Letter from the Steering Committee - Counsellor Registration

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This is a Letter sent by the Steering Committee of PCA SW to a number of different organisations and MPs
- its structure has been slightly amended from the version printed in the newsletter.

Dear -

PCA-SW is a subscription association founded in 1999, for counsellors and others throughout South West England who are interested in the person-centred approach (PCA), one of the principal humanist counselling models, originated by Carl Rogers in the 1940s. It has 138 active subscribers.

In a nustshell

Our subscribers are expressing serious concerns about the regulation of the psychotherapeutic profession currently proposed by the Health Professions Council (HPC). The proposals are not evidence-based and the HPC has not demonstrated system capability to act as regulator. The proposals ignore existing, fit for purpose, regulatory structures, and thus represent a large and pointless investment of public money. They ignore the diversity of psychotherapeutic models, and are drafted in terms antithetical to long-established models well supported by research evidence, such as our own. Proposed standards are unclear, and out-of-line with proven structures in other jurisdictions. We believe regulation in these terms would cause immense harm to clients, practitioners and to the profession itself, limiting individual choice and driving ethical and committed practitioners from the profession, whilst doing nothing to reduce such instances of unethical practice as there may be. This will have a significant impact on your constituents and on our society, and we ask you to act now to oppose regulation in these terms.

Similar concerns are being expressed across the profession. We refer you to The Alliance for Counselling and Psychotherapy Against State Regulation www.allianceforcandp.org and the Maresfield Report on The Regulation of Psychotherapy in the UK (Maresfield Report). The consultation period in respect of these proposals has ended, yet we feel no confidence that these concerns have been heard or addressed.

The detail

  1. The proposals purport to endorse evidence-based practice, yet are themselves assertion-based. The 2007 White Paper “Trust, Assurance and Safety – The Regulation of Health Professionals in the 21st Century” stated: “Psychotherapists and counsellors will be regulated by the HPC, following that council’s rigorous process of assessing their regulatory needs and ensuring that its system is capable of accommodating them. This will be the first priority for future regulation.” The HPC has not demonstrated a “rigorous process”, nor has it adequately or appropriately assessed needs. It is seeking to introduce regulation which will have a major impact on the profession and radically change the relationship between therapist and client, yet shows no evidence to justify this interference. In particular, it has not demonstrated:-
    1. that there exists systemic or widespread abuse in the profession;
    2. that the existing regulatory framework is unfit for purpose; or
    3. that current proposals would reduce abuse, benefit clients or achieve stated aims.
  2. Furthermore, the HPC has not demonstrated system capability. It has proved unable to handle its existing volume of work. As the Independent Practitioners’ Network’s online journal comments, the HPC’s own statistics from its annual reports show it considered only 63 of 108 complaints made by the public in 2008, at an overall cost of £3.76M, and only 18 were found to have a case to answer (2007: only 34 of 78 – 12 were found to have a case to answer). By contrast, the Maresfield Report comments that existing regulatory bodies, such as UKCP, have a significantly higher “case to answer” rate, and deal with complaints more effectively and sensitively than the HPC. We currently have a number of voluntary regulatory bodies in the UK (giving clients the option of a regulated practitioner). We see no case for the large investment required to provide the HPC with a system capable of acting as a single mandatory regulator (even if other objections were addressed).
  3. The proposals ignore the diversity of psychotherapeutic models, and particularly do not take account of legitimate models – such as the person-centred approach and other humanistic therapies – which are antithetical to the HPC model in philosophy and practice.
  4. The proposals are drafted in language, and reflect a viewpoint, rooted in the medical model. Proposed standards are unclear. They assume a single (NHS management style) language and frame of reference. They also seek to regulate the content of therapy. None of this is generally accepted or applied as appropriate within the profession, in the UK or elsewhere:-
    1. The HPC’s proposals require practitioners to use “accepted terminology” and “conduct appropriate diagnostic or monitoring procedures”, without defining these terms – which will presumably be imposed from outside. Counselling models such as our own seek to validate the individual client’s frame of reference, and are conceptually and linguistically incompatible with this approach. As The Alliance for Counselling and Psychotherapy Against State Regulation states: “In trying to apply a predetermined set of external principles to a particular individual, the practitioner must override the client’s individuality and sacrifice the therapeutic process to the demands of a fixed technique. This is ethically unacceptable for the practitioner as well as therapeutically ineffective for the client.”
    2. The Maresfield Report comments: “Therapy is defined [by the HPC] as the correction or “treatment” of developmental and psychological dysfunction via the application of a set of techniques to the patient. Yet many schools of therapy see their work as totally opposed to this model....For them, therapy is a joint creative work, a collaborative effort to explore human life with no manifest aims to “correct” dysfunction or promote health.” It adds that the HPC position is “unacceptable to many long-established traditions”, (which include the PCA), and that “Both practitioners and the public are ill-served by this conception of therapy”.
  5. Despite assertions made within the medical model and sometimes repeated by the media, there is no evidence to suggest that counselling models such as the PCA are ineffective, or effective only with less serious client issues. On the contrary, research shows the efficacy of all main counselling models, and suggests the decisive element is not theoretical orientation, but the quality of the relationship between therapist and client (Cooper, M. (2008) Essential Research Findings in Counselling and Psychotherapy: The Facts Are Friendly – SAGE). The tendency within the NHS has been to ignore evidence supporting other models, and to fund research only into its favoured model of cognitive behavioural therapy. This is not supported by the wider facts, and is inconsistent with the government’s professed goals of increasing client choice and independence.
  6. The government has repeatedly made statements in the context of the NHS and elsewhere supporting choice. Many clients chose to work in models other than that posited by the HPC. These proposals would reduce client choice by further marginalizing (or even driving from the profession) those who do not accept the HPC approach as the only valid one, and are likely to have disastrous consequences for the substantial UK psychotherapeutic needs currently met by the private and voluntary sectors.
  7. We believe the HPC proposals reflect a growing trend towards increased regulation in our culture, based on apparent assumptions that:-
    1. individual professionals cannot be educated or trusted to regulate themselves; and
    2. state-sponsored regulation serves to reduce or even eliminate risk.
    We have witnessed increasing regulation for years – for example – in such areas as child care and medicine. Despite this, abuses crop up with depressing regularity. The response to this is not to question the underlying assumptions and efficacy of this approach, but to regulate further. Most psychotherapeutic models accept that risk and uncertainty are inherent in the human condition, and seek to enhance the ability of individuals to navigate this in a self-reliant and constructive way. THIS is a valid model for social change, not the ill-considered and unevidenced imposition of regulation in the McCarthy-esque cause of “public safety”. Those on both sides of this debate support safety – the issue here is how that interest is actually served.

Regulation as envisaged will not safeguard the profession against those few therapists who practise unethically or abusively. On the contrary, such individuals will presumably pay lip service to registration and continue to practise. What it WILL do is effectively drive from the profession many experienced therapists, who are committed to their clients and profoundly concerned with ethical practice – and for precisely those reasons, feel unable to sign up to ill-conceived, disrespectful and inappropriate regulation. These measures will deprive those practitioners of a living, rob clients of choice and diminish the profession. They will increase distress in our society (and its manifold destructive consequences), not alleviate it.

Our challenge to you

We believe arguments emanating from within the profession opposing regulation – which are supported by daily experience and by evidence, unlike the HPC proposals - have gone largely unheard and unreported. You have been elected to represent us and our clients, and the oft-stated government policy of supporting evidence-based practice/legislation, and increasing individual choice. We therefore ask that you, as a matter of urgency, look into the case for opposing regulation in this form. There are numerous other forms which regulation could take, for example the Professional Full Disclosure model put forward in the Maresfield Report, and already applied in Australia and various U.S. States.

Please let us know if you would like to discuss the points made in this letter.

Yours sincerely,

[all our names]

Steering Group for and on behalf of The Person-centred Approach South West