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Regulation will not necessarily protect clients against malpractice in psychotherapy or counselling

September 8, 2010

Last year Andrew Samuels ran for chair of the UKCP on a platform of opposition to the Labour governments proposals for regulation of the pschotherapy and counselling professions under the Health Professions Council. He was elected by a significatn majority, wchihc seems to indicate that a siginificant number of practising psychotherapists and counsellors are uneasy about the proposed regualtion strategy. Samuels in a letter to The Times (12/12/2009) said:

"Everything about the HPC is wrong for us. We are not a health profession and are very far from being a homogeneous group. The standards of entry to the HPC are incredibly low. The system of ethics and discipline is not attuned to the kind of work that we do and will deter people from making legitimate complaints because of its bureaucratic and adversarial nature. Charlatans and rogues will not be eliminated by these proposals.
Psychotherapists are not usually vocal or politically active, yet almost 3,000 have signed petitions against the HPC as their regulator. Even more have indicated taking up a position of conscientious objection."

And yet the psychotherapy/counselling professions are not very well regulated currently. Anyone can set themselves up as a counsellor / psychotherapist with no accreditation or training without fear of sanction, leaving the public at the mercy of impostors. Even if a practitioner has a qualification that is no gaurantee of their professional competence; the proliferation of counselling/psychotherapy courses at craven, market-driven universities and colleges are often second-rate, despite conferring MAs and even PhDs on graduates. The increasing demand for talking therapies is thus being met by a cohort of providers who are often under-trained and for the most part under-regulated. Add to this the increased vulnerability of people with mental health issues and there is good reason to be concerned.

However, regulation is not the magic bullet. Two recent cases of sexual abuse, by mental health professionals, one which led to a suicide were perpetrated not by unregulated professionals but by pscyhiatrists Theodore Soutzos and Robin Lawrence. These two men were highly qualified and strictly regulated and yet still managed to do severe damage to several clients. In the case of Robin Lawrence he was previously sanctioned by the GMC in 2000 for an improper relationship with a patient and despite employing its stiffest sanction, by striking him off for 12 months, the GMC was allegedly not able to stop him practising, according to this article in The Telegraph.

What then is the answer? I suggest that you read around the topic to form your own opinion by visiting, to begin with, the HPC site and the UKCP site. However, it seems to me as a psychodynamic counsellor trained in the old-fashioned style (compulsory, lengthy personal analysis; three years of academic seminars; and three hundred twenty hours of closely supervised client contact) and with a strong allegiance to the analytic community (the various psychoanalytic and Jungian professional associations) that the answer lies partly in stronger professional societies, which will bring increased peer scrutiny.

Another factor that I consider important is that all psycotherapists/counsellors and indeed psychiatrists should undergo a compulsory and comprehensive personal analysis. Both Jung and Freud felt that this was essential and I think it is the most significant factor in guaranteeing the quality of care that a practitioner provides. Sadly most of the flimsy curricula of the hastily cobbled-together counselling/psycotherapy courses (MAs and PhDs) on offer at money-hungry universities and colleges require only a paltry number of hours of personal therapy, amounting over the course to 100 hours or less. For psychiatrists there is no requirement for personal counselling. For all professionals working one-to-one with clients or patients with mental health issues there should be a substantial requirement (four years minimum – 160 hours) for personal therapy in training and compulsory ongoing personal therapy for the first few years of practice.

One of the UKCP’s arguments against HPC regulation is that it will add layers of obfuscation and bureaucracy without addressing the risk of abuse, and this seems valid. However, some more stringent form of regulation is required. This should not however, be informed by the medical profession, who as a group both disdain psychotherapy and are blind to its unique insights into mental health. The analytic community with its strict training requirements, inlcuding compulsory in-depth personal analysis, and its system of peer scrutiny through supervision, provides a much more valid model. I further feel that no unviersity or college should be able to offer a counselling course without submitting the curriculum to a training board comprised of the analytic and other professional societies.

Of course, I am idealising the analytic societies, but against the onslaughts of sceptiscism, anti-semitism, faddism, malpractice and more, they have delivered to us a discipline and a community that together enables us to continue our researches into the mystery of the human pscyche.

Further reading:

For a view significantly different to mine please visit Mental Nurse a blog written by a team of mental health nurses, which offers a bottom up view of mental health service provision. Amidst the general disillusionment with the state of mental health services, the posts occasionally takes a stridently anti-psychotherapy line, particularly taking issue with the UKCP’s opposition to the proposed regulation (in its current form) of counselling/psychotherapy. Read a full set of interesting and informed posts on the topic at Mental Nurse: http://www.mentalnurse.org/series/regulation-of-psychotherapy/Currently

An organisation that assists people who have been the victim of professional malpractice at the hands of counsellors, psychotherapists and other mental health professionals: http://www.professionalboundaries.org.uk/Home.aspx

The HPC: http://www.hpc-uk.org/aboutus/professionalliaisongroups/psychotherapistscounsellors/

The UKCP: http://www.psychotherapy.org.uk/health_professions_council.html

http://www.dailymail.co.uk/news/article-1309902/Psychiatrist-suspended-sex-patient-accused-sharing-sexual-fantasies-vulnerable-victim-miscarriage.html

http://www.dailymail.co.uk/news/article-1299697/Psychiatrist-Theodore-Soutzos-preyed-patients-sex-groomed-suicidal-woman.html

Andrew Samuels write to The Times in December 2009: http://www.timesonline.co.uk/tol/comment/letters/article6953728.ece

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