Who’s trying to stop psychotherapy being regulated?


12:14 pm - June 26th 2009

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article by Zarathustra

Earlier this month the arts therapist Derek Gale was struck off by the Health Professions Council for an appalling litany of misconduct and abuse .

He touched patients inappropriately, discussed his sexual fantasies with them, called a patient a ‘cunt” and breached confidentiality by telling a therapy group about a patient’s self-harm. Despite being struck off, he was able to simply retitle himself as a psychotherapist and carry on practising.

The reason he could do this is because absolutely anybody can call themselves a psychotherapist, regardless of qualifications, professional registration or criminal record. The government is working to close this loophole by requiring psychotherapists to register with the Health Professions Council alongside their arts therapist colleagues (as well as occupational therapists, paramedics, radiographers and other professions).

They have the full support of the mental health charity Mind. However, a vocal lobby of psychotherapists is working to stop this, and has enlisted celebrities such as Tracey Emin and Will Self.

Psychotherapy needs to be regulated because people seeking therapy are often deeply vulnerable. Furthermore, unless they manage to access the scant psychotherapy resources of the NHS, they’re often paying large sums of money – £50 an hour would be considered cheap. Add that up over months or years of therapy and you’re shelling out a lot of cash for something that offers no guarantees that the therapist will make you feel better and not worse.

The Coalition Against Over-Regulation of Psychotherapy sees things differently. Their list of signatories reads like a who’s who of the chattering classes. The writers Will Self and Hanif Kureishi, artist Tracey Emin, the musicians Peter Gabriel and Michael Nyman, philosophers John Gray and Alain de Botton – all insist that regulation would destroy therapy.

Analytic work involves an open-ended relationship, where results may emerge that were never predicted or even thought of beforehand. The proposed regulation leaves no room for the unknown, as if the solution to each person?s problems were known in advance: therapist and patient will be expected to adhere to a clear predetermined agenda. Government intervention thus threatens the very foundation of analytic work, compromising both its creativity and authenticity.

This is utter bilge, and the reason it’s bilge is because the HPC already successfully regulates arts therapy. Regulating arts therapists has not required them to “adhere to a clear predetermined agenda” (which in arts therapy would be impossible anyway), but it has required them to keep accurate records, maintain confidentiality, treat patients with respect and so on. Anyone who thinks such things impinge on their therapeutic technique shouldn’t be practising therapy.

If the Coalition’s argument seems illogical, other campaigners against regulation seem downright off-the-wall. The Ipnosis website contains a bizarre twopart account of the Derek Gale hearings that seems obsessed with its ‘psychodrama’ and supposed illegitimacy, but shows little regard for the patients he abused.

On the same website, they compare therapists who support HPC regulation to collaborators with the Vichy regime. As therapists go, they seem unaware of the concept of projection.

In all fairness to these campaigners, they insist that they’re not against regulation per se, just that it should be done by existing professional bodies such as the UK Council for Psychotherapy. However, the complainants against Derek Gale allege that they approached such bodies, and received a ‘bullying’ response that seemed designed to impede a complaint rather than facilitate it.

We cannot know if this is true because, unlike with HPC, their disciplinary hearings are held in secret, leaving them unaccountable to anybody but themselves.

Psychotherapists operate in a position of power over deeply vulnerable people, and they earn large sums of money doing it. That means they need to be properly accountable, and to a proper regulator, not to fig-leaf self-regulation by an internal clique.

———–
Zarathustra is a mental health nurse working in child and adolescent mental health services (CAMHS). He edits the Mental Nurse blog.

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Reader comments


Dolly Draper?

Wow, I guess even the chatterati get it right occasionally. Of course, there should be regulation. But voluntary regulation. We don’t need the government defining what a legitimate “psychotherapist” is when private councils could do the job as well and with less opportunity for capture by special interests.

Yes Jailhouselawyer, Dolly Draper is indeed one of these unregulated psychotherapists. I have no idea what his views on HPC regulation are though. I’d imagine he’d probaby be against it, since there’s probably no way the HPC would allow him to register.

It does beg the question, would you trust the inner workings of your psyche to Derek Draper?

4. Denim Justice

@1 Snap, I saw the headline on Twitter and thought – Dolly Draper is trying to defend the only profession he hasn’t yet been hounded out from.

Incidentally, a bullying response from an organisation that is supposed to be protecting patients interests ought to be evidence enough that the organisation not worth taking seriously and whose views should be disregarded. But what happens when an equally lazy organisation gains statutory fiat? Then you have to take it seriously and you have no option to set up a rival.

@nick

I wouldn’t have a problem with self-regulation if the existing professional bodies showed they were doing a good job. Unfortunately that’s not the case.

Since highlighting the issue on Mental Nurse, we’ve received input from the original complainants in the Derek Gale case. They report that Derek Gale’s own professional bodies (the UK Council for Psychotherapy and the UK Association of Humanistic Psychotherapy Practioners) tried to bully them into not complaining, and had a lousy complaints system.

Go here to read the whole story, but here’s an excerpt.

Unlike the HPC where the complainant becomes a witness for the HPC and is put in the hands of very experienced professionals who support the investigation and the victims welfare needs the AHPP /UKCP process dictates that the complainant in effect carries out their own prosecution with the guidance of someone called a complaints facilitator, mine is Jochen Lude, an apparently well meaning guy who seems to be genuinely disgusted at the way I have been treated by the AHPP. To be quite honest though I think he would agree that he is out of his depth. With the “self regulation” system it is up to the complainant to find evidence, prepare it by attributing specific complaint events to breaches of specific code, present it to the committee, present any witnesses, question them, cross examine the “defendant” and his witnesses, in fact the complainant or his McKenzie style friend is supposed to do work as complex as that of the CPS and very experienced lawyers. Of course the complainant may seek counsel but unlike the HPC who engaged Michael Caplan QC the complainant must bear any costs themselves with no chance of reimbursement from either the AHPP or UKCP.

Nick, you’re right that regulation should not be in the hands of special interests, but the AHPP and the UKCP *are* a special interest. They’re a special interest for the psychotherapist and not the client.

I was at Manchester with Derek in 1989, when he nearly bankrupted our student newspaper, in a truly spectacularly inept attempt to be interesting.

“We don’t need the government defining what a legitimate “psychotherapist” is when private councils could do the job as well and with less opportunity for capture by special interests”

Quite frankly Nick, I feel I have the right to demand some evidence from you to support this assertion.

8. Shatterface

Psychotherapy is as vulnerable to quackery as medicine was before regulation. Most of it’s snake-oil; some of it’s still reliant on psychoanalysis, for christ’s sake.

Therapies have to be proven effective scientifically, not anecdotally. See a psychotherapist for long enough and you’ll either get better of your own accord (grief, for instance, will go away) or you’ll pick up a mental condition which is actually created by the therepy process itself (‘recovered’ memory, etc).

If you just want to spill your guts to someone who isn’t qualified, find a friend and save some money.

Hmm, mixed feelings on this (disclosure: I’ve had some training in counselling skills and am planning to train as a counsellor in the next year or two).

I agree that, from what I’ve read, the self-regulation of the likes of UKCP and BACP leaves a lot to be desired and isn’t nearly open or transparent enough. However, I’m not convinced that the HPC are the right body to regulate the effectiveness of therapy.. Counselling and psychotherapy tend to be open-ended processes (with the exception of behaviourist approached such as CBT) and it would be nearly impossible to assess an encounter’s effectiveness properly. I’d be reluctant to let a Dept of Health body get its hands on assessment due to its reductionist tendency to go by measurable results only.

I think my compromise would be to get the HPC to provide an effective complaints service, combined with branding ‘counsellor’ and ‘psychotherapist’ as restricted titles requiring training and membership with a body such as BACP or UKCP but not to give the HPC a remit to discipline members over the apparent effectiveness of outcomes if no issue of conduct arises.

#8 >>Therapies have to be proven effective scientifically, not anecdotally.>>

Or else? In terms of access to NHS funding, an increasing number of PCTs won’t fund any type of therapy other than CBT. Or do you suggest making it illegal for non-behaviourist therapists/counsellors to operate at all?

11. the a&e charge nurse

I suspect 80% of the coalition (against regulation of psychotherapy) have all received psychoanalysis – in other words they have all been brainwashed.
Let’s face it you’d have to have pockets as deep as some of these media luvees to be able to afford sessions in the first place?

I’ll give Freud his due though – I do think there is some substance to ‘defense mechanisms’ but things like the oedipus complex (or kill daddy fuck mummy) have me howling with laughter, although maybe Woody Allen sees it differently?

I agree with regulation to the extent that ripped off punters should be able to get their money back in the event of ineffective treatment, and certainly when the type of abuse highlighted in the main post takes place – although defining succes/failure is not always a straightforward matter.

Remember the line in ‘Analyse this’ when Billy Crystal (playing the therapist, Dr Sobel) asks to the Mafioso hardman (played by De Niro) – “what is my goal – to make you a happy, well adjusted gangster”
http://www.youtube.com/watch?v=89jJa8-Hb88&feature=related

@Seany C

I think my compromise would be to get the HPC to provide an effective complaints service, combined with branding ‘counsellor’ and ‘psychotherapist’ as restricted titles requiring training and membership with a body such as BACP or UKCP but not to give the HPC a remit to discipline members over the apparent effectiveness of outcomes if no issue of conduct arises.

To be honest, organisations like the HPC (along with similar bodies like the General Medical Council, the Nursing and Midwifery Council, the General Social Care Council) aren’t generally involved in measuring outcomes anyway.

Their main remit is to validate training, maintain a register and enable complaints against people on that register to be made and heard.

So, the anti-regulation campaign’s argument that it would force them to provide measurable outcomes is simply full of shit.

“I’d be reluctant to let a Dept of Health body get its hands on assessment due to its reductionist tendency to go by measurable results only.”

So, you’re not a big fan of evidence based medicine then?

“I think my compromise would be to get the HPC to provide an effective complaints service, combined with branding ‘counsellor’ and ‘psychotherapist’ as restricted titles requiring training and membership with a body such as BACP or UKCP but not to give the HPC a remit to discipline members over the apparent effectiveness of outcomes if no issue of conduct arises.”

Again, can we have some kind of model for the effective implementation of this kind of set up?

Me, I’d say the patients/clients/profit-centres deserve the same kind protection offered (supposedly) to the patients of doctors, nurses and dentists.

I mean, why on earth shouldn’t they? Unless of course, the burden of meeting such standard of training and behaviour, is simply beyond them. Which, on the whole I think it is.

14. the a&e charge nurse

[12] So, the anti-regulation campaign’s argument that it would force them to provide measurable outcomes is simply full of shit ………… yes, and no, Zaruthustra.

The NMC (for example) DOES specify both generic and specific ‘standards’.
To illustrate the point here are the ‘proficiencies’ relating to nurse prescribing.
http://www.nmc-uk.org/aDisplayDocument.aspx?documentID=1645
When things go wrong at least nurses are aware, or should be, of the expectations of their professional regulatory body.

But how would this work for the many different schools of thought amongst the psychotherapists (some who seem to hold opposing constructs by the way)?

Short of following a few basic rules about confidentiality and not abusing patients, etc I am unsure how therapists can regulate activity that by definition involves inflicting psychological pain of one sort or another – of course this is not because of sadism (in most cases) but because of the mountain of misery and the misfortune therapists have to navigate as part of the reason for patients being in therapy in the first place.

15. Shatterface

A&E (11): ‘Psychoanalysis – if it’s not one thing, it’s your mother.’

Or ‘Oedipus, schmedipus – what’s it matter so long as a boy loves his mother?’

And these crackpots call CBT or pharmaceutical based therapies ‘reductive’.

I think the coverage of Michael Jackson’s childhood we are currently being swamped with shows just how pervasive pop-psychology has got.

Men are from Mars, women are from Venus, pop-psychology is from Uranus.

@Charge Nurse

Regarding your point about regulatory bodies like the NMC and HPC having both generic and specific standards:

Rather than nurse prescribing, a closer analogy would be the HPC standards that it sets down for arts therapists. These are online at http://www.hpc-uk.org/publications/standards/index.asp?id=39

Regarding generic (things that apply to everyone on the HPC register) standards, there’s things like:

– understand the need to act in the best interests of service users
at all times

– be able to assess a situation, determine the nature and severity of
the problem and call upon the required knowledge and
experience to deal with the problem

– understand both the need to keep skills and knowledge up to
date and the importance of career-long learning

As for the specific (things that apply only to arts therapists) standards, these include:

– understand the value of therapy in developing insight and self-
awareness through their own personal experience

– recognise the role of arts therapists and the contribution they can
make to health and social care

– be able to undertake and record a thorough, sensitive and
detailed assessment, using appropriate techniques and
equipment

– understand core processes in therapeutic practice, such as the
therapeutic frame, transference and counter-transference and
concepts from other therapeutic models, and be able to engage
these to achieve productive therapeutic outcomes

– know theories of group work and the management of group
process

These strike me as suffficiently worded that it allows scope for a wide range of practice – e.g. it says you need to know “theories of group work” but doesn’t dictate which ones.

The only standard I can find that deals with outcomes is this one:

– be able to work with clients both to define a clear end for
the therapy, and to evaluate the therapy’s strengths, benefits
and limitations

But again, that doesn’t dictate HOW one ends the therapy, just that it needs to be done in a clear way.

I really don’t see anything in these standards that ought to be in any way offensive to a competent, responsible psychotherapist.

This conspiracy isn’t going to get very far, if this is the usual quality of Orbita Dicta.

I declare Boy-Nursey the winner.

18. Shatterface

A&E (11): One of the things I admired about The Sopranos is that Tony’s therapy ultimately did nothing but validate his sociopathy.

Most psychotherapy-based dramas present us with a sudden revelation after which the patient emerges as a new man, free of hang ups.

In a psychiatry obssessed culture where everyone wants to lay their problems on as many people as possible, that was one of the show’s most subversive tricks.

Urgh, that list of celebs makes me shiver…odious people..

20. scillysnowprincess

The “profession” has had more than enough time to self regulate and yet situations like the Derek Gale case happen.

Surely this demonstrates that self regulation has NOT worked and therefore it is time for regulation to be introduced, as has happened in other professions (take FSA for example). I for one would be proud that I belonged to a profession and could demonstrate the highest of standards – regulation introduces consistency across the board so that the client receives equally high standards of psycotherapy, whomsover they see.

Ranters…well, can’t agree that they’re odious, just abusing their public profiles to pile ignorance onto public debate…as per usual.

Misguided, perhaps?

Too certain of their own intellectual/perceptual superiority? (Mr. Self…?) 🙂

My personal greatest disappointment is, alas not for the first time, Peter Gabriel.

Huge fan of his music, WOMAD was a great idea, but outwith the musical sphere…

Oh dear.

Ach well.

But he’s definitely *not* ‘odious’. I’ve met him, and he was extremely generous with his time and effort when he was under no obligation whatsoever.

No idea about the rest, though… 🙂

22. Shatterface

What’s hilarious is that these fuckwits think that describing therapy as ‘open-ended’ (i.e. a bottomless pit for tossing your money into) and claiming results may emerge that were ‘unpredicted and never even thought of beforehand’ is a GOOD THING!

Can you imagine ANY other profession making their case in these terms?

“Psychotherapy is as vulnerable to quackery as medicine was before regulation. Most of it’s snake-oil; some of it’s still reliant on psychoanalysis, for christ’s sake.”

I dunno. Medicine (especially psychiatric medicine) was pretty vulnerable to quackery even after government regulation came into practice. In fact, Foucault almost made a career out of showing how medical practice might have become, in some ways, worse after governments became involved as it started to take over various judicial/social functions. Today, in the US especially, special interests have managed to bid up the cost of medicine to ridiculous amounts. One might argue that at least the vast majority of it works, but that might be more to do with the fact that, at its core, it uses the same natural science techniques that work pretty well elsewhere.

Almost by its nature, psychotherapy cannot be judged on that narrow basis (it involves too many subjective or normative outcome measures). So one might argue that psychotherapy is almost inherently vulnerable to snake oil (even if it does have value for many people) and that government regulation would have little to contribute to it. Not that the current scheme is the best there can be: I am sure a more patient-focussed association of psychotherapists is possible, I am just not convinced government is a good way of delivering it.

I’m all for regulation if it will mean there will be more money to pay for the thousands of people on therapy waiting lists via the NHS and people don’t have to apy privately.

The NHS is nor paying for Homeopathy which has been proven scientifically not to work – I don’t know why it can’t pay for psychotherapy which is more of an artform and cannot be double blind tested.

25. the a&e charge nurse

[25] I don’t know why it can’t pay for psychotherapy which is more of an artform and cannot be double blind tested.

He hee, who needs the shrink when there’s blogging, eh?

@ Andy Gilmour

Misguided!!

Really?? The most shrewdness(not a word, I know) of people!! Celebs??

I’ll care when they do something of substance, that doesn’t equate their ego…

27. The Grim Reaper

The strongest argument in favour of regulation for psychotherapists? Derek Draper.

28. the a&e charge nurse

[16] I really don’t see anything in these standards that ought to be in any way offensive to a competent, responsible psychotherapist.

If we believe Jeffrey (Against Therapy) Masson then psychotherapy’s past is littered with abuse – perhaps most famously when the Daddy of them all, Sigmund Freud sent his patient Emma Eckhart to his mate – the ENT surgeon (or nose man) , Wilhelm Fliess.

Freud believed his vulnerable young patient had developed a ‘nasal reflex neurosis’ and might benefit from a spot of nasal excavation – the bungling Fliess left a swab in situ which caused both bleeding and an infection that nearly killed Emma.
http://en.wikipedia.org/wiki/Emma_Eckstein

From today’s ‘evidence-based’ perspective such ‘therapy’ borders on madness but who knows, maybe Freud really thought he was onto something back then.

Don’t forget patients will buy into all sorts of nonsense – remember Janov’s ‘primal scream therapy’ which John Lennon amongst others thought might cure them of various childhood hang ups?

God knows what the HPC would make of this motley crew?

Nearly all U.S. states regulate psychotherapy. This creates minimum standards. Also, they can use the force of law if necessary (egregious or repeat offenses). But the licensing boards are themselves regulated, and take a measured response from what I’ve seen. I’ve been over transcripts of a hearing and seen many board responses. They were quite well-considered and appropriate.

Many states also require some continuing education. This helps make sure that therapists stay up-to-date. The field is really evolving with new innovations and insights from research and practice.

Here in the U.S., people will say horrible things will happen if some law is passed, and not bother to see that it’s going swimmingly in other countries. Looks like we aren’t the only ones that do that.

Regards,

– Bob

| Free Mindfulness Meditation with Shimmer Sound
| http://www.PsychInnovations.com/smpl_mindfulness.htm

Robert A. Yourell, LMFT
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Interesting article about psychotherapy. Thanks for the post.


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