8 September 2014

The PSA, the AVRs and Informed Consent in Counselling and Psychotherapy

by Amanda Williamson

Now I'm at the tail end of a horrible experience regarding what I believe to be a deeply unethical therapy experience (which the BACP seemed to agree with given that they withdrew membership) I had at the Palace Gate Counselling Service in Exeter, I have been turning my attention to how to create meaning and purpose out of the experience.

This post is not about thrashing over the ins and outs of that experience. More can be read about that, albeit in a highly abridged version, here.

What the case I was involved in highlights is the problem with the lack of regulation of counselling and psychotherapy and the current limitations of the PSA's AVRs.

Is that last sentence clear? If you are a therapist you will know what I'm referring to, but what about the lay public? I'll clarify rather than thoughtlessly using acronyms…

What the case I was involved in highlights is the problem with the lack of regulation of counselling and psychotherapy and the huge limitations of the Professional Standard Authority's Accredited Voluntary Registers.

Hopefully that's clear? Except that the chances are, if you are not a therapist, that you will have never heard of the PSA nor their AVRs. I speak to my clients during their first session about the lack of regulation and the fact that I am a member of the BACP and that there is a complaints procedure in the event that they feel that I have acted unethically. Almost every single one of them had no idea we were an unregulated profession, let alone the fact that regulation is voluntary (or where to look).

The problem is, that the government see this system as being perfectly adequate to protect the public from unethical therapists, even though most of the public haven't heard of it.. They say that there is insufficient research to demonstrate that the expenditure required to regulate the professions is worth it. First of all, how can they know that when there is no way of collecting facts and figures because there is no centralised system. Secondly, how can a system that clients have no awareness of help?

A potential scenario: A victim of sexual abuse goes to get help and ends up with a sexually abusive therapist who has been struck off - THIS COULD HAPPEN WITH THE CURRENT SYSTEM

As an example, a woman called Sarah might be dealing with a difficult time in her life and struggling to deal with childhood sexual abuse issues. She may have children who have reached the age she was which has triggered flashbacks and be causing her a lot of anxiety. She may discuss this with her GP who may suggest she sees a counsellor and seeing as the NHS list is several months+ long she could see a private counsellor sooner. How many GPs explain that they need to check that any private counsellor they see is a member of a professional body or is on an AVR? Prior to the Palace Gate situation going nuclear and even afterwards, there were GPs in Exeter automatically recommending PGCS; a counselling agency that is run by directors/counsellors who are not members of any professional body. The staff are not required to be members (although some are) and nobody whatsoever is CRB/DBS checked. The staff are clinically supervised by the directors too. So Sarah might be recommended to go to an agency that had it's membership removed twice by the BACP, and could even end up being seen by a therapist who was seen by the BACP as being sexually abusive towards a client.

I don't think that one needs to be a therapist to grasp an idea of how it would retraumatise the client to trust a therapist enough to discuss their experience of sexual abuse and then be used by that therapist for their own sexual gain.

Yet this is the state of our profession. This can happen and at the moment there is nothing to stop it and nobody to take responsibility to ensure that this doesn't happen.

So this has become a bit of a mission for me. I have been in contact and been contacted by a wide variety of stakeholders and information, needs and perspectives are being collated. There are many of us determined to move forward with this.

If my experience can go anywhere towards making this profession an actual profession rather than the current free for all it currently is, then this can only be a good thing for the majority of counsellors and psychotherapists* who work responsibly and ethically and most importantly, our clients.

Informed Consent

"The Person must be given all of the information in terms of what the treatment involves, including the benefits and risks, and whether there are reasonable alternative treatments…"  


Something that I have spent a long time pondering over is whether to have some kind of health warning on my website to warn of the potential pitfalls of counselling. I have felt rather nervous about that and don't want to scare people. Last week I had a conversation with somebody who made a very valid point. If doctors are required to obtain informed consent from patients before treating them then why not therapists?

There are potential pitfalls of therapeutic interventions but we as a profession do not seem to like acknowledging that fact. It was refreshing to read an article in The Guardian last month regarding the potential side effects of mindfulness. I heard some accusations of scaremongering but I believe that this sort of journalism is responsible.

Counselling and psychotherapy can be very useful and even positive, life-changing experiences for people. BUT, it is not for everybody, not all types of therapy work for all people and things can (and do) go wrong.

I am a realist. Life is life - there are misunderstandings, genuine human error and sadly, some who use their position of trust to exploit. I believe that we need a system that acknowledges this and has a framework to ensure that as few people as possible are negativey affected and if a therapist is being found to be exploitative or abusive then they should be removed from the profession.

That's the sort of profession I would feel proud to be a part of.

*this is an assumption. I have no proof that it is the majority of counsellors and psychotherapists work ethically and responsibly.

To check my registration with an AVR click here.

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