In recent months I’ve been working with Amanda Williamson on a report, Unsafe Spaces: Why the lack of regulation in counselling and psychotherapy is endangering vulnerable people. The report is available for free download from this website.
The report finds that of those counsellors and psychotherapists who are struck off for misconduct, one in four continues to practice afterwards. These included practitioners struck off for very serious allegations, including serious sexual misconduct. We recommend that “counsellor” and “psychotherapist” become protected titles and are subject to a statutory regulator. We also recommend that psychological therapies for mental disorder should become a protected function of professionals who belong to a statutory regulator.
An increasing number of people in the UK, many of whom are vulnerable, are accessing counselling or psychotherapy services. However, almost uniquely among mental health professionals, neither counselling nor psychotherapy are subject to a statutory regulator, and neither the terms “counsellor” nor “psychotherapist” are protected titles. Voluntary registers exist, such as the British Association for Counselling and Psychotherapy and the UK Council for Psychotherapy, which have been granted Accredited Register status by the Professional Standards Authority. However, if such registers strike off a practitioner for misconduct, there is no legal requirement for this individual to stop practising.
To find out how many counsellors and psychotherapists continue to practice after being struck off, withdrawal of membership notices were downloaded from the BACP and UKCP websites for a ten year period. Internet searches were then completed to look for business websites for these individuals advertising counselling or psychotherapy services. From these searches, nearly one in four of those struck off during this period by the BACP or UKCP appeared to be still practising. For the UKCP in the latter five years of this time period, every single one of those struck off was continuing to advertise their services as psychotherapists. These included individuals struck off for very serious allegations, including serious sexual misconduct.
A case study is examined of Palace Gate Counselling Service in Exeter. This company was struck off by the BACP in 2014 after the director was found to have committed serious sexual misconduct against two women, a counsellor and a trainee counsellor at the firm who he was seeing for private therapy sessions. In addition, the director and his co-director (both of whom practice as counsellors and clinical supervisors for counselling trainees) were found to have conducted a sustained campaign of harassment and defamation against the two women after they complained. However, the company remained in business, and both individuals remained in their posts as directors and counsellors.
The case was the subject of media attention, including in the Health section of the Mail on Sunday, and a sustained effort was made by local activists to ask organisations not to signpost people to Palace Gate. Despite these efforts Palace Gate continued to be publicised by the NHS, churches and the voluntary sector. The two individuals continue to practice counselling at Palace Gate and in private practice to this day.
From this evidence, it is clear that, from a safeguarding perspective, the current system of accredited registration is a complete failure. It is simply not effective at removing rogue practitioners from the counselling and psychotherapy professions. This safeguarding failure is putting vulnerable people in danger of serious abuse, including sexual abuse.
Opponents of regulation suggest that counselling and psychotherapy are difficult to define, and that if “counsellor” and “psychotherapist” became protected titles, practitioners could avoid regulation by simply changing their job titles. To test this, we surveyed 151 people to ask which professional titles they would look for and accept a service from when seeking treatment for a mental health problem. 64.93% said they would look for a psychotherapist and 60.43% would look for a counsellor. By comparison 50% would look for a cognitive-behavioural therapist and 24.41% would look for a psychoanalyst. For a life coach, this number dropped to 7.09%. This suggests that certain other titles may need to be protected alongside “counsellor” and “psychotherapist”, but also that this need not be an infinite number of titles to have an impact.
The protection of titles would be made more robust if combined with a restriction that only professionals with a protected title can offer psychological therapies for mental disorder. A survey of 50 adverts for counsellors and psychotherapists found that every one of them advertised their services as being for mental disorder. These often included serious and debilitating conditions such as eating disorders, bipolar disorder and obsessive-compulsive disorder.
If the professional titles were protected, and only professionals with protected titles were permitted to offer psychological therapies for mental disorder, a practitioner could indeed avoid regulation by using a different title and not suggesting that they can treat mental disorder. However, these two surveys suggest that if they were to do so, they would incur a serious loss of business and they may find this to be not commercially viable.
It is therefore recommended that:
- “Counsellor” and “psychotherapist” should become protected titles and these titles should be subject to a statutory regulator.
- Consideration should be given to also protecting certain other titles, for example “cognitive-behavioural therapist” or “psychoanalyst”.
- The provision of psychological therapies for mental disorder should be restricted to professionals who have a protected title and are subject to a statutory regulator.