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 This has resulted in their membership of the BACP being withdrawn.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.

17 August 2016

The Use of Cannabis Extract in Treating Anxiety

I was sent the following press release which I found interesting and thought was relevant to this blog. It talks about the therapeutic use of the cannabis extract CBD (cannabidiol) for treating anxiety. Unfortunately, most of today's street-available cannabis tends to be hydroponically grown Skunk weed which has a proportionately lower amount of CBD (the calming chemical) than THC (tetrahydrocannabinol) which can induce anxiety and paranoia. So self-medicating might not be the answer in this case. There is also an interesting article on using cannabis to treat psychosis here.

- Natural cannabis extract CBD tackles symptoms of panic and anxiety
- One in three adults in UK will suffer from anxiety at some point

An entirely natural food supplement derived from the hemp plant could help thousands of people suffering from anxiety while reducing the need for medication. Cannabidiol (or CBD) is a naturally occurring extract produced from the cannabis plant which has been associated with a number of health benefits and has been found to have a positive effect on the symptoms of anxiety.  
Numerous scientific studies have shown the beneficial effects of hemp extract on people suffering from anxiety.  Anxiety is one of the most common neurotic disorders and affects a huge number of people every day. Around a third of people will experience episodes of anxiety or panic attacks at one point in their lives, while one in ten will be affected by severe symptoms.
Studies have shown that CBD extracts play an important role in reducing anxiety. In a double-blind experiment carried out at the University of São Paulo, the extract was given to a randomized group of people preparing for a public speaking event. Compared to the control group, those given CBD were found to feel significantly less anxious and more comfortable both in the run up to the event and during. They also reported thinking more clearly than the control group.[1]

Other studies using neuroimaging have shown that CBD can affect the limbic and paralimbic regions of the brain including the amygdala, which play a role in the fear response. When exposed to stressful situations, subjects who had been given CBD showed less activity in these parts of the brain and felt less anxiety.[2]

Neurologist Professor Mike Barnes said: “Anxiety is an issue that affects millions of people every day and CBD can have a real, positive impact on their lives.  There is a great deal of scientific literature on Cannabidiol but it’s only in the past few years that we’ve begun to fully realise the potential.  Much like the way Dopamine has revolutionised the treatment of Parkinson’s Disease, I am sure the role of Cannabis extracts will expand into modern medical practice.  CBD is now credible and continues to surprise the scientific community.  This is a very exciting time for Cannabis research and whilst international studies are ongoing, there is strong evidence to support the treatment of other major issues such as Epilepsy and PTSD.  I believe we will see CBD becoming much more widely accepted as its beneficial properties are better understood.”

“There are so many misconceptions around this market and we’re a long way behind other places like the US where hemp extract has a mainstream acceptance.” said Tom Rowland, co-founder of CBD Oils UK.   “Every week, we hear from customers that our products have improved their wellbeing.  Whilst we would not advocate CBD as an alternative to professional advice, there is a growing weight of scientific evidence to support its use.”

It is estimated that the global CBD industry is already worth around $200million and the UK market is expanding rapidly.  CBD Oils UK is the first company to offer high strength 40% (4,000mg) oil which adheres to strict UK regulations.

Tom added:  “Some people may be concerned because the products are derived from cannabis but CBD does not have psychoactive properties and is entirely safe.  It’s a fast growing market and we are proud of our products. The feedback from our customers has been overwhelming.”

Visit www.cbdoilsuk.com for more details.

[1] Cannabidiol Reduces The Anxiety Induced By Simulated Public Speaking In Treatment-Naïve Social Phobia Patients”
MM Bergamaschi, Department of Neuroscience and Behavior, School of Medicine of Ribeirão Preto, University of São Paulo, SP, Brazil.
Neuropsychopharmacology, May 2011

[2] “Distinct effects of {delta}9-tetrahydrocannabinol and cannabidiol on neural activation during emotional processing”
P Fusar-Poli, Neuroimaging Section, Division of Psychological Medicine, Institute of Psychiatry, London
Archives of General Psychiatry, January 2009

16 August 2016

The Palace Gate Counselling Scandal - Why it was right to blow the whistle

2 years ago today The Mail on Sunday published an article exposing the scandal of the Palace Gate Counselling Service and the owner John Clapham's abusive behaviour as a therapist and owner of the service and that of his colleague/supervisee/employee/client Lindsey Talbott, whom he promoted to Director of the service in the midst of the crisis. 
Tina and I braced ourselves for the backlash and the ridicule and more worryingly, the impact on our private practice. We also risked losing our homes as we were threatened with being sued.
2 years on I can gladly say that I wholeheartedly stand by the decision to expose this abuse and to protect others from enduring likewise.
Sadly, Palace gate Counselling, Clapham and Talbott are still operating. I'm happy to say that most of the referral sources are now obsolete. However, NHS Torbay Trust still signpost to the service, which is ridiculous and quite disturbing.
I am also pleased to say that the push for regulation is gaining momentum (thanks to joining forces with Philip Doré) and our paper on regulation via the campaign, 'Unsafe Spaces' and the Palace Gate case were referred to in Parliament.
I have also gained a bit of a niche speciality in working with people who have had abusive experiences in therapy. Some have found me via that article which gave them hope that they would believed and that I would get it. It is a shame that we live in a  world where this niche area is required but sadly, without regulation, far too much of this goes on and remains in the shadows.
It's pretty much behind me but I must confess that the behaviour of Talbott in particular got under my skin. She knows what he did. She knows it was wrong. But chose to make mine and Tina's life as hellish as she possibly could and tell the world that we were liars. Very scary. And she's a therapist...out there...as is he...
The good news is that it wasn't only the BACP that validated our truth; the Catholic Church cancelled Clapham's imminent ordainment, the Rosen Method bodywork organisation cancelled his internship and the police, although unable to prosecute, were very validating. 
And finally, my business is thriving and I have made this a viable and fulfilling career. As is Tina's. Some potential clients might read about my experience and be put off. However, many have stated that it is because of my stance and experiences that they chose me.

8 August 2016

For therapists; Compete or Collaborate? by Cathy Towers

This has been reblogged with kind permission from a blog by Cathy Towers published on LinkedIn: https://www.linkedin.com/pulse/compete-collaborate-cathy-towers-mbacp-senior-accred?
It is hard enough promoting yourself as a therapist ... then you see all the other therapists.  Traditional marketing can make us look at all others as competition, but I think that causes huge stress for therapists who are, by the nature of the healing work they do, more inclined to creating relationships than competing.
I have had people interested in renting a room at my clinic then saying "oh, you already have a reflexologist/counsellor/life coach so we would be in competition".  I believe this is a thought pattern which hinders us in the business of private practice.  Our professions are already high up on the scale of isolated working, why add to that?  
Look around the area you live: similar types of business congregate in the same street or industrial park.  Restaurants cluster together, car sales cluster together.  Yet they are in competition - so how does that work?  Well that area of town gets known for cars, so it is the place that everyone goes to when they want a car.  By having their sales units close together, they make it easy for the customer to look around, rather than give up and stick with what they have. It encourages a sale as the customer has choice. The decision is which car is right for me rather than shall I have a car or not?
I believe that together we therapists are stronger and better.  I like to take things a step further - cooperate, be helpful to each other, share knowledge and expertise generously and it comes back to you. Collaboration is a professional way forward.  My peer group has provided advice, supervision, cross-referrals, recommendations, ideas, emergency back-up... in fact a whole host of practical and emotional help.
The team at my clinic have also worked together at conferences, fairs, talks, written articles and peer-led learning. This also presents us as clearly client-focused, as we ensure that the right referral gets to the right person.  Result? Happier client, better word-of-mouth reputation for the group as a whole.
Look kindly at your colleagues.  I feel blessed to have such excellent 'competition'.  Their support helps me raise my game, act with integrity and also creates a safety net for clients. 

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