maresfield report

Debates around the possible state regulation of the talking therapies began in the UK in 1970 when, following a minor scandal associated with Scientology, representatives of a handful of psychology and psychotherapy organisations approached the DOH with the recommendation that Scientology be outlawed in order to protect the public. The subsequent developments are mapped out below:

1971 The Foster report is published concluding that there should be legislation to control psychotherapy in the UK.

1978 The Sieghart report recommends indicative (not functional) registration and the formation of a psychotherapy council.

1981 Graham Bright MP introduces the first psychotherapy bill which falls at the second reading in the House of Commons.

1983-89 Psychotherapy organisations meet annually in Rugby and form what is known as the Rugby Conference where the question of some form of regulation by the state and the formation of a voluntary register are discussed and planned.

1989 The United Kingdom Standing Conference for Psychotherapy is inaugurated based on the section module: therapy groups are divided into sections depending on their orientation.

1990 European debates lead to the formation of the European Association of Psychotherapy.

1992-3 The Standing Conference changes into the Council (UKCP) and produces the first voluntary national register for psychotherapy. UKCP is later approached by the Council for the Professions Supplementary to Medicine (CPSM) with a view that it should join in with their application to effectively become the now HPC. This proposal is rejected, with the view psychotherapy was not a profession supplementary to medicine and would not benefit itself or the public by either being seen as a Health Profession or by becoming regulated by the Department of Health.

2000-1 Lord Alderdice introduces his Psychotherapy Bill which is rejected by the DoH, who announce that they are going to fit counselling and psychotherapy into the existing Health Profession Council (HPC). All stakeholder groups protest.

2004 In Brussels, the European Commission adds psychotherapy to the list of professions for which it issues Directives. Directives are used, inter alia, to standardise certain aspects of different professions throughout the European Community (EU), a process also misleadingly known as harmonisation. A major concern here is the practice, in some EU countries, to restrict training in psychotherapy to psychiatrists and/or those who hold a PhD in clinical psychology.

2005 Department of Health funds UKCP & BACP to scope training and practice of psychotherapy and counselling and to examine proposals for statutory regulation by HPC.

2006 All major stakeholder groups report to government that HPC is wholly inappropriate as regulator for psychology and psychotherapy. They propose instead the
establishment of a Psychological Professions Council.

2007 Despite the recommendations of the reports from UKCP and BACP, the White Paper, ‘Trust, Assurance and Safety – The Regulation of Health Professionals in the
21st Century’ charges HPC with exploring the regulatory needs of the field and its own suitability to regulate it.

February-March DH commissions Skills for Health (SfH) to develop National Occupational Standards (NOS) for psychotherapy, initially under three modalities.

May-June Without public tender or consultation SfH give contract for drawing up NOS for all modalities to University College London (UCL) Dept. of Clinical Health Psychology. Personnel in this department, arguably, may be said to have a vested financial interest in the outcome of the NOS: the directors of this department have developed a form of manualised psychotherapy to be used in the NHS. The department, jointly with the Anna Freud Centre, offers training courses in this treatment, specifically aimed at NHS personnel and Trusts.

June – October It is decided that the NOS will be based solely on manualised treatments which have undergone trials to demonstrate their efficacy. No other research evidence is admissible. This decision appears to have been taken by UCL Dept of Clinical Health and adopted by SfH. The research literature used is reviewed by the Expert Reference Group (ERG). SfH nominates Director of UCL Dept of Clinical Health as Chair, who invites selected colleagues on to it. Almost all of these work within the NHS and there are no psychoanalytic texts in the research material used. None are nominated by UKCP.

October-December UCL group start working up draft NOS for psychoanalytic/ dynamic modality from this highly limited research. UCL group establish a biased list
for ‘Modality Working Group’ (MWG) which will scrutinize draft NOS: significant controversy concerning how membership is formed.

December HPC publishes ‘Counsellors and Psychotherapists - road map to their statutory regulation’. This document proceeds on the assumption that the current
training standards, complaints procedures and regulatory frameworks of counselling and psychotherapy organisations (established by UKCP and BPC) are not adequate to protect the public. No risk assessment of the current situation is undertaken. It assumes that all kinds of psychotherapy, including psychoanalysis, can be absorbed into the same framework without taking into account the many strands within the profession that argue cogently against this. Meetings between stakeholder groups and HPC produce no results, as if dialogue cannot take place.

2008 January SfH receive queries from several professional organisations concerning the membership of the psychotherapy working groups. SfH state that “the list circulated is not representative of the organisations present within the field”.

2008 March Working party list confirmed, though UCL director says it “goes slightly too far in the direction of UKCP”. Out of 16 people, 11 are from the same grouping as UCL director, with only 2 from UKCP. Stakeholders are excluded. No user groups are consulted, despite a statement in favour of this in original Strategy Group meeting in April 2007.

2008 April CP-UK writes to SfH under the Freedom of Information Act (FIA) asking for full disclosure of documents concerning the planning and formation of the Expert Reference Group (ERG) and the Modality Working Group (MWG).

2008 April-June Draft NOS worked on by MWG, published on SfH website. 450 detailed rules claiming to detail every aspect and stage of a psychoanalytic/psychodynamic treatment. UKCP reps describe them as wholly inaccurate for anything outside a very narrow manualised treatment within NHS type settings and not representative of psychoanalysis or dynamic psychotherapy.

2008 June onwards: SfH replies to The College of Psychoanalysts-UK FIA request with incomplete disclosure of documents requested. Extensive critique of the NOS from SfH produced by The Psychoanalytic Consortium. The section of the UKCP representing the psychoanalytic modality, the CPJA, and many individual training organisations have registered significant objections to the NOS, pointing out that they do not reflect the nature of psychoanalytic work. The following aspects of psychoanalytic work are contradicted by much of the content of the NOS:

- Psychoanalysis is based on transference and the idea that our conscious demandsare moulded by unconscious desires
- Psychoanalytic work is not conducted on the basis of an expert doing something to the analysand in order to make them well (again)
- The analyst is not in receipt of knowledge about how the analysand should be and which they attempt to impart to the analysand.
- Neither the analysand nor the analyst can know in advance what it is that the analysand is struggling with. Through the analysis they can together recognize that they have stumbled upon an indication of it. The symptoms an analysand complains of indicate a now failing solution to an unconscious difficulty.
- The analyst will not know beforehand how the analysand will progress with their encounter with themselves, nor in what way their intentions with regard to their symptoms will change. So they will not be able to predict how the analysand will ‘get better’ nor how they will eventually measure the degree of the analysis’ success
- Psychoanalytic work does not fit into a medical model of Health Care and psychoanalysis is not one of the Health Care Professions.

2008 June invite nominations from all psychotherapy organisations for the Professional Liaison Group (PLG): of 16 members a maximum of 6 will be from within
the profession.

2008 August HPC issue ‘Call for Ideas’ requesting responses to 10 questions to assist the PLG in its deliberations on what recommendations to make to the HPC on the formation of the Register. Many of the responses to the HPC, now made public, point out the significant difficulties they and their members have, not with regulation but with the way that regulation is being undertaken. These focus on the fact that the framework being applied to the profession is in conflict with many of its fundamental premises.

2008 December Alliance for Counselling and Psychotherapy Against State Regulation formed to encourage debate about how protection of the public is not served by regulation by HPC : www.allianceforcandp.org

2008 December -May 09 HPC sets up Professional Liaison Group to ‘advise’ on the suitability of the HPC regulating counselling and psychotherapy. The range of objections and difficulties with the project as detailed by responses to the HPC ‘call for ideas’ is distributed. Most of these are then ignored by the following proceedings.

2009 March HPC holds a stakeholder meeting in Manchester. Stakeholder groups endeavour to open up discussion of problems with HPC proposals.

2009 March The largest group of psychoanalytic psychotherapists in the UK (CPJA) unanimously approve report pointing out severe limitations to SfH NOS documents.
The report sent to SfH

2009 April SfH issue briefing claiming NOS are applicable and accepted across the profession, in both NHS settings and private practise. The College of Psychoanalysts- UK publish response to SfH briefing pointing out errors and misinformation.

2009 May Coalition Against Over-Regulation of Psychotherapy formed. www.coregp.org

2009 May Opposition to regulation by HPC grows as greater understanding of the inadequacy of HPC to protect the public increases.

	The Maresfield Report

	Appendix 1: The History

	Debates around the possible state regulation of the talking therapies began in the UK in 1970 when, following a minor scandal associated with Scientology, representatives of a handful of psychology and psychotherapy organisations approached the DOH with the recommendation that Scientology be outlawed in order to protect the public. The subsequent developments are mapped out below: 1971 The Foster report is published concluding that there should be legislation to control psychotherapy in the UK. 1978 The Sieghart report recommends indicative (not functional) registration and the formation of a psychotherapy council. 1981 Graham Bright MP introduces the first psychotherapy bill which falls at the second reading in the House of Commons. 1983-89 Psychotherapy organisations meet annually in Rugby and form what is known as the Rugby Conference where the question of some form of regulation by the state and the formation of a voluntary register are discussed and planned. 1989 The United Kingdom Standing Conference for Psychotherapy is inaugurated based on the section module: therapy groups are divided into sections depending on their orientation. 1990 European debates lead to the formation of the European Association of Psychotherapy. 1992-3 The Standing Conference changes into the Council (UKCP) and produces the first voluntary national register for psychotherapy. UKCP is later approached by the Council for the Professions Supplementary to Medicine (CPSM) with a view that it should join in with their application to effectively become the now HPC. This proposal is rejected, with the view psychotherapy was not a profession supplementary to medicine and would not benefit itself or the public by either being seen as a Health Profession or by becoming regulated by the Department of Health. 2000-1 Lord Alderdice introduces his Psychotherapy Bill which is rejected by the DoH, who announce that they are going to fit counselling and psychotherapy into the existing Health Profession Council (HPC). All stakeholder groups protest. 2004 In Brussels, the European Commission adds psychotherapy to the list of professions for which it issues Directives. Directives are used, inter alia, to standardise certain aspects of different professions throughout the European Community (EU), a process also misleadingly known as harmonisation. A major concern here is the practice, in some EU countries, to restrict training in psychotherapy to psychiatrists and/or those who hold a PhD in clinical psychology. 2005 Department of Health funds UKCP & BACP to scope training and practice of psychotherapy and counselling and to examine proposals for statutory regulation by HPC. 2006 All major stakeholder groups report to government that HPC is wholly inappropriate as regulator for psychology and psychotherapy. They propose instead the establishment of a Psychological Professions Council. 2007 Despite the recommendations of the reports from UKCP and BACP, the White Paper, ‘Trust, Assurance and Safety – The Regulation of Health Professionals in the 21st Century’ charges HPC with exploring the regulatory needs of the field and its own suitability to regulate it. February-March DH commissions Skills for Health (SfH) to develop National Occupational Standards (NOS) for psychotherapy, initially under three modalities. May-June Without public tender or consultation SfH give contract for drawing up NOS for all modalities to University College London (UCL) Dept. of Clinical Health Psychology. Personnel in this department, arguably, may be said to have a vested financial interest in the outcome of the NOS: the directors of this department have developed a form of manualised psychotherapy to be used in the NHS. The department, jointly with the Anna Freud Centre, offers training courses in this treatment, specifically aimed at NHS personnel and Trusts. June – October It is decided that the NOS will be based solely on manualised treatments which have undergone trials to demonstrate their efficacy. No other research evidence is admissible. This decision appears to have been taken by UCL Dept of Clinical Health and adopted by SfH. The research literature used is reviewed by the Expert Reference Group (ERG). SfH nominates Director of UCL Dept of Clinical Health as Chair, who invites selected colleagues on to it. Almost all of these work within the NHS and there are no psychoanalytic texts in the research material used. None are nominated by UKCP. October-December UCL group start working up draft NOS for psychoanalytic/ dynamic modality from this highly limited research. UCL group establish a biased list for ‘Modality Working Group’ (MWG) which will scrutinize draft NOS: significant controversy concerning how membership is formed. December HPC publishes ‘Counsellors and Psychotherapists - road map to their statutory regulation’. This document proceeds on the assumption that the current training standards, complaints procedures and regulatory frameworks of counselling and psychotherapy organisations (established by UKCP and BPC) are not adequate to protect the public. No risk assessment of the current situation is undertaken. It assumes that all kinds of psychotherapy, including psychoanalysis, can be absorbed into the same framework without taking into account the many strands within the profession that argue cogently against this. Meetings between stakeholder groups and HPC produce no results, as if dialogue cannot take place. 2008 January SfH receive queries from several professional organisations concerning the membership of the psychotherapy working groups. SfH state that “the list circulated is not representative of the organisations present within the field”. 2008 March Working party list confirmed, though UCL director says it “goes slightly too far in the direction of UKCP”. Out of 16 people, 11 are from the same grouping as UCL director, with only 2 from UKCP. Stakeholders are excluded. No user groups are consulted, despite a statement in favour of this in original Strategy Group meeting in April 2007. 2008 April CP-UK writes to SfH under the Freedom of Information Act (FIA) asking for full disclosure of documents concerning the planning and formation of the Expert Reference Group (ERG) and the Modality Working Group (MWG). 2008 April-June Draft NOS worked on by MWG, published on SfH website. 450 detailed rules claiming to detail every aspect and stage of a psychoanalytic/psychodynamic treatment. UKCP reps describe them as wholly inaccurate for anything outside a very narrow manualised treatment within NHS type settings and not representative of psychoanalysis or dynamic psychotherapy. 2008 June onwards: SfH replies to The College of Psychoanalysts-UK FIA request with incomplete disclosure of documents requested. Extensive critique of the NOS from SfH produced by The Psychoanalytic Consortium. The section of the UKCP representing the psychoanalytic modality, the CPJA, and many individual training organisations have registered significant objections to the NOS, pointing out that they do not reflect the nature of psychoanalytic work. The following aspects of psychoanalytic work are contradicted by much of the content of the NOS: - Psychoanalysis is based on transference and the idea that our conscious demandsare moulded by unconscious desires - Psychoanalytic work is not conducted on the basis of an expert doing something to the analysand in order to make them well (again) - The analyst is not in receipt of knowledge about how the analysand should be and which they attempt to impart to the analysand. - Neither the analysand nor the analyst can know in advance what it is that the analysand is struggling with. Through the analysis they can together recognize that they have stumbled upon an indication of it. The symptoms an analysand complains of indicate a now failing solution to an unconscious difficulty. - The analyst will not know beforehand how the analysand will progress with their encounter with themselves, nor in what way their intentions with regard to their symptoms will change. So they will not be able to predict how the analysand will ‘get better’ nor how they will eventually measure the degree of the analysis’ success - Psychoanalytic work does not fit into a medical model of Health Care and psychoanalysis is not one of the Health Care Professions. 2008 June invite nominations from all psychotherapy organisations for the Professional Liaison Group (PLG): of 16 members a maximum of 6 will be from within the profession. 2008 August HPC issue ‘Call for Ideas’ requesting responses to 10 questions to assist the PLG in its deliberations on what recommendations to make to the HPC on the formation of the Register. Many of the responses to the HPC, now made public, point out the significant difficulties they and their members have, not with regulation but with the way that regulation is being undertaken. These focus on the fact that the framework being applied to the profession is in conflict with many of its fundamental premises. 2008 December Alliance for Counselling and Psychotherapy Against State Regulation formed to encourage debate about how protection of the public is not served by regulation by HPC : www.allianceforcandp.org 2008 December -May 09 HPC sets up Professional Liaison Group to ‘advise’ on the suitability of the HPC regulating counselling and psychotherapy. The range of objections and difficulties with the project as detailed by responses to the HPC ‘call for ideas’ is distributed. Most of these are then ignored by the following proceedings. 2009 March HPC holds a stakeholder meeting in Manchester. Stakeholder groups endeavour to open up discussion of problems with HPC proposals. 2009 March The largest group of psychoanalytic psychotherapists in the UK (CPJA) unanimously approve report pointing out severe limitations to SfH NOS documents. The report sent to SfH 2009 April SfH issue briefing claiming NOS are applicable and accepted across the profession, in both NHS settings and private practise. The College of Psychoanalysts- UK publish response to SfH briefing pointing out errors and misinformation. 2009 May Coalition Against Over-Regulation of Psychotherapy formed. www.coregp.org 2009 May Opposition to regulation by HPC grows as greater understanding of the inadequacy of HPC to protect the public increases.