BAPCA leads call for BACP to consult on regulation

The Future Of Counselling And Psychotherapy In The UK:

An open letter to the British Association for Counselling & Psychotherapy (BACP) calling for open consultation with the membership of BACP

Since our original post, this initiative has been modified somewhat, and now aims to reach out to all BACP members.

The letter requests that BACP consult with its membership regarding:

* Increasing BACP involvement in developing an alternative form of regulation to that offered by the Health Professions Council (HPC).

* Providing an Alternative Practitioner Accountability (APA) system for BACP practitioners who do not want/intend to register with HPC should the current process continue.

Open consultation with the membership on these issues will reveal the level of BACP membership support for and against regulation by HPC.

As over 80% of its membership voted against regulation by HPC, BAPCA initiated this request. However, it has been signed by practitioners of many modalities and so is from ‘Concerned Practitioners of Counselling & Psychotherapy’.

To add your signature, feedback, comments, or to contact the coordinators of the campaign, please send an email to cppcoordinator@gmail.com. If possible, please include your membership status with BACP.

[Post edited: 25 July 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
PP45
PP44 - Education & Training Committee
PP43 - Post Confer Conference
PP42 - Prepping The Confer Conference
PP41 - Interview With Mind
PP40 - National Audit Of Psychological Therapies
PP39
PP38
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.

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.

Regulation Round-up - Judicial Review

Just arrived in the PCAyorks inbox is the following, from Darian Leader, updating us all on progress with the judicial review.

You know - the judicial review that is challenging the HPC's fitness to regulate those of us who use the title counsellor or psychotherapist.

Read on:

The judicial review of HPC is now in its first stage. Documents prepared by Dinah Rose QC and John Halford of Bindmans have been sent to the High Court which point to problems with the HPC's actions to date. It had been charged with assessing the regulatory needs of counselling and psychotherapy and whether its own system was capable of accommodating this field, yet proceeded as if this was a foregone conclusion. Despite stating several times unequivocally that it had not made any attempt to study these questions, HPC could then write to the Department of Health in December 2009 claiming that it had in fact done so. Attempts to query this contradiction proved fruitless.

The JR papers discuss and document this, as well as other major failures in the process, which indicate that the HPC did not approach its work in a rational or fair way. Alternative models of regulation were not given proper consideration despite being repeatedly brought to HPC's attention. Key questions about the nature of the talking therapies were ignored, and hardly any of the HPC's criteria for regulating professions, such as homogeneity of knowledge base or practice, are applicable to our highly diverse field.

The first set of documents will now be scrutinised by the courts. The instructing organisations are The Association for Group and Individual Psychotherapy, The Association of Independent Psychotherapists, The Centre for Freudian Analysis and Research, The College of Psychoanalysts-UK, The Guild of Psychotherapists and The Philadelphia Association. Funding of the review has been made possible by contributions from thousands of therapists and members of the public who feel strongly about the issue.

Significantly, the Department of Health has now said that it will await the outcome of the judicial review before acting on the HPC's recommendations and that it is exploring alternative models of regulation. This is an important decision, as until now the DoH has simply stated that it will regulate the talking therapies via HPC, and the HPC itself has refused to discuss alternative models of regulation. The fact that other models will now be studied is real progress, and we hope that the DoH will work with our organisations and examine the models used in other countries, where regulatory arrangements have been arrived at that are satisfactory to both government and the field itself.

BAPCA AGM, Regulation, Links

A bit of a round-up, this post.

BAPCA AGM
This year's AGM will take place on 27 March 2010 at the Letchworth Settlement, 229 Nevells Road, Letchworth Garden City, Herts SG6 4UB.

It's an exciting time for BAPCA, and the Co-ordinating Group (trustees) have issued a recent statement in response to the Open Letter on Statutory Regulation that signals a potential shift towards a more robust - or at least multi-stranded - response to the unpopular HPC would-be regulator.

Their website is a bit wonky at times (who are we to throw stones?), but you can find out a bit more at:

BAPCA 2010 AGM

Coordinating Group's Response to the Open Letter:
The Future of the Person-Centred Approach in the UK and the Case against HPC and State Regulation

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REGULATION RESOURCES
Statutory Regulation and the Future of Professional Practice in Psychotherapy & Counselling: Evidence from the field

October 2009 / King’s College London – Department of Management
Dr Gerry McGivern, Dr Michael Fischer, Prof Ewan Ferlie, Dr Mark Exworthy

http://www.kcl.ac.uk/content/1/c6/06/35/90/StatutoryRegulation1.pdf

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LINKS
We've done a fairly major update of the links section - have a click around and see what you can find.

Remember, you can always leave a comment and let us know you are out there.

Counselling & Psychotherapy Regulation - Event

Viewpoints on Counselling and Psychotherapy Regulation
13 March 2010, 10.30am–4.30pm
University House, University of Leeds
Cost: £65/£50

Jonathan Coe
Witness
Nick Totton
Alliance for Counselling and Psychotherapy

The essential issue that will be debated and discussed during the day is what form of accountability is most appropriate for the profession. Is regulation by the government-appointed HPC the best way? Or should we regulate ourselves and, if so, by what means? Is the situation of counselling and psychotherapy broken, and if so how should it be fixed? Stimulated by two speakers with very different approaches to the issues, participants will be invited to debate the issue themselves with the help of various small and large group structures, including Cafe Conversation.

Full details and booking:
http://www.healthcareconferences.leeds.ac.uk/conferences/details.php?id=4

Statutory Regulation - Links

BAPCA Documents:

BAPCA Report: Meeting with Shadow Health Minister, November 2009 - Allan Turner and Teresa Cosgrove represent BAPCA at the meeting in the Grand Committee Room at Westminster Palace called by Anne Milton, MP and Shadow Health Minister.

BAPCA Members in Action:

Open Letter - The Future of the Person-Centred Approach in the UK and the Case against HPC and State Regulation: An open letter to BAPCA

Government body:

HPC - Regulation of Psychotherapists and Counsellors
'The HPC is a UK-wide regulatory body which keeps a register of health professionals meeting its standards for training, professional skills, behaviour and health. Currently, 13 professions are registered including arts therapists.'

HPC Watchdog - 'Watching the HPC to protect the public’s liberty.'

Professional bodies:

The Alliance for Counselling and Psychotherapy - Against State Regulation - A host of reports, articles and links can be found under ‘Resources’.

BACP on Statutory Regulation - 'BACP continued to favour statutory regulation in principle but believe the current proposals are not 'fit for purpose'.'

BPS on Statutory Regulation - Statutory regulation for psychologists was introduced on 1 July 2009 and the Health Professions Council (HPC) Register of practitioner psychologists opened.

IPN on Statutory Regulation - IPN is 'committed to defending freedom of practice, and to creating a culture of openness and challenge. The Network grows out of the belief that no centralised organisation has the right or the ability to decide who should practise therapy, facilitation or equivalent skills.'

UKCP on Statutory Regulation - 'UKCP has always advocated statutory regulation as a mechanism to protect the public interest and to give psychotherapy professional recognition and responsibility, as well as to unite the profession.'

Articles by person-centred practitioners on Regulation and related subjects:

‘Dare We Do Away With Professionalism?’ Why the person-centred approach is opposed to the state regulation of the psychological therapies by Andy Rogers - Article originally published in Therapy Today, May 2009

Notes on the Increasing Access to the Psychological Therapies Programme by Paul McGahey & David Murphy - Article published in PCQ, August 2008

Response to Proposals on Statutory Regulation by Paul McGahey - Article published in PCQ, August 2007

Ahead of His Time: Carl Rogers on 'Professionalism', 1973 by Richard House - Article published in Ipnosis, Summer 2002

BACP speaks for me (occasionally)

I confess I haven't always been able to say that, but BACP's position statement on the Statutory Regulation issue/s is surprisingly good - particularly when viewed from the precarious position of the Person-Centred Approach in all this *stuff*.

Check it out and tell me i'm wrong:

http://www.bacp.co.uk/regulation

DON'T SAY YOU WEREN'T ASKED

It would be nice to think that you are all BAPCA members and that there would be no need to post or circulate this. But knowing otherwise, here is the guts of an email I received yesterday, inviting comments on that hottest of potatoes (I'm never quite sure if there's an 'e' in that plural?) - STATUTORY REGULATION.

Please read, respond, circulate to colleagues.

Here it is...

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Dear BAPCA member,

The Health Professions Council has launched its call for ideas on the proposed statutory regulation of psychotherapists and counsellors.

The call for ideas seeks the views of stakeholders, organisational and individual, on a number of relevant topics including information about the potential size of the occupational field, existing voluntary registers and education and training programmes. They also welcome the views of stakeholders on other relevant topics.

The call for ideas runs until 24 October 2008. You can download a copy of the document from the HPC website or they can provide hard copies on request. You can find the call for ideas at:

http://www.hpc-uk.org/aboutus/consultations/

Please forward your comments to Di English at di@bapca.co.uk and the CG will co-ordinate a BAPCA response.

Aside from this HPC are also pleased to receive your individual response.

Andrea Uphoff
Convenor