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.


10 thoughts on “How much therapy abuse is out there?

  1. Thanks for the post, Z. I hope you enjoyed you holiday.

    I want to think about this a bit more, but there are two hairs that I would like to split in the mean time because they are at the heart of what I was getting at with my questions.

    I asked, “Is there actual evidence that a community of statutorily regulated health professionals commit fewer abuses on average than the unregulated?” You answered that “We don’t know”, when what you really mean is, “No, there is no evidence”. That is quite an important distinction when looking at evidence.

    I certainly agree with you that it might be comforting to clients that if a problem arises, they know that they have somebody to complain to, but that is not to say that regulation has been shown to lead to less abuse. It seems to me that there have been lots of people saying the latter because they favour the former when as you point out, no evidence supports this.

    Secondly, I want to question your assumption about the c. 30 civil cases of which the solicitor informed you. These might be ‘settled’ in the sense of being hushed-up with damages payments, but equally they may not see the light of day because they have little or no merit in the law of tort and are dropped or are settled for nominal fees to remove any further legal risk. It seems very dangerous indeed to assume either of these possible situations dominate. It could just as easily be the case that lawyers are milking the system rather than that psychotherapists are actually causing harm.

    Anyway, I want to think about this some more before I respond properly.

    • Hi Reader, I did indeed enjoy my holiday.

      You answered that “We don’t know”, when what you really mean is, “No, there is no evidence”.

      In a sense, yes, but only to the degree that without some form of regulation then how can one even gather that evidence? Somebody needs to be looking. That said, there certainly is evidence that abuse cases involving unregulated therapists are out there, and I am in regular e-mail contact with several victims of such abuse.

      What there’s certainly evidence of is that historically people making complaints about UKCP-registered therapists often received a very raw deal – I have documented extensively on this blog how the former clients of Derek Gale, John Smalley, Geoffrey Pick and Stuart Macfarlane were treated when they made their respective complaints. All had experiences that I cannot imagine a complainant to the GMC, NMC or HCPC would have (which is not to say that those bodies are necessarily perfect or always make the right decision.)

      I certainly agree with you that it might be comforting to clients that if a problem arises, they know that they have somebody to complain to,

      Isn’t it in fact vital that a robust and fair complaints procedure exists? I’ve heavily criticised the UKCP in recent years, but they have (after much delay) finally got their complaints procedure in order. How could that be anything other than a good thing for clients?

      Regarding your point about whether some of those civil lawsuits might be vexatious – sure, I’ve no doubt that vexatious lawsuits can and do exist, but surely that only makes the case even stronger for a proper complaints procedure to hear the allegations in a way that’s fair to both complainant and respondent?

  2. My former therapist resigned his membership of BACP so that my complaint could not be heard. I would like to say that this act of cowardice has possibly caused me equal damage to the abuse itself, not having a proper end to things, not having him face me and answer my questions, not having the chance for someone else (the panel) to draw a reasoned conclusion about what happened has made things so much worse for me. I wanted my allegations heard and dealt with fairly but that opportunity has been taken away from me. Thankfully BACP have since changed their policy so that complainants can complain against former members, I notice that UKCP and NCS have not closed this loophole in the same way – people need to be aware that if their therapist realises they may have a complaint heading their way they can simply resign to avoid it then join another membership body. It may well be that proper regulation will not necessarily prevent abuse but I can say wholeheartedly that having the chance to have my complaint heard would have benefitted me hugely and allowed me to move on from this traumatic experience.

    • Hello,
      I stumbled across this article by accident and your reply caught my attention. I was able to relate to the things you said about not having a proper ending and being able to face him in order for you to the get the deserved ‘closure’ that you need. I felt that I needed to write this to you because I currently am experiencing the failings of the complaints process, and am feeling the same sort of stuff that you described here. Because I have very little evidence to prove what happened, and the fact that the therapist is highly respected in struggling for my voice to be heard.
      I guess what I’m trying to say is that you’re not alone – and don’t give up, shout as loud as possible until your side of the story is heard.
      Take care and best wishes

  3. Just as bad are social workers who refer single mothers to domestic violence refuges for counselling without any proper assessment of their real needs. They get exposed to some seriously dodgy stuff in those man-hating places.

  4. Reblogged this on .

  5. Abuse goes on behind closed doors, after careful conscious or unconscious grooming. Other times the therapist is not an abuser as such but an abusive pattern is co-created in the therapy dynamics and played out by the therapist. Whether the profession is regulated or not will not change projective identifications being acted out by the well meaning therapist neither will it stop an abusers mind set who is looking for vulnerable prey.
    Therapy can only work on a deep level when both parties meet on an intimate emotional level, this leaves both parties vulnerable but it is the therapist’s duty to make sure s/he is held enough (via supervision for example) to stay grounded enough to not abuse the client but offer a safe environment even in turbulent times when feelings are strong.
    This is when most therapies break down; ether by the therapist acting out those strong counter transference feelings or by withdrawing completely which explains the many complaints about counsellors regarding endings.

  6. I think that this area is completely unaddressed, and not acknowledged enough – abuse in therapy does happen, but unfortunately goes unheard for many complex reasons,
    A lot of the time, the individual has very few places to go to have their voice heard.
    The lasting damage though is inequitable.

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