Warning
Government plans for statutory regulation defy research evidence and may prove ineffective

The government is persisting with its plans to introduce statutory regulation to psychotherapy and counselling in the United Kingdom via the Health Professions Council (HPC), though "unlikely to happen before 2008". Despite bullish statements from government ministers and Department of Health (DH) officials, there are serious and well-founded concerns that the proposed form of regulation will not effectively achieve its advertised aim of protecting the public from harm. Indeed, there are precedents elsewhere to suggest that fostering clients' dependency on state-endorsed credentials to choose a practitioner may actually increase the risk to the public and erode the integrity of the profession generally. As well as restricting the choice of therapists and therapies, it is very likely that clumsy regulation would increase the cost of services and discriminate against the poor and minorities becoming therapists. For example, the voluntary counselling sector already appears to be significantly constricted by the portent of statutory regulation.

The flaws in the approach taken by the government so far include:

  1. The level of danger in psychotherapy and counselling has not been scientifically assessed, especially relative to other activities for which no demand for regulation exists. The DH has failed to provide statistically significant or even substantive evidence concerning the prevalence and severity of harm caused to clients by psychotherapists and counsellors. This official DH reply shows the paltry and unscientific standard of evidence being applied:

    "[T]he Department does have correspondence concerning individual cases where harm allegedly occurred. However, as they are not claims the Department investigated directly, they would not fall into the category of 'evidence'. Further, the Department does not have permission from the authors to disclose their personal details. The Department has, however, listened to organisations such as POPAN (the Prevention of Professional Abuse Network) [now WITNESS] and has seen their data concerning the number of calls, cases advocated and supported. Departmental officials have talked to organisations that have been prepared to share their information about complaints and have also looked at independent research conducted into the area. By these means, the Department has been convinced that there is a case on abuse to answer."

  2. The DH does not have evidence that the HPC regulatory route is the most likely to improve public safety while having the least restrictive impact on services and practitioners. Other regulatory routes have not been objectively considered (see resources below).
  3. Psychotherapy and counselling are being treated as "health professions", despite the overwhelming research evidence (Wampold, 2001; Bohart & Tallman, 1999; Mowbray, 1995) that psychotherapy is fundamentally a different activity from medicine and allied professions.
  4. The HPC's assumptions about what constitutes "professional standards" defy the longstanding research evidence (for example, Beutler, 1994 & 1997; Berman & Norton, 1985) which shows that a therapist's qualifications, training, experience, and participation in personal therapy are not significantly linked to competence. Outcome in psychotherapy is much more dependent on the personal qualities of the practitioner.
  5. The conduct of the DH has left much to be desired, lacking openness and being positively furtive at times. While "behind the scenes" machinations (including substantial payments of public money) took place between the DH and two of the largest trade and training associations, enquiries from other organisations and individuals were ignored or deflected for months. Freedom of Information requests were required to extract even basic information (see resources below). This lack of transparency and public accountability is unacceptable in a democracy.

"Mapping exercises" have been commissioned by the DH to identify training, qualifications, roles and competencies in all psychotherapy and counselling (see resources below). However, the first such exercise has now been acknowledged by the DH to have been a failure. Ros Mead of the DH has controversially proposed that psychotherapy roles would be based upon theoretical orientation whereas counselling roles would be based upon work context. According to Wampold, 2001 and others, this proposal again defies our best research evidence.

Opposition to the government's plans is also growing from the field's largest practitioner associations, with the British Association for Counselling and Psychotherapy (BACP), the UK Council for Psychotherapy (UKCP), and the British Psychological Society (BPS) declaring that the HPC is inadequate for the task. (But of course, these organizations have major vested business interests of their own and have sought in the past to acquire statutory powers for themselves rather than the HPC.)

Should the case for statutory regulation be properly substantiated by research evidence, sounder and more effective ways of achieving public protection are discussed in the comprehensive works of Hogan (1979-1999) and Mowbray (1995). Any form of regulation must sensibly incorporate our current best evidence from research into psychotherapy and counselling. The knowledge base in these fields is now substantial and for several years the National Health Service has proclaimed evidence-based practice to be a central tenet of its work.

If you are also concerned about these developments, either as a practitioner or as a potential client, please write to your MP (and/or MSP in Scotland) and request information from the DH.

Resources


Copyright in this article has been waived in the interests of public information
Last updated 3 June 2007