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.
I put together a list of job titles along those lines. For comparison purposes, I also added the title “clinical psychologist”, which already is a protected title. The list was as follows.
Jungian or Freudian analyst
I then created a short survey on Surveymonkey, with three questions asking what people would do when trying to access psychological therapies for mental health problems (yes, I know mental health isn’t the only reason people might see a counsellor or psychotherapist, but those that do are more likely to be vulnerable, and therefore more likely to be in need of protection from unscrupulous or incompetent practitioners).
The three questions I asked were:
- Which of those titles they had accessed therapy from in the past
- Which titles they would look for when trying to access therapy
- Which titles they would accept therapy from if offered
I then passed around a link to the survey on Twitter, and also on a couple of mental health Facebook pages. I got 151 responses.
Here’s a PDF file of the results, which I’ll summarise more briefly here.
Q1 From which of the following professionals have you previously accessed psychological therapies for a mental health problem (tick all that apply)?
Clinical psychologist 26.17%
Cognitive-behavioural therapist 24.83%
Jungian or Freudian analyst 4.03%
Life coach 2.68%
Humanistic therapist 1.34%
I have never accessed psychological therapies for a mental health problem 22.15%
Q2 If you were looking for a professional to provide psychological therapies for a mental health problem, which of the following job titles would you be likely to look for?
Answered “very likely” or “quite likely”
Clinical psychologist 66.19%
Cognitive-behavioural therapist 50%
Humanistic therapist 21.26%
Jungian or Freudian analyst 9.6%
Life coach 7.09%
Q3 If you were offered psychological therapies from the following professionals for a mental health problem, how likely would you be to accept?
Answered “very likely” or “quite likely”
Clinical psychologist 73.57%
Cognitive-behavioural therapist 55.48%
Humanistic therapist 27.95%
Jungian or Freudian analyst 11.77%
Life coach 11.6%
What this results suggest to me is that if regulation were brought in, and the baddies of the therapy world simply responded by changing their job titles…yes, they could do it, but they’d be at a significant commercial disadvantage. Suppose there’s a psychotherapist from the Jungian modality who decides, “Stuff that, I’m not going to be regulated. I’ll just call myself a Jungian analyst.” According to these results, he could potentially be looking at a loss of six-sevenths of his customers. People who were Googling around for a psychotherapist wouldn’t be looking for him, and if he was touting for trade he’d have people telling him, “No thanks, I don’t want a Jungian analyst. I want a psychotherapist.” That could well be enough of a loss of business to make him either suck it up and accept regulation, or go looking for a new career in the burger-flipping industry.
An additional observation is that as for the suggestion that regulation would be disastrous for the counselling and psychotherapy professions – well, it certainly doesn’t seem to be harming clinical psychologists, at least in terms of public confidence. They may have been only the third most-popular in terms of who people had previously seen, but they were the profession that people were most likely to look for and to accept help from.
Another observation is that people were more likely to look for and accept help from a psychotherapist than a counsellor, even though the BACP takes the view that there isn’t really any meaningful difference between the two professions. It does show that job titles do matter in terms of how professionals are perceived.
Looking at the results, it seems that if “counsellor” and “psychotherapist” were to become protected titles, then there would be other titles that would need to be protected along side them. “Cognitive-behavioural therapist” seems like an obvious example, though this would bring in an added complication in that a lot of CBT is done by doctors, nurses, social workers etc. Realistically, if this were made a protected title, there would probably need to be some sort of exemption in the legislation, along the lines of, “You can still practice CBT if you’re registered with the Nursing and Midwifery Council, General Medical Council, Health and Care Professions Council etc.”
“Psychoanalyst” also strikes me as one that perhaps ought to be added to any list of protected titles. I can think of other examples; say, “family therapist”. That said, it doesn’t necessarily need to be an endless list. Once you get down to some of the more obscure-sounding titles, then it’s likely to have a serious impact on a practitioner’s viability as a business.
So, would bringing in protected titles eliminate the risk of rogue practitioners carrying on in business? No, it wouldn’t. But would it reduce the risk? Yes, it would.