Thursday, April 22, 2010

Psy-Praxis - The Changing Context

I know this blog has been banging on about the regulation of counselling and psychotherapy issue a lot in recent times and this is not an apology for that.

Although the person-centred approach has influence and application in many fields, the majority of our current membership - and of BAPCA, the main membership body in the UK for the PCA - is training and/or working in the field of the talking therapies. And the proposed regulation of the counselling and psychotherapy professions by the Health Professions Council has the potential to influence the future of those professions and all practitioners within them.

For those wanting to keep on top of HPC/regulation-related issues, you should probably be making regular visits to the websites of the Alliance for Counselling & Psychotherapy and the HPC Watchdog blog -

and I would also recommend that you subscribe to receive 'Psy-Praxis – The Changing Context' reports by Janet Low.

If you are already on the mailing list of the Alliance, you might already be receiving messages from Janet Low PhD, whose main contribution to informing the debate consists in keeping a close eye on the functioning of the HPC and related bodies.

It always makes for fascinating reading.

For those unfamiliar with Psy-Praxis, I've uploaded the last 6 months' worth of her reports - here they are, most recent first:

PP50 - The Generic Standards
PP49 - The Mystery Of FTP
PP48 - Review Of First Quarter 2010
PP47 - Power
PP46 - Politics
PP44 - Education & Training Committee
PP43 - Post Confer Conference
PP42 - Prepping The Confer Conference
PP41 - Interview With Mind
PP40 - National Audit Of Psychological Therapies
PP37 - HPC Fudge Consultation Results
PP36 - Collapse of GSCC
PP35 - State Machinery: IAPT, NICE etc
PP34 - UKCP Election Results
PP33 - Anne Milton Meeting.

If you just want to grab them as a job lot, here's the zipped bundle.

Janet's email is on each of them - just drop her a line and ask to be added to the mailing list. Let her know you read about it here.

She would welcome contributions - most helpfully in the form of monitoring the HPC website, FTP (Fitness To Practise) hearings and other relevant developments.

Financial support for the 'project' would also be welcome - she attends a lot of meetings when she could be earning a living (she is registered as a practising analyst with the New Lacanian School (NLS) – but we won’t hold that against her). Here’s her website.

Hope you dip in - always worth reading.

Tuesday, April 13, 2010

Confused about regulation?

Many counsellors and psychotherapists are. Confused, that is, when it comes to this whole statutory regulation business. Don't be ashamed if you are too. Why exactly are we all banging on about it? And why are we opposed to it - or opposed to the Health Professions Council (HPC) imposing it upon us? What's the problem with the HPC?

I'm glad you asked. Here's a great piece by that Darian Leader bloke, which answers pretty much all of those questions. A couple of points he makes jar a little for us PCA folk (he is a psychoanalyst, after all), but he does hit the nail repeatedly on the head when it comes to all this stuff. Read on...

Problems with HPC
Since the 2007 White Paper, Trust, Assurance and Safety, the Department of Health has given the Health Professions Council the task of assessing the regulatory needs of the talking therapies and its own suitability to regulate them. This brief, however, was understood as an imperative to regulate, with a resultant neglect of representations from the field and no questioning of the suitability of its own regulatory framework.

The Health Professions Order states that any profession to be regulated by HPC “must cover a discrete area of activity displaying some homogeneity”. Counselling and psychotherapy constitute a diverse field and display little homogeneity. Many therapies do not consider themselves or advertise themselves as health professions. They focus on human relationships and not medical-style interventions with set outcomes or promises of cure. Unlike health professions, many therapies do not aim at removal of symptoms, but at an exploration of human life, understood in a variety of ways.

HPC has claimed recently that it is able to encompass relationship-based work, pointing to its apparently successful regulation of psychologists and arts therapists, yet there are very significant differences between these fields and our own, and there are many psychologists and arts therapists who feel that their work has already been compromised by HPC. Crucial to our work is the way in which elements from early life may be re-enacted in the therapy, and the long process of exploring this is generally not shared by these other fields.

The consultation process initiated by the Department of Health was intended to assess the feasibility and suitability of state regulation through dialogue with all of the professional field. However, the consultation process became monopolised by a small number of people with a narrow view of talking therapy. This reliance on a small number of people with a set agenda has created the illusion that counselling and psychotherapy are a homogenous field. It has also meant the wholesale exclusion of professional groups and user groups, despite initial inclusion in draft documents.

The key issue in the regulation debate has been protection of the public. Therapists accept that their clients need the highest possible form of protection from inadequate and unethical practitioners. No therapy organization or individual has argued against this principle. Indeed, therapists have consistently been open and active to strengthen the effectiveness of their current systems by all reasonable means. However, there is no research based evidence suggesting that the client-group here is in the degree of danger that would justify being forced into a type of regulation that, in many respects, is unsuitable and unworkable for current professional practices.

HPC complaints procedures are formal and adversarial. Most complaints in the field of the talking therapies are resolved by informal process and mediation. HPC gives no place to these processes, and thereby risks alienating potential complainants who do not wish to enter into such formal procedures, held in public with none of the confidentiality that a hearing may require. It also lacks the expertise to deal with the complexity of complaints in this field. Note that HPC reject more than 70% of complaints from the public as 'no case to answer' compared to around 10% in the main therapy organisations. As HPC states on its website, if they don't think a complaint will have a clear outcome, they won't hear the case, in contrast to the acceptance of complex complaints by therapy organisations.

HPC focus on two central issues regarding protection of the public: that any unscrupulous individual may set up a brass plate advertising their services as a therapist, and that, once struck off by a professional body, a therapist can simply continue to practise independently. Yet neither of these concerns is addressed by HPC regulation. HPC regulate professional titles not functions, so as long as the individual does not use a title protected by HPC, they can set up shop through use of any unprotected title: life coach, mentor, therapist, lifestyle consultant etc. Other models of regulation used abroad are much more effective, yet to date HPC have refused to examine them.

The HPC brings with it mechanisms that may be suitable for professions allied to medicine, but which threaten the survival of the very essence of psychotherapy. Therapy is forced into a one-size-fits-all model of healthcare intervention, with its focus on outcomes and protocol-based procedures. By marginalizing and even making illegal those forms of therapy which follow a different model, HPC regulation would deprive the public of their free choice of which therapists to consult.

The Regulation Debate
The field of counseling and psychotherapy in the UK is rich and diverse, with several hundred different schools and orientations. Approaches to therapy differ enormously: some therapies focus on symptom-relief, some specifically avoid this; some aim at insight into unconscious phantasies, some reject the very notion of an unconscious; some try to bolster a patient’s belief-system, some to undermine it; some encourage physical warmth, some proscribe this; some aim to get patients back to work, some do not. The range of practices is extraordinarily wide, and the public benefits from a choice as to this range of different approaches.

Since the early 1970s, the field has organized itself into a small number of umbrella organizations - UKCP, BACP, BPC - which have worked progressively on codes of ethics, practice and complaints procedures. There have been various attempts over the years to add a statutory framework to the field’s own set of procedures, yet these have been consistently ignored or rejected by government. Nearly every practitioner currently working in the UK belongs to a professional association with codes of ethics, practice and complaints procedures, which is inspected periodically by its umbrella organization. These codes were found by the UKCP-BACP mapping project, funded by the Department of Health, to fulfill or exceed HPC requirements.

This situation has not been especially controversial, yet calls for statutory regulation have been made by some therapists and lay people for the following reasons: there is nothing to stop any untrained person setting up a brass plate calling themselves a therapist; if a therapist is expelled from their professional organisation, there is nothing to stop them continuing to practice elsewhere; there are a small number of therapists who do not belong to any organisation and so are not subject to any agreed codes of ethics, practice and complaints procedures. These three factors are deemed to represent a significant risk to the public, which is the main reason given for statutory regulation.

The scare stories circulated to the media by HPC and by Witness, an advocacy group that the HPC has worked closely with and that is largely funded by the DoH, serve to inflate the risks involved and confuse the relevant issues. No therapy organization in the UK to date has shown any opposition to regulation. The question for them is whether HPC regulation is the best way to deal with these issues of protection of the public. HPC regulates professional titles, so if it regulated the title ‘psychotherapist’, it would be illegal for anyone to use this title without being HPC-registered. Likewise, being struck off the HPC register would make it illegal for someone to continue to offer their services as a psychotherapist. This seems to solve the issue of public protection, yet HPC regulation in fact fails to do so since the practitioner may simply set up shop using another title not regulated by HPC: life coach, therapist, life skills advisor, mentor etc. It thus fails to deal with the brass plate argument or the practicing after expulsion issue.

Even if it were to close these loopholes by regulating functions and not simply titles, HPC regulation poses a number of very serious problems to the field of the talking therapies. It subscribes to outcome-based notions of health and wellbeing which are rejected by many schools of therapy, as well as redefining the actual concept of therapy itself. Therapy is defined as the correction of developmental and psychological dysfunction via the application of a set of techniques to the patient. Yet many schools of therapy see their work as totally opposed to this model based on the health/illness framework. For them, therapy is a joint work, a collaborative effort to explore human life, with no manifest aims to ‘correct’ dysfunction or promote health.

The very notions of health, wellbeing, normality and dysfunction are rejected by many schools of therapy. These schools of therapy have a tradition of social critique, and distance themselves from the contemporary industry of ‘wellbeing’. Terms like ‘health’ and ‘wellbeing’, they argue, often carry a political agenda in any given society, and the work of therapy has to go beyond them. Psychoanalysis, for example, has always aimed to subvert received forms of knowledge, and hence the current objection from most of the UK’s psychoanalytic groups to subsume analysis into a framework which is based on received forms of knowledge and power.

Given that the notions of health, wellbeing and illness run through HPC regulations, and influence its requirements regarding education and training, conduct, performance and the hearing of complaints, they naturally see HPC as unsuited to regulate their work. To construe therapy as a set of techniques to be applied to a patient, rather than as a relationship, an ongoing work between two people which can have no predictable outcomes or set goals, is to misunderstand its basic principles and ethics. HPC has redefined therapy though a medical lens which is not appropriate to the relationship-based paradigm of analysis and many therapies.

HPC uses a model of health professions as service industries: a client pays an expert for a service, which they deliver. But for many schools of therapy, the service is actually provided by the patient. Like an artist’s studio, the therapist provides a space where the patient can create something, following their own rhythm and logic. Therapy is thus not about the performance of any procedure. No outcome can be predicted in advance and so, contrary to the service industries, it is not self-evident what product the patient is paying for. This inherently risky work is clearly not served by pretending that its results and procedures are clear, predictable and transparent.

So where medical interventions may involve set outcomes which the patient could complain about if not achieved, many therapies are about the open-ended work done not by the therapist but by the patient. One could visit a therapist’s office for years and not actually be doing a therapy, in the sense of being authentically engaged in an activity of self-exploration. Therapy, for many schools, is about what the patient manages to invent and construct in their encounters with the therapist, who does not apply the kind of protocol-based procedure envisaged by HPC.

Likewise, some schools of analysis and therapy hold that patterns of thought and behaviour that produce suffering in the patient derive from childhood responses to what is unknown and unpredictable in their caregivers. The compulsion to please others, for example, may have its roots in interactions with an erratic and unpredictable parent. Therapy will play out this situation, so that the therapist may behave in an erratic and unpredictable way, allowing an access to the process by which the patient’ patterns of response were established. HPC’s emphasis on clarity of communication and behaviour may fit a small group of therapies, but cannot subsume this latter model.

Many clinicians who do not subscribe to the healthcare model see their work as an exploration of the human condition, a journey in the same sense that becoming a Buddhist monk involves a long process of questioning one's life, ideals and expectations. Like a Buddhist training, this long process of psychotherapy cannot be identified with a set of techniques or procedures to be applied to a human being, but forms rather a strange kind of relationship which operates in unpredictable and unexpected ways. One cannot know what will happen in advance, and change often takes place through surprise, bafflement, shock and disappointment. HPC regulates professions within a framework which explicitly aims to remove these variables, and so it cannot accommodate those therapies which give a valued and central place to risk, shock and disappointment, seen as tools of growth and development. With HPC, will therapists really continue to challenge their patients or, fearing complaint, will they little by little change the way that they work?

A further and critical reason for the unsuitability of HPC as regulator lies in the field of ethics. Psychotherapy has, for the last 100 years, offered the patient a system of values freed from the moral judgments of social authorities. This has indisputably been the central characteristic of psychotherapy and what set it aside from the mental hygiene movement and from techniques of social engineering. Therapy provides a space for challenging received wisdom, social imperatives and norms of all kinds. Yet HPC regulation, for many schools of therapy, would involve the wholesale application of such norms to the therapeutic encounter. The therapist would have to become a ‘health professional’, whose practice must adhere to a moralistic and normative framework. Failing this, the practitioner would be struck off.

This tension between psychotherapeutic ethics and social morals is a crucial issue, yet it must not be misunderstood to suggest that therapists see their work as somehow beyond the law. All therapy organisations agree that rigorous codes of ethics and conduct must be in place, as well as complaints procedures. In the event of any instance of sexual assault or financial fraud, the criminal justice system should be appealed to. In line with international practice, in other cases, mediation and informal resolution of complaints are the first step, rather than automatic escalation of a complaint to the level of litigation.

For some critics of traditional models of regulation, mediation and informal resolution are a profession’s way of avoiding responsibility for mistakes and misconduct. Yet escalation to the level of litigation and formal complaint may constitute barriers to real resolution of issues for those working within a non-healthcare model. For those therapies that are relationship-based, the parallel is less with HPC-regulated disciplines such as radiology or physiotherapy than with the introduction, encouraged by government, of mediation procedures as a first step when the divorce of a married couple is considered. Although this might seem surprising, it reflects more accurately the kind of problems some patients may experience in therapy - which, for many schools, is about re-living problematic relationships from the past – than the model of a failed medical intervention.

Psycho Filler - qu'est ce que c'est?

Spotted some interesting stuff recently. Not person-centred, per se - but definitely blog-worthy.

1. Do Humans Have A Daily Requirement For Certain Kinds Of Emotions, Like The Body Does For Certain Nutrients?

A Web-based psychology experiment is investigating whether human beings have a daily requirement for certain kinds of emotions, in the same way that the body has a proven requirement for certain nutrients. Based on animal studies and human research, Dr. Imam Saqib of the National Institute of Psychology at Quaid-i-Azam University in Pakistan is interested in finding out if there is an optimum state of emotional health describable by regular experiencing of certain feeling states. Is it optimally healthy for a person to experience a certain amount of love every day? Of creativity? Of connection with others? Of competition, or even aggression?

We are all the products of long periods of evolutionary adaptation. Presumably, if the same emotions exist in most people, they must be there for a reason. Even the so-called negative feelings may have their place.

Researchers are studying whether hormones which are characteristically released in response to certain emotional states, like oxytocin, cortisol, and adrenaline, have an optimum level of release which makes the individual healthiest.

There is a discussion group which the public is welcome to join. The study is sponsored by the World Mind Network and is co-moderated by Irina Higgins of the Oxford Foundation for Theoretical Neuroscience and Artificial Intelligence and Melissa Mendoza of the University of La Verne.

The website is here.

[Source: World Mind Network, 3170 Bonita Rd., Bonita, California 91910]

2. Hoarding

Hoarding can cause many personal and social problems but psychologists are only just beginning to understand what causes it and how to help sufferers.

Here's an interesting item on the subject.

Resilience key to LMU flagship conference

Leeds Metropolitan University CONFERENCE 2010
Friday 18 June 2010

Resilience: Counselling and Coaching for Physical, Emotional and Spiritual Wellbeing

Resilience is often referred to as ‘the ability to bounce back’ from adverse life experiences. What does ‘Resilience’ means to you? How important is it to the way we live our lives? How might we find it for ourselves and what can we do to enable others to develop it?

Through lively and stimulating keynote presentations and by getting ‘up close and personal’ with the speakers in a workshop setting later in the day, this conference will give delegates a ringside seat with 3 of the leading experts in the field.

John Allen – “Physical Resiliance … From Surviving to Thriving”
John Allan is Senior Lecturer in Adventure Education and Psychology in the Carnegie Faculty of Leeds Metropolitan University. His published interests focus on adventure and personal growth with emphasis upon the development of psychological resilience through adventure programming. He has just joint authored two chapters in this area within a new Human Kinetics book on Mountaineering. As an outdoor educationalist and practitioner, he has been instrumental in developing arguably the world’s largest data base investigating the impact of adventure residential programmes on student inductees’ transition into Higher Education. Being a member of the sports science research team supporting Everest West Ridge 2006, he undertook two trips to the Himalayas. He was also Deputy Expedition Leader on a recent staff and student visit to Everest Base Camp.

Elie Godsi – “Emotional Resilience … Out of the Mists of Time”
Elie Godsi is a Consultant Clinical Psychologist, therapist, broadcaster and author. The son of Sudanese and Israeli parents, he was born in Nigeria where he spent the first few years of his life before coming to live in Britain as a young child. In the course of a career spanning over two decades he has worked extensively with violent men and women as well as their victims. He has also spent many years working in community based mental health and forensic services, in various hospital and prison settings and with young offenders in residential units. He currently works as a freelance expert witness for civil, criminal and family courts and also carries out assessments for social services child protection proceedings. His second book, Violence and Society – Making Sense of Madness and Badness was published in 2004 by PCCS books.

William West – “Spiritual Resilience … Getting By through What We Believe In”
William West PhD is a Reader in Counselling Studies at the University of Manchester in Britain where he is Director of the Counselling Studies Programme and where he delights in supervising doctoral students. William’s key areas interest include: counselling and spirituality, culture, traditional healing, supervision and qualitative research methods. William has written: two authored books – Psychotherapy and Spirituality (Sage 2000), Spiritual Issues in Therapy (Palgrave 2004), one edited book Exploring Counselling Spirituality and Healing (Palgrave 2010), one co-edited book with Roy Moodley, Integrating Traditional Healing Practices into Counseling and Psychotherapy (Sage 2005), 26 academic papers, 15 book chapters and 29 professional journal papers. William is a keen cyclist, amateur poet and beginner piano player.

£110 Organisation fee
£90 Community Groups/ Individuals

Booking deadline: Friday 28 May

All enquiries to Jenny Partington
T: 0113 812 5974

For more details: click here