Are some Accredited Registers better than others at handling complaints?

Here’s a question I want to think about. If you want a counsellor or a psychotherapist, the Professional Standards Authority accredits 11 different registers for you to choose from. Suppose something goes wrong and you need to make a complaint. Do any of those registers handle complaints better than others?

The Professional Standards Authority does ask people to share their experiences of Accredited  Registers, which comes with quite a big caveat.

Please note that this is NOT a complaints process. We do not investigate individuals’ complaints about regulators or registers and cannot resolve them for you, but you can help others by sharing your experience.

So, if you don’t  agree with the decision of an Accredited Register, who do you appeal the decision to? Basically, you can’t appeal it to anyone, which is hardly reassuring. The most the PSA can do is take your concerns into account when it’s time to revalidate the register. By comparison with the statutory regulators (the General Medical Council, Nursing and Midwifery Council etc) the PSA can appeal decisions to the High Court. Possibly this may be a distinction between accredited registers and regulators that hasn’t been discussed enough in debates over whether psychotherapy should be regulated.

I decided to find out whether any of the registers are getting more concerns raised than others. So, I sent the PSA a Freedom of Information Act request asking them to provide a list of how many concerns have been received for each Accredited Register over the last two years. I got this response.

To help interpret the data, I created a table of just those registers that are for counsellors and psychotherapists. These registers vary wildly in size, so I added a column listing the number of registrants each has on their books. If they were all doing equally well, one would expect them to have a number of concerns raised that’s roughly equal when adjusted for the size of the register.

The Association of Christian Counsellors, the National Associaton of Play Therapists, COSCA and the Human Givens Institute all had no concerns sent to the PSA about their complaints handling.

Looking at these numbers, you’d expect the highest number of concerns to be for the BACP, simply because it’s by far the biggest register. But it’s not. The UKCP is only a quarter of the size of the BACP, but they had more concerns raised about them.

From November 2015 to January 2016 the UKCP had its accreditation suspended by the PSA, in part due to apparent mishandling of a sexual misconduct case. I emailed the PSA back to ask how many of these concerns were received before, during or after the suspension. They informed me that 8 of them were before, one of them during, and 2 of them afterwards. I hope this reduction in concerns means their complaint handling has improved since then. However, a quick glance at their complaints decisions page raises an eyebrow or two.

They haven’t sanctioned anyone since last November.

The result for the British Psychoanalytic Council also seems rather striking. They have less than a twentieth of the size of register compared to the BACP, but get almost as many concerns to the PSA. If we restrict it to only those concerns sent by complainants, the numbers are exactly the same.

Arguably the numbers for the Association of Child Psychotherapists could also be considered disproportionate to their size, but it’s only 3 concerns so we’re getting into pretty small numbers there.

Obviously this is a pretty rough-and-ready way to gauge the relative effectiveness of the different registers, but it does raise questions about whether or not they’re doing an equally good job.

 

 

 

 

Therapist who sexually abused clients returns to practice

A Jungian psychotherapist who was found to have sexually abused a mentally ill client in his care has put up a new website advertising his services.

Stuart Macfarlane was previously registered with the Guild of Analytical Psychologists, a member organisation of the UK Council for Psychotherapy. In 2012 the Guild of Analytical Psychoanalysts found allegations proved that he had committed serious breaches of boundaries with a vulnerable client. Unsafe Spaces learned that these breaches were of a sexual nature, and the client experienced severe trauma as a result of his behaviour.

The case was controversial, because the Guild of Analytical Psychologists chose not to strike him off, but instead gave him a suspension. However, Macfarlane resigned from the GAP during his suspension period. UKCP member organisations are now no longer allowed to handle complaints in-house, which instead go through the UKCP complaints process.

In 2014 a second ex-client came forward to the Daily Mail, accusing him of abusing her in a very similar way to the first.

Macfarlane has now put up a blog, describing himself as a “seasoned and well-respected therapist with over 30 years of experience”. It also states that he “still resides in London and continues to delve into the world of psychology, helping many people along the way.”

This sort of behaviour is sadly not unusual. Our Unsafe Spaces report found that one in four counsellors or psychotherapists struck off by professional bodies continue to practice. This is legal because neither “counsellor” nor “psychotherapist” are protected titles, and anybody can use these titles.

Unsafe Spaces has also issued guidance on keeping safe from abuse when accessing counselling or psychotherapy. We strongly recommend that clients check their therapist’s registration before beginning therapy.

 

 

Unsafe Spaces report discussed in Parliament

Today the Health Select Committee of the House of Commons met with the Professional Standards Authority to discuss their role in professional regulation. Sarah Wollaston MP and Ben Bradshaw MP both raised the issues described in our Unsafe Spaces report, which describes how one in four counsellors and psychotherapists struck off for misconduct simply carry on practising.

The meeting can be viewed online here. It’s quite a lengthy video, but all the discussion of counselling and psychotherapy is finished by 15:16 (there’s a break in the video due to a vote being called, with the meeting resuming at 15:07:15).

Something that’s of interest is that the PSA is working on a risk assessment model for which professions should be on a regulator and which should be on accredited registers. This model is described as based on three factors – the risk of the intervention, the context in which it takes place, and the vulnerability of the patient or service user. They would then go back to ministers with a recommendation as to whether or not a profession should be regulated.

Counselling and psychotherapy are mentioned as professions that the government may wish to look at as ones that could move from accredited registration to regulation. They also seem to be suggesting that arts therapists could move the other way, from regulation to accredited registration. The rationale given for this latter move (by Harry Cayton, Chief Executive of the PSA, at 15: 15:39) is that, “I’m only aware of one ever fitness to practise case involving an arts therapist, and that was for theft, or dishonesty rather than competence.” This seems to miss out the incredibly nasty case of Derek Gale, who was struck off by the HPC in 2009 for running a cult disguised as a therapy centre. Admittedly that was some years ago, but even so that leaves me concerned about the idea of arts therapists no longer being regulated.

That said, I’m pleased to hear that regulation of counselling and psychotherapy is not necessarily off the agenda, and I’ll look forward with interest to hearing about the PSA’s proposed risk assessment model.

Unsafe Spaces report highlighted in Therapy Today

Last month we published our report, Unsafe Spaces: Why the lack of regulation in counselling and psychotherapy is endangering vulnerable people. The report is highlighted in this month’s edition of the BACP’s magazine Therapy Today (click here and go to page 5).

As a slight correction to the Therapy Today article, although it correctly states that the report calls for “counsellor” and “psychotherapist” to be made protected titles, we didn’t call for the title “coach” to be protected (though we did recommend consideration be given to protecting other titles, such as “psychoanalyst”).

The Unsafe Spaces report was also previously mentioned in the Mail on Sunday.

Our report found that one in four counsellors or psychotherapists struck off by the BACP or UKCP for misconduct continued to practice after being removed from the register. These included individuals struck off for very serious misconduct, including sexual abuse of clients. We believe this evidence shows the pressing need for regulation of these professions in the UK rather than the voluntary registration systems we have now.

Unsafe Spaces report mentioned in Mail on Sunday article

Last week the report, Unsafe Spaces: Why the lack of regulation in counselling and psychotherapy is endangering vulnerable people was published on this site. Authored by Amanda Williamson and I, the report found that one in four therapists struck off by the BACP or UKCP continue to practice.

Today, the report gets a mention in this Mail on Sunday article about a therapist and spiritual healer who has been accused of psychological manipulation. Check out the blue box at the bottom, which has a few names that will be familiar to people who read this blog. The article also states that Geraint Davies MP is hoping to re-present his previous Private Members Bill on psychotherapy regulation.

New report highlights risk to public from unregulated counsellors and psychotherapists

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.

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.

Would regulating counselling and psychotherapy make a difference?

I’ve argued on this blog in favour of making counsellors and psychotherapists protected titles in the same way as nurses, social workers, occupational therapists etc. A previous survey suggested that at least one in four counsellors or psychotherapists who were struck off by the BACP or UKCP for misconduct simply carried on practising. And that’s perfectly legal to do, because neither “counsellor” nor “psychotherapist” are protected titles.

In response, some have argued that there’s no point in having protected titles. Suppose you have a practitioner who’s been struck off and doesn’t want to stop practising, or doesn’t want to submit themselves to a statutory regulator, or simply never acquired any qualifications in the first place. If protected titles were brought in, all they would have to do is change their job title. Say, to “humanistic therapist” or “Jungian analyst”. I decided to test this hypothesis.

Professional Standards Authority issues statement on transgender conversion therapy

Following a recent controversy over conversion therapy and transgender people, I contacted the Professional Standards Authority for comment. Today I received a reply.

Conversion therapy is a controversial form of psychotherapy which aims to turn gay people straight, or in some cases to revert transgender people to their birth gender. Pretty much all the research evidence suggests it’s ineffective and harmful. Most psychotherapy organisations in Britain have condemned conversion therapy for gay people, but have not done so for transgender people.

Professional Standards Authority publishes reasons for recent UKCP suspension

From November 2015 to January 2016, the Professional Standards Authority briefly suspended the UK Council for Psychotherapy from their list of accredited registers. After the UKCP made a number of changes, the suspension was lifted. The PSA have now published their reasons for the suspension. When I commented about it online, various people suggested I was making a fuss about a “storm in a teacup”, and that this was simply a normal part of the reaccreditation process.

From reading the PSA’s review, it becomes clear that this was no storm in a teacup. It involves, among other things, the apparent mishandling of a sexual misconduct case.