Stafford is a registered and an accredited member of the BACP. He runs a thriving private practice in Cambridge, UK as an integrative therapist and supervisor. Duncan comments on one of the potential problems of having statutory regulation. He says:

"BACP has now taken a different angle to regulation. I wonder if the seemingly good sign-up response to the new register is due to the fact that: 1) it is voluntary; and 2) it appears to be based around the ethics of good practice and protection of the public rather than when there was a drive to regulate therapists through the protected title route. I was resistant to the previous attempt, through HPC, since I felt it was about creating or developing a hierarchy that served no one well and because it seemed to weld a wide-ranging profession to becoming just about a process of ‘mental health’. What about curiosity of self and the whole individuation task? 

However, I wonder what compulsory regulation would really achieve in our field. How much of the process of regulation is a process of ‘threat’. How well do we work under threat? We might think of it as a good response if professionals take ‘fewer risks’. This would be a positive outcome from regulation – but think again. Think about the number of times during a year you are creative as a therapist, how many times you walk with people to the edge of their shadow material and how often you take risks along that route, together in the name of therapy, the moment at which people begin a recovery process. I’d hate for that to be ‘regulated’ out of our profession just because there are a few bad therapists. I would rather that we insisted on a far greater degree of supervision per month. I would rather that we insist that all therapists are members of a professional development group and that we all write a paper each year about what we have learned about therapeutic encounters.

Let’s not make regulation about ‘rule following’ and ‘threat avoidance’. Let regulation be a process of taking the genuine responsibility for our professional actions and development of professional self."

Jane Barclay is registered with AHPP, BACP and UKCP. She works privately in Exeter as a therapeutic counsellor, psychotherapist and supervisor. She has expertise in boarding school experience and runs workshops on this topic. She is also author of the book "Does Therapy Work":

"I’ll be honest – in my early years as therapist I was relieved there was no statutory requirement for regulation, based on my as-yet unresolved lack of confidence or more extreme, being ‘found out’ to be a fraud. During my own therapy, I’ve come to know this part of me a great deal better, which has little to do with my competence with clients and a great deal to do with impact of former abuse and subsequent ‘splitting’ – where one part simply didn’t recognise another, hence the sense of feeling fraudulent.

My overriding view now is that until counselling and psychotherapy are aptly regulated, they will always stay on the periphery, attract mistrust, prejudice and lack of credibility – at a high cost to the general public who might otherwise benefit.

So, please add me to the list of ‘advocate regulation to promote safe and accountable practice.’"

Sarah Ashworth is an accredited and registered member of the BACP and a teacher of counselling skills. This is what she had to say:

"I am in full agreement that regulation of counselling and psychotherapy are essential, at the very least to bring counselling and psychotherapy into line with other professions. Regulation ensures that no one can describe themselves as a doctor of medicine, clinical psychologist, nurse, social worker, teacher or even a chiropodist unless they have been appropriately trained and are registered with the relevant regulatory body. 

Currently, ANYONE can advertise themselves as a psychotherapist or counsellor. There is no requirement for a minimum training and little recourse for complaint if something goes wrong. I am aware of individuals who are advertising themselves as psychotherapists having attended unaccredited courses of only TWO WEEKS duration. Many clients (wrongly) assume that an individual would need to be appropriately trained and registered in order to appoint to describe themselves as counsellors or psychotherapists. I'd like to think that clients would only pick their therapists from either BACP or UKCP's registers, but I'm also aware that this is not always the case. 

As you point out, even in regulated professions such as medicine, nursing, teaching and so on, there are some rotten apples who slip through the net and harm or exploit those in their care through their actions. We are never going to stop exploitative individuals being attracted to professions where they can gain power over others who may be vulnerable. However, as these professions are regulated, these individuals CAN be held accountable for their actions and stopped from practising, if appropriate. Not so with counselling and psychotherapy - at least not at the moment.

I have heard some counsellors/psychotherapists claim that they choose not to be members of either BACP or UKCP because there is little protection if a client makes a complaint against them. From what I understand of BACP's complaints procedure, although arduous and unpleasant from the perspective of the counsellor/psychotherapist, it is nevertheless a fair process conducted by highly respected individuals with expertise of the law, an understanding of those who practice counselling and psychotherapy and of the needs of clients, who may be presenting for support because they have been exploited by others. Please, let's do all we can to ensure that clients are not exploited further by their counsellors/psychotherapists!

In the course of my work, I have heard of a number of therapist comments from "I'm sorry, I haven't been able to concentrate on what you've been saying over the past 45 minutes because I'm hungry; would you mind if I went to the kitchen to get something to eat?" to "so, you haven't had a boyfriend for 3 years...do you masturbate? I do, because my wife won't have sex with me: she's got post-natal depression". When I was in training, I did encounter first hand what it was like to be was the receiving end of such comments (the latter quote was directed at me, by the counsellor I was paying). Fortunately, I realised that my counsellor was inappropriate and terminated the counselling in addition to passing on my concerns. Had I met with this particular counsellor a few years previously, when I was far more vulnerable and without the knowledge of the Ethical Framework and therefore an understanding of the standards expected, I might have been very damaged by the experience and blamed myself for what happened. Although my own experience was unpleasant and certainly not therapeutic, I do think it could have been worse and at least the counsellor was a member of BACP, so the option of a complaint and accountability was available to me. What of those clients who might be financially or sexually exploited, or subjected to substandard, careless and unprofessional practice, by a so-called counsellor who is not a member of any regulatory body?

Finally, let's forget for a moment about whether counsellors and psychotherapists think they should be regulated or not (and quite frankly, I am fed up with this debate - for me, it's a no-brainer...); it's clear from your survey of the public/potential clients, that not only do the overwhelming majority think that counselling and psychotherapy SHOULD be regulated professions, there is also an assumption in the public's consciousness that they MUST ALREADY BE REGULATED! 

As it stands, you or I may be more protected in law if we purchase a cheeseburger which gives us a stomach upset than if we purchase counselling or psychotherapy from an individual who behaves in a manner which is unethical and potentially psychologically damaging. 

Dr Dawn Devereux is a psychotherapist and Director of Public Support at the Clinic for Boundaries Studies, a registered charity working exclusively on abuse by health and care workers. I asked Dawn what she thought about the results of the research, and her thoughts on regulation in general, as I think that she is particularly well place to comment either way:

"The findings of this research are very much in line with the views expressed by members of the public who call the Clinic for Boundaries Studies following an abusive experience of therapy.  If 'therapists' are not registered with a professional body there is nothing that can be done to hold them accountable.  Not surprisingly members of the public can't understand why it is that occupational therapists (for example) are regulated by statute whilst psychotherapists and counsellors are not.  The problem with the lack of statutory regulation is not however just one of bogus professionals with no training.  There is also a problem with fully trained therapists choosing not to register with a professional organisation.  This means that although someone can legitimately claim to be a fully trained and experienced therapist, if they are not registered with a professional body they cannot be held accountable.  When professionals are regulated by statute they are obliged to belong to a regulating body.  I would add that I have noticed that both bogus practitioners and those who choose not to register with a regulator often have very impressive, websites and a string of meaningless accreditations. "

I have aleady referred to Graham Baldwin above. He runs Catalyst Counselling, a charity which offers help, assistance or counselling to those that have been damaged by religious groups or abusive relationships.

"We strongly support the need for statutory regulation in respect of counselling, psychotherapy and alternative therapists. We have been pushing for regulation since 1998. Every year we deal with numerous cases of therapist abuse including financial, psychological and sexual...carried out in the name of therapy." 

He also said that he would go so far as to say that a large proportion of therapists should come with a health warning. 

Somebody else who has been campaigning to raise awareness is Phil Dore who goes by the online moniker Zarathustra. He is a trained nurse currently working in Child and Adolescent Mental Health Services. He has written numerous blog posts regarding the lack of statutory regulation and the problems with the existing system of voluntary regulation. Recently he has written a post aimed at educating the public about the BACP and UKCP's roles in making therapists accountable. He has serious doubts about the UKCP's ability to handle complaints. This is an excerpt from his blog post which he has kindly given me permission to reproduce here:

"It’s not that there aren’t good, reputable psychotherapists in the UKCP. There are many. If I was one of those, I’d be feeling rather nervous about being registered with an organisation that’s likely to wind up officially second-rate. If the UKCP can’t get their act together and develop a robust complaints system – and they may well not be able to do so – then the results are likely to be utterly predictable. All the reputable therapists will sign up with the BACP or BPC. Meanwhile the UKCP will be left with the quacks, cultists and charlatans of the therapy world.
So, if you’re looking for a therapist the take-home message is this. The British Association for Counselling and Psychotherapy has been officially designated as an effective regulator. The British Psychoanalytic Council hasn’t yet but is likely to do so. The UK Council for Psychotherapy hasn’t and probably won’t be for some time, if ever. I suggest you take this into account when hiring a psychotherapist."

And finally I have some input from a service user. Laura blogs regularly sometimes refering to her therapeutic encounters (click here to see her blog). This is Laura's reponse to the reserach:

"As someone who has been to see several counsellors and therapists during my lifetime, I find the discussion of regulation fascinating. When I first discovered that regulation was voluntary I was shocked. To think that professionals who are supporting people in some of the most difficult times in their lives, talking through some of the deepest and most painful things, only need to voluntarily join a regulatory body, just seemed impossible. 

I have experienced bad practice had client confidentiality breached, therapists changed without my consultation, records lost and sessions stopped with no warning or explanation. Not all of those occasions happened while working with counsellors who were not members of any of the regulatory bodies, some were but I just didn't know that there was anything I could do about it. Had I known that I had somewhere to go to voice my concerns and complaints about the professionals who were supposed to be committed to helping me, perhaps I would have felt more confident seeking help when I needed it in the years following. 

Over the years I have learnt more and do understand that counsellors might feel that their creativity could be hampered by being regulated. Perhaps, having to stick to working within the 'rules' set out and not being able to do certain things within therapy that might be considered 'on the edge', but that the therapist feels would help the client. 

Just like in medicine, counsellors could be considered 'healers' and should have the best interests of their client at heart, but this isn't always the case. 

I would never consider seeing a counsellor who is not a member of a regulatory body. Without it, I have a sense of distrust over what 'rules' they are working with me on, creativity or not, I would prefer the safety of some sort of process by which to reprimand a therapist who's work causes more harm than good. There is too much at stake." 

In Summary

People have being trying to change things for years and many, if not most therapists are for regulation. There may have been flaws in previous frameworks for regulation that have been suggested, but I believe that we have a duty to the public, to ensure that people entrusted to work with them psychotherapeutically, are held accountable. This is what the public want. 

I'm not afraid to be accountable. I know all too well of nefarious therapists that are. It's time to protect the people that choose to see counsellors, and to protect the profession.


Amanda Williamson is registered and accredited member of the BACP, with a thriving private practice in Exeter, Devon. 

More posts on regulation:

Guest Blogger Patrick Killeen - Accredited Registers vs Protected Titles (July 2015)

If I had the power to regulate counselling (April 2015)

A new name for the PSA's registers for counselling and psychotherapy (February 2015)

Regulation - a client and therapist friendly way forward? (November 2014)

The problems with a voluntary regulatory scheme (Sept 2014)

Spreading the word on AVRs - the Professional Standards Authority responds (Sept 2014)


Oods said...

Fantastic work, Amanda. I admire how you are personally so committed to your cause, and obviously the cause of many! And how you take on board the varying opinions of many others, and make our choices clear to us all. May you continue to find the support you need, more and more so. I am sharing on facebook...to get this known to a wider circle of people.

Amanda Williamson (She/her) said...

Thank you Oods. Glad you liked the post, and thanks so much
for sharing it.

Anonymous said...

I think this is a bit protectionist. What is a 'counsellor'? Are we going to put vicars and the clergy under this banner? How are you going to distinguish between who is allowed in and who is not?

After all, everyone is a winner with counselling as research shows t is not the therapy but the 'person' performing the therapy.

Evidence base for lots of therapies is limited, would this not stifle innovation?

Individuals are already able to join a list if they choose so. Even if they don't the disclosure and barring service & CRB checks are available.

Amanda Williamson (She/her) said...

People who are abused by counsellors who are in it for egotistical or blatantly exploitative reasons, they are not winners. Clients who are retraumatised by therapists specialising in sexual abuse who are are sexually predatory, they are far from winners.

Besides, as I've clearly demonstrated, it's what the majority of the public want. My research correlates with some research done in Ireland: http://www.thejournal.ie/80-think-counselling-and-psychotherapy-should-be-regulated-841306-Mar2013/

DBS (which replaced CRB in 2012)) does not protect people who want to see a counsellor. Anybody who calls themselves a professional counsellor and is charging for counselling services should be accountable in order to protect the public.

Anonymous said...

I'm not sure your one study 'clearly demonstrates' that it's what the majority of the public want, but even if it did, is it always right to decide policy on that basis? e.g. capital punishment

Amanda Williamson (She/her) said...

Thank you for your comment, 'Anonymous' (why anonymous?). My one study happens to correlate with two other independent studies; http://www.thejournal.ie/80-think-counselling-and-psychotherapy-should-be-regulated-841306-Mar2013/ and http://www.cpcab.co.uk/Content/Publicdocs/The%20Protection%20We%20Deserve%20-%20survey%20report.pdf

I really don't see the comparison between asking the public about killing criminals and protection from rogue therapists. It reminds me of Professor Brian Thorne's assertion that statutory regulation is like putting ballet dancers under the direction of a regimental sergeant. Analogy can be very useful in the therapy room but I don't think it is helpful in this debate.

Anonymous said...

Anonymous because your blog affords that right and my experience is that the digital world/Twitterverse etc. can be cruel, unreflective and thoughtless places, particularly around emotive issues, such as therapy regulation has become. People who challenge the arguments for state regulation by protection of titles have in the past been labelled via the internet as unethical, irresponsible and many other unpleasant things besides, so for now I would like to exercise the right to anonymity, in the same way that you retain the right to moderate my posts.

I think the comparison is relevant, not because capital punishment and therapy regulation are the same thing, but because some of the issues around them as pieces of potential policy-making are indeed analogous, particularly in light of the emphasis you place on your ‘what the public want’ research. While public opinion is interesting and valuable, we surely want that opinion – and its interpretation and transition into law – to be informed by all the arguments. There are issues to consider that a simple for/against survey does not even begin to address, e.g. will the policy be effective? does it really ‘protect the public’? what are the unintended negative consequences? what is the nature of therapy and what is its relationship to the State?

You might not agree with the comparison but I’m surprised that, as a therapist, you see analogy as ‘very useful’ in the therapy room but not for teasing out the subtleties in political debate, particularly when that debate is actually about therapy.

Carrie said...

I may be getting confused but I'm trying to work out if counsellors register with the HCPC, BACP or UKCP. I am looking to compare the social work BASW code of ethics with the counselling code of ethics but am a little confused!

Amanda Williamson (She/her) said...

Hello Carrie, further information about the regulation can be found on this post:

Go to the paragraph "Accredited Registers". The BACP and UKCP (amongst others) have registers accredited by the Professional Standards Authority. Drama Therapy and Art Therapy are regulated by HCPC but not counselling and psychotherapy.

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