Stuart Macfarlane, the Daily Mail and therapy abuse

Back in September, I broke the news of Stuart Macfarlane, a Jungian psychotherapist who committed serious sexual misconduct with a vulnerable client, causing huge psychological trauma to her. Outrageously, he was not struck off by the Guild of Analytical Psychologists, but merely given a two year suspension. He could be practising again in September.

Today, the Daily Mail has broken the news that he had a second victim, Flora McEvedy has clearly shown a great deal of courage in stepping forward to tell her account. Sadly, the Mail’s presentation of the story is dreadful.

A word of advice to the Mail. When reporting the exploitation of a vulnerable adult by a professional, here’s a few pitfalls you really should try to avoid. Continue reading

Reading a charlatan writing about charlatans

This week I was up at my local university doing a bit of training. While I was browsing the bookshelves, I randomly made an interesting find. What is Psychotherapy? A Personal and Practical Guide by Derek Gale. That name immediately rung a bell. He was struck off by the Health Professions Council and by the UK Council for Psychotherapy for a horrific litany of abuse against his patients. I was curious to see what such a character would say about psychotherapy, so I got the book out on loan.

Gale’s story is a pretty nasty one. He groped his patients, discussed sexual fantasies with them, called one a “stupid cunt”, got them to do unpaid work for him, smoked cannabis in front of them and in some cases went on holiday with them. The list of allegations put before the HPC reads more like the behaviour of a cult leader than a therapist. Tragically one of his victims, Gena Dry, later took her own life. Despite this he had some surprising connections. His in-house book company, Gale Centre Publications, listed Windy Dryden, Professor of Psychotherapeutic Studies at Goldsmiths, among its authors.

His saga was also something of a test case in the regulation of psychotherapy. He was registered as an arts therapist with the Health Professions Council (now the Health and Care Professions Council) and as a psychotherapist with the UKCP. At the time, proposals were underway for psychotherapists to also be state-regulated by the HPC rather than the current system of voluntary self-regulating bodies like the UKCP. Although these proposals were subsequently shelved, it’s worth noting that the UKCP ignored complaints about him for years until the HPC took action.

Ironically, his book actually has a chapter on “Charlatans well intentioned and otherwise”. I browsed to it to see what he had to say.

I do not intend to dwell on the proliferation of cranks and charlatans, some of whom are out to make a quick buck. Fortunately the public do not seem to be as gullible as it is sometimes assumed to be and these people do not stay in business long, unless they have some genuine service to offer…

Wow, that took some gall for him to state.

…I find more seriously worrying the practices of people who have a recognised qualification in one of the caring professions and a job which puts them in a position of trust. These professional qualifications are not a qualification in psychotherapy and a doctor, social worker or educator who claims to practise psychotherapy while remaining blissfully ignorant of what psychotherapy is, trades on the public’s confidence in his profession and is therefore as great a charlatan as the person who holds a bogus diploma.

Though perhaps not as great a charlatan as someone who urges their patients to strip naked during group therapy.

Gale isn’t the person to make this point, but there is a valid point in here about who is or isn’t a psychotherapist. A large number of professionals, myself included, are involved in providing psychological therapies but don’t have a formal qualification in the field. You might hear of a doctor or nurse doing, say, cognitive-behaviour therapy, without being a qualified cognitive therapist. In many cases those involved – again, including me – have to acquire training and supervision on the hoof, as and when we can.

Interestingly enough, there isn’t a fixed definition of who is a psychotherapist. If a psychotherapist wants work from the NHS or social services, they’d need to have some sort of recognised qualification and usually be registered with either British Association for Counselling and Psychotherapy or the UKCP. However, if they’re practising independently they could vary from having completed an arduous post-graduate training to being just some hippy with no qualifications at all.

Then, of course, there’s the thorny question of what’s the difference between a counsellor and a psychotherapist.

Thinking about my own nursing practice, I’m heavily influenced by cognitive-behaviour therapy and family therapy. Interestingly enough, I tend in daily practice to be more willing to saying I’m “doing CBT” than “doing family therapy”. Perhaps due to a perception that CBT is more straightforward and less complex than family therapy – though I’m sure there’s people who’d be more than happy to dispute that.

If a psychotherapist is someone’s registered with the UKCP or BACP, then it’s worth noting that Derek Gale was accused of continuing to practice after being struck off. Though according to his Twitter profile he appears to have now retired to write books and send tweets to Ricky Gervais.

Who is a psychotherapist? Ultimately the only thing I can say for certain is that it isn’t Derek Gale.

UKCP takes 3 and a half years to not sanction a therapist

Back in February I obtained some court documents relating to a psychotherapist who was on a fitness to practise hearing with the UK Council for Psychotherapy. The case was a failed attempt by John Smalley, a Jungian analyst, to have a judicial review of his hearings on the grounds of delay. Since then a copy of the final ruling has landed in my e-mail inbox. On 16th March 2012, the UKCP complaints panel decided that seven allegations had been proven, but that these did not impair his fitness to practise, and that there would therefore be no sanction.

From the time a complaint was originally received by his UKCP member organisation, it’s taken a grand total of three and a half years to reach this conclusion (over 3 years of which were spent in UKCP’s Central Final Appeals (CFAP) and Central Complaints (CCP) procedures), stringing out both complainant and registrant for an inordinate length of time. The case illustrates some of the problems in complaining against a UKCP-registered psychotherapist.

Mr Smalley is a member of the Independent Group of Analytical Psychologists (IGAP), which is a member organisation of the UKCP. Currently anyone making a complaint must first complain to the member organisation. If the complaint is rejected, they can then appeal to the UKCP. This process has such a poor reputation that even the UKCP’s own former chair recently admitted that, “There has been too much crony-ism and amateurism in the conduct of complaints for far too long.” The UKCP complaints archive is surprisingly small. In fact, it lists only two decisions in the last three years – one of which was Derek Gale, a notorious abuser who was struck off by the Health Professions Council before the UKCP struck him off.

At present the UKCP is moving towards replacing this two-tier system with a single Central Complaints Process (CCP), though this has reportedly been met with resistance from some of the member organisations.

In August 2008 IGAP received a complaint against Smalley from a former client (or analysand, as they’re sometimes called in psychodynamic therapies). IGAP initially ruled in November 2008 that there was no case to answer, and also turned down an appeal in January 2009, but the complainant then appealed this decision to the UKCP’s Central Final Appeals Procedure (CFAP) in February 2009.

The CFAP ruled that IGAP’s decision had been “perverse and incorrect”, and ordered that the case be heard before the new Central Complaints Process. Incredibly, it took them until March 2010 – over a year – to come to this decision.

Cue another year and a half of procedural faffing and delays, resulting in the attempt by Mr Smalley to have a judicial review on grounds of delay, before the final UKCP hearings were scheduled for December 2011. And finally in March 2012 (another four months later!) the UKCP gave its ruling.

A number of other allegations were found to have been not proven.

The panel ruled that Mr Smalley had reflected on his errors, that there was no evidence of financial gain from his misconduct, and that no other complaints had been received. For that reason they decided not to apply any sanction.

It’s taken three and a half years from the time IGAP first received a complaint, and over three years since the complainant first lodged an appeal with the UKCP. All to arrive at this not-very-impressive result. For comparison purposes my own regulator, the Nursing and Midwifery Council, aims to resolve Fitness to Practise hearings within 18 months.

During the process, Mr Smalley’s services continued to be advertised on the IGAP website, with no mention that his fitness to practice was being called into question.

From what I’ve been told, it sounds like both Mr Smalley and the complainant have remonstrated bitterly about this inordinate length of time.

I e-mailed IGAP for comment, and received the following reply.

In response to your queries we have to state that IGAP’s ethical obligations about confidentiality prevent us from giving information beyond publicising the outcome of a hearing where there has been a breach of our Code of Ethics and Practice.

In the case you mention we confirm that IGAP found no case to answer. We cannot confirm the statements you made referring to UKCP.

The UKCP said of the case:

Our fitness to practise and complaints processes aim to be fair, transparent and proportionate, and to work in the public interest. At present we have a two-tier system, with our organisational members dealing with the first stage of a complaint and UKCP acting as the appeal body. This can mean that cases take longer to conclude than we would like. We work hard to reduce delays but sometimes they occur for reasons outside our control – for example, the availability of all parties.

This particular case took longer than normal, partly because it was considered by two separate panels when an appeal panel referred it to UKCP’s Central Complaints Process.

We are confident that we gave sufficient opportunities to the parties and their legal representatives to put forward their views to receive a fair and transparent consideration and this inevitably lengthened the timescale. We had four public hearings, including a two-day hearing, one judicial review application, both in writing and a high court hearing. The parties were able to present their views, and all parties were legally represented. There was further delay when one hearing had to be adjourned because of circumstances beyond our control.

The final hearing of this case was decided by an independent panel, and they documented their decision and reasons.

Complaints against UKCP psychotherapists do not normally take 3 years to resolve. In fact we have never had a case like this one, and hope we never again have a case that takes so long to resolve. We recognise that there is room for improvement and we are committed to review and improve our processes. For example, we are currently introducing a centralised complaints system which will replace the two-tier system. This will be in place for all UKCP registered members by the end of next year.

I e-mailed Mr Smalley for comment, but did not receive a reply.

If I was a client of a UKCP-registered psychotherapist, I’d be worried about this. If I were to make a complaint, I’d like to feel it would be processed without excessive delay.

Likewise, if I was a UCKP registrant, I wouldn’t be very happy either. I wouldn’t want to be strung out for three years wondering whether I might be struck off.

At present there is no statutory regulator for psychotherapists, though organisations such as the UKCP are supposed to provide self-regulation of the profession. The previous Labour government was proposing that psychotherapists become regulated by the Health Professions Council, which currently regulates arts therapists, occupational therapists and clinical psychologists. The Con-Lib coalition shelved that plan in favour of a proposal for “assured voluntary registration” where the likes of the UKCP could apply for an official stamp of approval from the Council for Healthcare Regulatory Excellence (to be renamed the Professional Standards Authority).

This case appears to show that the UKCP’s complaints system has some serious problems. The therapist’s member organisation decided there was no case to answer, even though he was smoking in therapy! It then took over a year just to agree to hear the complainant’s appeal and send it forward into the new Central Complaints Process.

But even then the CCP took two years to find at least some of the allegations proven, but not do anything about it.

Is the UKCP ready yet to receive approval from the CHRE/PSA? I’d say this case raises some question marks about that.

A Dangerous Method Indeed: Therapist Investigated for 3 Years, Still Able to Practise

Today the David Cronenberg film, A Dangerous Method, was released. It depicts the pioneering psychoanalyst Carl Jung (played by Michael Fassbender) engaging in what would now be considered serious professional misconduct.

A Dangerous Method

In a chilling parallel, The Not So Big Society has obtained court documents showing a Jungian psychotherapist has been under investigation for alleged misconduct for over three years, apparently with no conclusion reached. Throughout this period he has been able to continue advertising his services with no warning that his fitness to practice may be impaired.

The case is likely to raise serious questions about the way psychotherapy is regulated in the UK.
Continue reading

What Kind of Therapy?

A lot of my working day is spent doing psychological therapies. Despite the image of child psychiatry as Ritalin-obsessed drug pushers, CAMHS probably makes more use of talking treatments than any other branch of NHS mental health services. Hence I take a keen interest in news about psychotherapy.

Just recently I was browsing a petition from the Alliance for Counselling and Psychotherapy (ACP) which calls for reform of the NICE guidelines with regard to psychotherapy.

We, the undersigned providers and/or users of counselling and psychotherapy, call upon the Department of Health to instigate an urgent independent investigation into the National Institute for Health and Clinical Excellence (NICE) guidelines for the use of psychological therapies in the NHS. These guidelines currently display unwarranted and well documented bias in favour of cognitive behaviour therapy (CBT). Their formulation involved inadequate representation of and consultation with the counselling and psychotherapy field, and relied upon a very narrow range of research methodologies which fail to do justice to clients’ subjective experience and the complexity of human interaction.

Continue reading

Not Being Richard Littlejohn Therapy

A few days ago I read this deeply skeptical article about dolphin therapy.

I’ve lost track how many times my disabled daughter has been offered a swim with a dolphin. While disabled people struggle to get a hoist or a few hours’ home help, numerous charities will fly them to Florida to experience the miraculous feeling of frolicking in the water with a friend of Flipper. According to organisations that sell such snake oil, “dolphin therapy” alleviates a wide range of disabilities, from increasing the attention span of a child with attention deficit disorder to curing paralysis.

I must admit swimming with a dolphin sounds like fun, though conservationists point out that it can be less fun for the actual dolphin. Even so, the idea that it can cure your ADHD sounds a little dubious.

“Therapy” is quite a nebulous word that can mean anything and nothing. You can be a beauty therapist, an occupational therapist, a drama therapist…apparently even a dolphin therapist. Even something more formal-sounding like “psychotherapist” can mean anything from a highly skilled professional who’s completed a long, arduous postgraduate training down to some utter woo-peddler with a crystal pyramid. As I’ve previously pointed out the government is currently watering down plans to regulate psychotherapists in the same way as doctors, nurses and social workers. Instead they’re going for “assured voluntary regulation” which will at least give some form of quality kitemark, but will allow the quacks and charlatans to carry on practising.

But, you know what? If you can’t beat ’em, join ’em. I’m fed up with banging the drum for proper therapy regulation. There’s a recession on and I need some ready cash. So, here’s my very own therapy, for which I’ll be promoting a book and a lecture tour. Some impressive-looking research papers will be doodled out, showing an improvement in psychological and social functioning based on an assessment scale that I scribbled on my lunch break.

I hereby announce the launch of At Least You’re Not Him Therapy.

Clients will be taken through a series of activities to enter into the psyche of Richard Littlejohn. They’ll be asked to read through his regular Daily Mail columns. There’ll be readings from his magnum opus To Hell in a Handcart. The client is then taken through a guided visualisation, where they are asked to imagine walking down a street convinced of being surrounded by communists, “pooves”, liberals and immigrants – all of them intent on destroying everything that is decent and wholesome. Finally, they’ll be brought back to their own world with a nice soothing mug of lorazepam, and gently reassured that, whatever their current difficulties and failings, they are at least Not Richard Littlejohn.

“Wow, that put it all into perspective for me! Now that I’ve realised I don’t live in a mindset based purely on malice and fear of the other, I feel so much better about having been done for fiddling my expenses!”
– Some Celebrity You Haven’t Cared A Monkeys About Since 1997

A sequel to the book will follow at a later date. Possibly when sales of the first book are dwindling. For clients with deep-rooted, intractable problems, there will be supplementary modules in Not Being Robert Kilroy-Silk, Not Being Nadine Dorries MP and Not Being George Galloway.

Retreat into the Medical Model

Like just about everywhere else in the public sector, Child and Adolscent Mental Health Services (CAMHS) are feeling the effects of the cuts. As in so many other areas right now, jobs are having a nasty habit of not getting re-advertised when people leave. We haven’t yet had actual redundancies in our neck of the woods, but the whispers are in the wind.

Particularly vulnerable to the cuts are the psychotherapists – psychodynamic therapists, family therapists, art therapists, play therapists. There aren’t many of them employed in CAMHS, but their influence extends beyond their numbers. I’ve had some fascinating conversations with our psychodynamic therapist who keeps “accidentally” leaving papers on attachment theory on my desk. The opportunity to co-work with systemic and family therapists has genuinely transformed the way I conduct my clinical practice. They don’t just change kids and families. They change their colleagues too.

We get a complex mix of cases coming through our doors. Kids with neurological disorders such as ADHD and autism. Kids who have been abused, neglected or traumatised. Young carers to physically or mentally ill parents. Families under enormous strain, or with tortuous family dynamics. Educational issues. Child in need/child protection issues. It can be a bewildering variety of problems. To navigate it requires an eclectic mix of clinical models in your toolbox – medical, psychosocial, cognitive-behavioural, systemic, psychodynamic.

In hard times, it seems to be the psychotherapists – with their specialist outlooks and long, arduous training – who are most likely to be for the chop. My worry is that as we retreat to a core of doctors, nurses, psychologists and social workers, we’ll also retreat into a more narrow view of what CAMHS is for and what it does. Possibly diminishing into simply a medication and CBT service.

Don’t get me wrong, I’m not anti-medical model. I’ve worked with plenty of kids who’ve genuinely benefited from a bit of methylphenidate or fluoxetine. I’m not anti-CBT either, though I don’t think it’s the panacea cure-all it’s sometimes touted as. But one of the reasons I chose to work in CAMHS is because of its wide mix of models to suit the equally wide mix of problems that we deal with. Seeing our toolbox get smaller before my eyes is something that worries me.

The More Acceptable Kind of Stigma

Today is World Mental Health Day. Among the various excellent articles I’ve read to mark the occasion, the one that stuck out the most for me was on the F-Word blog.

I’ve taken psychiatric medications for 17 years, and that’s unlikely to change any time soon. I’m not overjoyed at the sheer range of pharmaceuticals I swallow every morning and evening, but it is far from the most significant aspect of my mental distress. So why do so many people focus on the pills as the problem?

The author points to articles raising concerns over the rise in antidepressant use. She responds that, while it’s true that medications shouldn’t be a replacement for psychological therapies where required, we also shouldn’t criticise people who genuinely need those medications. She quite reasonably concludes.

Antidepressants are not the enemy. I agree that appropriate psychological support should be more widely offered, and that medications should be reviewed regularly. However the problem is not with the pills. The problem is the world we live in that makes so many of us despair enough to seek medical help to manage it. It’s with the levels of rape, domestic violence, female genital mutilation and sexual abuse that can make live unbearable for so many. World Mental Health Day should not be ‘celebrated’ by stigmatising us for coping in whatever ways we can.

I couldn’t agree more. When I tell people I work in mental health, I regularly get asked whether I “believe in therapy or medication”. I always think that’s a really weird question. It’s not as if car mechanics get asked if they “believe in” spanners or screwdrivers. If somebody did, then that mechanic would respond that some problems need a spanner, some need a screwdriver, and he needs a variety of different types of each.

Likewise, some people need a certain type of meds, some people need a certain type of therapy. Some people need both. I really don’t get why that’s so difficult to understand.

But some people do seem to have a problem understanding it. There’s pretty much an industry in chin-stroking broadsheet articles decrying the evils of psychiatric medications – the Guardian seems to average one every couple of weeks at the moment. They have a habit of coming out with slightly crass remarks like this.

But doctors could recommend group running for depression, proved to have far better effects than SSRIs. Reading groups, too, offer a definite lift.

Depressed? Join a reading group! Well, that’s fine until you remember that as people get more depressed their concentration and short-term memory gets worse and worse. I’m sure a reading group would get somebody out of a bit of a rut, but a deep depression? They’d probably smack you in the mouth for suggesting it, if only they had the energy.

I really am tired of this tedious meds-versus-therapy false dichotomy, as though offering one prevents us from offering the other. I’m not saying everybody should take a pill, but there are a lot of people who can cope with life when they use psychiatric medications and can’t when they don’t. Those people shouldn’t be criticised or patronised for it.