Followers of my blog will be aware that I have been campaigning for the statutory regulation of counselling and psychotherapy in the UK. Click on my articles link and you will see a number of posts under the heading "Regulation Issues".
Fellow blogger Phil Dore is the author of the blog unsafespaces.com. I made contact with Phil in 2013 whilst I was in the midst of the traumatic ordeal of raising a complaint about the therapist/clinical supervisor I had whilst in training, who abused his position of power with myself and several other counsellors who worked under him. I was relieved that somebody else cared so passionately about making counselling and psychotherapy a safer space and who shared my concern that being struck off a professional body is not enough to stop unsafe practitioners from continuing their unsafe practice unimpeded.
Since going public with my experience I have received a steady stream of enquiries from people who have been abused by their therapist. The current complaints procedures are expensive, daunting, stressful and pretty much useless.
In campaigning for statutory regulation I have approached my local MP Ben Bradshaw who has been very helpful, insofar as he is able. In a letter to Jeremy Hunt, Ben was told:
Phil Dore and I decided to work together on this and have written the following paper. We have drawn upon existing research and research of our own to demonstrate that there is a need for statutory regulation.“We are not ruling out introducing further compulsory statutory regulation. However any decision to extend… must be based on a solid body of evidence demonstrating a level of risk to the public that warrants the costs imposed…”
Executive Summary
An increasing number of people in the UK, many of whom are vulnerable, are accessing counselling or psychotherapy services. However, almost uniquely among mental health professionals, neither counselling nor psychotherapy are subject to a statutory regulator, and neither the terms “counsellor” nor “psychotherapist” are protected titles. Voluntary registers exist, such as the British Association for Counselling and Psychotherapy and the UK Council for Psychotherapy, which have been granted Accredited Register status by the Professional Standards Authority. However, if such registers strike off a practitioner for misconduct, there is no legal requirement for this individual to stop practising.
To find out how many counsellors and psychotherapists continue to practice after being struck off, withdrawal of membership notices were downloaded from the BACP and UKCP websites for a ten year period. Internet searches were then completed to look for business websites for these individuals advertising counselling or psychotherapy services. From these searches, nearly one in four of those struck off during this period by the BACP or UKCP appeared to be still practising. For the UKCP in the latter five years of this time period, every single one of those struck off was continuing to advertise their services as psychotherapists. These included individuals struck off for very serious allegations, including serious sexual misconduct.
A case study is examined of Palace Gate Counselling Service in Exeter. This company was struck off by the BACP in 2014 after the director was found to have committed serious sexual misconduct against two women, a counsellor and a trainee counsellor at the firm who he was seeing for private therapy sessions. In addition, the director and his co-director (both of whom practice as counsellors and clinical supervisors for counselling trainees) were found to have conducted a sustained campaign of harassment and defamation against the two women after they complained. However, the company remained in business, and both individuals remained in their posts as directors and counsellors.
The case was the subject of media attention, including in the Health section of the Mail on Sunday, and a sustained effort was made by local activists to ask organisations not to signpost people to Palace Gate. Despite these efforts Palace Gate continued to be publicised by the NHS, churches and the voluntary sector. The two individuals continue to practice counselling at Palace Gate and in private practice to this day.
From this evidence, it is clear that, from a safeguarding perspective, the current system of accredited registration is a complete failure. It is simply not effective at removing rogue practitioners from the counselling and psychotherapy professions. This safeguarding failure is putting vulnerable people in danger of serious abuse, including sexual abuse.
Opponents of regulation suggest that counselling and psychotherapy are difficult to define, and that if “counsellor” and “psychotherapist” became protected titles, practitioners could avoid regulation by simply changing their job titles. To test this, we surveyed 151 people to ask which professional titles they would look for and accept a service from when seeking treatment for a mental health problem. 64.93% said they would look for a psychotherapist and 60.43% would look for a counsellor. By comparison 50% would look for a cognitive-behavioural therapist and 24.41% would look for a psychoanalyst. For a life coach, this number dropped to 7.09%. This suggests that certain other titles may need to be protected alongside “counsellor” and “psychotherapist”, but also that this need not be an infinite number of titles to have an impact.
The protection of titles would be made more robust if combined with a restriction that only professionals with a protected title can offer psychological therapies for mental disorder. A survey of 50 adverts for counsellors and psychotherapists found that every one of them advertised their services as being for mental disorder. These often included serious and debilitating conditions such as eating disorders, bipolar disorder and obsessive-compulsive disorder.
If the professional titles were protected, and only professionals with protected titles were permitted to offer psychological therapies for mental disorder, a practitioner could indeed avoid regulation by using a different title and not suggesting that they can treat mental disorder. However, these two surveys suggest that if they were to do so, they would incur a serious loss of business and they may find this to be not commercially viable.
It is therefore recommended that:
Opponents of regulation suggest that counselling and psychotherapy are difficult to define, and that if “counsellor” and “psychotherapist” became protected titles, practitioners could avoid regulation by simply changing their job titles. To test this, we surveyed 151 people to ask which professional titles they would look for and accept a service from when seeking treatment for a mental health problem. 64.93% said they would look for a psychotherapist and 60.43% would look for a counsellor. By comparison 50% would look for a cognitive-behavioural therapist and 24.41% would look for a psychoanalyst. For a life coach, this number dropped to 7.09%. This suggests that certain other titles may need to be protected alongside “counsellor” and “psychotherapist”, but also that this need not be an infinite number of titles to have an impact.
The protection of titles would be made more robust if combined with a restriction that only professionals with a protected title can offer psychological therapies for mental disorder. A survey of 50 adverts for counsellors and psychotherapists found that every one of them advertised their services as being for mental disorder. These often included serious and debilitating conditions such as eating disorders, bipolar disorder and obsessive-compulsive disorder.
If the professional titles were protected, and only professionals with protected titles were permitted to offer psychological therapies for mental disorder, a practitioner could indeed avoid regulation by using a different title and not suggesting that they can treat mental disorder. However, these two surveys suggest that if they were to do so, they would incur a serious loss of business and they may find this to be not commercially viable.
It is therefore recommended that:
- “Counsellor” and “psychotherapist” should become protected titles and these titles should be subject to a statutory regulator.
- Consideration should be given to also protecting certain other titles, for example “cognitive-behavioural therapist” or “psychoanalyst”.
- The provision of psychological therapies for mental disorder should be restricted to professionals who have a protected title and are subject to a statutory regulator.
It’s telling that you come up three recommendations, if protected titles were really a path to compulsory regulation then you wouldn’t need the second two. There would be no need to protect any other titles because everyone who wanted therapy would turn to a practitioner calling themselves a Counsellor or a Psychotherapist; and there would be no need to put restrictions on who can offer psychological therapies for mental disorders because the only people offering such therapies would be registered.
ReplyDeleteOn their own protected titles are toothless kite marks with no more power to stop people who have been struck off from practicing than Accredited Registers. Being struck off the statutory register of Art Therapists meant Derek Gale could no longer use the protected title “Dramatherapist” but he could go on practicing psychodrama; and being struck off the statutory register of Podiatrists hasn’t stopped Stephen Gardiner from being the Director of Clinical Services and an “Extended Scope Practitioner” in his podiatry practice. So it would appear that, by your standards, when it comes to safeguarding statutory regulation based on protected titles has also been a complete failure.
The truth is that neither the system of protected titles nor of accredited registers attempt to stop struck off individuals from practicing, they are there as an independent quality mark that lets the people commissioning services identify suitably qualified and regulated practitioners. Which is fine when a competent professional is commissioning the services of other professionals and so knows what to look for, but when the public commission services for themselves (e.g. when someone chooses their own counsellor) they are only protected if they know what to ask (“What Accredited Registers are you on?”).
To date, public awareness of Accredited Registers is dismal so it offers virtually no protection against unregulated counsellors and psychotherapists. Although it’s worth noting that the scheme has led to considerable improvements to the regulation of tens of thousands of therapists, so it has had significant safeguarding successes.
On the other hand the terms “Psychotherapist” and “Counsellor” are widely known, so using that pre-existing awareness by making them protected titles would (initially at least) offer better protection; the sting in the tail is that “better” isn’t always good enough. Based on your figures a significant proportion of the population would still be left unprotected, for example even the 7.09% that would consider going to a Life Coach equates to 4.4 million people left at risk of unwittingly going to an unregulated practitioner.
But there is an even more fundamental problem with the idea of using professional regulation to protect vulnerable clients: professional regulation can ensure that practitioners are competent and understand the ethics of their actions, but it cannot ensure that they act ethically. Even if the law was such that only suitably trained and registered practitioners were allowed to offer psychological therapy it would still not be illegal for therapists to abuse their clients. For example, it would be legal for a sexual predator to train and register as a counsellor and then see how many clients he can have sex with before getting struck off; as long as he stopped practicing when told to he would be free to do as he pleased.
With all this in mind I’d like to put forward two alternative recommendations, that:
1: A massive publicity campaign be carried out so that the public recognise the logo of the Professional Standards Authority and they understand the importance of checking any health or social care professional they consult is on an appropriate Accredited Register.
2: Consideration be given to extending the offence Controlling or Coercive Behaviour in an Intimate or Family Relationship so that such behaviour is also a criminal offence when it occurs in a Professional Relationship.
Why do therapist wish to be so secretive about what they do? How about some transparency? They are in a position of power, patients are the vulnerable ones. In the absence of regulation I wish someone would make a trip advisor style site where you can rate and read a therapists ratings. Done.
ReplyDeleteThere is absolutely no proof that statutory regulation would provide greater public protection against counsellors who full foul of their accrediting bodies. Indeed, the worst examples of abuse by therapists have been committed by those already regulated by statute. Yes, they'd be stopped from practising, but it's certainly not a deterrent. Further, as someone with interest in the law, the possibility of accounting for the proliferation of therapy approaches represents a minefield for regulation. It could not be done without reducing the approaches through a severe culling programme!
ReplyDeleteThank you for your comment ‘Anonymous’. I would imagine that the reason why you think that it’s members of professional bodies who are the worst abusers is because at least you can see details of some of their hearing outcomes. Or do you have another reason to state this? What about the many, many cases which do not go to complaints hearings because there is no professional body? I get contacted regularly by people asking what they can do about their abusive therapist. In many cases they can do absolutely nothing because there is no professional body to complain to. Further, I take it you have not read the Unsafe Spaces report linked to above? Our research shows that1 in 4 therapists struck off by professional bodies continue to advertise their services as therapists. There is no deterrent at the moment and it being illegal to continue as a therapist if found to be abusive is surely more of a deterrent than absolutely no impact on ability to carry on (and subsequently reoffend completely outside of accountability).
DeleteFinally, I don’t think there does need to be a culling of therapy types for an adequate regulation model. The HCPC oversees some creative therapies such a drama therapy and art therapy.
It would be good if you could put a name to your arguments rather than post anonymously.
There is no evidence that statutory regulation supports your idea and you cannot rely on personal experience. You have to produce clear statistical evidence. And if there has been serious misconduct the avenue to take is the police.
ReplyDeleteEven if they complain to a professional body there is actually nothing that the body itself can do. Striking them off? So what? What does it change for who has been harmed? I have met complementary therapists working and doing the job way better than other "accredited" professionals, with contracts and insurance coverages higher than what's available for the public sector. The Register that you have mentioned is just a scam, you join voluntary and pay, lots of money, to just feed an oligarchy of mediocrity. There is no protection there for the people. Only a desperate trial from psychologists of been finally recognized after being ignored for over a century and compared to yoga teachers. Truth is that, same with abortion etc, citizens have to be able to choose who is going to treat their mental illness and if they do not want to fit in the pages of the DSM5 then it is up to them to defend their uniqueness! By imposing regulations you discriminate UK citizens who will be forced to emigrate looking for psychotherapists who do not judge them holding an American book in their hands!
ReplyDeleteMany thanks for your comment/s Anonymous. I'm unsure as to whether the last two comments are from the same person or not. Either way (both of) you might benefit from reading the Unsafe Spaces report linked to at the top of the article.
ReplyDeleteBest wishes
Amanda
I really wish our profession was regulated. I have met many "counsellors" who are very vague in disclosing/sharing where they obtained their training and what their approach is. Just a few weeks ago I was at a training session when an "experience counsellor" (who works with young people) asked a few of us what is it what we do in supervision along many other comments that made me doubt the validity of his training and his experience. I was shocked and feel that there is nowhere I can go with my concerns. There are many "counsellors" that are causing great damage to vulnerable people. I really wish our titled was protected, an organisation has no way of knowing how a counsellor arrives at that position and that is why they prefer (for peace of mind and protection) to look for counsellors that are registered with a professional body and are accredited. I wish all the professional bodies would get together (put their differences aside) and campaign for regulation. There are many rogue counsellors practising, this is a sad fact.
ReplyDeleteIn my experience the majority of ethical and self aware counsellors and psychotherapists seem to be pro regulation. There will be disadvantages I’m sure as it will be a complex change. But something has to change. This free-for-all is ridiculous and particularly as mental health problems are destigmatised (a wonderful thing) and more people are seeking talking therapies. All very well but when there are flakey therapists who have attended a flakey course and have an inflated sense of entitlement...（and don’t even know what supervision is) well I worry about how that plays out in the therapy room.
DeleteThank you
ReplyDeleteI have never understood why clinical psychology, counselling psychology etc, should be protected titles but not so for a counsellor, cognitive therapist , psychotherapist ?
ReplyDeleteOne problem with this is often I have found psychologists from these professions claiming to be trained as Schema therapists or Cognitive Therapists, psychodynamic etc and yet have not met the required training for specific self interest groups for these modalities such as the ISST , BABCP. The BPS appears immune to this and is able to promote it's own professional groups as having expertise in all things related to psychotherapy . I wonder if this is misleading the public on some level ?
Thank you for raising this very important issue. As a trainee art psychotherapist, when I qualify I will be required to register with HCPC in order to practice. I will have a legally protected title, and I can apply for jobs in the NHS where HCPC registration is a basic mandatory requirement. I will pay an annual registration fee, like nurses and midwives. All these things help to regulate the profession and protect the public.
ReplyDeleteIf I were to be struck off, I would not legally be able to practice, nor refer to myself or my work as art therapy / art therapist, nor apply for certain jobs. These all seems fair, safe and reasonable to me. I find it worrying that similar restrictions don’t apply to counsellors or psychotherapists. I would also question the professional integrity of anyone who is opposed to regulation and registration.
The BBC addressed this issue earlier this year:
https://www.bbc.co.uk/news/av/uk-51273607/can-anyone-call-themself-a-therapist-or-a-counsellor
If you were struck off you would have to stop marketing yourself as an "Art Therapist" but as long as you change the way you describe yourself you would be free to carry on regardless (just as Derek Gale did).
ReplyDeleteLegally, you wouldn't have to cancel any appointments, or stop seeing any of your clients, or change your practice in any way.
As things stand counsellors and psychotherapists can't apply for certain jobs unless they're on a register accredited by the same statutory body that overseas the HCPC's register (the PSA), and they can't legally claim to be on a PSA Accredited Register unless they actually are. It's fundamentally the same sort of kitemark system, it's just the nature ot the kitemark that differs.
I completely agree with the need for statutory regulation in the field of counselling and psychotherapy. It is alarming to see that current complaints procedures are expensive, daunting, and ineffective, leaving victims of abuse by therapists in a vulnerable position. The case study of Palace Gate Counselling Service highlights the failure of the current system to protect individuals from serious misconduct.
ReplyDeleteThe idea of introducing protected titles, such as "counsellor" and "psychotherapist," is a step in the right direction. While some argue that practitioners could simply change their job titles to avoid regulation, the survey results show that a significant majority of people seeking mental health treatment specifically look for these titles. This suggests that protected titles would indeed have an impact in guiding individuals towards regulated professionals.
However, it is important to acknowledge that protected titles alone may not offer full protection. Additional measures, such as restricting the provision of psychological therapies for mental disorders to professionals with protected titles, should be considered. This would further ensure that only qualified and regulated practitioners can offer these services.
I also appreciate the alternative recommendations put forward by Patrick Killeen. A comprehensive publicity campaign to raise public awareness of Accredited Registers and the importance of checking the credentials of therapists would provide an additional layer of protection. Moreover, extending the offense of Controlling or Coercive Behavior in an Intimate or Family Relationship to include Professional Relationships would address the issue of unethical behavior by therapists.
In conclusion, it is crucial to establish statutory regulation in counselling and psychotherapy to safeguard vulnerable individuals and prevent abuse. Protected titles, combined with restrictions on offering therapies for mental disorders, can significantly enhance the safety and quality of these services. Additionally, public awareness campaigns and legal measures can further contribute to protecting clients and holding unethical practitioners accountable.