What kind of regulation for counselling and psychotherapy?

On this blog, I’ve highlighted the need for statutory regulation for counselling and psychotherapy. This is demonstrated by cases such as Palace Gate, where a counselling firm was struck off by the BACP due to 30 proven allegations, but has no legal impediment to stay in business. And indeed, still is in business.

What I haven’t talked about so much is what kind of regulation might work. Time to muster some thoughts.

At the moment there are accredited voluntary registers (AVRs) such as the British Association for Counselling and Psychotherapy and the UK Council for Psychotherapy. The Professional Standards Authority provides a degree of regulatory overwatch, accrediting their complaints procedures and ensuring they reach a certain standard. This has resulted in some improvements. It required the UKCP to jettison its piecemeal (and often shockingly bad) complaints systems and replace them with a unified Complaints and Conduct Process. It also pushed the Association for Christian Counselling (which aspires to AVR status) to ban gay-to-straight conversion therapies, widely regarded as ineffective and unethical.

But the problem is that these registers are purely voluntary. “Counsellor” and “psychotherapist” are not protected titles, and being struck off by an AVR doesn’t stop people from continuing to call themselves one. A reader of this blog did a survey of 53 people struck off by the BACP, and found that 22% of them still had live business websites advertising counselling and/or psychotherapy services. The UKCP has struck off two people in the five years. Both of them still advertise themselves online.

At the moment Geraint Davies MP has a private member’s bill going through Parliament to have counselling and psychotherapy regulated by the Health and Care Professions Council. It’s widely expected to fail, because the Coalition government doesn’t support it. I don’t see state regulation happening this side of a general election.

There’s been a lot of resistance to the idea of HCPC regulation from some quarters of the psychotherapy profession, who raise concerns that the HCPC would expect them all to stick to cognitive-behaviour therapy rather than other modalities. Personally, I think those fears are overblown. The HCPC already regulates arts therapists, not to mention clinical psychologists, occupational therapists and social workers. Arts therapists don’t have to stick to CBT, and I’m not even sure that would be possible in such a modality. Meanwhile, I’m a registered mental health nurse and I’ve just completed an intermediate-level qualification in systemic and family therapy. The Nursing and Midwifery Council is not stopping me from using such approaches.

Nevertheless, it’s resistance that would need to be overcome. I’m wondering if there’s a simpler way that could get around such difficulties. Why not take the V out of AVR and give it a statutory backbone? Make counsellor and psychotherapist protected titles, and require people using those titles to belong to a PSA-accredited register such as the BACP.

I’m not saying the current system doesn’t need work before strapping a legal framework to it. As cases such as Rob Waygood (found by the UKCP to have committed serious sexual misconduct, given a 6 month suspension and then allowed to re-register) demonstrate, the UKCP in particular still needs to do more to show it has a robust fitness-for-practise system.

Also, I’m not saying all accredited voluntary registers should be put on a statutory footing. The Society of Homeopaths now has AVR status. They shouldn’t be given the dignity of government approval because, quite frankly, they’re all a bunch of quacks and charlatans.

But, doing it this way could be quicker, easier and have the advantage of building on already-existing frameworks. There might be some mileage to it.

34 thoughts on “What kind of regulation for counselling and psychotherapy?

  1. If the titles are protected, regardless of the body that might own them, won’t we simply see a rise in people using terms that sound closely related such as analyst, psychotherapeutic consultant, humanistic practioner, counselling coach etc. Even the struck-off can call themselves such things.

    It seems to me that the important step is to widely publicise what PSA-list membership really means. We need to put the effort into raising public awareness of the importance of the registration rather than worry what practitioners call themselves. This essentially has to be done anyway, whether the words are protected or not and is the step which will actually ensure people know how to distinguish the validated from the non-validated.

    • Why not do both? I agree that a public information campaign is needed even if those are made protected titles. Something along the lines of “counsellor and psychotherapist are protected titles. Life coach/analyst/humanistic practitioner etc are not.”

      • OK. So why not do the job we what we already have? “Look for a PSA therapist” We don’t even need a law change. There already is this equivalent of a protected status that can be advertised without waiting for the politicians to agree anything with anyone. The public is more than capable of understanding the idea of a registration scheme. It can tell the difference between medical and non-medical doctors after all. It can be done right now.

      • Not so sure that the public can tell the difference. If I walked into my local pub and asked the regulars to tell me the difference between, say, a psychiatrist and a clinical psychologist, I’m sure I’d get a lot a wrong answers and/or blank looks.

        I recently tested this out when I did a talk to Cardiff Skeptics in the Pub. I asked for a show of hands as to who would feel confident to explain the difference between a clinical psychologist, a psychiatrist, a counsellor and a psychotherapist. Only a quarter of people in the audience raised their hands, and that might be an overestimate as due to the subject matter of the talk, a number of counsellors, psychotherapists and mental health professionals were in the audience.

        I think there is a problem with somebody being allowed to call themselves “counsellor” or “psychotherapist” whether they’re PSA-accredited or not (or even if they’ve been struck off by a PSA-accredited body). If most people don’t know the difference between a psychotherapist and a psychiatrist, how can we expect them to know the difference between a PSA and a non-PSA psychotherapist?

        At the moment the onus is entirely on the public to vet and check the background of their therapist, often asking them to do so at a time in their lives when they’re vulnerable. And most people simply don’t have the knowledge base to do this.

  2. CORGI used to be a voluntary register for gas engineers. Despite a lot of publicity it wasn’t enough to protect the public from incompetence so it became compulsory to be CORGI registered if practicing as a gas engineer. The government also raised public awareness in conjunction with the new legislation. I see this as a similar situation.

    The AVR scheme is not working and nobody seems to be doing anything significant to educate the public (or even GP’s) on this matter, although I am expending a lot of energy doing my bit.

    We need a statutory register for counsellors and psychotherapists AND to educate the public that therapy can carry risks and that the way to reduce those risks to to see somebody who is registered. This would help the issue of unregistered professionals calling themselves eg ‘person-centred practitioners’.

    I’m working on a hefty blog post on this subject and will share when published. I’m liaising with various bodies so might be a couple of weeks away yet.

    • That’s interesting. I didn’t know CORGI was originally a voluntary register. Well, if voluntary registration wasn’t enough to stop gas fitters blowing people to pieces, I can’t see how it’s going to work in psychotherapy.

      Personally, I can’t see why any reputable counsellors or psychotherapists would be opposed to protected.titles. If you’ve studied, undergone therapy, put in your practice hours, are paying for your registration etc etc….why would you want some yahoo down the road who’s done none of those to be allowed to claim the same job title as you?

      And yes, I know that there’s issues around people switching to other titles – rather like food quacks such as Gillian McKeith calling themselves “nutritionists” because the protected title is “dietitian”. But imagine the uproar from the dietitians in my local hospital if Gillian McKeith was allowed to call herself a dietitian.

      • CORGI lost its right to deliver statutory regulation of gas installers due to its abusing that position for commercial gain so it may not be the best example upon which to draw. Capita now runs the scheme, which, given its interest in PFI and other estate management schemes, is somewhat questionable, also.

  3. If I’m employing a guy to route potentially-lethal explosives through my house then I’d rather he was regulated by someone who’s had some controversies about commercial conflicts of interest than by nobody at all.

    I would also want my next-door neighbours to be required to use someone registered with said imperfect regulator.

    If we wait around for the “perfect” regulator we could be waiting until the stars burn out.

  4. There’s a danger here of confusing Protected Titles with Protected Functions, the gas engineer is an example protecting a function with a statutory register, not protecting a title. Anyone can legally call themselves a “Boiler Fitter” because the title isn’t protected, but no-one can legally fit a boiler unless they’re registered regardless of how they describe themselves. So Robert, who isn’t registered can’t carry out the function of fitting a boiler even if he calls himself a “Builder” rather than a “Boiler Fitter”.

    If the title “Counsellor” was protected that wouldn’t protect the function. So Charles, who was struck of the statutory register of counsellors, would still be able to maintain a practice that carried out the function of counselling just so long as he didn’t use the title of “Counsellor”. So Charles could still practice as a “Talk Therapist” doing exactly the same stuff as he got struck off for.

    The more I look into it the more I agree with the AVR approach, rather than add more titles to the list of titles that people already can’t distinguish between there is a single AVR kite-mark that they can look for. When you add to this the fact that the AVR covers “Mental Health and Wellbeing”, “Physical Health” and “Health Promotion and Protection”, bringing them all under this single kite-mark, then the benefits go much further than just counselling and psychotherapy.

    Neither protected titles nor the AVR stop people from practicing the function of counsellor or psychotherapist, both approaches aim at making it possible to identify competent practitioners. It’s just that the former uses titles to identify them while the latter uses membership of an accredited register. They are both voluntary schemes, under the protected title scheme Charles is still free to choose whether or not to use the title “Counsellor” and with it be bound by the HCPC standards. All in all the two approaches are not as different as they first appear.

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  6. I think protecting titles such as psychotherapist is problematic. It would offer peace of mind to clients but in the long wrong I think it will harm the profession. On can get BACP accreditation in a 1 year course. I have had 7 years training and can’t get BACP accreditation – I would have to do a course that they accredit. My 7 years in various forms of psychotherapeutic training effectively means nothing to them. That’s a problem as I follow approaches I believe work and not ones that get me accredited.

    • Please can you show me the course that leads to BACP Accreditation after one year? I had to do 3 yrs training (cert plus BACP accred advanced diploma) with 150 client hrs and 40hrs personal therapy then 3 yrs of practice plus 450 logged, supervised client hrs (and a bundle of written submissions). I achieved accreditation fairly quickly at 6 years (i.e. one of the first in my college cohort).

      That’s the standard route as far as I’m aware.

      I did not have to follow a particular approach to attain accreditation. I trained in integrative counselling and simply had to explain why I work in my chosen way and demonstrate via written submissions and supervisors’ reports that it is safe and effective and delivered with self-awareness.

      BACP membership does not have to be via a BACP accredited course but the training has to meet minimum requirements in terms of supervised client hours being part of the training.

      Am I missing something?

      • Ah, perhaps you are referring to basic membership?

      • The BACP no longer accepts applications for accreditation unless it is through one of their chosen institutions, there is no longer any individual route. Psychology and therapy is no longer an individual concern for the BACP and has become completely collectivised. Hence your comment about a standard route – psychology and therapy is anything but standard. The great founders knew what they knew largely through self-analysis and their psychologies – now referred to as modalities, of which there are 100’s – were really something like personal confessions. There is no scope for this anymore in the BACP. A therapist has a personal relationship with a client within a professional context – that was Jung’s definition anyway, one which I agree with. With my electrician and I have a professional relationship wholly, but with my therapist it is personal.

    • I think that there should be some consistency in the profession in respect of terms used. I’m confused now so it must be tricky for clients I’d imagine!

      Perhaps the problem stems from the word “accredited”. BACP Accreditation involved the rigmarole in my comment above (minus the compulsory personal therapy my course required and the fact that it’s 100 client hours not 150 as my course required). So yes, it would still take a number of years to build up 450 supervised hours and the 3 years minimum of practice to be an accredited member of the BACP.

      But, the PSA now have an Accredited Voluntary Register. Being on the register does not make a registered member accredited, it just shows that they are registered on the Accredited Voluntary Register (The PSA accredits the register, not the members registered within).

      Then we have the National Counselling Society who also have accredited status for membership, however, looking at their criteria, their accredited status is equivalent to BACP basic membership. NCS basic membership is equivalent to BACP student membership.

      Seems rather messy and confusing.

      • I see a lot of talk about “diplomas” but that would be the minimum requirement Amanda! Most therapists including myself have Hon degrees and masters in psychology! Diploma is the BACP minimum requirements. So accredited says nothing about education, merely that one has met minimum standards! Do you have a degree or masters Amanda?

      • Is the number of letters after your name what makes somebody a good therapist? I agree there needs to be a minimum standard, but academic qualifications are by no means the totality of what is needed.

      • Hello John

        I do not have a degree. I left half way through my A-levels due to very difficult personal circumstances at the time. I eventually trained in computing but ended up in financial administration, then after, some years worked in special needs education. When it came to retraining in my 30’s I looked at the various options and the most direct route to practising as a counsellor was via an advanced diploma. I was impressed with the syllabus and how much emphasis was given to practical skills as well as self-development and decided that these were going to equip me best for actual practice. It was also a direct route to BACP accreditation which is something I knew would stand me in better stead in terms of working specifically as a counsellor. Another thing that put me off unnecessarily spending 3 years on a psychology degree was that I had already devoured textbooks on psychology for years and wanted a course and learning specifically about counselling.

        The institute where I trained does now run a degree level course in relational integrative counselling and I would probably have opted for this if it had been available then. This has much to do with an old fear of people who are degree snobs and how they may judge or sneer at a more vocational qualification. Thankfully I have found this to be no problem whatsoever thus far.

        Why do you ask? Is your therapist having a degree important to you? Of course you have every right to ensure that any therapist you see has a degree. I do think we must live in different worlds though as some of the finest therapists I know do not have a degree or have a degree completely unrelated to this profession.

        I’ve been trying to dig out an article I read just this week on yet more research demonstrating that the education and approach of a therapist are the least reliable predictors of outcome. The quality of the therapeutic relationship and the traits of the therapist are far more important. The BACP Accreditation process at least involves demonstrating that one has the qualities outlined in their Ethical Framework, as well as being able to work with a high degree of self-awareness and the ability to integrate theory into practice. I can’t find it but will continue to look although I’m sure you have read similar research findings.

      • “I see a lot of talk about “diplomas” but that would be the minimum requirement Amanda! Most therapists including myself have Hon degrees and masters in psychology!”

        The minimum standard would be the one laid out in the relevant National Occupational Standards (NOS). Therapist qualifications are occupational qualifications so the important standards to meet are occupational standards not academic ones.

        The academic level of a qualification tells you nothing about whether it meets the standards needed to practice outside of academia in its field of study. As it turns out, counselling qualifications that aim to meet both academic and occupational standards end up being assessed by Ofqual to be at least level 4 (the same as a certificate of higher education or the first year of a degree).

        Some ordinary and Masters degrees also set out to meet relevant occupational standards (such as the ones accredited by the BACP). Holding one of these doesn’t indicate that you’re any better trained to work as a therapist, they just show that you are capable of studying it academically as well as practicing it.

        By the way, where do you get the idea that most therapists have a degree or higher degree in psychology? That’s not been my experience, have you got any evidence to support your belief?

  7. On the BACP website today:

    4.1 You have been awarded a qualification from a BACP accredited training course
     Have been in practice at least three years when you apply for accreditation
     Have at least 450 hours of supervised practice accumulated within three to six years
    (they do not have to be consecutive years)
     Of the 450 hours at least 150 of the hours of supervised practice must be after the
    successful completion of your BACP accredited course
     Have been supervised for at least 11⁄2 hours per month throughout the period of practice
    4.2 You have successfully completed and received an award for practitioner training that:
     Included at least 450 hours of tutor contact hours
     Was carried out over at least two years (part-time) or one year (full-time)
     Had a supervised placement as an integral part of the training
     Covered theory, skills, professional issues and personal development AND
     Have been in practice at least three years when you apply for accreditation
     Have at least 450 hours of supervised practice accumulated within three to six years
    (they do not have to be consecutive years)
     Of the 450 hours at least 150 hours of supervised practice must be after you have
    successfully completed your practitioner training
     Have been supervised for at least 11⁄2 hours per month throughout the period of practice

    Is there some other information that I am missing?

  8. The supervision has to be through a BACP accredited course with a placement being an integral part of the course.

  9. I’m sorry I just don’t understand what you are saying. Supervision doesnt happen through a course.

  10. Here is an email I received from the BACP: “If none of the courses you have discussed in your past training required you to complete a minimum of 100 hours of supervised practice as an integral part of the course, you would need to complete a BACP accredited course that meets the below criteria to be eligible to apply for membership with the BACP and have routes available towards registration and accreditation”

    • You don’t have to do a BACP Accredited Course, if that was true then there would be a lot of miffed people currently on non-BACP accredited courses that are squarely aimed at achieving BACP membership (like me). There’s more paperwork involved in joining if your course isn’t BACP Accredited, because you have to provide evidence that your course is up to scratch when you apply, but that’s the only real difference.

      BACP is strict about your placement being an integral part of your course and about it having at least 450 contact hours. So you’re right, unless your 7 years training includes a course that wraps everything up in a single integrated package the BACP won’t accept it.

      The National Counselling Society has more flexible entrance requirements, so if the problem is that you’ve got the required experience and training but it’s come from several sources rather than a single course then they might be worth considering. They haven’t got the high profile of the BACP, but they have had their register accredited by the Professional Standards Authority so you would still be on an Accredited Voluntary Register.

  11. Okay I see. What they are saying is that they require that members’ training to have involved seeing clients (under supervision). They are differentiating between training which involves practical experience and training which is about theory only (I think).
    What is confusing here is that all their literature states that if it isn’t a BACP Accredited course then you can still become a member if you pass their proficiency test. So I am not sure why they have omitted that on the email to you.

    Click to access 13431_im%20application%20booklet%20sept%202014.pdf

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  13. Phil,

    Why isn’t BABCP PSA accredited? Is there a good reason?

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