- 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
(Guest post by Arthur Musgrave)
My apologies for the delay in posting this, the second part of my response to your comment – Arthur
Your point about a solution to the current debate as to who should have prior claim to the titles ‘counsellor’ and ‘psychotherapist’ demands careful consideration.
I agree with you that the business of psychotherapy/counselling is done with people who are suffering and in psychological distress. I also agree with you that personal coaching is generally seen as a self‑improvement thing. In other words these two activities are distinct. But the HPC doesn’t regulate activities – it regulates titles. So, as far as the principles underpinning this form of regulation are concerned, provided people don’t either use a protected title or imply they’re entitled to use it, they can do what they want. So there’s still the problem that HPC regulation will allow someone like Derek Gale to practice, even though he has been struck off the HPC register.
But you seem to be arguing that, despite the huge cost of the Derek Gale case and the resulting unsatisfactory sanction, nonetheless HPC regulation is still worth pursuing because, once the terms ‘counsellor’ and ‘psychotherapist’ can only be used by those registered by the HPC, the public will be well enough protected – and they will be well enough protected because, although some people may still make use of someone like Derek Gale, if people clear they’re after a counsellor or psychotherapist, they would be less likely than now to end up seeing the wrong person.
This is all well and good as far as it goes. But I think that, if the whole field of counselling and psychotherapy is to be reshaped in the fundamental way it will be by a regulatory process that discounts the scientific and other research evidence, then we should be thinking about this problem not in terms of how a prospective ‘consumer’ might be encouraged to think (ie “I’m looking for a counsellor/psychotherapist registered by the HPC”), but in terms of the product that will be on offer. In other words, if we’re thinking about the distinctions that need to be made in order to set up proper systems of accountability, the better analogy is with consumer protection legislation.
To answer your original point properly, we first need to step back and view HPC regulation of counselling and psychotherapy in its wider context. That context includes the raft of changes emanating from the Department of Health. It includes NICE Guidelines, the Improving Access to Psychological Therapies initiative and the re-commissioning of GP counselling services at PCT level. These initiatives are underpinned by a commitment to a particular view of ‘evidence based practice’ that is founded on a skewed or partisan view of the evidence. This view is predicated upon the medical model of counselling and psychotherapy (see Bruce Wampold’s book The Great Psychotherapy Debate for a precise definition). This version of ‘evidence‑based practice’ overvalues evidence derived from randomised controlled trials and seeks to impose on everyone a definition of counselling and psychotherapy that may suit the needs of NHS managers, but which is otherwise inadequate and unsatisfactory.
The benign view of all this is that those driving these initiatives forward have a superficial but honestly held belief that their view of counselling and psychotherapy will eventually be vindicated by the research data. This way of thinking has much in common with party politics and Government Department policy making. It is utterly unsatisfactory as a foundation on which to build good professional practice. That has to start from scrupulous and detailed attention to evidence, if there is not to be endless muddle and confusion.
If this argument is right – and there has been no serious counter argument I have heard that suggests it is not – then we have the basis for disentangling terminology. Here I’m making the obvious point that any attempt to re‑define existing practice should, for the sake of clarity, use different concepts.
The terminology already being used by proponents of these changes provides the best pointer. The term ‘psychological therapy’ is a recent invention and it came not from the field but from NHS initiatives. It is prominent in the title IAPT (Improving Access to Psychological Therapies) and it has been used extensively in by Skills for Health. Why not stick with it? In other words the right term for an exponent of the particular version of evidence‑based practice promoted by the NHS would be ‘psychological therapist’.
Let’s pause a moment and take stock of the position in which we find ourselves. Let’s assume, for the sake of argument, that counselling and psychotherapy don’t end up being regulated by the HPC – perhaps because a new Government takes a different view of the issue. What would things then look like?
Psychologists and arts therapists are already regulated by the HPC. Taken together IAPT, NICE Guidelines and the re-commissioning of GP counselling services are already beginning to re-shape practice within the NHS so that there is greater focus is on treatment that is based on the precise diagnosis of narrowly defined psychological conditions. This is in line with the psychiatric profession’s use of classificatory systems such as DSM-IV. From an NHS management perspective it is clearly important to make the most efficient use of limited resources and it is equally quite legitimate to want to tidy up the whole arena of psychological therapy into a coherent framework of ‘stepped care’.
Furthermore it seems unlikely to me that NHS mental health services will ever need very many NICE‑approved talking therapies. From the point of view of the skewed view of evidence based practice I referred to above, as far as I can see the NHS could manage quite well with not much more than CBT plus a few variants, such as CAT and behavioural family therapy, along with something more expressive, such as the various arts therapies for those who struggle with words and thinking based (as opposed to feeling based) approaches to therapy. In addition there’s an existing term – ‘counselling psychology’ – available that has a large overlap with counselling (the difference being in the prior requirement for a first degree in psychology rather than in anything particular in the training). The standards of proficiency on which the HPC is currently consulting attempt to define the distinction between counselling and psychotherapy solely on the basis of the extent to which psychotherapists are better equipped to address severe mental disorders. This is seen as a matter of additional training and experience (defined for counsellors as level 5 and for psychotherapists as level 7 in terms of the National Qualifications Framework). It wouldn’t be difficult, then, for the NHS to implement fully its particular agenda of ‘evidence-based practice’ without taking over the label ‘counsellor’ or that of ‘psychotherapist’. It would be better off with two levels of ‘psychological therapist’ operating above the IAPT categories of High Intensity Worker and Low Intensity Worker.
Much of the disagreement about HPC regulation is based on a fundamental confusion about purposes. The priority for the NHS is to manage and, if possible treat, various conditions that medical science has been able to diagnose. Traditionally counselling and psychotherapy, while on the surface being about the management of the problems of everyday life, are at a deeper level also about meaning‑making. They are fundamentally different from the notion of ‘evidence‑based practice’. The Department of Health is slowly but surely making changes that ought eventually to result in the emergence of two distinct professions. This should therefore be made explicit to all at this stage.
At present an attempt is being made to impose the HPC version of what counselling and psychotherapy is on the very much larger group of practitioners who work outside the NHS. Many of the representative bodies are going along with this because of the economic and vested interests involved. Many trainees and less well established practitioners are also going along with it because they want the widest possible access to jobs. These are bad reasons for colluding with a form of regulation which will do little to protect the public and will bring with it a whole series of further problems that are likely to set the field back for years to come.
Well, that’s cleared that old chestnut up then!
Hi Arthur. Thanks for your, as always, thoughful and thought-provoking response.
I have to say though, I’m simply not convinced that HPC regulation needs to be seen in the context of whatever machinations are underway from NICE, IAPT etc. My own professional body – the Nursing and Midwifery Council – does not normally concern itself with implementing such strategies. Its remit is professional competence and protection of the public, not setting wider policy agendas for the provision of healthcare. I don’t see any evidence that the HPC is any different in this respect.
For more evidence that IAPT etc are separate, unrelated issues, one might wish to read the HPC’s Draft standards of proficiency for psychotherapists and counsellors. It simply doesn’t include any push towards CBT or anything else. Just to give a few examples of the kind of competencies they expect counsellors and psychologists to adhere to:
“be able to devise a strategy and conduct and record the assessment process that is consistent with the theoretical approach, setting and client group”
“be able to apply a chosen theoretical model to assess the clients’ needs”
“be able to recognise when further therapeutic work is inappropriate or unlikely to be helpful”
“be able to make appropriate therapeutic interventions consistent with the chosen theoretical approach”
This is not language that strikes me as trying to shoehorn psychotherapy into a narrow, CBT-oriented frame of reference. In fact, it seems to be doing the complete opposite – simply setting standards while keeping the field open for a wide range of theoretical models and approaches.
It might also be worth noting that yesterday another arts therapist, Andrew Davies, was struck off by the HPC. As with Derek Gale, Mr Davies was not struck off for failing to adhere to New Labour’s latest policy diktats. He was struck off for shagging his clients.
Hi Zarathustra – I think we’re somewhat at cross purposes here. My point is not about what the HPC’s remit is or what it thinks it is trying to do. Instead I’m trying to step back and understand what the effect of HPC regulation will be – after all that’s what will count in the long term and we surely agree that the intention of HPC regulation is that it should lay down for the foreseeable future the parameters within which counselling and psychotherapy will develop?
But if you want to quote a selection of what, on the face of it, seem to be eminently sensible “standards of proficiency” (the HPC’s jargon) let me quote a further selection from that same document-
· know how to operate equipment and minimise the risk of infection.
· know how to select appropriate hazard control and risk management, reduction or elimination techniques.
· have a knowledge of health, disease, disorder and dysfunction.
· be able to evaluate and implement intervention plans using recognised outcome measures.
· know how to use protective equipment.
· know how to formulate and deliver plans and strategies for meeting health and social care needs.
· understand the principles of quality control and quality assurance and conduct audits correspondingly.
· maintain an effective audit trail, participate in audit procedures and work towards continued improvement.
· be able to formulate specific and appropriate management plans including the setting of timescales.
· demonstrate a logical and systematic approach to problem solving and be able to initiate problem solving techniques.
· be able to demonstrate effective and appropriate skills in communicating information, advice and instruction.
· understand the need to engage service users and carers in planning and evaluating the diagnostics, treatment and interventions to meet their needs and goals.
· understand the importance of maintaining their own health.
The HPC’s standards of proficiency constitute the yardstick against which courses training counsellors and psychotherapists will be judged by the HPC.
The ones I have quoted are all ‘generic standards’ that apply across all the health professions regulated by the HPC and, even if some of them accurately describe some aspects of the way some counsellors or psychotherapists work, they have very little to do with the general practice of counsellors and psychotherapists outside the NHS. What is utterly outrageous about their inclusion in this consultation process is that, in its consultation document, the HPC admits (section 7.1.3 Generic standards) that they cannot be altered as a result of this consultation! Instead comments about their inappropriateness will be noted and fed into a subsequent review. In short, we are being asked to accept for the purposes of regulation an inaccurate description of counselling and psychotherapy, which may or may not be altered as a result of a review that may or may not be carried out at later date. Given the range of health professions regulated by the HPC it seems obvious that very few changes will be possible without all the other health professions complaining about a watering down of standards. In other words this turns this consultation into an absurdity and shows up the HPC as incompetent.
Surely, Zarathustra, on the basis of this evidence alone, you must agree that these standards are drafted with the needs of the NHS taking precedence over the needs of the great majority of counsellors and psychotherapists who work outside the NHS?
Which goes back to main point of the piece with which I kicked off this thread – if we’re going to sort this mess out we need two separate professions, one based on the research evidence (eg Wampold’s detailed and scrupulous meta-analysis of the scientific evidence) and the other, if need be, based on NHS management needs which purports to present itself as ‘evidence-based practice’.
Hi again Arthur,
Since we last had the opportunity to spar there have been a couple of developments in the Gale case that may be of interest to you.
The first directly involves this matter of the HPC only protecting title rather than function or activity.
It is my understanding from the HPC, based on my continued direct contact with them concerning ongoing matters in the Gale case, that they too are very concerned about this problem of Mr Gale having blatantly stuck two fingers up at them by continuing to practise not only by changing title to psychotherapist (a title he already used and mixed and merged with Dramatherapist, voice coach, singing teacher, guru, writer, teacher, motorcycle expert or anything else he fancied to impress his clients and cronies) but by also advertising and continuing to openly practise recognised drama and arts therapy methodologies and techniques like psychodrama, music therapy, singing therapy etc ie continuing to practise as an Arts Therapist.
As I am sure you understand it would be imprudent of me to say much more other than the HPC have committed some of their substantial legal resources, which Arthur seems to resent so much, into looking at what may be able to be done about this. Who knows we may yet have a criminal court test case that actually sets a precedent for not only title protection but also acting under title by definition of activity. Now that really would empower the HPC to take on the charlatans. Imagine a world where struck off radiographers could no longer set up business in their bedsit claiming to be bone seers
Once again this reassures me that the HPC are very much responsive to the real world and are willing to commit resources to working out how to get this right for the protection of the public. I would also like to thank Derek Gale once again for giving us all such a cut and dried case with which to reinforce the law. How are your plans to “take this work abroad” coming along Derek?
Meanwhile the self regulation cabal of psychotherapy seem to be as confused and knicker twisted as ever. As you probably know from my previous blogs I still have a complaint against Gale outstanding with the UK Association of Humanistic Psychology Practitioners (UKAHPP) a member organisation of the UKCP.
The UKCP have followed the HPC’s lead and (unfairly in my view) struck Gale off without any due process. But that still leaves him as a longstanding founder (by his own definition) member of the UKAHPP who I have asked to reinstate my original complaint so that Gale can be brought before their disciplinary panel. Despite having requested this back in June the only reply they have given me is in essence “we are considering what to do and will get back to you when we deem it appropriate”. Stay awake at the back because this is where it gets interesting.
However in the meantime the UKAHPP have informed David Pink the chief executive of the UKCP that they intend to go ahead with the hearings to (finally) conclude the matter. Pity they forgot to tell me and when I raised this with them I got a note back from Ian Doucet, their admin officer, saying that he found me refering to the UKAHPP as being bullshit as being “offensive and inaccurate”, he concluded this sympathetic e mail to a complainant of four years standing with; “(I) will not respond to any further communications from you”. So at least that’s one person from the UKAHPP who has agreed not to lie to me anymore. Meanwhile old David Pink was digging his hole even deeper by refusing to take any action about Gale still advertising his Gale Centre services as being with UKCP endorsement.
So in summary we have the HPC at least listening and trying to work out how to do something about the problem.
Then we have the self regulators striking Gale off to look big and tuff in the HPC shadow and then doing nothing to stop him continuing to use their endorsement while his friends at the UKAHPP go on protecting his interests and their own over any other consideration whatsoever.
So Arthur I will ask you once again; who do you envisage running this system you propose if it’s not the HPC?
psssst there’s also a rumour that the HPC may have faith healers in their sights……………………….
Cheers
Howard Martin
Hi Howard –
Thank you once again for a very informative contribution. I appreciate you may not be in a position to reveal details, but it’s good to hear that the HPC is very concerned that its sanctions are ineffective and it isn’t quite sure how to get them to work. But surely what the Derek Gale case shows more than anything else is that the Government would be wise to delay HPC regulation for counselling and psychotherapy until they are quite sure they have a system that actually does protect the public?
My earlier points still stand, namely –
· It is already clear that HPC regulation, at present is cumbersome and expensive.
· There is a real question as to whether it represents value for money.
And please understand that in saying this I’m not here to defend any of the procedures you have been at the receiving end of, Howard, nor would I want to do so. It sounds from all you’re written you’ve been through an extremely difficult time.
Nor am I arrogant enough to presume that I know the answers. I have some suggestions and I outlined these in the previous thread [‘A Psychotherapist responds (1)’], but there are undoubtedly other ideas that should be considered as well. My hunch is that, in the end, what will be needed will be series of complementary initiatives that, taken as a whole, will have a greater cumulative impact on public protection than the proposals from the HPC that are out for consultation at present – and without the unintended negative consequences.
The best I can offer is a procedure for getting to an answer –
· The HPC should recommend to Government that it is not appropriate for it to proceed further.
· Government should then call a halt to HPC regulation and set up an enquiry that will (1) undertake research to identify the nature and scale of the problem to be addressed, (2) take account of all the relevant evidence, (3) build on best practice from around the world and (4) devise a scheme in which the benefits to the public exceed any negative unintended consequences. It’s important not to bodge this.
As for who should run whatever results I’m open minded – though it’s clearly crucial that, whoever they are, they should have the confidence of everyone affected.
Best wishes
Arthur
Its like saying ‘give us reiki’ from an evil person. Ewwwwww bad transference