How much therapy abuse is out there?

I recently had a question posted in the comments thread to one of my blog posts, by ‘Reading Enquirer’.

Is there actual evidence that a community of statutorily regulated health professionals commit fewer abuses on average than the unregulated? Does this cure depend only on supposition and faith or is there an actual peer-reviewed evidence base? Is there evidence that statutorily regulated health professionals have greater efficacy in the relief of human suffering than the unregulated?

This is an important question, and one which raises a further question – how can we know how much abuse by psychotherapists is out there?

Abuse, by its very nature, is something that happens behind closed doors, without records being kept. No practitioner – regulated or unregulated, is likely to be auditing how much people they’ve abused. Not everyone who has been abused reports it. Still less of those who report it have their allegations proven in a fitness-to-practise hearing and/or a court of law.

If we’re talking about unregulated professionals, then that does beg the question of who they can report it to. Historically, even being a member of a professional body has not necessarily been a guarantee that a complaint will be heard properly. Until recently, complaints-handling at the UK Council for Psychotherapy was dominated by “crony-ism and amateurism” (not my words, but the words of the then UKCP chair). To give an idea what this “crony-ism and amateurism” looks like, one can read the decision letter for the UKCP’s application to be accredited by the Professional Standards Authority.

The Panel considered a summary of the main themes identified in the Call for Information, and the UKCP’s response to these submissions. It observed that many were related to UKCP’s previous complaints processes, involving the handling of complaints by itself and its OMs. It was felt that the former complaints system was characterised by lengthy times from initial complaint to completion, poor communication from the UKCP and OMs and a lack of support for complainants. There were suggestions of conflicts of interest and procedural failures that appeared not to consider public protection.

The UKCP has now instituted a series of reforms to address these issues, with the result that they’ve now achieved PSA accreditation, though the PSA is insisting on auditing their complaints-handling after 6 months. To be fair to the UKCP, they’re now publishing a growing number of complaints decisions, which appear to have been handled in a considerably improved way.

But…what psychotherapy has at the moment is only regulation-lite, not full statutory regulation. “Psychotherapist” and “counsellor” are not protected titles and you don’t have to belong to a professional body to call yourself one. Indeed, the UKCP recently struck off a psychotherapist called Julia Eastwood. She’s still advertising herself for coaching and counselling.

And then there’s all those people who use other titles similar to psychotherapists and counsellors. Even if those professions became protected titles, there’d still be all the Jungian analysts, life coaches, shamanic therapists…did I mention Ms Eastwood also advertises herself as a “conscious channel of the Archangel Gabriel”? Good luck finding someone to complain to if your conscious channel engages in misconduct.

Still, even if you can’t find anyone to complain to, you could always sue them, though that can be hugely expensive, and you’ll only get no-win no-fee if you have a strong case. So presumably we could find out how much misconduct is out there by looking at the number of lawsuits?

I spoke to somebody who sued their psychotherapist. According to them, their solicitor knew of about 30 ongoing cases, which sounds like a worryingly high number. However, we don’t get to hear about many of these cases, for the reason that most of them end in a civil settlement. These settlements tend to include a confidentiality clause, effectively stuffing the complainant’s mouth with gold.

If it’s a serious form of abuse, say, if someone was sexually exploited, there’s also the police route. But conviction rates for sexual assault are shockingly low. No guarantee there’ll even be a prosecution, never mind a conviction.

One could simply try to publicise one’s case. But that carries the risk of being clobbered by our notoriously draconian libel laws, which have a well-documented “chilling effect” on free speech in the UK. Even with the recent reforms to defamation law, the risk of being hit by a lawsuit would make a lot of people think twice.

So, to answer Enquiring Reader’s question as to whether there’s evidence that unregulated professionals commit more abuse than regulated ones – the simple answer is we don’t know. The reason for that is that without regulation we can’t know the extent of the problem, because there’s nobody to complain to.

On a more pragmatic level, I think it’s important that people have the confidence that if something goes wrong, they have access to a robust complaints procedure. For that reason, my advice to anyone seeking a therapist is to ensure that they use someone either in a state-regulated profession (e.g. clinical psychologists or arts therapists, which are regulated by the Health and Care Professions Council), or belong to a PSA-accredited body (e.g. the BACP, the UKCP or the National Counselling Society). If they don’t fulfil those basic criteria, don’t use them.