20 July 2015

Who is publicising the PSAs Accredited Registers?

I recently published a post written by guest blogger Patrick Killeen on the Professional Standards Authority's Accredited Registers (ARs, previously known as Accredited Voluntary Registers/AVRs) the closest thing we have in the UK to the regulation and accountability of counsellors and psychotherapists. Patrick wrote a compelling argument about how the registers could effectively protect the public without the need for statutory regulation...if only the public knew of their existence... I highlighted the lack of awareness of the ARs in an article last year.

In light of Patrick's post and the few comments I received from other pro-regulation therapists on Twitter, I decided to ask the PSA what exactly they were doing to raise public awareness of the registers. As usual, they were very forthcoming with a prompt response:

The Authority works in partnership with each of the Accredited Registers to share information about the programme with a mixture of high level opinion formers in the health and care sector, and the general public. We each raise awareness through our stakeholder channels (including, for example, NHS England and NHS Employers) and the registers’ registrants do so directly with their patients and clients.

As the programme enters its third year, we are undertaking increasing amounts of work to raise awareness of its role in ensuring public protection.

One example of the work which we’ve done to increase awareness of the programme was our recent publication of Accredited Registers - Ensuring that health and care practitioners are competent and safe (this link no longer works and has been removed) which we sent to a wide range of stakeholders across national and local government, charities and the private sector. We are following up with meetings with key people. On 1 July we held a Round Table attended by around 40 representatives from all of those sectors, including National Voices, NHS Employers and the National Care Forum. This event generated a very positive discussion regarding ways in which all sectors could work in partnership to promote patient care through the use of accredited registers. Taking the suggestions from that meeting forwards, and building on the work already undertaken, we are drawing up a new communications plan for the forthcoming year. We are also developing an information hub for commissioners and referrers and we will be sharing further information about this shortly.

My advice to fellow practitioners who are on an AR is to publicise this on your website, directory listings and in person to new clients. Explain what it means and help spread the word. I'll be relieved when the public at large start to wonder why a therapist or organisation is not on an Accredited Register.

Amanda Williamson Reg MBACP (Accred)

8 July 2015

The Regulation Debate; The PSA's Accredited Registers versus Protected Titles by Guest Blogger Patrick Killeen

(edited Jan 2024 as some of the links are now defunct; Google no-likey that)

I am honoured to be able to publish this guest post written by philosopher and trainee counsellor Patrick Killeen. I have come to know Patrick through his commenting on this blog as well as the unsafespaces.com blog hosted by Phil Dore. Patrick leaves very helpful, well thought out comments and is always very polite and respectful. We have had ongoing discussion about the regulation of counselling and psychotherapy. I recently published my ponderings following Patrick asking me what I would do if I had the power to regulate counselling and psychotherapy.

I invited Patrick to collate his thoughts on the regulation debate in a post for my blog. Here goes…

In 2013 the Professional Standards Authority For Health and Social Care (the PSA) launched a new regulatory framework under which any group that maintains a register of health or social care professionals, and who can prove to the PSA that their register is run to protect the public and run well, can have their register accredited. As a result there are now over 34,000 counsellors and psychotherapists working under professional regulations that are overseen by a statutory body [1]. However, it is still often said that "Counselling is unregulated because anyone can call themselves a 'Counsellor,'" and there are continuing calls to make "Counsellor" and "Psychotherapist" Protected Titles to stop unregulated practitioners posing a risk to the public. This position is misguided, the practice of counselling would be no more regulated under Protected Titles than it is under Accredited Registers; when it comes to public protection there is nothing that could be achieved with Protected Titles that couldn't be done with existing laws.

The problem with regulated registers is that they only police registered professionals, so someone can sidestep them by simply not registering. This limitation is obvious with Accredited Registers, which are explicitly voluntary, but it is also a feature of Protected Titles. The Council for Healthcare Regulatory Excellence had this to say:

Protected titles create a boundary for professional practice, in that titles are reserved for registrants, and cannot legally be used by non-registrants. However, this does not stop people from practising in an unregulated way. There are examples of practitioners, including some who have been struck-off by a former regulator, who use non-protected titles. They may even state correctly that they are trained in a field of practice, and offer services to the public, without using a protected title. [2]

To get an idea of the limits of Protected Titles it's worth looking at the case of chiropodists and physiotherapists. When the Health and Care Professionals Council (HCPC) was set up in 2003 "Chiropodist" (along with "Podiatrist") and "Physiotherapist" were made Protected Titles. In 2007 the HCPC commissioned market research which found that the public were unaware of the difference between someone operating under unprotected titles like "Foot Health Practitioner" and "Sports Injury Therapist" and someone using the Protected Titles "Chiropodists" and "Physiotherapist"; some practitioners even complained that the titles used by unregistered individuals were more attractive to potential clients than the protected ones. [3]

All that protecting the titles had changed was the words needed to describe the problem of unregulated practitioners. In 2002 you might have said "Not all chiropodists are suitably trained and regulated so make sure you see a State Registered Chiropodist", while in 2007 you would have said "Not everyone offering foot health care is suitably trained and regulated so make sure you see a Chiropodist or Podiatrist"; both statements refer to the same people doing the same things with the same levels of regulation.

The thing that can give professional regulations real teeth isn't their power over registered professionals, rather it is the extent to which they curtail the activities of everyone else. For example, anyone can call themselves a "Gas Engineer" just as anyone can call themselves a "Counsellor", but if you are aren't on the Gas Safe Register you are forbidden from working on mains gas appliances [4]. It's the fact that unregistered individuals are banned from working with mains gas that protects us from incompetent gas engineers, without that ban the regulation of registered engineers would be ineffectual.

If you tried to enact a similar ban for counselling then you would hit an immediate problem, there is no well-defined activity that unqualified individuals should be banned from doing. Physically what a counsellor does is listen and talk; but it would be absurd to say that no-one is allowed to listen and talk with anyone else unless if they weren't a registered counsellor. Try to finish the following sentence: If you are not Gas Safe Registered you must not even attempt to fit or repair gas appliances, and if you are not a qualified counsellor you must not even attempt to…

As things stand, if you are not on a PSA Accredited Register of counsellors then legally you must not claim to be on a PSA Accredited Register of counsellors; but seeing as most people have no idea what Accredited Registers are it wouldn't stop you counselling. If "Counsellor" was made a Protected Title then we would have a situation where if you are not on the statutory register of counsellors you must not use the word "Counsellor" to describe yourself; it wouldn't stop you from counselling, it would just force you to be more creative in your marketing (e.g. "Person-Centred Practitioner" or "Psychodynamic Therapist"). On their own Accredited Registers are completely toothless and Protected Titles would have one useless tooth.

Fortunately the statute books are not the whole story. The more that people and organisations who engage or recommend counsellors look for Accredited Registers the greater the limitations will be on unregistered practitioners; not in the form of things that you mustn't do by law, but in the forms of things that you can't do because others insist on dealing with registered practitioners. If Accredited Registers become widely understood and respected, to the point that potential clients are put off if a counsellor isn't on an Accredited Register, then they will become effective tool of professional regulation (the same would be true of Protected Titles). The PSA's assessment is that "awareness of the programme is at an early stage. Considerable ongoing promotion is needed to increase its public profile and bring it to the attention of the people best placed to spread the word about its existence or make referrals, such as GPs and social workers." [1] If they manage to make Accredited Registers a household name then the practice of counselling really will be regulated.

So, if you are outraged at the fact that counsellors and psychotherapists can continue to practice after being struck off, quitting their regulatory body, or flatly refusing to be regulated, then I urge you not to press for Protected Titles, the statutory battle has already been won with the introduction of Accredited Registers. Instead, use your energy to get behind the PSAs and Accredited Registers: tell people how they can use Accredited Registers to protect themselves; complain to the PSA when complaints are mishandled by governing bodies; respond to their calls for information; scrutinise their decisions; and if they drag their heels shove them forward as hard as you can. Accredited Registers are a promising start, let's do what we can to get them to fulfil their promise.

[1] Professional Standards Authority for Health and Social Care, March 2015, "Accredited Registers: Ensuring that health and care practitioners are competent and safe."
http://www.professionalstandards.org.uk/library/document-detail?id=98755a9e-2ce2-6f4b-9ceb-ff0000b2236b

[2] Council for Healthcare Regulatory Excellence , February 2010, "Protecting the public from unregistered practitioners: Tackling misuse of protected title."
http://www.professionalstandards.org.uk/library/document-detail?id=79ad1501-7542-4051-a992-498603cb4783

[3] Health and Care Professionals Council, July 2007, "Evaluating public awareness concepts."
http://www.hcpc-uk.org/mediaandevents/research/index.asp?id=959

[4] The Gas Safe Register. http://www.gassaferegister.co.uk

For more posts about regulation please see below:

Regulation - a client and therapist friendly way forward? (November 2014)

The problems with a voluntary regulatory scheme (Sept 2014)

Spreading the word on AVRs - the Professional Standards Authority responds (Sept 2014)

The Regulation of Counselling and Psychotherapy - What the Public Want (June 2013)

19 June 2015

On Therapy as Social Control by Phil Dore

This is a post written by Phil Dore and reblogged from unsafespaces.com

I was reading an interesting article in the Medical Humanities journal, about use of psychological therapies to “help” unemployed people find work. The article, rightly in my view, points out that such therapies are on very dubious ethical ground.

There’s a view out there, which I think is utterly erroneous, that therapy and psychiatry can act as a remedy for all sorts of social ills. Give everyone enough CBT and fluoxetine, so the idea goes, and poverty, social inequality, abuse, bad housing etc will simply cease to be a problem. Does it work? Of course it doesn’t.

The article describes some “motivational” statements that were sent out to people on the Work Programme.

Go hard or go home
My only limitations are the ones I set for myself
Failure is the path of least persistence
It's always too soon to quit

Unsurprisingly, those who received this responded with “anger, humiliation and depression” rather than being encouraged to get up and seek work. One can only imagine how such banal rubbish sounded to people who sent out multiple job applications at the height of the Credit Crunch, only to discover that nobody was hiring.

There’s other examples of such “therapy” being offered as a solution to problems in society. News reports have suggested that jihadists may be forced to undergo “deradicalisation” therapies. Although I agree that radical Islamism is a danger, the idea that people will give up their beliefs because a therapist told them to strikes me as naive in the extreme.

We’ve been here before. In the seven years I’ve worked in Child and Adolescent Mental Health Services [insert usual disclaimer here about how views expressed are in a personal capacity and not necessarily those of my employer] I’ve seen the vogue come and go for anger management. Schools, voluntary services, youth offending services and CAMHS were all sending vulnerable, often traumatised kids to anger management, so they can learn how to control their “anger problem”.

I’ve been struck by how many young people benefited from this. Virtually none of them. If they did, it usually wasn’t for a reason to do with the actual model of therapy. Perhaps they developed a good relationship with the worker, and the anger management exercises were simply something to do while they got to know each other.

Part of the problem is how it’s framed as an “anger problem”. Of course, the problem isn’t really anger. Children aren’t sent to anger management because they kept writing indignant letters to their MP. The problem that everyone is concerned about is their behaviour – smashing up bus stops, getting into fights and so on. It’s what they do that gets them sent to anger management, not how they feel.

As for those feelings of anger, those are often rooted in a much wider systemic problem – they live in a bad part of town, they aren’t getting appropriate parental boundaries, in some cases they’re being abused or neglected. To simply say they have an “anger problem” is a reductionist, narrow explanation that ignores wider issues outside of their control. What they often need is nurture, care, compassion and stability, not a finger pointed at them saying that they’re the problem and they need to sort it out.

Mostly importantly, what all these therapies ignore, whether it’s mandatory CBT on the Work Programme, forced deradicalisation or anger management, are the issues of consent and a client-based approach. It ignores a basic and fundamental tenet of therapy – that it’s there to help the client do what they want to do, not what everyone else wants them to do. That’s what makes such therapies not only unethical, but ultimately ineffective.

31 May 2015

The Law in respect of Counselling for Adoption Issues

Update December 2023 this law no longer exists. Adult adoptees and adopters do not need to have counselling with ofsted registered therapists anymore. https://www.bacp.co.uk/news/news-from-bacp/2023/20-december-new-law-change-to-improve-access-to-adult-adoption-related-therapy/

Update April 2023 https://www.communitycare.co.uk/2023/01/10/dfe-proposes-law-change-to-improve-adults-access-to-adoption-counselling/

In 2010 there was a law passed that means that only counsellors registered as an Adoption Support Agency and with Ofsted are able to offer specialist adoption counselling. This is an extract from a relevant page on the Counselling Directory website :

Approved Adoption Counselling

In December 2010, the law changed so that only counsellors and psychotherapists registered as an adoption support agency (ASA) with Ofsted are able to offer specialist adoption services. These amendments to the Adoption and Children's Act of 2002 were designed to ensure that the one in four UK individuals affected by adoption in some way, are provided with support and services from practitioners who hold the proper qualifications and experience. The introduction of this legislation now means that any counsellor working with a client for whom any aspect of adoption is the main focus, must be registered with Ofsted and subject to regular inspections.

It may be that some individuals are seeking counselling for issues they feel may be related to adoption (such as low-self esteem) but where adoption is not the key issue. In cases such as these where the entire counselling experience is not likely to revolve solely around the adoption itself, it is fine to seek help from a professional who is not an Approved Adoption Counsellor.

I am able to work with other issues that may be part of what is going on such as addictions or low self-esteem, but it is illegal for me to take on a client specifically with the purpose of working with the adoption issue itself.

In my experience many counsellors are not aware of this legislation so please do ask anybody that you enquire with whether they are registered specifically with Ofsted and as an adoption support agency. If you would like specific, adoption counselling I would contact your local council Adoption Unit practice manager and ask if they can refer you to anybody suitably registered.

I have happily worked with people affected by adoption issues but there has always been another presenting factor such as gambling, a personality disorder, trauma or relationship problems which has been the cause for seeking counselling.

Amanda Williamson Counselling and Coaching for Couples and Individuals

24 May 2015

How Counselling Can Help With Divorce and Separation

by Amanda Williamson

As a professional counsellor I often see clients with issues around family break ups, affairs, problems with ongoing divorce settlements and conflicts about children. These issues often leave people feeling rejected and very vulnerable. Sometimes these issues can tap into old wounds from childhood.

Divorce and separation involves loss for both parties and is one of the most stressful things we can go through as adults. A huge loss like this is akin to a bereavement and it is normal to experience a range of emotions such as shock, denial, anger, guilt, sadness and depression.

The shock is particularly present for those who did not make the choice to separate and it can leave them feeling bewildered and powerless as well as impacting on self-esteem. Guilt often haunts the person who makes the decision, sometimes for years afterwards, even if the relationship was beyond repair.

Our emotions are there for a reason and we need the opportunity to express them or we can end up stuck with them which can in turn affect our future relationships or sense of happiness. We might not always have the opportunities in our personal lives to explore emotions without other people imposing their agenda. There may be friends and family members who mean well, but we can feel pressured to be feeling and behaving in a way that others expect of us, despite the fact that grieving is a very individual process.

Some people are used to being the “strong” or “responsible” one and do not feel comfortable sharing their difficulties with anybody in their personal lives.

One of the ways which counselling works for many people is that it provides the opportunity to talk about our inner world of emotions. A good therapist will help their client to explore what is lying behind symptoms such as depression, anxiety or anger without imposing judgement or an agenda. In paying attention to and understanding these difficult emotions and how they might be tied up with judgements or beliefs about ourselves we can be in a better place to move on.

There may have been relationship dynamics present in the relationship which continue to play out post separation and divorce. Perhaps one partner is perceived by the other as being controlling or manipulative. Clearly there is a limit to what counselling can do to alter somebody else’s behaviour but it can help people to have clearer boundaries and feel more comfortable in asserting their own needs. If somebody has had a lifetime of shelving their own needs then some coaching in assertiveness can really help them.

Many people are pleasantly surprised at how a different perspective from a trained and experienced counsellor can really help them get on with life in a better place. It is well worth considering, particularly if someone is struggling in the aftermath of a difficult separation.

Amanda Williamson Coaching and Counselling Service in Exeter, Devon

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