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

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Robert A. Yourell, LMFT
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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?

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…

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

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.

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.

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

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…

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.

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.

I declare Boy-Nursey the winner.

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.

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.

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.

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.

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’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

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?

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.

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.

“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.