Protected Titles or Protected Functions? How best to regulate psychotherapy?

I’ve been mulling over some of the counter-arguments to bringing in regulation for counselling and psychotherapy. One of the main objections is that if “counsellor” and “psychotherapist” were made protected titles, practitioners who didn’t want to be regulated would simply switch to other job titles. “Life coach”, “Jungian analyst”, “humanistic therapist” and so on.

The survey I recently did suggests that protecting those titles would have at least some impact. People looking for therapy to help with a mental health problem are more likely to look for a counsellor or psychotherapist than a life coach. So somebody switching their job title could expect to lose business by doing so. That said, on its own this doesn’t seem particularly foolproof as a measure to squeeze out the cowboys.

Pathological Demand Avoidance: does it exist, and if so what is it?

In recent years in the UK there’s been an increasing amount of talk about something called pathological demand avoidance, or PDA. It’s described as a subtype of autism that children (and some adults) are increasingly being diagnosed with. The National Autistic Society has been promoting acceptance of it, there’s a PDA Society, training courses and parent support groups are being set up. Paediatric and CAMHS services are seeing increasing numbers of referrals requesting assessment for PDA.

This is perhaps surprising because (and you wouldn’t know this from scanning the NAS or PDA Society websites) it’s not a recognised condition. Neither the DSM-5 nor the ICD-10 (the two main classification systems for mental disorder) have anything to say about pathological demand avoidance. The NICE guidelines (which set out best practice for UK clinicians) don’t mention PDA in their guidelines for diagnosing autism either for children or adults. It’s virtually unkown outside the UK (and a few parts of Scandinavia and Australia), and the research evidence base for it is wafer-thin.

So, I decided to look into PDA. What is it, does it really exist, and if it does exist, is it really a form of autism?