How much therapy abuse is out there?

I recently had a question posted in the comments thread to one of my blog posts, by ‘Reading Enquirer’.

Is there actual evidence that a community of statutorily regulated health professionals commit fewer abuses on average than the unregulated? Does this cure depend only on supposition and faith or is there an actual peer-reviewed evidence base? Is there evidence that statutorily regulated health professionals have greater efficacy in the relief of human suffering than the unregulated?

This is an important question, and one which raises a further question – how can we know how much abuse by psychotherapists is out there?

Abuse, by its very nature, is something that happens behind closed doors, without records being kept. No practitioner – regulated or unregulated, is likely to be auditing how much people they’ve abused. Not everyone who has been abused reports it. Still less of those who report it have their allegations proven in a fitness-to-practise hearing and/or a court of law.

If we’re talking about unregulated professionals, then that does beg the question of who they can report it to. Historically, even being a member of a professional body has not necessarily been a guarantee that a complaint will be heard properly. Until recently, complaints-handling at the UK Council for Psychotherapy was dominated by “crony-ism and amateurism” (not my words, but the words of the then UKCP chair). To give an idea what this “crony-ism and amateurism” looks like, one can read the decision letter for the UKCP’s application to be accredited by the Professional Standards Authority.

The Panel considered a summary of the main themes identified in the Call for Information, and the UKCP’s response to these submissions. It observed that many were related to UKCP’s previous complaints processes, involving the handling of complaints by itself and its OMs. It was felt that the former complaints system was characterised by lengthy times from initial complaint to completion, poor communication from the UKCP and OMs and a lack of support for complainants. There were suggestions of conflicts of interest and procedural failures that appeared not to consider public protection.

The UKCP has now instituted a series of reforms to address these issues, with the result that they’ve now achieved PSA accreditation, though the PSA is insisting on auditing their complaints-handling after 6 months. To be fair to the UKCP, they’re now publishing a growing number of complaints decisions, which appear to have been handled in a considerably improved way.

But…what psychotherapy has at the moment is only regulation-lite, not full statutory regulation. “Psychotherapist” and “counsellor” are not protected titles and you don’t have to belong to a professional body to call yourself one. Indeed, the UKCP recently struck off a psychotherapist called Julia Eastwood. She’s still advertising herself for coaching and counselling.

And then there’s all those people who use other titles similar to psychotherapists and counsellors. Even if those professions became protected titles, there’d still be all the Jungian analysts, life coaches, shamanic therapists…did I mention Ms Eastwood also advertises herself as a “conscious channel of the Archangel Gabriel”? Good luck finding someone to complain to if your conscious channel engages in misconduct.

Still, even if you can’t find anyone to complain to, you could always sue them, though that can be hugely expensive, and you’ll only get no-win no-fee if you have a strong case. So presumably we could find out how much misconduct is out there by looking at the number of lawsuits?

I spoke to somebody who sued their psychotherapist. According to them, their solicitor knew of about 30 ongoing cases, which sounds like a worryingly high number. However, we don’t get to hear about many of these cases, for the reason that most of them end in a civil settlement. These settlements tend to include a confidentiality clause, effectively stuffing the complainant’s mouth with gold.

If it’s a serious form of abuse, say, if someone was sexually exploited, there’s also the police route. But conviction rates for sexual assault are shockingly low. No guarantee there’ll even be a prosecution, never mind a conviction.

One could simply try to publicise one’s case. But that carries the risk of being clobbered by our notoriously draconian libel laws, which have a well-documented “chilling effect” on free speech in the UK. Even with the recent reforms to defamation law, the risk of being hit by a lawsuit would make a lot of people think twice.

So, to answer Enquiring Reader’s question as to whether there’s evidence that unregulated professionals commit more abuse than regulated ones – the simple answer is we don’t know. The reason for that is that without regulation we can’t know the extent of the problem, because there’s nobody to complain to.

On a more pragmatic level, I think it’s important that people have the confidence that if something goes wrong, they have access to a robust complaints procedure. For that reason, my advice to anyone seeking a therapist is to ensure that they use someone either in a state-regulated profession (e.g. clinical psychologists or arts therapists, which are regulated by the Health and Care Professions Council), or belong to a PSA-accredited body (e.g. the BACP, the UKCP or the National Counselling Society). If they don’t fulfil those basic criteria, don’t use them.

 

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BACP closes regulatory loophole

A few weeks ago I wrote about a loophole that could enable an unscrupulous psychotherapist to evade a misconduct hearing. Of the various professional bodies, it usually isn’t possible to bring a complaint against a practitioner who has resigned their registration prior to the complaint being made. Admittedly this is true for other professions such as nursing. But there’s a difference in that “nurse” is a protected title and in order to practice you have to be registered with the Nursing and Midwifery Council. Any nurse who resigns in anticipation of a complaint is effectively striking themselves off.

This isn’t true of psychotherapy. “Psychotherapist” and “counsellor” are not protected titles, and although various professional bodies exist (the British Association for Counselling and Psychotherapy, the UK Council for Psychotherapy, the British Psychoanalytic Council etc) there’s no legal obligation to belong to one of them. So, if a counsellor or psychotherapist gets wind that a complaint of misconduct is about to be made, they can just resign from their professional body and carry on practising. No complaint can then be made, therefore there’s no record of any safeguarding concerns that could put vulnerable adults or children at risk.

Just so people know why I mentioned this particular loophole, it’s because the above scenario isn’t a hypothetical one. It’s happened. On more than one occasion by the sound of it.

I previously had an e-mail from the British Association for Counselling and Psychotherapy, which is the UK’s largest psychotherapy body. They said they were “currently engaged in the process of changing this procedure.” It now appears they’ve done exactly that.

The BACP have published the following amendment to their Professional Conduct Procedure.

1. Page 1, paragraph 1.3 ‘Complaints against non-members’ is now replaced with:

1.3 Complaints against non-members / former members

a) The Association cannot deal with complaints against individuals or organisations that were not member/registrants of the Association at the time of the alleged misconduct.

b) The Association can deal with complaints made against a former member/registrant if that former member/registrant was a member at the time to which the complaint relates, subject to the provisions of paragraph 1.5.

c) Members/registrants of the Association referred to herein will be deemed to include former members/registrants.

d) Paragraph 1.3 b) only applies to members/registrants whose membership was current at the time of the adoption of this revised paragraph 1.3 by the Association by resolution of its Board of Governors pursuant to 5.1 of the Standing Orders of the Association on the 20th day of September 2013.n [emphasis added]

That should prevent any unethical practitioners from thinking they can avoid a BACP hearing through a just-in-the-nick-of-time resignation. This is welcome news, and I hope the other professional bodies will follow suit.

There’s been a couple of other developments recently with regard to professional regulation in psychotherapy. Under the previous Labour government there were plans to make counselling and and psychotherapy state-regulated professions under the auspices of the Health Professions Council (now the Health and Care Professions Council) which already regulates clinical psychologists and arts therapists. This was shelved by the Conservative-Lib Dem coalition in favour of regulation-lite or “assured voluntary registration” where the existing professional bodies could apply to be accredited by the Professional Standards Authority. So far only the BACP has achieved this accreditation.

In July Geraint Davies MP tabled an early day motion, calling for the previous plan to be reinstated.

That this House notes that anyone can set themselves up as a counsellor or psychotherapist without training or experience with no recourse for the patient if something goes wrong; further notes that there are more than 50,000 registered counsellors or psychotherapists and an unknown number unregistered; further notes that millions of people, often with mental health problems who are therefore vulnerable and at risk, are being given therapy in an unregulated industry with no uniform code of conduct or ethics; and calls on the Government to regulate counsellors and psychotherapists by bringing them into the jurisdiction of the Health and Care Professions Council.

So far 53 MPs have signed it: mostly Labour, though with a fair sprinkling of MPs from the other parties.

Back when HPC regulation was first mooted, there was a small but very noisy campaign by certain psychotherapists who predicted that the sky would fall in if psychotherapists had to be accountable for their actions in the same way as doctors, nurses, social workers or just about any other profession that routinely works with vulnerable people.  I’ve previously (and only semi-jokingly) referred to those campaigners as “the worst bunch of malevolent hippies since the Dharma Initiative in Lost.”

Their argument was essentialy that state regulation would bring in “market values” to psychotherapy. If that argument sounds oxymoronic, then…well, that’s because it is. They used a lot of left-wing language to argue against regulation, but essentially what they were saying was that psychotherapists should be left to regulate themselves, much in the same way financial services and the tabloid media were. And we all know how well that ended.

If you’re wondering about the commitment of these anti-regulation campaigners to protecting the public from abuse, take a look at this beyond-parody article by Denis Postle, reporting on the hearings for Derek Gale, struck off by the HPC as an arts therapist for running a nasty therapy cult.

The imaginal universe of the human condition is ubiquitous. Since the Vedic traditions, Buddha, and Freud, we know we can’t turn it off. It runs. It leaps. We may hide from it but we can’t escape. We resonate with the world, the world reverberates through us. As practitioners we know that grasping the ‘real’ is matter of navigating multiple transferences and embodied foregone conclusions, this article included. The HPC as it seems to me stands in defiance, studied intentional defiance of this. The HPC has spectacles through which it sees only categories. Health. Standards. Competence. Treatment. Note-keeping. Effectiveness. This is a ‘hearing’ and in this room, as we were repeatedly reminded, what matters are ‘particularized facts’.

Also in defiance but of another order, from another paradigm, is Mr Gale, who for almost thirty years has had a private practice of individual psychotherapy and groupwork.

His defiance, as was apparent from the first three days proceedings, has its roots in Humanistic Psychology and the Human Potential movement, personal development traditions that stand outside the HPC’s medicalised models of healthcare.

I guess it was the HPC’s “medicalised models” that decided that Gale was sexually, physically, emotionally and financially abusing his clients. I’d attempt to deconstruct Postle’s article, but at this point we’re not talking about oxymoronic arguments. Just plain moronic.

Postle is a leading figure in the Alliance for Counselling and Psychotherapy, which helped coordinate the anti-regulation campaign. What are they doing now? Among other things, they’re crying foul about another development, in which the BACP has apparently applied for a royal charter. If they’re successful, this could mean that the BACP might bestow such titles as “chartered counsellor” or “chartered psychotherapist”.

The Alliance has written an open letter objecting to this.

We do not believe that BACP’s desire to bestow chartered status on its members will do anything for the field as a whole, nor do we think it in the interests of service users or of the public generally. On the contrary, we consider BACP’s move to be a potentially divisive and retrograde step which could be construed as a predatory attempt to steal a march on other organisations at a time when the government’s new voluntary register system, under the PSA, is just beginning to find its feet.

In due course, we will be writing to the Privy Council, the Department of Health, MPs and Peers, asking them to join with us in resisting this move by BACP. But we feel that the major membership organisations of counselling and psychotherapy should
join with us and we invite you to allow us to mention your names in whatever further communications we send out.

Or, to put it another way….

 

The BACP are of course entitled to apply for a royal charter. If other bodies feel that’s giving the BACP an unfair competitive advantage, then they could apply for one too, and take their place among such august organisations as Marylebone Cricket Club and the Worshipful Company of Lightmongers. Unless of course, such bodies simply aren’t good enough to meet the criteria for a royal charter.

If the BACP are successful, then that would be very good news for them indeed. It would mean that they’re the only psychotherapy body that could give a practitioner both chartered status and PSA accreditation. In other words they’d be the gold standard that any respectable counsellor or psychotherapist would be expected to be registered with.

These anti-regulation campaigners wanted to be free from the shackles of a single state regulator, so they could be left to set their own standards. Well, they got that. Now, for all their anti-market rhetoric they could well be about to discover exactly what happens in the marketplace when your product is visibly inferior to that of your competitor.

I can’t say I feel sorry for them.

A second therapist commits serious sexual misconduct, is not struck off

Back in April I broke the news of Geoffrey Pick, a psychotherapist registered with the Arbours Association and UK Council for Psychotherapy. After conducting an “inappropriate relationship” with one of his patients, he was suspended for a year instead of struck off. He was then allowed to re-register with the Arbours and UKCP. Only when it came to media attention did he resign his registration. Shockingly, I’ve now discovered that this is not the only case of its kind.

A couple of months ago I was researching this blog post, which I wrote after I’d noticed that a high percentage of psychotherapists facing misconduct hearings seemed to be Jungians (Pick was from a Jungian background). It was pointed out to me that there was a case involving a Jungian that didn’t appear in the UKCP complaints archive. Stuart Macfarlane had been suspended for two years by the Guild of Analytical Psychologists (formerly the Guild for Analytical Psychology and Spirituality). The details of what he did were rather vague.

Stuart MacFarlane has been found to be in breach of the GAP Code of Ethics 2008 (1.7) in
two areas:
1. personal relationships – infringing and violating the trust of a client
2. inadequate standards of practice.

He has also been found to have breached the Code of Ethics 2008 (3.6) concerning
Professional Boundaries:

3.6 psychotherapists shall not take advantage of or exploit the dependent nature of the
therapeutic relationship, current or past, for example with regard to fees, sex or in any
other respect.

These breaches constitute Serious Professional Misconduct under section 7.1(b) of the
Code of Ethics.

I’ve since been able to establish that Mr Macfarlane engaged in serious sexual misconduct with a client. The individual in question is a vulnerable adult with mental health difficulties. As a consequence of his actions, she experienced a deterioration in her mental health. She continues to receive psychiatric support.

To give a comparison of what would usually be the sanction, here’s the indicative sanctions guidance for my own regulator, the Nursing and Midwifery Council.

In all cases of serious sexual misconduct, it will be highly likely that the only proportionate sanction will be a striking-off order. If panels decide to impose a sanction other than a striking-off order, then they will need to be particularly careful in explaining clearly and fully the reasons why they made such a determination, so that it can be understood by those who have not heard all of the evidence in the case.

Macfarlane, however, was not struck off. He received a two-year suspension order. Potentially at the end of this he could be allowed to rejoin the Boy’s Club, sorry, Guild of Analytical Psychologists, and resume practice. Oh, and he was also ordered to write a letter of apology to the client and refund her fees – as though she’s a dissatisfied customer at Sainsbury’s rather than somebody subjected to the worst possible breach of boundaries.

I e-mailed the GAP. They declined to elaborate further on his misconduct besides the information posted online. I asked why he was not struck off and whether he would be allowed to re-register. They replied, “The decision reached was in accordance with the complaints process set out under the G.A.P. Complaints Procedure Code, which emphasises the confidentiality of the proceedings. We are unable to comment on an individual’s possibility of being allowed to re-register until the suspension period has ended, and such matters as compliance with the sanctions have been considered.”

And why is his case not in the UKCP’s online complaints archive? The outcomes listed there are, by and large, far less serious than Macfarlane’s. In case there’s any doubt that Macfarlane was a UKCP therapist, here’s his entry on the register, dated 29th October 2011.

Stuart Macfarlane UKCP Page

I e-mailed the UKCP to ask why he’s not in the archive, and if he will be allowed to rejoin the UKCP register. I haven’t so far received a reply. [Edited to add: the UKCP have now responded]

I did, however, get a reply from Macfarlane himself.

Thank you for your email, and for giving me the opportunity to answer your questions in advance of your publishing. I have made a mistake and I am doing all I can to make amends, including attending therapy weekly.
I broadly support your goal to improve and standardise regulation across the psychotherapy profession, but as I do not agree with the way you are going about it, I shall not be engaging any further with you about this .
However, I wish you well.
Another therapist who has completely overstepped the mark with his client, resulting in catastrophic consequences to a vulnerable person. And this time next year he could possibly be practising again.
Utterly unbelievable.

Reading a charlatan writing about charlatans

This week I was up at my local university doing a bit of training. While I was browsing the bookshelves, I randomly made an interesting find. What is Psychotherapy? A Personal and Practical Guide by Derek Gale. That name immediately rung a bell. He was struck off by the Health Professions Council and by the UK Council for Psychotherapy for a horrific litany of abuse against his patients. I was curious to see what such a character would say about psychotherapy, so I got the book out on loan.

Gale’s story is a pretty nasty one. He groped his patients, discussed sexual fantasies with them, called one a “stupid cunt”, got them to do unpaid work for him, smoked cannabis in front of them and in some cases went on holiday with them. The list of allegations put before the HPC reads more like the behaviour of a cult leader than a therapist. Tragically one of his victims, Gena Dry, later took her own life. Despite this he had some surprising connections. His in-house book company, Gale Centre Publications, listed Windy Dryden, Professor of Psychotherapeutic Studies at Goldsmiths, among its authors.

His saga was also something of a test case in the regulation of psychotherapy. He was registered as an arts therapist with the Health Professions Council (now the Health and Care Professions Council) and as a psychotherapist with the UKCP. At the time, proposals were underway for psychotherapists to also be state-regulated by the HPC rather than the current system of voluntary self-regulating bodies like the UKCP. Although these proposals were subsequently shelved, it’s worth noting that the UKCP ignored complaints about him for years until the HPC took action.

Ironically, his book actually has a chapter on “Charlatans well intentioned and otherwise”. I browsed to it to see what he had to say.

I do not intend to dwell on the proliferation of cranks and charlatans, some of whom are out to make a quick buck. Fortunately the public do not seem to be as gullible as it is sometimes assumed to be and these people do not stay in business long, unless they have some genuine service to offer…

Wow, that took some gall for him to state.

…I find more seriously worrying the practices of people who have a recognised qualification in one of the caring professions and a job which puts them in a position of trust. These professional qualifications are not a qualification in psychotherapy and a doctor, social worker or educator who claims to practise psychotherapy while remaining blissfully ignorant of what psychotherapy is, trades on the public’s confidence in his profession and is therefore as great a charlatan as the person who holds a bogus diploma.

Though perhaps not as great a charlatan as someone who urges their patients to strip naked during group therapy.

Gale isn’t the person to make this point, but there is a valid point in here about who is or isn’t a psychotherapist. A large number of professionals, myself included, are involved in providing psychological therapies but don’t have a formal qualification in the field. You might hear of a doctor or nurse doing, say, cognitive-behaviour therapy, without being a qualified cognitive therapist. In many cases those involved – again, including me – have to acquire training and supervision on the hoof, as and when we can.

Interestingly enough, there isn’t a fixed definition of who is a psychotherapist. If a psychotherapist wants work from the NHS or social services, they’d need to have some sort of recognised qualification and usually be registered with either British Association for Counselling and Psychotherapy or the UKCP. However, if they’re practising independently they could vary from having completed an arduous post-graduate training to being just some hippy with no qualifications at all.

Then, of course, there’s the thorny question of what’s the difference between a counsellor and a psychotherapist.

Thinking about my own nursing practice, I’m heavily influenced by cognitive-behaviour therapy and family therapy. Interestingly enough, I tend in daily practice to be more willing to saying I’m “doing CBT” than “doing family therapy”. Perhaps due to a perception that CBT is more straightforward and less complex than family therapy – though I’m sure there’s people who’d be more than happy to dispute that.

If a psychotherapist is someone’s registered with the UKCP or BACP, then it’s worth noting that Derek Gale was accused of continuing to practice after being struck off. Though according to his Twitter profile he appears to have now retired to write books and send tweets to Ricky Gervais.

Who is a psychotherapist? Ultimately the only thing I can say for certain is that it isn’t Derek Gale.

Of Hidden Cameras, Care and Panorama

Tonight’s  Panorama is focusing on care of the elderly or rather, lack of care. Maria Worroll was placed by her mother in a care home in Camden which had an ‘excellent’ rating by the CQC (Care Quality Commission).

Jane Worroll, Maria’s daughter, noticing something amiss and perhaps having concerns, set up a hidden camera in her mother’s room to observe how her mother’s treatment. Mistreatment and abuse were filmed and it led to a conviction by a care worker, Jonathan Aquino, under the provisions of the Mental Capacity Act (2005) and a jail term of 18 months.

There are a few key points to take into this and to note. Prior to June 2011 (when the filming took place), the previous assessment and inspection by the CQC was in 2009. It was an unannounced inspection and as described above, the outcome found the home was excellent.

There were a couple of ‘compliance’ visits after the incidents films came to light but the important thing to note is that an excellent care home can provide appalling care if there is one abusive care worker. Similarly a care home which may have a poor inspection report can provide excellent care if there are caring and good quality care staff. Historical reports of care by regulators actually tell us little about the quality of the care today, at this moment, as staff in these care homes tend to be transient and low paid.

There is an issue about management culture of course. I have seen a switch in manager making both a very positive and very negative effect on residents in these homes. While more regular ‘spot’ inspections – perhaps by lay visitors as well as official regulatory bodies – may be one answer, it may not root out the individually abusive members of staff. A much better way to do that is to firm up whistleblowing procedures and supervision procedures for care workers – perhaps more peer discussion and supervision as well as managerial supervision.

As for the effects I see, I am no longer surprised by the increase in surveillance by family members which is a definite increased trend that I’m seeing. While there may be issues of privacy, the concerns of families are very real.

Until our care systems can provide better qualities of regulating and monitoring care – and not only from the CQC but from commissioners – whether they be local authorities or privately funded – there will always be these questions that linger at the back of the mind.

I expect I’ll be watching tonight, if I am able. I think I know what I’ll see but it is important that these incidents come to light so that changes in the systems can be made. This is one incident but it is very far from isolated. Our society needs to deliver the type of care and the methods of monitoring of care and the financial provisions for care that are not age-dependent. Until we do so, I can only infer that the systems of social care in this country are inherently ageist.

“Child Stealing” and the Tin Foil Hat Conspiracy Theorists

Ermintrude last week pointed out how David Lammy MP had played on exaggerated fears of social services taking peoples’ children away. It’s a pretty widespread fear, but one that doesn’t bear any relation to the complex and often tortuous way that child protection procedures actually operate.

In the past couple of weeks I’ve had a few run-ins with what happens when that fear gets taken to extremes by the conspiracy theory brigade, some of whom have links to the far-right.

[Warning: this post contains links to far-right websites. If you’re in work be careful what you click on]
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