- Darian Leader calls for a waaaahmbulance
- Regulation of Psychotherapy – why it matters
- Regulation of Psychotherapy – Who’s Against it
- Regulation of Psychotherapy – More from its opponents
- Psychotherapy self regulation – a licence to carry on abusing?
- Psychologists join the HPC register
- The sham of self-regulation
- Regulation of Psychotherapy – A Psychotherapist Responds (1)
- Regulation of Psychotherapy – A Psychotherapist Responds (2)
- Regulation of Psychotherapy – Response to Zarathustra
- Regulation of Psychotherapy – Another Arts Therapist struck off
- Regulation of Psychotherapy: The Maresfield Report (1)
- Regulation of Psychotherapy: Maresfield Report (2)
- Regulation of Psychotherapy: Something rotten in the state of Denmark?
- Regulation of Psychotherapy: Something Rotten in the State of Denmark (2)
- Professor Andrew Samuels caught lying about his role in abuse case
- An Open letter to the UKCP
- Regulation of Psychotherapy: UKCP document leaked to Mental Nurse
- Regulation of Psychotherapy: More on the leaked UKCP document
- Regulation of Psychotherapy: More leaks from the UKCP
- Regulation of Psychotherapy: Samuels’ Damascene Conversion
- Regulation of Psychotherapy: Therapist struck off by BACP, remains registered with UKCP
- Regulation of Psychotherapy: HPC calls UKCP critique “gobbledegook”
- Regulation of Psychotherapy: 85% of service users want statutory regulation
- Regulation of Psychotherapy: Acclaimed Journalist Calls for Psychotherapy Regulation
- Regulation of Psychotherapy: Charity Commission urges UKCP to seek legal advice
[We've previously covered the proposed regulation of psychotherapy by the Health Professions Council, as well as cases of abuse by psychotherapists such as Derek Gale. In my view, such cases highlight a need for psychotherapy to be regulated in order to protect the public. In this opposing view, psychotherapist Arthur Musgrave explains why he believes the Health Professions Council does not provide the answer. A second response by his colleague Richard House will be published tomorrow. Z]
My name is Arthur Musgrave and I work in private practice in Bristol. I am accredited by the British Association for Counselling and Psychotherapy as a counsellor/psychotherapist and as a supervisor of individuals and groups. For eight years I have belonged to a Full Member Group of the Independent Practitioners’ Network. I regard these two means of making myself accountable as complementary.
During the 1990s I served for a number of years on the Management Committee of what was then the British Association for Counselling as well as on its Standards and Ethics Committee, but I resigned from both over the organisation’s approach to professionalisation, which seemed to me to be putting the interests of practitioners before those of the public at large.
I’m going to argue here against a register of counsellors and psychotherapists that involves the protection of titles, and – in particular – against Health Professions Council [HPC] regulation, which I think is an especially bad idea. If regulation is to be introduced at all, it should be done in the most effective way possible and two general principles are crucial – The advantages of any specific form of regulation must outweigh any unintended negative consequences. The merits and demerits of any particular course of action should be dealt with by argument and by looking at all the relevant evidence and experience.
Although the Government has insisted that counsellors and psychotherapists “will be regulated by the Health Professions Council”, in her introduction to the White Paper Trust, Assurance and Safety that kicked off this whole exercise, Patricia Hewitt made it clear that any such regulation must have the confidence of both the public and professionals. She listed five key principles “that should underpin statutory professional regulation”. These are ambitious. But what if – as seems likely – none of these are met? Will HPC regulation therefore be halted?
What’s become clear is that the HPC can only regulate within very particular, predetermined boundaries. For example, when the HPC began its work, it made what it termed ‘A Call for Ideas’. When these were summarised for the body charged with working out the detail of regulation, they were presented as anecdotal assertions (ie “one person says this, another organisation says that…”). There was no attempt to set HPC regulation in context or to examine the research evidence, and the day‑long meeting that had been scheduled was called to an end just after lunch. In short, if there were a better way of regulating counselling and psychotherapy, the HPC wasn’t going to be in a position to deliver it, and – scandalously – no attempt was to be made even to consider it.
The HPC appears to have taken no account of what is by far the most substantial study of psychotherapy regulation ever undertaken. This is an academic 4-volume study that looks into the variety of regulatory systems adopted by the different states in the USA. The author of this study, Professor Daniel B. Hogan, concluded that, at least as far as psychotherapy is concerned, the unintended negative consequences of the kind of regulation currently being considered in the UK by far outweigh any positives. Put briefly, the standards used to regulate the field tend to involve arbitrary, non-evidence-based criteria that protect existing vested interests and thereby both reinforce the status quo and ossify therapy practice. Hogan’s view is that, because we know far too little to be able to put together a regulatory system based on appropriate rational (as opposed to emotive) criteria, we need to exercise considerable caution, to conduct detailed research into different regulatory systems, and to seek to create an accountability framework that is not only effective, but which is congruent with the values and ethics of therapy work.
Although his original study was published in 1979, Hogan has produced a much more recent set of recommendations tailored to the situation in the UK. I want to draw attention to just two of these. One is that, in order to deal with the most serious kinds of abuse, we consider possible changes to the criminal law (he writes as a lawyer) – though it would first be necessary to do a proper risk analysis and to determine the nature and extent of the problem (eg to what extent do counsellors and psychotherapists sexually, financially or emotionally exploit their clients, and in what way is the existing criminal law unable to address this exploitation?). Changes of this kind, he argues, might well, on their own, obviate much of the need for regulation via the HPC.
The other recommendation is to develop conflict resolution or mediation schemes. Whereas taking out a formal complaint is almost bound to entail the assumption that therapy has irretrievably broken down (and so easily become a self-fulfilling prophecy), engaging in a carefully designed, scrupulously fair and appropriately transparent conflict resolution procedure constitutes a progressive step towards repairing what has gone wrong. A small‑scale pilot scheme indicates that around 50 per cent of matters notified as potential complaints are resolved when complainants have someone allocated to them to help them clarify matters and identify what remedy they want to pursue. Only then is the therapist notified of the complaint. Another 20 per cent of potential complaints are resolved once the therapist has access to similar help. A further 20 per cent or so are resolved through formal face-to-face mediation, and only about 10 per cent go beyond this into a traditional complaints procedure. OK, this might not be incontrovertible evidence, but it is far more “evidence” than the government is drawing upon in its non-evidence-based imposition of HPC regulation! At the very least, the case for caution, and for more careful research before imposing any regulatory system, seems quite unanswerable.
Over the last couple of decades, the British Association for Counselling and Psychotherapy [BACP] has developed a well‑respected complaints procedure, but it has been so puzzled by how few clients use it that it has supported research with the title, ‘Why don’t people complain?’ It is a considerable indictment of an organisation of some 30,000 members that BACP has never managed to build an initial mediation stage into its complaints procedure. In the present context, what is even more concerning is that the HPC’s procedures specifically rule out mediation until after the formal hearings are over – an absurd state of affairs.
Professor Hogan argues for an approach that is far more subtle than the blunder-buss approach to regulation based on title protection, to one that devises a legal framework that facilitates the development of good quality, low-cost, accountable and effective services that maximise access to the psychological therapies. He makes a number of other recommendations that there isn’t space for me to address in this initial posting, but the essence of his approach is to be proactive and innovative so as to put the public in a position to make informed decisions based on relevant information.
The reason it is important to weigh up the merits and demerits of any approach to improving public protection is that no approach is likely to be perfect. HPC regulation uses the blunt, non-discriminating weapon of legalistic procedure to stop both the unregistered and the deregistered from using a protected title. But both are free to use any other title, to continue to work with existing clients, and to continue to attract new clients through word of mouth recommendation! All they can’t do is lay claim to a protected title either directly (eg through advertising) or indirectly (eg by implication). At best, the protection this provides is partial – and the propaganda on behalf of HPC regulation may well cause some to lower their natural protective guard, and hence, ironically, be more susceptible to abuse! This is – to put it mildly – deeply unsatisfactory. And it simply won’t do to respond to this by arguing that the state should therefore regulate by function as well as by title, as the diversity in the therapy field has made impossible even for therapists themselves to define what is and what is not ‘psychotherapy’ or ‘counselling’ – let alone state functionaries who know that much less about the field.
The situation is not helped by the fact that some of the most widely circulated material in favour of HPC regulation is emotive and based on mere assertion. For example, in May 2009 BACP published in its journal Therapy Today a piece by Jonathan Coe from Witness that was accompanied by a lengthy case history, which (misleadingly) asserts that “following statutory regulation the therapist… would not be able to continue to practise as a counsellor or psychotherapist”. This isn’t the first time that BACP has argued the case for regulation in this way. Three years ago in May 2006 it published another lengthy personal account, which (also wrongly) concluded with the assertion, “State regulation provides the best way to ensure that professionals offering psychological support can be held accountable.”
But for me the biggest stumbling block with HPC regulation is the medical model. Many argue that this isn’t an issue – and quote the case of arts therapists who have been regulated by the HPC for years, seemingly without difficulty. Evidence is emerging that, in the longer term, HPC regulation is likely to considerably restrict the range of talking therapies available in society as a whole – which of course constitutes a major client interest. A raft of changes emanating from the Department of Health is, at present, profoundly reshaping psychotherapy and counselling. The uncritical and un-researched drive to HPC regulation also needs to be seen within the context of a wider shift in the field as a whole. This shift is powered by a commitment to a particular version of so-called ‘evidence-based practice’ that, in reality, is based on a highly selective understanding of what constitutes relevant evidence, and which predominantly favours one therapy approach – CBT – which is a highly inappropriate ‘treatment’ for many presenting problems.
The only ‘brands’ of counselling and psychotherapy likely to win approval from NICE are those that can be tested by randomised control trials. This means reducing interactions to a manual, much as call centres restrict the interactions of their workforce with members of the public to a robotic script. This view of research rests on the presupposition that the interventions that are distinctive about a given therapy are those that make the key difference to client outcomes. This assumption, in turn, is based on another one, namely that psychotherapy is most appropriately viewed as a medical intervention – that is, that ‘the patient’ has a disorder, problem or complaint for which there is a psychological explanation, and that the mechanism of change involves delivery of specific therapeutic ingredients that are remedial.
Both of these assumptions are simply wrong, as Professor Bruce Wampold (University of Wisconsin-Madison) has shown in a meta‑analysis of thousands of studies (see his book The Great Psychotherapy Debate, ISBN 0-8058-3201-7). The medical model does not adequately explain the benefits of psychotherapy – and he contrasts it with a model that fits the research data much more closely. This is the one proposed by Jerome Frank and his daughter Julia (see Persuasion and Healing: a comparative study of psychotherapy, ISBN 0-8018-4067-8). Wampold’s is a devastating scientific finding for anyone who regards the HPC as the appropriate regulator for counselling and psychotherapy – and one that has been systematically either ignored or discounted by advocates of HPC regulation, which is after all, given the manifold vested interests involved, hardly surprising.
Let’s spell this out. If HPC regulation goes ahead (and assuming Wampold’s findings stand), it’s difficult to see how anyone learning the subject for the first time will end up anything other than deeply confused. The research will point in one direction, but Government policy and the need to find employment in another. The casualty is likely to be due regard for evidence and research: most people will reach after the obvious conclusion, namely that if counselling and psychotherapy are regulated by the Health Professions Council, then counselling and psychotherapy must, to all intents and purposes, therefore be health professions. And Wampold’s research will be conveniently sidelined as being of no practical consequence.
Few people in the UK seem to have much understanding of how deeply the practice of counselling and psychotherapy will be affected by the imposition of the pernicious principles of narrowly defined ‘evidence-based practice’. For anyone interested, a recently published American book, The Clinician’s Guide to Evidence-Based Practices (ISBN 978-0-19-5333532-3) spells this out in considerable detail, using three extended scenarios to illustrate what will be involved.
The difference is between a psychotherapy that is based on deference to external authority and centrally drawn‑up guidelines, and one that is based on critically reflective practice. These are such profoundly different approaches that it can now be argued that what we are currently seeing is the emergence of two quite distinct professions. The one, evidence‑based practice, is essentially a subset of psychiatry, where the prime focus is on the containment of mental-health difficulties (and where treatment is secondary), while the other is traditional non medical-model counselling and psychotherapy. The one prioritises a managerialist approach that seeks to micro‑manage decision‑making and referral, while the other has at its core the notion of the critically reflective practitioner who has the capacity to respond appropriately to the unique, ungeneralisable contingencies that emerge in psychotherapy relationships. The one claims that it will eventually be possible to build a coherent set of working practices based on the principles of evidence‑based practice. The other claims that there is insufficient scientific evidence to justify such a belief – and certainly far too little to impose such a model on the rich diversity that currently exists.
HPC regulation will sow muddle and confusion at the very heart of psychotherapy practice because of a fundamental disregard for evidence and argument that has characterised the whole enterprise of HPC regulation. This is likely to have a deeply corrosive impact on training courses everywhere, as trainees attempt to jump through the hoops that they believe will lead them to gainful employment.
In conclusion, in view of the foregoing arguments, the case for an independent commission to investigate thoroughly the various regulatory possibilities is, in my view, absolutely unanswerable.
Hi Arthur, and thanks for this contribution, which strikes me as considerably more thoughtful than previous critiques on this subject that I’ve read by authors like Darian Leader and Denis Postle. I haven’t come across Hogan’s study before, but shall endaevour to find out more about it.
A few points in response though:
Mediation – Might there not be a danger of this wherein the emphasis on conflict resolution could wind up taking precedence over fitness to practice? I recently was involved in a child protection case where the child insisted that he did not want the accused person to get into any trouble or lose his job, even though there was evidence that this person had acted abusively. If a similar case wound up being resolved through mediation, couldn’t that carry the risk of an abusive professional simply being given carte blanche to carry on and abuse the next client?
Medical model – As you say, arts therapists have so far not been required to work in accordance with the medical model or embrace CBT despite their HPC regulation, but you express concern that this may happen in the longer term.
So far at least, there’s simply no sign of this happening. The HPC’s Draft standards of proficiency for psychotherapists and counsellors appears to avoid medical language or specifying particular models of working.
For example, the draft states that psychotherapists should “be able to apply a chosen theoretical model to assess the clients’ needs”, but it does not state what that theoretical model should be. Overall, I’m actually quite impressed with the wording of the draft, which seems deliberately designed to set standards without limiting approaches.
I think it might also be instructive to mention that “health” has a much broader definition than simply a narrow, medical-model assess-diagnose-treat way of working. As well as arts therapists, occupational therapists are regulated by the HPC, and much of what they do goes well outside the medical model.
As a mental health nurse, I simply couldn’t do my job if I stuck purely to the medical model and ignored psychosocial, humanistic or psychodynamic issues or approaches. A lot of my doctor colleagues would say exactly the same thing – especially psychiatrists, but even the local GP has a “secular priest” role that they’re usually acutely aware of. Neither the Nursing and Midwifery Council nor the General Medical Council has ever suggested that doctors and nurses have to stick purely to the medical model at all times.
I’m not suggesting that HPC is a perfect organisation, but the Gale case says to me that the status quo is unacceptable, and the HPC would be, to borrow a psychotherapy term, a “good-enough” regulator.
Response to Zarathustra
Thanks, Z, for your very helpful comments. I will deal with them in order but leave the points you raise about the practical impact of the medical model to a separate response to Em’s piece.
1. Mediation – I don’t want to claim too much for mediation. I just want to argue that – done properly – it could make a huge difference by making it easier for anyone dissatisfied with the counselling or psychotherapy they’ve received. Because it’s less stressful, many more dissatisfactions would be raised, they’d be raised earlier and – often – there would be the possibility of repairing, and perhaps at times even strengthening, a disrupted therapeutic relationship. Nick Totton has written a thought provoking piece about all this called Scapegoats and Sacred Cows: towards good enough conflict resolution in a book edited by Roger Casemore – Surviving Complaints Against Counsellors and Psychotherapists: towards healing and understanding (PCCS Books, 2001 – ISBN 1-898059-38-1).
This isn’t a question of finding perfect solutions to every scenario. Rather it’s matter of weighing up the pluses and minuses of the various alternatives. The example you give from your own work doesn’t sound to me as though it would be dealt with appropriately through the kind of mediation process I’ve described. There are clear legal procedures available in cases of child protection. The extent to which these are satisfactory is another question altogether, but we’d be veering into different territory if we started exploring that here.
2. My argument is not so much that arts therapists will be required to work differently – though I have heard some argue that there are pressures that do have this effect. My argument is much more that it’s the range of talking therapies available that will be restricted, not by virtue of HPC regulation alone – I agree with you on that point – but as a result of the cumulative impact of the changes coming out of the Department of Health. Here I’m thinking about the impact of NICE guidelines, the IAPT [Improving Access to Psychological Therapies] initiative and the re commissioning of GP counselling services at PCT level.
And, locally, we certainly are already seeing an impact on the ground. I know a number of experienced and highly respected practitioners working in GP counselling services who have lost their jobs and have been replaced by lower paid, IAPT compliant trainees. I am referring here to practitioners who were highly respected by patients, GPs and practice managers.
Locally, too, I am aware of one training course that has already closed because of changes made in preparation for HPC regulation – it wouldn’t fit within the bureaucratic format required – and I understand another is likely to close. Trainings are threatened when students choose not to undertake them not because there’s anything wrong with them – they can be widely acknowledged as excellent trainings – but because they want to know that the course they invest time and money in completing will be more rather than less likely to lead to paid work. Many of my colleagues are desperately completing expensive CBT or EMDR courses because they think that will mean they won’t be shut out of employment opportunities.
One of the arguments that HPC regulation is wrong is that it will have the effect of imposing NHS priorities on all counselling and psychotherapy. As far as I can see NHS managers don’t actually need many different kinds of talking therapies – they’d be quite happy with (say) the first half a dozen or so brands that get approved by NICE. I can see that, in some respects, their jobs would be easier if everything else was weeded out. Does this matter? I think so – and not just to me and those of my colleagues squeezed out by the juggernaut of ‘evidence-based’ practice. I believe it is in the public interest that a wide diversity of talking therapies flourish.
There’s a sense in which it’s unhelpful that the impact of all these changes has become entangled with the arguments over HPC regulation – the different strands inevitably get conflated together and it can take an inordinate amount of time to separate out the various issues. However, if we cut the argument to the bone, I think it is right to see all these changes as part of a common agenda that is driven by a specific set of beliefs that makes selective use of the research evidence. And the one point at which counsellors and psychotherapists have any meaningful choice in all this is over whether to allow their names to go forward on to the HPC register.
3. Will the HPC prove a “good-enough” regulator? Good enough for whom? I think you’re in danger of short-circuiting matters here. Legislation is likely to be bad when the various counter-arguments haven’t been properly examined. One reason this hasn’t happened is because there has been an unhealthy collusion on the part of many of the organisations representing counsellors and psychotherapists. These bodies have been keen to get the status and financial rewards that come with professional recognition. This was clearly an important factor in getting arts therapists regulated – many, if not of them, were previously working alongside NHS colleagues but on much lower rates of pay, a matter which I understand has been rectified following HPC regulation.
Arthur
Agree with Zarathustra that is nice to see a more measured thoughtful contribution on this subject than some of the previous rather bizarrely lacking in insight, and inherently contradictory outpourings in the media from those who are opposed to regulation, so thanks Arthur for taking the time to explain your views.
I may have misunderstood, so please do put me right if so, but I had a few questions initial questions arising from your argument:
1. You state NICE would demand RCTs of counselling, and seem to be of the belief that this is the only type of evidence deemed sufficient by organisations such as NICE.
This is something I hear quite a lot, but have seen very little evidence for, and wonder how true it actually is? Sure, there are hierarchies of strength of evidence-type, usually something along the lines of: 1. Systematic Reviews of RCT’s, 2. RCTs / Mega-trials (interventional), 3. Cohort studies (observational), 4. Case control studies (observational)…, but no self respecting epidemiologist / public health consultant I have known asserts that RCTs are possible for answering all research questions, indeed in the field of mental health especially there are often massive ethical issues with regard to RCTs and other types of approach to evaluation are more appropriate.
Are you familiar with the literature on the evaluation of complex health interventions (of which many counselling approaches might be better described). This kind of approach would perhaps be much more appropriate methodologically for examining the effectiveness of interventions in this field than an RCT. Why do you think NICE and other similar bodies would not understand this?
2. You talk about the medical model, seemingly almost as if all those working within ‘health’ work solely on a medical model (I’m presuming you mean a biomedical model here – I’m not denying this exists, or that it poses challenges and uncomfortable issues for those working mental health, and I’m also aware that psychiatry is the area of the biological medical view which has the weakest physiological evidence base supporting the links between its disease categories and describable biological phenomena,) but, it seems perplexing to suggest as you seem to that health professions incorporate only the medical model into their ways of working and that these are the only models their regulators and regulatory frameworks can cope with. As Zarathustra puts more eloquently than me, many health professionals work using other models too, or a combination, and are not blinkered by a purely biomedical gaze. It is perhaps worth remembereing that the World Health Organisation definition of mental health is: “[...] A state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community”. That’s not exactly biomedically straightjacketed is it? That definition has been around for a while now. Counsellors and psychotherapists are not the only ones to see the bigger picture of people’s lives and the social space that they occupy. I’m still not quite sure I understand what makes you so different, and why you will be so badly affected by regulation when with transparent regulatory processes in place other professions have thrived.
Em
Response to Em
You raise some interesting points, Em, and I will do my best to respond. My interest is as a practitioner rather than as a researcher and I am primarily concerned by the way in which government policy is shaping what happens on the ground.
Take IPT (interpersonal psychotherapy), for example. This is a NICE recommended intervention, but as far as I can tell from the literature it was initially devised as “a research intervention, described in clinical research trials but otherwise unknown to practising clinicians” (The Journal of Psychotherapy Practise and Research 1998 p.185). There doesn’t appear to be much that is especially distinctive about it, but it’s now a brand name and practitioners can receive an accredited training in it. There are even circumstances, according to one of the case histories in The Clinician’s Guide to Evidence-Based Practices (see pp 221/3), in which it would be unethical not to make it available to certain clients.
There seems to be no acknowledgement of the problems that can arise from the rigid application of such an approach to endorsing certain brand name therapies over others – for example, the work of Professor Bruce Wampold that I referred to in my initial posting seems to have been completely discounted and government policy proceeds as though he had never published The Great Psychotherapy Debate. Equally, there appears to be no critical awareness of some of the major problems with randomised controlled trails (eg the difficulties posed by the apparent extent of publication bias) or of the unsatisfactory nature of findings that ignore researcher bias, something that Bruce Wampold goes into in some detail.
And this is even before we get into the problems posed by the availability of funding. In July 2008 BACP published a short item in Therapy Today (p 10), from which I will quote an extract –
‘Professors Mick Cooper and Robert Elliott of the University of Strathclyde, William B Stiles of Miami University and Art Bohart of Saybrook Graduate School claim the government, the public and health officials have been sold a version of the scientific evidence that is not based in fact, but on a logical error. In a collective statement, they said: “This is how it works: 1) more academic researchers subscribe to a CBT approach than any other. 2) These researchers get more research grants and publish more studies on the effectiveness of CBT. 3) This greater number of studies is used to imply that CBT is more effective.” ’
Perhaps one of the problems lies with beliefs and values of some of the individuals involved in shaping government policy. I came across an interview with Steve Pilling, one of key people making recommendations to NICE (published in Therapy Today Nov 2008 pp 12/16). In it he was asked about the tendency for therapists to become more eclectic as they gain experience. My own position is that I think it’s important to be open to learning and changing as a result of feedback from clients about what works and what doesn’t work so well. Steve Pilling thinks this is “a dangerous path”. He quotes an example from his own practice when he noticed that he was no longer following a particular CBT framework “and I thought, I’ve stopped doing that, that’s not very good. And I shifted my practice back again.” Notice that he didn’t pause and ponder what might be the right thing to do: it didn’t seem to cross his mind that he might just possibly have come across a new and better way of working.
Steve Pilling goes on to assert that, “We have evidence that when people stick within those frameworks they get better outcomes.” Now this is interesting, because in The Great Psychotherapy Debate (pp 175/183) Bruce Wampold shows that such evidence is weak and not strong enough to guide practice.
Like many counsellors and psychotherapists, I find my beliefs and values are fundamentally different from the ones Steve Pilling seems to hold – so much so that, as I argued in my initial posting, I think we may well be engaged in two fundamentally different activities.
The difference between these two boils down to how you view the evidence about the validity of the medical model. Some – the Government, the HPC and a few counsellors and psychotherapists – choose to be selective and refuse to take account of, for instance, Wampold’s meta-analysis (or show in what way it is wrong). Yet they want to impose their view of counselling and psychotherapy on everyone.
This is a complex issue and I agree with you, Em, and with Zarathustra that there is a great deal of practice within the NHS doesn’t fit tidily within the theoretical definition of the medical model. But that’s not my point. It’s hard to convey the specifics of how practice will be reshaped without going into a great deal of tedious detail – and it can be boring reading lengthy spiels about this kind of thing on a computer screen. The book I referred to in my initial posting, The Clinician’s Guide to Evidence-Based Practices, teases out the practical implications of all this with very specific case histories. Now I agree that many practitioners will often be able to get away with ignoring these “good practice” guidelines and continue with their existing way of working. If they are well respected and sensitively managed they may even continue to be judged by the results they produce. But that doesn’t alter my underlying point about the muddle and confusion that will result on training courses where DoH practice points practitioners in a different direction from the research data. Nor does it alter the long-term disastrous impact that such a disregard for evidence and argument is likely to have on counselling and psychotherapy as a whole.
Arthur
just got time to say this is a great post.
my position is simply this: i reject state regulation on the basis that government does not have a legitimate right to forcibly come between voluntary agreements between persons.
I have responded with a series of questions to Mr Musgrave over on the other thread which I hope he will find the time to answer.
http://www.mentalnurse.org/ind.....esponds-2/
However my first reaction to the above is that once again he is presenting the case for non HPC regulation as being nice in theory but very short on practical ideas for how and who actually would administer his special needs regulation for psychotherapists. He says that there should be laws created for the worst offending therapisits but gives no notion of what these laws might be or how they would work or who would adminsiter them.
For example; Gale was accused of smoking dope in front of his clients and of encouraging his clients to participate – clearly a criminal offence. But can you imagine an offended client trying to take that to the police? With the HPC however they had the capacity to consider it as a criminal offence pass it forward as a complaint based on the civil liability of balance of probability, find against Gale as having been respopnsible for serious misconduct and can hand the file to the director of public prosecutions for criminal follow up. The client is appeased, Gale is sanctioned and the criminal law obligation fulfilled.
Why does he also refer to foreign based (ie American) research that is out of date and bears no relation to the contemporary situation in the UK merely because the psychotherapy industry here in the UK has systematically failed to undertake any research of any worth whatsoever in the past 30 years.
So Mr Musgrave – I can give you lots of very specific detail on the failures of self regualtion as it now stands as well as the failngs of the HPC because they are underempowered but you can not provdie a single fucntioning model from anywhere in the world of specifically what you are proposing as a legitimate and viable alternative. And you’ve had 30 years since the first publication of the Hogan report to prepare and throughoughly research one.
Is it any wonder that the government is running with the HPC model that is tried and tested and has hundreds of years of legal precedent and good evidence based practise on which to draw.
To be honest Mr Musgrave you doth protest too much…what are you really afraid of? Client empowerment so they’ll stop handing money over for any old claptrap from someone with a few spurious letters after their name?
Response to Howard Martin
Howard, I’m not afraid of anything. I’m just concerned that we should have a proper system in place and not one where the negative unintended consequences outweigh the benefits. I’ve suggested that, before there is any attempt at legislation, the pros and cons of different options should be weighed up carefully. I’ve quoted an eminent legal authority who has examined – in great detail – the ways in which therapists have been regulated under different legal systems and he says that priority should be given to tightening the criminal law. And then you challenge me to produce a specific legal draft. What on earth would be the point? I have already said that any such draft should be based on research data as to the harm that needs to be remedied and, once that research is done, it seems obvious to me that any such draft should be produced by someone with an expert understanding of the law.
You go on to quote the example of Derek Gale, but what you overlook is that he is still free to practice. And he would still be free to practice even after HPC regulation of counsellors and psychotherapists – he just wouldn’t be able to advertise using a protected title or imply that he was entitled to use one. But he can go on seeing existing clients and he can also work with new ones. Reading your piece I have to question whether you are seriously interested in protecting the public. What you’ve written is that it’s enough if the client is appeased, the therapist is sanctioned (though ineffectively) and “the criminal law obligation fulfilled”.
As regards Hogan, how can you be so sure that his research is out of date (he produced a brief update specifically for the UK situation only six years ago)? And how do you know that, as regards the question of psychotherapy regulation, the American situation “bears no relation to the contemporary situation in the UK”?
I suspect I share a good number of your reservations about the self–serving attitudes of many in the mainstream counselling and psychotherapy world, but I think you do this case no favours at all when you make such wild assertions as “the psychotherapy industry here in the UK has systematically failed to undertake any research of any worth whatsoever in the last 30 years”.
Those of us who are keen to see a proper system of accountability in place are up against, on the one hand, the mainstream counselling and psychotherapy bodies who are pursuing power, status and money and, on the other, people like yourself who, it would appear, are unwilling to pay attention to important evidence that deserves to be taken into account before we rush into a half-baked regulatory framework.
Arthur
HowardM,
You seem to be assuming that state regulation will prevent “any old claptrap.” If only state intervention elsewhere in the mental health field had been this successful!
Ted,
It’s not that regulation per se will remove the claptrap it is that there will be a frame of reference for consumers that will enhance their knowledge and expectations as well as give them a recourse if they discover that what they have been sold is psuedo religion and therapist worship rather than well grounded effective therapy they were sold – as per the Gale case.
Re the psy industry being power based. In my view the whole relationship between the therapist and the client is one based on a presumption of superior knowledge in the therapist that is completely untested and reliant upon the therapists’ honesty. While many psy industry workers achieve the aims of their industry many, far too many, see it as a easy source of income.
Arthur,
I think you are right, we probably do share some common beliefs with regards to the psychotherapy industry being under regulated and identifying the need for more and improved legislation. However it appears that I more readily accept the reality of the present situation and would wish to maximise the potential of it through ongoing input and development rather than just screaming that it must stop before it’s too late and we must now conduct the research your industry has systematically failed to undertake for the past 30 years.
Why can’t we start with the HPC regulating by title and then work from there to develop a tighter and more effective model for legally defined restraint to prevent the switching of title? Why do you feel we need some out of date foreign research to justify some other impossible to achieve model?
By the way I do take great offence from someone in your industry saying that I do not care about public protection. Unlike a very long list of supposedly very respected professors, doctors and lecturers in your profession, many of who are at the very top of the anti regulation business, I did not happily take Mr Gale’s largesse for thirty years, socialise with his clients, reinforce his position as leader of his cult, make statements in his defence even though he had been identified as a potential risk to the public by two seperate organisations, accept his idolisation about my courage for indecently exposing myself to female clients, participate in his abuse of clients…………….no, unlike anyone in your industry I did something. So call me pompous, arrogant, thick or stupid but please do not call me uncaring.
As regards to relevent UK originated research. So where is it? Now I could go all Ben Goldacre and demand blind testing, random sampling, imperical balance of all modalities currently being sold as psychotherapy. But I won’t. I’ll give you a chance. In the past thirty years has the psy industry ever used its vast resources to conduct any type of full independent market research as to effectiveness of various modalities from consumers, public perception, outcomes (oooh that dirty word) from users and non users of defined situations? Nope I guess not. Has the psy industry used its vast resources to undertake effective research into business regulation models or does it just throw theory into the air along with lists of lifestyle indulgent celebs who sign petitions? It’s also very good at producing cod research that shifts tens of thousands of books but when it actually comes to the nitty gritty pretty much zilch.
With no model being proposed for what type of mediation you are actually advocating I would have very serious concerns about who was running it and meeting it’s costs. If it is not independent, legally bound with enforcible outcomes (must stop using that word otherwise people might start to believe there is a point to psychotherapy) what would the point be other than to bully the complainant into accepting the therapists view? Without legal grounding the therapist could just sit there and say “yeh yeh alright I’ll give you your money back….” No sanction, no enforcability.
You see my problem is that since I got involved in the Gale case I have discovered that almost every aspect of the private sector psychotherapy industry is corrupt and self serving. With two honourable exceptions I have not found anyone in it who was willing to stand up to Gale and expose him for what he is. One of those two has now found himself ostracised, threatened and discredited by his training organisation and his UKCP member organisation and is in constant battles in and out of courts after trying to do something about a group of Gale cohorts. Sound familiar? The other one is a completely different breed who takes lunch with MPs, sets precedents in court and operates without fanfare but with great effect.
So unlike you Arthur I have a solution that I propose at every available opportunity and have lobbied the the DoH, NICE and HPC with. It is a simple to execute extension of the already accepted intention to regulate by title.
Pass a law (let’s call it the psy industry act 2015) that offers a straight forward definition of people offering psy industry services and equates that definition has a privilege similar to the privileges bestowed on medical doctors. The HPC would then regulate and administer that privilege through a system of accreditation and complaints procedures.
“A psy industry service provider is defined as being a person who presents themselves as being, or it is reasonable to believe is, engaged in a relationship with a member of the public whereby an intended principal purpose of that relationship is for the engaged person to adapt, adopt or improve the emotional, psycholgical, spiritual and /or cognitive well being of the member of the public.”
Not a perfect definition but it took me, a lay person, ten minutes to come up with it. It also has the catch all for the “humanist” contingent and could even be adapted to cover pastoral care by priests etc.
That privilege position would also apply to anyone offering services without being registered with the HPC and would be augmented by incorporating into criminal law the civil definition of “position of influence” presently defining most branches of medicine and the priesthood.
The spirit of the law will be that anybody offering a psy service or something it is reasonable to believe is a psy service, should have a set of ethical and procedural guidelines that are not specific to their modality or method of practise but are designed for consumer protection. Contracts limited by time, payments etc. Limits of the relationship. Avoidance of social contact or sexual contact etc. The requirement for consistent consent at all junctures. No physical contact unless specifically explained and consented to every time with the option of a same sex chaperone. I personally would outright ban the “supportive hug” which I believe is only ever used by the therapist to emotional control the client. For their own protection the psy industry would then be drawn towards the perfectly normal business procedure of written contracts that expalin the expectations of the client and therapist.
Through this process there would be a reversal of power in the relationship between psychotherapist / counsellor and client. The vulnerable client would be assured that there was cost free and legally defined redress available through the HPC and the therapist would have a clearly defined set of guidelines in which he operates, with the background demand that he would have to consider having to justify his every action with any given client. Nothing to fear there because surely that’s what they are doing already isn’t it?
You see Arthur it really is that simple. There is even room in there for the HPC to build in a process of mediation whereby the complainant could be given a series of options for the track of their complaint or the psy industry worker could lobby for an option and differing sanctions.
So Arthur, are you against client empowerment?
Cheers
Howard Martin
Repose to Howard Martin
Howard – Thanks for you long response. I will to respond as best I can to what I think are the key points you make, taking them in order.
I differ from you in believing that it will be possible to do much to modify and improve HPC regulation, once it is in place. The HPC has one size fits all approach to the health professions and shows little sign of being able to make significant adjustments to the specific needs of any of the various professions it regulates.
You persist in asserting that Hogan’s research is out of date. I repeat my earlier question – on what basis do you know this to be so? As I said he specifically updated his argument and tailored his recommendations to the UK situation in 2003.
Why do you say what I’m asking for is impossible to achieve? I’m making a middle of the road case for sound legislation (ie first identify evidence of the nature and extent of problem(s) you want to address and then make sure your proposed remedy/remedies are appropriate). The groundwork undertaken by the Government and the HPC on counselling and psychotherapy has fallen badly short of this standard.
When I said that you did not appear to be serious about public protection, I quoted your own words back at you (BTW I didn’t call you ‘uncaring’ and it would be unfair of me to do so). But it does seem to me that you overrate the value of client appeasement and the therapist being (ineffectively) sanctioned, when the real issue is setting up an effective framework for public protection. I very much appreciate your willingness to talk in detail about your experiences with the HPC. It is invariably worthwhile to look closely at how procedures work in practice and we all owe you a debt of gratitude for your readiness to talk about happened when you made your complaint. There’s clearly much to learn from your experience.
I think you overrate the importance of having UK originated research. I believe it’s possible to learn from research done elsewhere. The rigorous examination of the research data you claim not to want to rely upon has been done (though for technical reasons it’s not possible to blind test psychotherapy). Much important and relevant material is included in the book by Professor Wampold that I referred to earlier. If you want to look at what has been done in the way of outcome research on counselling and psychotherapy in the UK try
I’m not sure what you’re arguing about when you dismiss mediation. It would be perfectly possible for a mediation scheme to be funded by government or run by an independent body. I think you misunderstand the value and purpose of mediation as a preliminary step. If the existence of a mediation scheme increases manyfold the number of complaints that clients bring, surely that is valuable – especially if the overwhelming majority of these are settled to the client’s satisfaction? This preliminary step would be additional to any other procedure: at the very least it offers a user-friendly interface for complainants. The difficulty with the HPC’s procedures, as I understand them, is that mediation is specifically prohibited until the formal investigation and the hearing are over.
Your proposal for a new law is a version of regulation by function (as opposed to regulation by title, which is what the HPC set up to do). Lawyers have argued that this is particularly tricky to do because it is hard to define precisely enough what psychotherapy is (to take just one example, your definition of a psi industry service provider would cover all members of the clergy, as they undoubtedly are concerned with improving the spiritual well-being of members of the public). There’s much more we could say on this score, but one thing is certain and that is that regulation by function isn’t “that simple”.
Finally, I am about to go away on holiday for 10 days so please don’t take any lack of response as an indication that I don’t want to reply to anything you add to this discussion. I’m conscious I haven’t yet responded to the questions you raised on the other blog, but I find it confusing keeping two similar threads going simultaneously. I’m still hoping I will eventually find ways of introducing what I would say there here, but if not and the blog is still open I intend to reply.
Best wishes
Arthur
Arthur,
Thank you again for your detailed response.
You will note that my definition was intended to possibly bring in the clergy and I did note this – but you then use that possibility to dismiss my definition?
If you really do not see the need for UK based research when we have a very specific and unique, structure for health matters, ie the NHS, HPC regulation of Arts therapists and psychologists, a unique and very sophisticated social demographic structure with very broadly differing perceptions of psychlogical welfare from those in the US and elsewhere then I am really sorry but I feel you maybe should open up alittle bit.
I think I will let it rest there as you are clearly of a mindset that that is not adoptive and possibly worryingly scared of forward movement towards achievable goals – you’re not a psychoanalyist by any chance are you?
Thank you but you will never convert me to the need to stop what we are doing merely to conduct research you have failed for thirty years to do in the hope that hundreds of years of legally defined judicilly based structure will be overturned.
Thank you all for this very thought-provoking exchange.
As a reader am looking forward to Arthur’s return from his holiday.
May I ask you, Howard, why this -how can I call it- disdain about psychoanalysts?
I mean we can all have our different views, of course and by all means, but your comment reads a bit like a threat, don’t you think?
Hi coder.psi
Glad to hear that you feel you have gained something from the exchange.
Re psychanalysts. I have no personal experience of them it’s just that the total impression of themselves that they have managed to convey to me is of self interested, arrogant charlatans who have, and maintain, a vested interest in keeping people in analysis for as long as possible or until they can pay no more.
They set no goals, give no meaningful objectives. They constantly refer to the past without acknowledgement that the past cannot in anyway affect today or tomorrow other than as part of the natural ongoing learning process of life. They pander to the self indulgence of their clients. Has a psychoanalyst ever turned around to a client and said “actually you don’t need analysis…you are perfectly well and normal and I dont see any point in dragging up the past even if you were abused by your parents who are now dead…” Or “don’t worry your mother was just doing the best she could with what was available……you’re not traumatised in any way…I’d be wasting my time and your money….”?
If I had my way these people (also who claim that analysis is a private conversation when it is really a business transaction) would be cast out and made to sit among the psychics and tea leaf readers. They would also be made to have a disclaimer that says “Warning: I am a psychoanalyst what I tell you has no basis in fact or support in scientific evidence but I will lull you into a sense that you need to keep coming back to reach some indefinable goal that you have already failed to reach because it doesn’t exist and I will charge you money for years to come if not the rest of your life. It’s called a one on one cult but if you would like to join a proper cult I can arrange that too…it’s called group therapy…you will henceforth worship me and tell all your friends how fantastic therapy has been for you but if they ask specific questions you will go vague with a thousand yard stare until I tell you what the answer is at our next session”
Never met a psychoanalyst – but that’s how they come across to me. If I’m wrong it’s their PR and marketing problem not my lack of understanding or ignorance. But for some reason I bet they won’t acknowledge that, like they conveniently claim analysis is untestable – without ever seeming to have tried to establish any independent criterea by which it may be tested.
Hi Howard,
Thank you very much for your reply.
I understand what you say, but I am afraid I do not agree.
The impression I got from my experience with the psychoanalysts I have met, quite a few really, was not similar to yours.
In the main, I have encountered thoughtful and honest people, caring for their fellow man and willing to undergo exhausting, demanding, expensive and very very long trainings in order to obtain the honour to use this title, “psychoanalyst”.
You say they convey themselves to you as charlatans.
I guess it’s down to their lousy PR and marketing, I’d grand you that!
I do not agree with what you say because there is a tricky point in your argument, namely the need for “scientific evidence”. Obviously you would expect me to say that, given that you sort of anticipate it in your last paragraph.
But I won’t argue with you. If we decided to debate this here, we would be violating open doors.
No less a philosopher of science than Karl Popper has pointed his finger at what appears to be unscientific in psychoanalysis, and no less than a psychoanalyst than Freud himself formulated an answer, long before his death.
So it’s an old story really. Far from settled, yes, but old.
In fact, it would make fascinating reading were we willing to engage in some background preparation before posting our next comments.
But I guess we are not ready to do this now.
You, at least, come across as a person who has no time for that kind of waste of time and resources.
Me too, I don’t think I have time for what comes across to me as bullying. But perhaps it’s my lack of understanding.
Thank you.
PS: Still looking forward to Arthur’s return from holidays!
Dear Howard
Thanks once again for the trouble you have taken to reply. To respond –
1. I’m sorry I dismissed your idea for regulating the clergy as well. I just jumped to the conclusion that it would be hard – if not impossible – to get sufficient support for such a broad brush approach.
2. You have misunderstood me completely if you think I am opposed to research being done in the UK on the nature and extent of the problem that needs to be addressed. My point is exactly the opposite – I don’t think it’s sensible to agree solutions until such research has been done in this country. And it’s wrong to target therapists for this lack of research. It’s a fundamental principle of law making that if Government wants to propose good legislation it needs to do so on the back of sound research (which it has failed to undertake in this case).
3. You persist in attributing to me beliefs I don’t hold. I think that what is needed is a creative, proactive search for ways of improving the present situation without creating negative unintended consequences that outweigh the purported benefits of what is put in place. I’m very interested in pragmatic achievable goals and I suspect the single biggest gain for dissatisfied clients might be the establishment of an adequate national mediation framework. At the same time, only once proper UK research has been done, will it be possible to pinpoint potential alterations to the criminal law in order to deal with gross misbehaviour by counsellors and psychotherapists.
4. Is your query about whether I am a psychoanalyst intended as a sideswipe at me or what? I said who I was and what I work as at the beginning of the piece that kicked off this thread.
5. I really don’t understand your last paragraph. You seem to want to blame me personally for the lack of progress when, as I have said, I am a relatively lowly self employed practitioner. I have absolutely no wish to overturn hundreds of years of judicially based structure – what I want is to see it tweaked/improved in order to it to make it more effective.
Finally, there is one other matter I would like to put to you fairly forcefully, given your comments elsewhere about the income psychotherapists receive. Why have you been so preoccupied with what therapists earn when the HPC has undoubtedly been paying lawyers several times the hourly rate that the average therapist receives into order to present the case against Derek Gale? And therefore why target therapists in this way rather than lawyers? How much do you think it cost the HPC to take your case through to its conclusion? I’m sorry to be blunt and I’m not sure anyone outside the HPC is in a position to answer this, but I think there’s a real question to be asked about whether or not the Derek Gale case represents value for money. How many such cases a year do you think the HPC can possibly afford to fund in this way? And, given that Derek Gale can still practice (and will still be free to practice after HPC regulation of counselling and psychotherapy), in what sense does HPC regulation therefore represent effective public protection?
The wheels on the bus keep going round and round.
Just so that it is clear I have never meant to make any personal comments that are in any way offensive I just see this blog as an opportunity to enter into a robust discussion on a matter I have almost accidentally had experience of see it as an opportunity to put across some points in defence of the the HPC system and ideas for its improvement.
There is another opportunity for all you anti HPCites to actually see them in action with the following case:
http://www.healthprofessionsco.....amp;id=969
An occupational therapist who undertook art therapy with a client and is alledged to have committed multiple boundary violations.
From a mischievous point of view I find a couple of things interesting about these allegations: One the therapist is accused of involvement in Tarot reading – which I have made the case is exactly how some therapists see themselves and should be judged by the standards of.
The other concerns the hugging of a client. I personally am for the complete banning of the “sympathetic hug” and if this case sets aprescedent for having it removed from the therapists “tool box” I will be very happy indeed.
With regards to the cost of the Gale case – what does it matter? If therapists keep abusing their clients they should be brought to justice – it’s like saying what are the costs in bringing any criminal to court. But since you ask I would guesstimate from my personal experience that the HPC wouldn’t have had much change from £250k. But surely it’s better that they are that well resourced to bring such high profile and intimidating cases rather than be under resourced. By the way I mean intimidation for therapists to keep them inline. Yes I believe, like doctors, therapists should be intinmidated by the law and threats of very real sanctions.
By the way there seems to be some confusion: Gale cannot practise any longer as an arts therapist, when the new legislation kicks in he wont be able to practise a psychotherapist either – these sanctions are backed by criminal law. That law needs strengthening as we previously discussed.
Bye for now
Howard, thanks once again for your spirited defence of the HPC and the tenacious way you pursue your points. The way we’re going about this I think we’re starting to test both sides of this particular argument pretty thoroughly.
To recap – the case for the HPC is that it offers the public protection against bad practice by counsellors and psychotherapists. The case against is that the protection it offers is spurious.
But surely it doesn’t matter that much what Derek Gale calls himself? If he’s a danger to the public and he can go on working calling himself a voice coach, a group worker or a personal coach (to take just three possibilities), then that’s a problem, isn’t it?
I don’t know anything at all about Derek Gale’s current working practice, but my understanding is that, so long as he doesn’t either advertise himself using a protected title (eg arts therapist, or in the future – perhaps – counsellor or psychotherapist) or imply that he is entitled to use a protected title, he can still work with existing clients and he can still see others who come, for instance, by word of mouth referral. Why won’t you accept, Howard, that, while you personally clearly received incredible 5 star support and backing from the HPC, you can’t generalise from your particular experience? What is important about the Derek Gale case is not how good HPC regulation is (by contrast with what was available to you from the AHPP or UKCP), but how bad it is (because, even when no expense is spared, its sanctions offer inadequate public protection).
Howard, if as you say the law therefore needs strengthening, then you come back to my (and Hogan’s) original point about considering changes to the criminal law, which can only be done satisfactorily after proper UK research has been done about the nature and extent of the problem we’re all concerned to address. So why not do the job thoroughly from the outset without first setting up a whole pile of other negative consequences (ie negative for the public as well as for the quality of counselling and psychotherapy available)? It’s just plain daft to create a lot of mess and confusion and then say that you hope it can all be sorted out later.
Finally, I clearly need to spell out why I think the costs involved in the Derek Gale case are important. The HPC has a budget of some £13m a year. It raises this money from fees it charges registrants. The registrants in turn raise the money they pay the HPC from the fees they charge their clients. So, in the end, the very charges that you consider exorbitant will need to be even higher in order to fund more cases like the one taken out against Derek Gale. This is conceivably justifiable if the sanctions imposed work, but if they don’t how can you possibly justify these extra costs? I repeat my point – apart from a symbolic victory and any personal satisfaction you obtain, it’s the lawyers who are the main beneficiaries from this scam. And the public lose out both ways round because they end up paying higher fees and getting inadequate protection.
I agree with Arthur regarding his comment that HPC regulation is spurious.
Howard, your faith in HPC regulation is misguided: it is clear that Gale can (and does) practise as an Arts Therapist, despite being struck off by the HPC:
In July, I was informed that Gale was running his usual Summer Voice Workshop. ‘Voice work’, as I understood it, constitutes Arts Therapy, according to the HPC. I phoned the HPC and asked them to confirm this and they did: ‘He should not be doing it’ they said. ‘What will you do then?’ I asked. ‘We can write him a letter and say he shouldn’t be doing it’ they said. ‘What good will that do?!’ I responded.
I was then told by the Gale case manager that she would contact their ‘Protection of Title’ department to see what, if anything, they could do. She called me back and asked me to email the details of the workshop, which I did.
At our next conversation, I was told by the case manager that now Gale has been struck off the HPC register, it is difficult for them to police him and I was given the impression that they had more powers while he was on their register, albeit suspended. They can do spot checks but as far as I know they did not ‘spot check’ this incident despite knowing when it was taking place.
I have chased this several times now (both on the phone and via email) and still have not heard anything about what the HPC are doing. The workshop has now passed, so the opportunity to ‘catch’ Gale in the act has passed (for now). So, he is still practising Arts Therapy, he is still brainwashing his clients, he is still damaging vulnerable people and, in the process, hurting their families.
You bring to our attention the case of another therapist being heard by the HPC. Doesn’t it disturb you that almost all of the allegations listed against this therapist were things that Gale did and continues to do to his remaining clients, yet the HPC did not raise any of these points as allegations in the Gale case, even though they (or at least their solicitors who took the witness statements from the complainants) knew full well that he did many of these things too?
It is surely not the fault of the complainants because, ultimately, the HPC decided on the allegations brought forward against Gale. In fact, once the solicitors had interviewed the complainants, more allegations were made by the HPC. So why the inconsistency between these two cases? Surely every misdemeanour of Gale’s should have been brought to light in order that the public were fully aware of the danger of seeing him as a client?
It seems likely that few people are aware that the HPC only heard a subset of the original allegations made against Gale. There were a substantial number of even more serious allegations that included physical violence, financial manipulation and sexually inappropriate behaviour. These were never heard and never will be, simply because the witnesses could not be available to the HPC’s time scale. This was despite, and, at the same time, because the HPC took nearly 2 years to bring the case to a final hearing.
Ultimately, they decided to proceed out of fear of Mr Gale escaping through a loophole (that he might appeal to the High Court on the grounds that it was unfair that the case had taken too long to come to a hearing), rather than delay and hear all of the allegations.
None of these more serious allegations were dropped by the complainants (they were completely willing to appear as witnesses), they were simply not heard because Mr Gale would not get a chance to cross-examine the witnesses on the dates the HPC set for the hearing. The extremely worrying aspect of this is what the HPC would have done with the complaint if those witnesses were the only complainants in the case and how the reduced case did not highlight the full extent of Gale’s abuse of his clients.
If Gale was a radiographer, he would NOT be able to work in the UK after being struck off by the HPC because no one would employ him. He continues to be able to work because he is self-employed, something that does not seem to figure in the HPC’s ‘system’.
These, and many other reasons are why I think the HPC system (though it’s a start) does not work.
Hi Arthur
Can I respond to a couple of points?
True, though I wonder if perhaps this in itself might point the way to a solution to the current debate?
People looking for psychotherapy or counselling are often looking for help with a mental health problem (I appreciate that many psychotherapists would not describe it in those terms, but suffice it to say that we’re referring to people who are suffering and in psychological distress) and like or not psychotherapy/counselling is widely regarded as able to treat mental health problems (insert other words for “treat” and “mental health problems” if desired). This isn’t the case for personal coaching, which is generally seen as a self-improvement thing.
Therefore, given that vulnerable people will seek out a psychotherapist in a way that they’re less likely to seek out a personal coach or voice coach, perhaps it should indeed be the case that psychotherapist and counsellor be protected titles, and those who aren’t willing to submit themselves to the strictures of the HPC should indeed call themselves something else.
Regarding your point about registration costs.
I’m going through an analogous situation at the moment because I’m about to renew my registration with the Nursing and Midwifery Council, which is my equivalent body to the HPC. As with the HPC, the NMC charges its registrants and then uses the money to pursue those who are believed to have committed misconduct.
My registration fee is £76 a year. I moan about paying this £76. In fact, I moan about it a lot. Even so, a bit of quick maths reveals that such a sum constitutes 0.36% of my annual salary. It really doesn’t make a meaningful dent in my earnings – well, not over the course of the year, anyway. If I was a private practitioner charging patients individually, it wouldn’t push up my prices.
Thanks for your input, Zarathustra. Can I reply to your comment about fees now and return to your first point later on as I think it’s important and responding to it fully will require more time and attention than I have available at the moment?
You’re obviously right that £76 is a very small amount in relation to a full time worker’s annual income. But –
1) This annual fee will be enough to prevent many an experienced and respected volunteer counsellor from being able to continue working for a voluntary counselling service with a limited budget. This is something that has scarcely been touched on anywhere in the debate about HPC regulation. Many thousands of volunteer counsellors are affected and statutory services refer clients to them all the time.
2) I have made this point about HPC fees because (a) Howard has made great play both of what he sees as the exorbitant fees that counsellors and psychotherapists charge and (b) he doesn’t agree that the cost of bringing the Derek Gale case matters. To which I’d reply (a) that the average counsellor or psychotherapist on a recognised NHS scale undoubtedly earns considerably more per year than the average self-employed practitioner – so, while I think it’s unfair to attack private practice in this way, Howard appears to believe that private practitioners earn far too much anyway, which means that any increase whatsoever would push their unacceptable fees up even further, assuming the cost is passed on; (b) the work that the HPC can do is dependent entirely on the fees it charges registrants – so if it was to take up many more cases of this kind it would have to raise its fees even higher; and (c) I would be particularly incensed if any fees I was paying were being wasted on ineffective action against poor practice because the framework for regulation had been badly thought through.
3) You don’t take account of the fact that, if regulation goes ahead, many counsellors and psychotherapists will have to apply through the grand-parenting route and find an initial fee, not of £76, but of £420. I can’t see that not being passed on. Again the same arguments apply about it being a waste of money, since as this debate continues it’s becoming increasingly clear that HPC regulation is ineffective. And this charge will result in more experienced and respected volunteer counsellors having to stop working.
I’m sorry, but the more we go into the detail, the clearer it becomes how unsatisfactory HPC regulation would prove to be.
Best wishes
Arthur