- 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
[This blog previously hosted a two-part article by Howard Martin, the original complainant in the Derek Gale case. Martin heavily criticised the current professional bodies for psychotherapy, and argued that this demonstrates the need for psychotherapists to be statutorily regulated to prevent abuse. Richard House, a practising psychotherapist, responds here to Martin. Z]
This is a full critical response to Howard Martin’s recent ‘Mental Nurse’ post from someone in the Independent Practitioners Network and the Alliance for Counselling and Psychotherapy who is implacably against the HPC regulation of the psy therapies.
It would be very easy to respond with equally vituperative vitriol to Howard’s quasi-rant of a posting, in which he disparages what he discriminatingly calls the “moribund, arrogant and self interested indulgence of the ‘independent’ therapy community”,. However, the rationality of the case against the HPC state regulation of the psy therapies is so overwhelming that I have no need to resort to rhetoric or abuse in making the argument; so I will patiently rehearse some of the rational arguments here. In the process, I will systematically dismantle the threadbare case that Howard makes in favour of HPC regulation.
First, even if we assume that Howard is correct that the HPC has “proven that they can separate good practice and client protection from the confusions of what some claim to be good therapy”, merely because in one case, an appropriate outcome might have been reached (albeit after about 2+ years of HPC deliberations), it doesn’t at all follow that the HPC is the appropriate body for regulating the psy therapies. That case still remains to be made, just as it did before Gale; and as I will argue, Martin needs to show far more caution before claiming that the Gale process and outcome somehow makes some kind of positive case for the efficacy of HPC regulation. For there are at least as many compelling reasons as to why quite the opposite conclusion can be argued – as I will show later.
Howard is very adept at erecting straw men, and then demolishing them with great gusto and panache. Unfortunately for him, his straw-man edifices bear little if any relation to recognisable reality. Take his characterisation of the “Open List” concept. Howard refers to “a system of mediated arbitration and negotiation between the therapist and client [which] will take place that will leave everybody happy and smiling” (my italics). This is an absurdly fictional characterisation “©Howard Martin”, and Howard does his case no good at all by overreaching himself in this way. And another straw man: we are told that “With the ‘self regulation’ system it is up to the complainant to find evidence, prepare it by attributing specific complaint events to breaches of specific code, present it to the committee, present any witnesses, question them, cross examine the “defendant” and his witnesses”… Howard, this is “a” self regulation system (or rather, your [perhaps accurate] characterization of it), not “the” (only conceivable) one; and to assume that any and every self-regulation system will be like this is, again, ridiculous, and insulting to the intelligence of those reading this blog.
I will leave it to other psy organisations to defend themselves against Howard’s critique, for I cannot and have no wish to speak for those organisations. But I utterly reject Howard’s low-trust distortions of the Alliance for Counselling and Psychotherapy’s developing position on accountability; for, given that it hasn’t yet been announced to the public or the profession, he must possess truly clairvoyant insight to be able to criticize it with such seeming authority and outright dismissal.
Howard then reveals his ignorance about the nature of most of the psy therapies by characterizing practitioners as “these guys who claim to be able to fix your mind”. Little wonder, then, that Howard favours the HPC’s regulating the psy therapies, as he clearly has a simplistic “medical-model” view of therapy work that is simply rejected by the vast majority of therapy practitioners as not even remotely accurately describing our work. Regulating therapy practice via the HPC is akin to regulating his boiler-man as if he were a golf course – which, I assume, Howard would concede is an absurd situation.
More “playing fast and loose with the facts” then follows, with Howard asserting that “Gale was… in with the cabal who set up the first psychotherapy associations to protect themselves from state regulation”. If Howard had done any kind of homework, he would know that the AHPP is a member organization of the UKCP, which has (alas) been actively campaigning for statutory regulation for many years! So it is simply factually wrong to claim that the AHPP is an association formed to protect itself from state regulation… – if only…, some of us might say!
Howard also betrays his own partial paradigmatic cosmology in his apparent uncritical allegiance to “evidence based modalities”, and his ill-disguised contempt for any approach to healing which does not fit in with his implicit “modernist” worldview. It may come as news to Howard that a great deal of therapy practice embraces principled “post-modern” and transpersonal cosmologies, which entail assumptions about the world, reality and human experience which are in direct contradiction to the kind of positivistic, philosophically incoherent “evidence-based” ideology that both he and the HPC appear to champion. That is one central reason why a large swathe of principled therapy practitioners are simply refusing to accept the inappropriate hegemony of the Health Professions Council.
We are also told that “Gale has no recognised qualifications in psychotherapy or counselling of any kind”. Now that sounds all very scary – until one begins to deconstruct the assumptions implicit in such a statement. First, are we somehow supposed to assume that “recognised qualifications” somehow guarantee competence and ethical practice? – try telling that to the families of Dr Harold Shipman’s patients. Moreover, there is, indeed, compelling research evidence that lightly trained practitioners achieve therapy outcomes at least as successful as highly trained therapists; which gives further pause for reflection in the face of over-simplistic clichés about “recognised qualifications”. I have met probably hundreds of therapists in my career, and my experience is that there is no necessary relationship at all between formal training, on the one hand, and competence or ethical practice on the other. And it is therefore nothing short of rank deception to reassure potential clients that there is any such predictable causal relationship which can somehow be used to ensure their safety.
So all in all, the argument about “recognised qualifications” is far more subtle and complex than the type of simplistic assertion made by Howard implies.
It may surprise Howard to know that there are some therapists (far more likely to be found in the anti-HPC regulation Alliance than in the pro-regulation UKCP, by the way) who agree with him about the “profession-centred” nature of a significant amount of therapy practice. But to speak of “anything seeming to go so long as the client keeps paying” is to treat clients as hapless victims, and indeed to show contempt for clients’ capacity to make informed decisions from their own volition about whether therapy is helpful or not.
No-one is seriously disputing that there is abusive practice within the psy world; wherever one finds human beings, one will find abuse; and if the law were the answer to abuse, then it would have been eradicated from society a long time ago. But as one wise wag once revealingly said, “you cannot make people moral by act of parliament”; and to peddle the dishonest and misleading impression that clients will somehow be more protected by HPC regulation will, paradoxically, leave clients more vulnerable to abuse, not less.
It would be excellent to have an intelligent and sober conversation about the pros and cons of state regulation of the psy therapies; it’s just unfortunate that it still hasn’t remotely begun yet.
HI Richard. You mention that most therapies operate outside of the medical model, but my reading of the HPC’s draft standards of proficiency for psychotherapists and counsellors does not appear to contain anything that would require therapists to adhere to a specific model.
The draft competencies do include talk about the need for knowledge of “theoretical models” and to be able to apply them, but they seem to make a point of not actually specifying which models. Could this not be the HPC’s way of trying to accomodate a variety of approaches and viewpoints while also maintaining standards?
After all, arts therapists and occupational therapists are regulated by the HPC, and they don’t work within a narrow medical-model viewpoint either.
I should hope a qualification should indicate some kind of competence.
Yes.
Does anyone see an alternative interpretation?
I seem to remember that there was some research that suggested that talking to a close friend was as effective as talking to most therapists, regardless of their qualifications. Trouble is these days so many people don’t have a close friend they can talk to and have to pay a therapist to confide in instead.
I have told friends that problems are better solved without mental health care professionals if at all possible. It isn’t always possible to solve problems without the help of professionals, that is why they are there, but I think their necessity has been overstated.
There’s been plenty of times when I’ve been doing therapy with a child and I found myself thinking that I wasn’t doing anything that wouldn’t be done by talking to a good friend, but in their case they simply didn’t have a good friend to talk to.
Maybe that’s why most of the therapy I’ve had has been decidedly unhelpful – therapy with someone you’d never want to have anything to do with outside the therapeutic context isn’t a good starting point. I wish therapists had to tell you their IQs so that you can know whether they’re above average or not. Well, not really, but if there were a wisdom quotient, I’d be interested.
It amazes me, though, that if I want to get my boiler fixed, the person that does it has to be qualified and registered, but if I want to get my mind fixed, the person that does it doesn’t have to be.
I’m still interested in how the relationship of patient IQ to professional IQ affects outcomes. I’ve looked for studies, but I don’t think they are being done.
IQ scores are, at best, a rough measure of academic intelligence. One would assume that most professionals (in all walks of life) score more than the average 100 and many of them will have an above average (100-109) superior (120-129) or high superior score (130+). People with IQs of 130+ are apparently only 2.2% of the general population. At what point would you expect the relationship of patient IQ to professional IQ to affect outcomes? Would it matter, for instance, if the patient was a “high superior” but the professional was only a “superior”? How large would the IQ gap have to be? I think IQ is a very crude tool in this context.
PS There has always been a thin line between genius and madness!
Also, how would one factor out other differences besides IQ? Cultural differences, different interests and hobbies, and so on? I think it would be a very difficult study to do.
I’m seeing a lot of big words used to intimidate people out of disagreeing, and not a huge amount of actual argument. Now, I use that argumentative technique myself, I admit. (I also admit I have issues where I’d rather come across as a clever bitch than potentially wrong, so.) But it doesn’t do wonders to dispell accusations of arrogance, or lack of transparency.
In fact, what I see here is a scrabble to maintain a power relationship. The person who complained needs to mind their tone. They’re too angry and uncivilised. The person replying is proving how smart (how much better) they are. It’s the kind of clinging to an authority position that I hate about mental health treatment, and it’s the kind of dodgy power arrangement where abuse thrives.
Thank you very much Richard.
Thank you for taking the time to fully respond to my post and for taking the opportunity of my post to put across your case so powerfully. The readers now have a chance to directly compare diametrically opposed viewpoints delivered with similar style and passion. The Jury is out, as they might say.
My decision now is whether I should respond or just let your case lie. I have decided that I will respond but merely by way of clarification of a few points. I will also respond here to the posting by Mr Musgrove on the other blog.
First of all let me clarify something with regards to the length of time the HPC took to bring its case – June 2007 to April 2009. I in fact first lodged a letter of complaint with the HPC concerning Gale in February 2006, I then asked for them to delay proceedings due to personal circumstances and the need to deal with the lesser legal matter of the my UKAHPP complaint. I then presented new evidence in June 2007 and within two weeks the HPC had moved to form an independent review panel and instigated a suspension of Gale based on the seriousness of the complaint and his potential threat of harm to the public. The HPC then engaged lawyers and undertook thourough investigations that involved statements being taken all over the UK, witnesses in the US and Germany and interviews in Australia of key witnesses. Every six months they had to return to their independent review panel to explain and have reviewed their progress in compiling the complaint. After 18 months the HPC had to make a submission to the High Court (as required by their own statatuory regulation) to have Gale’s suspension reviewed. Throughout this process the HPC gathered thousands of pages of evidence, studied hours of videotape and hundreds of photographs. The time delay in processing the complaint should not be seen as somehow negative but should be taken as what it is, the HPC do not treat complaints lightly, they thoroughly investigate and prepare evidence to the legally required civil standard of balance of probabilty proof. Until Richard or anyone else can come up with a model of self regulation that comes anywhere near the HPC’s level of care, transparency and sound legal basis for execution of statuory implements then my view will always fall on the side of the hundreds of years of legal precedents and experience that the HPC carry with them. It is ironic that it was in fact Gale who caused some delay in the proceedings and requested more time (which was granted) to prepare his case yet the HPC are blamed for delays.
Richard has chosen to criticise me for drawing attention to what I believe to be the case made by the anti regulation bodies for mediation and arbitration even after I did make it clear that it was only what I presumed their case was because they themselves seem to be very confused as to what they are actually proposing. He also chose to criticise me for drawing attention to the failings of the present self regulation system as the model we are now working with, yet once again confuses me by not making clear what his alternative model for self regulation actually is. Lots of talk, lots of theory but no “this IS the alternative” “this IS how it will work”. How does he really expect rational people to support such a nebulous and ill thought through concept?
OK I will now move on to my lay understanding of what the anti regulation lobby seem to feel is at the heart of their need for a special position with regards to regulation. That is that you cannot regulate the special relationship between psychotherapist and client and that most complaints are based on client misinterpretation of transference issues. Please note the subtle way that whenever that case is put forward the blame more often than not falls instinctively on the client and can therefore be resolved, as Richard proposes, by pointing things out to the client without the therapist even being involved in the arbitration!
OK so from my lay persepctive what is the relationship between psychotherapist and client? Well as most psychotherapists work within the private sector it is obviously money. The vulnerable client goes to the psychotherpist because through whatever modality or “cosmology” the therapist is peddling they hope that by paying cash for an hour or two a week to someone who presents themselves as a professional will make them feel better and resolve their problems. The psychotherapist acknowledges that this is how he earns his living, pays his mortgages etc. I am sorry, and please excuse ignorance, but where is the special need for understanding in that relationship?
What I do see in that relationship is the need for a compulsion for the therapist to be scrupulously honest about the clients expectations. There is a need to compel the therapist to have the absolute highest possible standards of basic core ethical training and understanding otherwise who knows what might happen, the psychotherapist may just see his clients as a means by which he pays his kids school fees. The only way to compel to the appropriate level is the full redress of the law. Like medical doctors psychotherpaist owe it to themselves to be in fear of the 4 am knock.
With regards to Mr Musgrove over on the other blog I would like to put a series of questions which I hope he will find time to answer.
Mr Musgrove – straight forward question – but I bet you or anybody else in your industry refuses to answer: How much is the psychotherapy industry worth in income to psychotherapy industry practitioners?
As with a lot of your colleagues in the anti regulation lobby you are very keen to put your professional qualifications, professorships, universities etc right up front so as to somehow enforce your position of priveliged understanding. Yet with all that book learning the only source you can present as justification for your position is an out of date report from Hogan which drew on models from an entirely different cultural perspective and social circumstance in a foreign country. You claim it’s being updated for the UK’s present needs. Why? It’s entirely irrelevent to either UK legal structure or social experience in 2009.
Let’s work on a lay perspective guideline that psychotherapy has been a mature business model in the UK for about 30 years, since your Hogan report was published.
In those thirty years it is obvious to me that two things have NOT happened.
1. With the entirety of academia, private practise, public sector, teaching etc and with the tens of thousands of books published and the wealth accumulated by some practitioners why has the psychotherapy industry never thought it prudent to actually properly and throughoughly scientifically test any of the modalities, including some of the oldest like psychoanalysis, that you have been happily peddling to the public for over a century? Why is it only now that the spectre of government regulation is hovering over you that CBT is being tested at the government’s behest?
2. You have institutionally failed at all levels to ensure that you have appropriate procedures in place for the protection of the public and now that the government has finally indentified that there are very serious risks posed by your profession you have no resources on which to draw which are based on well grounded British based research models either in the legal or professional practise field.
Would it be fair to say that the psychotherapy industry has been complacent in its attitude to research of not only its own methodologies but also its social and business responsibilities?
Are the self regulation lobby’s arguments for their right to continue to call themselves psychotherapists or counsellors based on proven efficy of their modality practises or purely business needs?
Is there an argument for the psychotherapy industry to now grow up and decide whether it is a branch of the healthcare system, which most lay people and public believe it to be, or a branch of astrology, psychics, tarot readers and fortune tellers which many practitioners trade on it as being?
On that point it should be noted that if you trade as psychics / fortune tellers etc under the trade descritions act you now have to present yourselves as “for entertainment only”. Maybe that is the honest answer. Since you have no independently verifiable research to justify 90% of your claims and you have never bothered to properly research an independent legally grounded structure in which you can work would you actually object to having to carry the disclaimer; Psychotherapist – For entertainment only?
The debate will rumble on until the anti regulation lobby are regulated out of business or they decide to grow up and live in the real world and have to justify making vast amounts of money out of vulnerable people. Either way there will be a group of quacks and charlatans moaning about how tough it is to screw money out of clients now that they are empowered with knowledge of their rights and expectations of the psychotherapy.
PS:
Lorna, thanks, you are right the psy industries’ whole basis for existence is based on the therapist exerting power over their clients. The debate in a recent Guardian blog was reduced to semantics about a latin cliche and its correct usage.
And they wonder why they need regulating
HowardM, you say “the psy industries’ whole basis for existence is based on the therapist exerting power over their clients.”
Can you be a little more specific? There are, I’m sure, plenty of people who practice privately who enjoy and are good at what they do. There are, I’m also sure, plenty of people who find value in the interactions they have with practitioners. Absent state-legislated coercion, both are free to leave the relationship at any point, and in doing so demonstrate their preferences (just as forming and continuing the relationship demonstrates the preference for such services).
Ted,
From my view one of the most serious issues with private practise psychotherapy is that the vulnerable client is entirely reliant on the honesty of the psy industry practitioner for the good practise of his/her chosen modality.
How tempting is it for the practitioner to say “hmmm I think there’s something underlying this and we should spend the next couple of sessions looking at exactly why you have chosen this time in your therapy to stop the good work you have done and chosen to reverse the process….then we will have a clearer idea of if it is time for you give up….same time next week then…”
Hamfisted over selling to you sitting here reading it but put that in the context of a vulnerable client who had decided to finish their therapy and you may just realise what might be going on in the real world and begin to question your own notions of exactly how free some clients are to leave their therapy.
To me, the only way to protect against that type of shenanigans is to put the therapist in fear of legally defined retribution. There should be a golden rule of if the client wishes to end therapy – that is it. No discussion, no questioning of reasons. No “but you have to end therapy in the ‘right way’”. Thank you very much goodbye.
If you think about your relationship with a medical doctor, you have a lifetimes cultural understanding of how that works and what your rights and expectations should be. Sometimes it goes wrong but that is generally more to do with medical decisions or diagnosis than ethical interpretations….oh pleeeeeeeeeeeeeease do not say Harold Shipman as if he excuses abuses by the psy industry.
In my fantasy psy industry regulated world that is exactly the type of cultural understanding of the work of the psy industry I would be striving for. And that stems from investing in empowering the client and reducing the mystery, and therefore the power of, the therapist.
During the reformation one of the first acts of Henry VIII was to ban confession thus removing a large proportion of the priests’ power within their local communities. Psychotherapists currently have that same power of holding their clients in their thrall. Strip away the mystery of how they should behave and what they practise and we will have alot healthier population and profession.
I have just written a cheaque for £76 to renew my NMC subscription. Luckily for me I can do that with a degree of impunity but it will make the eyes of a lot of nurses water. I pondered aloud some time ago as to what they do with the many millions they rake in besides send me the occasional newsletter I neither want or need. It seems their current preoccupation is the diversity profile of nurses. What else ? Rather than greatly disappoint them with the fact that I`m white, straight, able and most disgustingly of all a married Christian, I`m chucking their questionairre in the bin. Naturally, the self important, money wasters couldn`t afford to send out a pre – paid envelope