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.
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.
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.
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. Continue reading
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.
In recent years in the UK there’s been an increasing amount of talk about something called pathological demand avoidance, or PDA. It’s described as a subtype of autism that children (and some adults) are increasingly being diagnosed with. The National Autistic Society has been promoting acceptance of it, there’s a PDA Society, training courses and parent support groups are being set up. Paediatric and CAMHS services are seeing increasing numbers of referrals requesting assessment for PDA.
This is perhaps surprising because (and you wouldn’t know this from scanning the NAS or PDA Society websites) it’s not a recognised condition. Neither the DSM-5 nor the ICD-10 (the two main classification systems for mental disorder) have anything to say about pathological demand avoidance. The NICE guidelines (which set out best practice for UK clinicians) don’t mention PDA in their guidelines for diagnosing autism either for children or adults. It’s virtually unkown outside the UK (and a few parts of Scandinavia and Australia), and the research evidence base for it is wafer-thin.
So, I decided to look into PDA. What is it, does it really exist, and if it does exist, is it really a form of autism?
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.