Last Friday I posted about a worrying case in which the UKCP has been taking since February 2009 to investigate the conduct of a psychotherapist, during which the individual has been able to carry on practising regardless.
The case is important because of the self-regulating nature of psychotherapy in the UK. The UKCP is currently trying to position itself to become an “assured voluntary regulator” for the profession, whereby its complaints and disciplinary procedures will receive official endorsement. Cases such as this could cast doubt on its ability to take on such a role.
At the moment, there’s no statutory regulator for counsellors or psychotherapists. There’s also no minimum qualification. A psychotherapist could be somebody who’s undergone an arduous post-graduate training lasting several years, or they could be just some yahoo with “psychotherapist” printed on their business card. They might belong to a professional organisation, or they might not. If they get struck off by one organisation, they can just join another one, or they can remain unaffiliated to any body and still practice.
Of the professional bodies out there, the two biggest are the British Association for Counselling and Psychotherapy (BACP) and the United Kingdom Council for Psychotherapy (UKCP). The BACP has a good, accountable complaints system with clear procedures.
With the UKCP, the complaints system is far more muddy, which is partly down to its nature as an umbrella body for nearly 80 smaller psychotherapy organisations. If you want to complain about a UKCP psychotherapist, you first have to complain to their member organisation. If the member organisation rejects your complaint, you can then appeal to the UKCP. These 80 organisations all have different complaints procedures.
For some of these organisations say, the Association for Family Therapy, their complaints systems are of good, robust quality. Others are clearly not.
Take a look at the Code of Ethics for the Guild of Psychotherapists. In particular Parts 4 and 5. A complaint has to be proved to the criminal standard of “beyond reasonable doubt” (the usual standard of proof for such procedures is the civil standard of “on the balance of probabilities”). The complaint is heard by members of the Ethics Panel, with no provision for lay members at the hearing. Oh, and “the Panel shall have the power in its discretion…to require the Complainant to pay such costs and expenses in the event of the complaint not being upheld.”
Yep, that’s right. If you can’t prove the complaint beyond reasonable doubt, to a panel made up of the therapist’s colleagues, you could be handed a huge legal bill! And only then can you take your complaint to the UKCP. Most people would just back away and not complain.
The UKCP is currently trying to replace this clearly-inadequate system with a new Central Complaints Procedure, but this is very much a work-in-progress. As the UKCP’s latest bulletin admits, only a third of member organisations have so far signed up for it. In a startling piece of candour, the same bulletin also admits, “There has been too much crony-ism and amateurism in the conduct of complaints for far too long.”
Under the previous Labour government, plans were underway for counselling and psychotherapy to be regulated by the Health Professions Council, which already regulates clinical psychologists and arts therapists. While many psychotherapists supported this move, there was also a vociferous campaign against it. The UKCP chair, Professor Andrew Samuels, has spoken against HPC regulation.
The new Coalition government currently favours a different approach of “assured voluntary registration”. Under such a system, the Council for Regulatory Healthcare Excellence (the uber-regulator that oversees bodies such as the General Medical Council, Health Professionals Council etc) will be renamed the Professional Standards Authority. This body will be able to give an official mark of approval to self-regulating bodies such as the UKCP.
Providing, of course, that they can show that they’re able to effectively police their own profession. However, a previous UKCP Bulletin admits that without reform, “we will not pass muster at CHRE/PSA.” The apparently mishandling of the Smalley case would certainly cast doubt on the ability of UKCP to be a credible self-regulator.
justdifficult
February 16, 2012
Only yesterday, I was discussing the case of a friend who told me two years ago that after taking the momentous step to go to therapy after having suffered many years of sexual abuse from his uncle. Sadly, he was then abused by his therapist – and herein lies the issue: psychotherapy is not a profession in the UK that is regulated properly at all. You don’t have to study medicine to qualify as a therapist, and whilst I’m not sure that this should be a mandatory stipulation (as it is in Germany and France), as you rightly point out, there is too much decentralisation within the profession and nothing that feels legally binding to give patients the confidence that they are not being mentored by a wolf in sheep’s clothing….
Zarathustra
February 16, 2012
Speaking personally, I don’t think only medics should be allowed to study psychotherapy – that would rule out a lot of perfectly good psychotherapists from backgrounds in social work, psychology, nursing or even the arts. But I do think there should be some sort of minimum qualification. Probably a masters degree.
And of course, there should be a proper regulator with a robust complaints procedure.
www.justdifficult.com
February 16, 2012
I agree entirely with what you say, except that if psychotherapists had medical training, it wouldn’t be left to psychiatrists (who often have little empathy) to be totally responsible for prescribing medicines to patients… the discussion goes on, but I do realise that currently, there are psychotherapists practising who don’t come from a medical background, and who are excellent at their jobs. And thank goodness for that!
Clarissa
http://www.justidifficult.com
guiltycommissioner
February 17, 2012
I struggle to see how any complainant can be obliged to pay costs, in the course of a complaints process, unless they first sign some sort of contract to do so, or if litigation ensues, when a judge can make an order for costs. Just a blatant scare tactic which does not bode well for this organisation’s attitude to complaints.
Practitioner
February 19, 2012
Zarathurstra brings forward some if the best evidence for statutory regulation of psychotherapist and counsellors. I would like to add to that debate from the perspective of a practitioner.
The UKCP leadership tried to implement a central complaints system from 2001 onward, without success. The rationale was simple; there (was) is an inequity in the way Member Organisations run their complaints. Yes there are absurdities i.e a client having to know the complaints system before they can make a complaint, executive committees of Member Organisations making decisions regarding complaints and many, many other ‘protective practices’ that are absurd. When the UKCP tried to start a separate organisation to hear complaints there was a concerted effort by about 23 member organisations to defeat it. It was finally closed by a vindictive verbal attack on personnel.
The UKCP saw a way around the inherent power of the vested interest of member organisations by making every registrant a member. This is why the central complaints may be possible now. The independence of the central complaints system should be of concern to everyone. The CHRE hasn’t published a check list so who knows what their criteria will require.
Please also consider that the vested interest of ‘professional organisations’, be it the BACP, the UKCP, the BPC, the BPS or the other 100+ organisations that claim representation of their members, discriminate against service users, carers, and their own members. The same offence that would warrant a suspension or sanction by say the HPC causes the member to struck off. Why? The professionals often have more than a bias to the purity of the theory than the idea of justice or rehabilitation. There is a real ‘luck of the draw’ in the choice of the hearing panel for both the client and the therapist.
The current UKCP elections were supposed to be a new start of the democratic process giving service users, carers and lay memers more authority and responsibility. The last election was hijacked by the anti-regulation brigade led by narcissistic and undemocratic individuals. Unfortunately the democratic process has failed again by restricting speech and communication. The likely candidate to win will create the bureaucratic equivalent to the NHS lite. The worst of all possible worlds.
PsychoMark
February 23, 2012
Dying to know who you think the likely candidate to win will be… have you been out polling?
Flowella
February 19, 2012
What does amaze me is how Zarathustra has consistenly provided a forum in which the supressed voices from UKCP get finally heard – that includes people hurt by their processes and it has also included clients who have come to harm
such as the case that you boldly exposed last week.
The concscience of UKCP appears to be embodied on this website.
A lot of people have a lot to thank you for Z.
You have increased the flow of energy and information.
www.justdifficult.com
February 23, 2012
After reading the comments here, I take back my conjecture that I don’t think that psychotherapy needs to include mandatory training. Weighing up Zarathruster’s reportage on the nonsense and cronyism at work within the UKCP, it is obvious to me that the reason why there is so much of this is precisely because members are arse-covering.
I’d love to know how much professional and acceptable training members actually have across the board; why else would they want to hijack regulation? Fear of losing business through lack of client trust and lack of transparency perhaps? Being legally held to account for unethical and even criminal practices?
Yet again; this is more than enough evidence to me that mental health is STILL NOT TAKEN SERIOUSLY! Why should we put up with practitioners who simply aren’t qualified, and can’t be held to account over poor practice, unless they actually break the law? The threshold for damaging a patient is so high for anyone with mental health. How can anybody defend the profession on this account? I am totally stunned. I have championed the use of psychotherapy and how valuable it can be in the hands of a skilled therapist. And yet I feel that self-regulation is totally unacceptable in any sphere of healthcare. Doctors are legally required to be licensed – why should psychotherapists not be subject to the same rigours and the same level of accountability?
Clarissa
http://www.justidifficult.com
Jocelyne Quennell
March 5, 2012
It is extraordinary today that you can legally set up practice as a psychotherapist without having ever been trained or educated, without a qualification, without a regsitration with any priofessional organisation, let alone a reasonable complaints process. You do not need to have a CRB and you can practice whatever you like in the name of psychotherapy as there is no nationally recognised scope of practice. You can advertsie whatever you like and you can charge whatever you like as legally no-one can do a thing about it because this is entirely within the law to do so. I find this unacceptable as a means of gaining access to very vulnerable children and adults especially when the work takes place predominantly in private practice – that is any room anywhere. I agree that it entirely devalues our mental and emotional health and reveals how little our society has understood about what is psychological injury and pain. It under-estimates the reality of the consequences of psychological harm to identity, sense of self, peoples lives and our society. I think we have a duty of care to do something about this.That is why we founded Integrity:Social Responsibility in Psychological Therapies (ISRPT).
I do not believe that psychotherapists need to be medically trained but I am convinced that some form of quality assurance needs to be in place however simple.Practice based evidence i simportant as much as evidence-based practice. Regulation with the HPC would legally protect the title, provide simple, clear threshold standards for training and education and provide good systems to make provision for independent complaints. It would be transparent, accountable and very cost effective for everyone.
This would leave organisations like the UKCP comprised of some really excellent people to focus their energy and strengths on developing new research methods, providing valuable opportunities for the promotion of good practice, networking, ongoing professional development and much more in the areas of marketting services and looking after the practitioners. It is the dual role of trying to be a professional association and a regulator all at once that will be the source of endless problems. The HPC are not restrictive or prescriptive about practice in any form of controlling way and support the diversity of approaches to flourish in a culture where otherwise only the market force will inadvertently regulate. Behavioural science has already found favour with the Government through the hierearchy of evidence, RCTs and the culture of NICE.
The HPC would instill good public service values like equal opportunities, competencies in working with inter-cultural issues and difference, inter-disciplinary practice, evidence-based practice but not just along the lines of a medical model. Then GPs could feel confident to refer to a well regulated profession of quality practitioners that when the short term programmes that the Governement currently reccomend prove not to be enough the service users have a choice to go privately.They can be referred with clear conscience to a properly regulated profession with assured quality and standards and a good working alliance for public-private partnerships.
At present without nationally recognised threshold standards for training and education and without independent complaints it is just not possible in my view for a really thorough promotion of the profession with integity.
Jocelyne Quennell