Untitled Document

Since the 2007 White Paper, the Department of Health has given the Health Professions Council the task of assessing the regulatory needs of the talking therapies and its ownsuitability to regulate them. This brief, however, was understood as an imperative to regulate, with a resultant neglect of representations from the field and no questioning of the suitability of the HPC’s own regulatory framework.

The Health Professions Order states that any profession to be regulated by HPC “must cover a discrete area of activity displaying some homogeneity”. Counselling and psychotherapy constitute a diverse field and display little homogeneity. Many therapies do not consider themselves or advertise themselves as health professions. They focus on human relationships and not medical-style interventions with set outcomes or promises of cure. Unlike health professions, many therapies do not aim at removal of symptoms, but at an exploration of human life, understood in a variety of ways.

The consultation process initiated by the Department of Health was intended to assess the feasibility and suitability of state regulation through dialogue with all of the professional field. However, the consultation process became monopolised by a small number of people with a narrow view of talking therapy. This reliance on a small number of people with a set agenda has created the illusion that counselling and psychotherapy are a homogenous field. It has also meant the wholesale exclusion of professional groups and user groups.

The HPC has now adopted a definition of psychotherapy as the ‘treatment’ of ‘mental disorder’ which is unacceptable to many long-established traditions. Both practitioners and the public are ill-served by this conception of therapy, which introduces a considerable distortion regarding what may be expected from therapy. The definition is based on the theory used by a small number of therapies, yet any workable definition needs to be less theory-based, recognising the practice of long-established traditions and open to change as new developments in the field take place. Future therapies also risk being excluded for
not fitting the HPC’s definition.

The key issue in the regulation debate has been protection of the public. Therapists accept that their clients need the highest possible form of protection from inadequate and unethical practitioners. No therapy organisation or individual has argued against this principle. Indeed, therapists have consistently been open and active to strengthen the effectiveness of their current systems by all reasonable means. However, there is no research-based evidence suggesting that the client-group here is in the degree of danger that would justify being forced into a type of regulation that, in many respects, is unsuitable and unworkable for current professional practices.

Although HPC spends the largest part of its budget on dealing with complaints, it fails to hear more than 30% of cases, and a backlog has been growing consistently each year since 2005. In 2008-9, it spent 4.66m on complaints, 36% of its total budget, yet only 17 complaints from the public were deemed to have a case to answer. Each complaint thus cost £274,000. Complaints from the public were also consistently heard at a much slower rate than complaints from employers. More than 70% of complaints from the public were deemed to have no case to answer. In contrast, one of the field’s main regulatory bodies - UKCP - found that only 10% of complaints from the public had no case to answer, and was able to use informal techniques of mediation to resolve nearly 60% of these cases at
a fraction of the cost, with the other 40% dealt with by formal complaints processes.

The HPC complaints procedures are formal and adversarial. Most complaints in the field of the talking therapies, in contrast, are resolved by informal process and mediation. HPC gives no place to these processes, and thereby risks alienating potential complainants who do not wish to enter into such formal procedures, held in public with none of the confidentiality that a hearing may require. It also lacks the expertise to deal with the complexity of complaints in this field.
The web-based model of Practitioner Full Disclosure offers a more efficient, balanced and cost-effective way of hearing complaints,
as well as the necessary expertise.

HPC focus on two central issues regarding protection of the public: that any unscrupulous individual may set up a brass plate advertising their services as a therapist, and that, once struck off by a professional body, a therapist can simply continue to practise independently. Yet neither of these concerns is addressed by HPC regulation. HPC regulate professional titles not functions, so as long as the individual does not use a title
protected by HPC, they can set up shop through use of any unprotected title: life coach, mentor, lifestyle consultant etc. As the BACP pointed out to the Department of Health: “the protection of a title, which is the main means by which statutory regulation operates, is proven to be ineffective: practitioners are able to re-title and re-brand themselves and continue working”. The alternative model of Practitioner Full Disclosure, in contrast to HPC, does address these issues: anyone practising any form of therapy would have to disclose full details of their training and professional history. The public would thus be
in a position to make an informed choice and could tell immediately if someone were not on the register.

The HPC brings with it mechanisms that may be suitable for professions allied to medicine, but which threaten the survival of the very essence of psychotherapy. Therapy is forced into a one-size-fits-all model of healthcare intervention, with its focus on outcomes and protocol-based procedures. HPC’s current Standards of Proficiency for psychotherapy effectively exclude many of the most widely practised forms of therapy, which cannot be made to fit its framework. By marginalizing and even making illegal those forms of therapy which follow a different model, HPC regulation would deprive the public of their free choice of which therapists to consult.

In the short-term, we suggest that the process of forcing counselling and psychotherapy into the existing structure of HPC be halted. Instead, efforts should be made to improve existing professional arrangements and to ensure that these are properly implemented. In the long-term, we suggest reviewing the excellent work done by the Government in the past (Foster Report 1971, Sieghart Report 1978) and most specifically Lord Alderdice’s Psychotherapy Bill (2000-1), all of which received significant support and approval from wide sections of the professions.

In the light of these reports and the research conducted to date on regulation of the talking therapies, we would recommend the development of a Practitioner Full Disclosure model of registration. This would involve the establishment of an independent body to administer a register of therapists, with the statutory requirement that anyone practising a therapy supply full details of training and professional history. The register would have its own complaints procedures sensitive to the particularity of the talking therapies. This would represent the most effective way to ensure public protection, avoid destroying long
and honorable therapeutic traditions, and uphold the long and so far successful British tradition of cooperation between the professions and the law.

	The Maresfield Report

	Executive Summary

	Since the 2007 White Paper, the Department of Health has given the Health Professions Council the task of assessing the regulatory needs of the talking therapies and its ownsuitability to regulate them. This brief, however, was understood as an imperative to regulate, with a resultant neglect of representations from the field and no questioning of the suitability of the HPC’s own regulatory framework. The Health Professions Order states that any profession to be regulated by HPC “must cover a discrete area of activity displaying some homogeneity”. Counselling and psychotherapy constitute a diverse field and display little homogeneity. Many therapies do not consider themselves or advertise themselves as health professions. They focus on human relationships and not medical-style interventions with set outcomes or promises of cure. Unlike health professions, many therapies do not aim at removal of symptoms, but at an exploration of human life, understood in a variety of ways. The consultation process initiated by the Department of Health was intended to assess the feasibility and suitability of state regulation through dialogue with all of the professional field. However, the consultation process became monopolised by a small number of people with a narrow view of talking therapy. This reliance on a small number of people with a set agenda has created the illusion that counselling and psychotherapy are a homogenous field. It has also meant the wholesale exclusion of professional groups and user groups. The HPC has now adopted a definition of psychotherapy as the ‘treatment’ of ‘mental disorder’ which is unacceptable to many long-established traditions. Both practitioners and the public are ill-served by this conception of therapy, which introduces a considerable distortion regarding what may be expected from therapy. The definition is based on the theory used by a small number of therapies, yet any workable definition needs to be less theory-based, recognising the practice of long-established traditions and open to change as new developments in the field take place. Future therapies also risk being excluded for not fitting the HPC’s definition. The key issue in the regulation debate has been protection of the public. Therapists accept that their clients need the highest possible form of protection from inadequate and unethical practitioners. No therapy organisation or individual has argued against this principle. Indeed, therapists have consistently been open and active to strengthen the effectiveness of their current systems by all reasonable means. However, there is no research-based evidence suggesting that the client-group here is in the degree of danger that would justify being forced into a type of regulation that, in many respects, is unsuitable and unworkable for current professional practices. Although HPC spends the largest part of its budget on dealing with complaints, it fails to hear more than 30% of cases, and a backlog has been growing consistently each year since 2005. In 2008-9, it spent 4.66m on complaints, 36% of its total budget, yet only 17 complaints from the public were deemed to have a case to answer. Each complaint thus cost £274,000. Complaints from the public were also consistently heard at a much slower rate than complaints from employers. More than 70% of complaints from the public were deemed to have no case to answer. In contrast, one of the field’s main regulatory bodies - UKCP - found that only 10% of complaints from the public had no case to answer, and was able to use informal techniques of mediation to resolve nearly 60% of these cases at a fraction of the cost, with the other 40% dealt with by formal complaints processes. The HPC complaints procedures are formal and adversarial. Most complaints in the field of the talking therapies, in contrast, are resolved by informal process and mediation. HPC gives no place to these processes, and thereby risks alienating potential complainants who do not wish to enter into such formal procedures, held in public with none of the confidentiality that a hearing may require. It also lacks the expertise to deal with the complexity of complaints in this field. The web-based model of Practitioner Full Disclosure offers a more efficient, balanced and cost-effective way of hearing complaints, as well as the necessary expertise. HPC focus on two central issues regarding protection of the public: that any unscrupulous individual may set up a brass plate advertising their services as a therapist, and that, once struck off by a professional body, a therapist can simply continue to practise independently. Yet neither of these concerns is addressed by HPC regulation. HPC regulate professional titles not functions, so as long as the individual does not use a title protected by HPC, they can set up shop through use of any unprotected title: life coach, mentor, lifestyle consultant etc. As the BACP pointed out to the Department of Health: “the protection of a title, which is the main means by which statutory regulation operates, is proven to be ineffective: practitioners are able to re-title and re-brand themselves and continue working”. The alternative model of Practitioner Full Disclosure, in contrast to HPC, does address these issues: anyone practising any form of therapy would have to disclose full details of their training and professional history. The public would thus be in a position to make an informed choice and could tell immediately if someone were not on the register. The HPC brings with it mechanisms that may be suitable for professions allied to medicine, but which threaten the survival of the very essence of psychotherapy. Therapy is forced into a one-size-fits-all model of healthcare intervention, with its focus on outcomes and protocol-based procedures. HPC’s current Standards of Proficiency for psychotherapy effectively exclude many of the most widely practised forms of therapy, which cannot be made to fit its framework. By marginalizing and even making illegal those forms of therapy which follow a different model, HPC regulation would deprive the public of their free choice of which therapists to consult. In the short-term, we suggest that the process of forcing counselling and psychotherapy into the existing structure of HPC be halted. Instead, efforts should be made to improve existing professional arrangements and to ensure that these are properly implemented. In the long-term, we suggest reviewing the excellent work done by the Government in the past (Foster Report 1971, Sieghart Report 1978) and most specifically Lord Alderdice’s Psychotherapy Bill (2000-1), all of which received significant support and approval from wide sections of the professions. In the light of these reports and the research conducted to date on regulation of the talking therapies, we would recommend the development of a Practitioner Full Disclosure model of registration. This would involve the establishment of an independent body to administer a register of therapists, with the statutory requirement that anyone practising a therapy supply full details of training and professional history. The register would have its own complaints procedures sensitive to the particularity of the talking therapies. This would represent the most effective way to ensure public protection, avoid destroying long and honorable therapeutic traditions, and uphold the long and so far successful British tradition of cooperation between the professions and the law.