Given the importance of this contribution and the changes within the profession we invite brief replies, which we may post at a later date. Please direct such replies to Course Director Judi Keshet-Orr.
History 1983 to 2002: relatively simple background and first steps
Once upon a time, around 1983, a group of professionals (counsellors, psychotherapists, sex therapists, psychoanalysts, psychiatrists, social workers, and other folk offering therapy) met together to get to know each other and share ideas, points of conflict and concerns. Many different modalities were represented and a certain competitiveness prevailed. Meetings were not always harmonious! Many folk were of the opinion that the methods they used were superior/more effective/better than some of those used by others.
One over-riding common concern was that a lot of unqualified people were offering their services as therapists without any training or defined practice standards. Anyone could set themselves up as a counsellor or psychotherapist of whatever modality. (They still can, by the way).
This group of professionals formed the basis of the UK Council for Psychotherapy, and included representation from many relevant member organisations, including the British Association of Sexual and Marital Therapists, later COSRT, and some observer members including the British Association for Counselling, (which later became BACP). They wanted their profession to be regulated by parliamentary statute, so that the public could be legally protected from malpractice and unqualified untrained people. They also wanted their titles, “psychotherapist”, “counsellor”, “sex therapist” and so on to be legally protected so only qualified people could use them.
There were differences between modalities and approaches which would need to be taken into account in this process. It wasn’t easy.
2002 to 2012 next steps: getting complicated, pay close attention…
Registers were created. That of UKCP arrived in 2002, BACP soon thereafter, but until 2012 these bodies holding the registers were not regulators. They were holding a list of people who met their standards of training and undertook to adhere to the relevant codes of conduct. In essence they were directories. They had each established general standards of practice and methods by which practitioners could be monitored. They created codes of conduct, and routes by which breaches of the codes of conduct could be processed and abuses punished. Other professional membership organisations had done the same.
In the interests of protecting the public from unqualified practitioners, these professional bodies came together and started to press for Statutory Regulation. They enlisted the help of interested members of both Houses of Parliament. The professions of Psychoanalysis, Psychotherapy and Counselling were strongly advised to present a set of ethics, trainings and practice standards they held in common, so that administering a Statutory Register would be simpler than having to accommodate differences between modalities of related but different approaches to talking therapies. These standards would apply to all modalities and methods. This was a very big ask.
In addition, the relevant professional bodies were advised to agree and establish a method of Voluntary Registration, acceptable and accountable to the Professional Standards Authority. (PSA).
See below for clarification…
2012 to 2019: tiny steps
PSA is an independent body accountable to Government. It was set up following the Health and Social Care Act 2012 to oversee health regulators such as the General Medical Council, the Nursing and Midwifery Council and so on. Including people like us.
After 2012 both UKCP and BACP (and some other bodies) became responsible of for ensuring internally that their members were practising/operating according to the requirements of the PSA. Getting PSA approval involved a great deal of effort by volunteers within these organisations, and changed them. Having been primarily providers of member services to ensure the best quality of therapy for the public, they became primarily regulators, applying strict procedures to deal with sub-standard practitioners and punish any abuses of clients.
In 2017, a Counsellors’ and Psychotherapists (Regulation) and Conversion Therapy Bill was introduced, to provide that the Health and Care Professions Council (HCPC) could be the regulatory body. UKCP, BACP, COSRT and others would then relate to the HCPC to regulate their members, but it failed to complete the process in Parliament within the time available. It fell.
This was a pity, as it would have lightened the burden on the organisations.
2019: so where have we got to by way of these steps?
The current situation is that anybody can practice as a counsellor or psychotherapist, whether trained and qualified or not. (Fast rewind to 1983, as outlined in the first paragraph above.) There now exist Voluntary Registers (UKCP, BACP etc) accountable to the Professional Standards Authority. There are codes of Conduct and Complaints Procedures. Apart from that and a lot of hard work and effort by a great many people, nothing has changed. If a therapist or counsellor is removed from a Register for malpractice, they can still continue practising, and give themselves whatever title they like. The titles remain unprotected.
Part of the 5 year Strategy in COSRT is to become a Regulatory Body. This will involve defining who can practice at what level, who can’t, and according to what qualifications. When I was around in UKCP in 2012 at the time they were setting this up, it changed the nature of the organisation from one focussing on member services and communication for public protection and best practice, to one whose priority became regulation. Watch out or the same will happen in COSRT. Currently member services are excellent.
If it works, then maybe “Sex Therapist”, “Psychosexual Therapist” and so on, can become protected titles, and only trained and qualified practitioners will be allowed to use them. Wait and see.
Margaret Ramage – Course Consultant LDPRT
…a more emotive view on regulations
In the early 80s, the major accrediting bodies for counselling often quoted research which stated that there was no qualitative difference in effectiveness between an untrained and inexperienced counsellor and someone with training and decades of experience. Having been in the field for some time now, two things stand out for me: first, which profession, with any pride in what it does, would really state that there is no point in training for the profession or, worse to that effect, that there is no point in professional experience? Secondly, research (often quoted in support of one thing or another) is, not unlike law, an arse. It will evidence, with the greatest of ease, just about anything as long as there is money in it.
Over the years we have been threatened with a number of issues ranging from data protection to human rights to European standardisation, all resulting in hastily cobbled together defensive legislation or ethical guidance best summarised as in the interest of “customer protection”. Whether it is wise to apply a commercial view in which clients are reduced to ‘customers’ and therapists to ‘service providers to counselling and psychotherapy (see Richard Mowbray in “The Impossible Profession”) I question, – is a client really a customer? – but the threat of having to protect the public keeps being quoted. Brexit, in which the “will of the British people” is quoted in a similar way there seems to be similar process, aiming to increase peoples fear.
Today, three and a half decades after the Rugby Conference and the formation of UKCP we are none the wiser. Are we a profession? If so, why are we so poorly regulated and at best inconsistently. If there is no difference in quality why spend time or money on ScopEd (BACP and UKCP) or on the recent attempt to differentiate levels of experience at COSRT? And what is the point of having different tiers of accreditation if these fall outside of the generally accepted frameworks anyway in terms of training duration and contact hours? Can it really be that a psychotherapist, after an absolute minimum of 4 years of training (900 contact hours) , or a sex and couples therapist trained over 3000 hours in the US, is been credited with the same status, ability and understanding as a ‘therapist’ who obtained their training (over 20 days and 200 contact hours) ? Is everybody really been taught the same competencies over what amounts to less than half the time? Would we base our choice of medical doctor or surgeon on the same criteria?
Bernd Leygraf (LDPRT Course Director. Consultant Psychotherapist, trained since 1978)