8 July 2015

The Regulation Debate; The PSA's Accredited Registers versus Protected Titles by Guest Blogger Patrick Killeen

(edited Jan 2024 as some of the links are now defunct; Google no-likey that)

I am honoured to be able to publish this guest post written by philosopher and trainee counsellor Patrick Killeen. I have come to know Patrick through his commenting on this blog as well as the unsafespaces.com blog hosted by Phil Dore. Patrick leaves very helpful, well thought out comments and is always very polite and respectful. We have had ongoing discussion about the regulation of counselling and psychotherapy. I recently published my ponderings following Patrick asking me what I would do if I had the power to regulate counselling and psychotherapy.

I invited Patrick to collate his thoughts on the regulation debate in a post for my blog. Here goes

In 2013 the Professional Standards Authority For Health and Social Care (the PSA) launched a new regulatory framework under which any group that maintains a register of health or social care professionals, and who can prove to the PSA that their register is run to protect the public and run well, can have their register accredited.  As a result there are now over 34,000 counsellors and psychotherapists working under professional regulations that are overseen by a statutory body [1].  However, it is still often said that "Counselling is unregulated because anyone can call themselves a 'Counsellor,'" and there are continuing calls to make "Counsellor" and "Psychotherapist" Protected Titles to stop unregulated practitioners posing a risk to the public.  This position is misguided, the practice of counselling would be no more regulated under Protected Titles than it is under Accredited Registers; when it comes to public protection there is nothing that could be achieved with Protected Titles that couldn't be done with existing laws.

The problem with regulated registers is that they only police registered professionals, so someone can sidestep them by simply not registering.  This limitation is obvious with Accredited Registers, which are explicitly voluntary, but it is also a feature of Protected Titles.  The Council for Healthcare Regulatory Excellence had this to say:

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. [2]

To get an idea of the limits of Protected Titles it's worth looking at the case of chiropodists and physiotherapists.  When the Health and Care Professionals Council (HCPC) was set up in 2003 "Chiropodist" (along with "Podiatrist") and "Physiotherapist" were made Protected Titles.  In 2007 the HCPC commissioned market research which found that the public were unaware of the difference between someone operating under unprotected titles like "Foot Health Practitioner" and "Sports Injury Therapist" and someone using the Protected Titles "Chiropodists" and "Physiotherapist"; some practitioners even complained that the titles used by unregistered individuals were more attractive to potential clients than the protected ones.  [3]

All that protecting the titles had changed was the words needed to describe the problem of unregulated practitioners.  In 2002 you might have said "Not all chiropodists are suitably trained and regulated so make sure you see a State Registered Chiropodist", while in 2007 you would have said "Not everyone offering foot health care is suitably trained and regulated so make sure you see a Chiropodist or Podiatrist"; both statements refer to the same people doing the same things with the same levels of regulation.

The thing that can give professional regulations real teeth isn't their power over registered professionals, rather it is the extent to which they curtail the activities of everyone else.  For example, anyone can call themselves a "Gas Engineer" just as anyone can call themselves a "Counsellor", but if you are aren't on the Gas Safe Register you are forbidden from working on mains gas appliances [4].  It's the fact that unregistered individuals are banned from working with mains gas that protects us from incompetent gas engineers, without that ban the regulation of registered engineers would be ineffectual.

If you tried to enact a similar ban for counselling then you would hit an immediate problem, there is no well-defined activity that unqualified individuals should be banned from doing.  Physically what a counsellor does is listen and talk; but it would be absurd to say that no-one is allowed to listen and talk with anyone else unless if they weren't a registered counsellor.   Try to finish the following sentence: If you are not Gas Safe Registered you must not even attempt to fit or repair gas appliances, and if you are not a qualified counsellor you must not even attempt to…  

As things stand, if you are not on a PSA Accredited Register of counsellors then legally you must not claim to be on a PSA Accredited Register of counsellors; but seeing as most people have no idea what Accredited Registers are it wouldn't stop you counselling.  If "Counsellor" was made a Protected Title then we would have a situation where if you are not on the statutory register of counsellors you must not use the word "Counsellor" to describe yourself; it wouldn't stop you from counselling, it would just force you to be more creative in your marketing (e.g. "Person-Centred Practitioner" or "Psychodynamic Therapist"). On their own Accredited Registers are completely toothless and Protected Titles would have one useless tooth.

Fortunately the statute books are not the whole story.  The more that people and organisations who engage or recommend counsellors look for Accredited Registers the greater the limitations will be on unregistered practitioners; not in the form of things that you mustn't do by law, but in the forms of things that you can't do because others insist on dealing with registered practitioners.  If Accredited Registers become widely understood and respected, to the point that potential clients are put off if a counsellor isn't on an Accredited Register, then they will become effective tool of professional regulation (the same would be true of Protected Titles).  The PSA's assessment is that  "awareness of the programme is at an early stage. Considerable ongoing promotion is needed to increase its public profile and bring it to the attention of the people best placed to spread the word about its existence or make referrals, such as GPs and social workers." [1] If they manage to make Accredited Registers a household name then the practice of counselling really will be regulated.

So, if you are outraged at the fact that counsellors and psychotherapists can continue to practice after being struck off, quitting their regulatory body, or flatly refusing to be regulated, then I urge you not to press for Protected Titles, the statutory battle has already been won with the introduction of Accredited Registers.  Instead, use your energy to get behind the PSAs and Accredited Registers: tell people how they can use Accredited Registers to protect themselves; complain to the PSA when complaints are mishandled by governing bodies; respond to their calls for information; scrutinise their decisions; and if they drag their heels shove them forward as hard as you can.  Accredited Registers are a promising start, let's do what we can to get them to fulfil their promise. 

[1] Professional Standards Authority for Health and Social Care, March 2015, "Accredited Registers: Ensuring that health and care practitioners are competent and safe." 

[2] Council for Healthcare Regulatory Excellence , February 2010, "Protecting the public from unregistered practitioners: Tackling misuse of protected title."

[3] Health and Care Professionals Council, July 2007, "Evaluating public awareness concepts."

[4] The Gas Safe Register. http://www.gassaferegister.co.uk

For more posts about regulation please see below:

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)

The Regulation of Counselling and Psychotherapy - What the Public Want (June 2013)


Roslyn Byfield said...

Useful article though it raises three particular issues for me: what is PSA doing to raise the profile of its registers? What is BACP itself doing since it sounds as if there's a kind of policy limbo during 2015 because of the Strategic Review, which doesn't report till December? What has been done to clarify the distinction (important to a good number of us, I suspect) between accredited counsellors and being on an accredited register? They don't mean the same thing and the current situation perpetuates the confusion to the public.

Patrick Killeen said...

Hello Roslyn

In response to your 3 questions:

1) In their March report the PSA identified the need for more promotion of the register but they didn’t state any definite plans. You could email them directly and ask them what they intend to do, they’ve been forthcoming so far.

2) The BACP has been strangely quiet about the Accredited Registers, what I find particularly worrying is how little some experienced counsellors know about them.

3) The problem here is that the BACP has been using the word “accredited” idiosyncratically for years and it conflicts with the normal use, the Accredited Registers have just brought an existing issue to a head.

The literal meaning of “accredit” is “vouch for”. The PSA vouches for the registers of governing bodies then the governing bodies use the registers to vouch for individual health and care professionals; so there is a simple chain.

The thing that causes confusion is that you don’t have to be an Accredited Member of the BACP to be a member of the BACP whose competence as a counsellor the BACP accredits; simply putting counsellors on its register is an act of accreditation; so “Registered Members” are accredited members even though they aren’t “Accredited Members”.

Among counsellors the phrase “accredited counsellor” is normally used to refer to accredited experienced counsellors; as opposed to newly qualified counsellors or established counsellors who haven’t had their experience accredited by a governing body. In the wider world “accredited counsellor” means simply a counsellor who some (hopefully reputable) body vouches for, regardless of post qualification experience.

So far the BACP have tried getting a Royal Charter so that Accredited Membership could be rebranded Chartered Membership, but the other counselling and psychotherapy bodies have objected, and there’s been no recent mention of this plan so it’s probably not going to happen. I don’t know if they have a plan B.

CAM said...

Interesting article, thank you. I am currently completing a top-up degree in Therapeutic Counselling and am one half of a debate around the regulation of counselling [and psychotherapy]. It is difficult finding academic based literature that is pro-regulation, if you know where such articles exist I would be grateful if you culd pass that on. Kind Regards.

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