The consultation process initiated by the Department of Health has followed two paths: that of the HPC and that of Skills for Health, charged with developing National Occupational Standards for psychotherapy. HPC were required to assess the ‘regulatory needs’ of the field and determine whether it was suited to accommodate it. Yet the fact that all the main therapy organisations rejected HPC as regulator was ignored, thereby foreclosing the question of ‘regulatory needs’. The process at SfH has been just as controversial as that at HPC, and has resulted already in a number of formal complaints. Documents released under the Freedom of Information act, detailed below, show staff at SfH conspiring to lie to stakeholders. Both SfH and HPC have also failed to remain faithful to the original Department of Health remit to include representation from the breadth of the professional field and to respect the difference and diversity of the
stakeholders concerned.

The HPC and SfH consultations give serious concern about the parity and transparency of the consultation process. They show both a failure to reflect the particular and differing nature of the psychotherapies in the mechanisms of regulation, and a hijacking of the process by a minority section of the profession to the exclusion of others. Re the crucial issue of complaints, there has been an over-reliance on the advocacy group Witness, which works closely with HPC and has received significant funding from the DoH.

Witness circulates stories to the media of abusive therapists and promotes the HPC as the solution to this, yet there have been questions as to the possible conflict of interest that may be involved in their approach, and the HPC’s collaboration with Witness as opposed to actual user groups. According to Companies House, Witness has been in administration for some time now and there have been concerns that if funding were to be a key issue for their survival, and if the DoH and even HPC were funding this organisation, there is the risk that Witness may not be in the best position to articulate critiques of HPC.

Both HPC and SfH have failed to include a representative cross-section of the field in their consultation. The HPC’s Professional Liaison Group, which deals with the talking therapies, was open to all stakeholders, yet membership was given almost exclusively to those who would not have a critical voice. Stakeholders involved in the regulation debate for decades were excluded, and HPC maintained a broadly disingenuous attitude throughout its meetings with stakeholders groups.

PLG meetings included such details as a member of HPC staff punching the air with joy when it was announced that the cost of making an appeal against HPC would rise for the party making the appeal, if unsuccessful, and a member of HPC staff circulating an inflammatory letter to stakeholders with allegations about a critic of HPC, and then refusing to circulate the response from the party concerned. The staff member admitted privately this had been a “mistake”, yet HPC refused to acknowledge that anything untoward had occurred, despite the damage done by the circulation of the letter. Complaints to HPC’s regulator, the CHRE, were not taken up due to the fact that CHRE decided that this was the action of HPC personnel, rather than HPC, and hence it could not be acted upon.

HPC, like SfH, have been working since at least 2007 on the proposed regulation of the talking therapies, yet their Chair could admit in late 2008 that as well as not knowing what transference was, he had no idea what psychoanalysis was either, despite the fact that Problems with the Consultation Process several explanatory documents had been received and acknowledged by HPC over that time. Documents from the field spelled out clearly the problems that not understanding
the concept of transference posed for the HPC model.

Stakeholder groups continue to remind HPC of their main areas of concern, and their difficulties with HPC’s handling of the consultation. From December 2008 to May 2009 there was a ‘call for ideas’ and stakeholder groups submitted detailed documents to HPC. The objections raised and the difficulties described are documented but were not acted upon or responded to. The process, for the stakeholder groups, was simply a formal show, to suggest that HPC had ‘listened’ to the field.

As for SfH, they appear to have failed to conduct the research they were briefed to carry out for themselves, relying almost exclusively on ‘outsourcing’ opinion about what is legitimate and what isn’t: this meant effectively emailing one of a handful of ‘experts’ to ask if an academic or clinician that SfH had themselves invited to be part of the consultation process should in fact be ‘invited’. These distortions to the consultation process – which are detailed below - have effectively ruled out a rational assessment of the feasibility and suitability of their project.

Problems with the Skills for Health Consultation

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, Skills for Health allowed their consultation to be monopolised by a very small number of people with both a narrow and restrictive view of psychotherapy and, arguably, a clear agenda to further their own particular brand of therapy which they endeavour to promote within the NHS.

The task of drafting psychodynamic/psychoanalytic competences was given by Skills for Health to Tony Roth and Steve Pilling, employees in the UCL Sub-Department of Clinical Health Psychology run by Peter Fonagy. Fonagy, in fact, chaired the Executive Group and the Strategy Group of the SfH project and also sits on the Reference Group, as well as sitting on the HPC Professional Liaison Group, charged with the regulation of the talking therapies. The influence of this highly controversial figure is thus unduly weighted in the consultation process. In one email disclosed under the Freedom of Information Act, Linda Hardy at SfH writes “I sort of feel I don’t want to ask [Fonagy] everything”.

Roth and Pilling, aside from having the link to Fonagy, are known for their work on CBT, a set of therapies which are totally at odds with psychoanalysis and most psychodynamic therapies. It is remarkable that the work was given to them rather than to one of the many university departments of psychoanalysis in the UK. It raises the question of how the UCL department managed to secure this contract.

This bias was continued in the composition of the project Expert Reference Group and the Modality Working Group, both of which were chaired by Anthony Bateman. Bateman is a close colleague of Fonagy and the two have co-authored a treatment manual for a form of therapy (MBT) which they endeavour to promote within the NHS. Fonagy is Director of the Anna Freud Centre, which holds courses on MBT in conjunction with the UCL Sub-Department of Clinical Health Psychology. These courses are held for those working in the NHS and generate revenue for the institution concerned. There is thus a line of economic benefit. The competences produced for psychodynamic/ psychoanalytic therapy, many commentators have pointed out, fit MBT very well, but not other therapies.

A historical note is important here. Fonagy, Bateman and their colleagues are members of the British Psychoanalytic Council (BPC). The BPC is a network of organisations centred around the British Psychoanalytical Society, also known as the Institute of Psychoanalysis - of which Fonagy and Bateman are members - an organisation which for many years claimed to be the only psychoanalytic training body in the UK. They repeatedly published statements that only their own members were psychoanalysts, and even wrote to newspapers claiming that those who pursued other psychoanalytic trainings were deceiving the public.

Over the years many other psychoanalytic organisations were established, attracting trainees who were not drawn to the Institute’s practices, their theoretical orientations or the ethics of their selection procedures: gay trainees were not accepted until quite recently. Today, the majority of psychoanalytic practitioners in the UK belong to the psychoanalytic section of the UKCP, a fact which has been difficult for the Institute to accept. As the untenability of the Institute’s position became clear, they moderated their claim to a monopoly, yet there is still a real tension between the Institute - and hence the BPC groups - and the other non-BPC psychoanalytic training organisations in the UK, most of which are in the UKCP. This is a major political factor in the current regulatory
landscape which should not be underestimated.

The composition of the Expert Reference Group and the Modality Working Group was biased quite radically in favour of BPC - Fonagy and Bateman’s organisation - with nearly all members coming from there. The list for the Psychodynamic Modality Group established on 16/10/07 consisted of 11 people, all of whom came from the BPC. Another list sent by SfH to Fonagy in January 2008 received the reply that it “goes slightly too far in the direction of UKCP”, yet this list of 16 people included 2 from UKCP compared with 11 from BPC. UKCP, moreover, had pointed out to SfH in Jan 08 that it represented the majority of psychoanalytic practitioners in the UK.

Documents released under the Freedom of Information Act show how the lists for the work groups were made up almost exclusively of those from BPC and that, when other names of organisations or user groups that had actually been invited to participate were proposed or added to the lists by SfH, they mysteriously vanish. When further information on these disappearances was requested by The College of Psychoanalysts- UK under the Freedom of Information Act, SfH replied by sending hundreds of pages of irrelevant documents relating to the CBT groups and then claimed that they could not help further as they were only obliged by the Act to perform a certain number of hours work collating documents.

Some BPC groups may also have failed to inform their members of developments in the consultation process, with a handful of those on the relevant committees making claims for their membership without proper consultation. Nearly everyone involved in the SfH working groups either comes from BPC or the Fonagy UCL Department. In the list of PLG members that HPC have published, Fonagy’s institution is listed as Skills for Health, a curious claim given he is not an employee of SfH and is in fact associated with the British Psychoanalytic Council, the same organisation as the person preceding him on the PLG list. If Fonagy’s affiliation had been stated correctly, it would obviously have shown a bias in the PLG composition. HPC has not acted with transparency in this matter.

Fonagy, likewise, has been relied on in a wholly unprecedented way by SfH: in an email of 19.10.07, Linda Hardy of SfH writes re Fonagy “I sort of feel I don’t want to ask him everything”. Fonagy is a highly controversial figure in the world of psychoanalysis. He has advocated genetic testing as a guide to focus psychotherapy intervention and brain scanning to ‘test’ the results of psychodynamic work. He has termed the traditional neuroses ‘disease processes’ or ‘weaknesses in brain function’, and even encouraged brain scanning of two year old infants to determine whether psychotherapy intervention is necessary (as reported in The Times 12/5/07).

For many psychotherapists, these are extreme views, and it is therefore questionable why Fonagy has assumed such an influential and powerful role in the HPC and SfH consultation processes. Documents released under the Freedom of Information Act show Fonagy making incorrect and adversarial remarks about organisations in the field which are not questioned or checked by SfH. He puts in question the training standards of organisations critical of the consultation process with no substantiation, and SfH make no effort to research or verify these allegations.

In September 2007 the UCL department apparently sent out a letter inviting participation in the expert reference group for psychodynamic therapy, yet this letter was not received by the psychotherapy organisations. It stated that the general framework would be that used for CBT, a fact which would have caused a great deal of protest in the profession had it been known. The methodology of the work is stated as “identifying manuals published in the UK, the US and elsewhere and building the framework from these sources”. This would also have caused a great deal of protest in the field for the simple reason that there are no manuals of psychoanalysis, a fact which Fonagy himself points out in a minuted SfH meeting of 11/4/08. On 5/2/08, Roth and Pilling claim to have sourced “the psychoanalytic treatment manuals” for the criteria they have formulated, yet in the list supplied by them in May 2008 to accompany the NOS there are no psychoanalytic texts at all.

The result of the dominance of Fonagy and his colleagues in the consultation process has been the exclusion of other voices: professional groups and user groups have been excluded, despite initial inclusion in draft documents, and the Skills for Health team have even conspired to lie directly to an accredited therapist seeking representation in one of the work groups who had been invited to participate. Steven Richards, Chair of the British Society for Clinical Psychophysiology, contacted SfH on 18.10.07 requesting involvement in the cognitive and psychodynamic work groups. Linda Hardy of SfH writes to Rod Holland, who Fonagy had recommended to SfH to chair this group, on 25.10.07, that “We need not have him on the group if you are not happy - I’ll rely on your superior knowledge of the therapies here!”. This illustrates SfH’s failure to conduct their research independently, leaving the process open to political manoeuvering. Holland writes that Richard’s school of therapy “is at variance with most concepts of CBT”, yet SfH do not assess this claim or even object to the exclusion of a diverse practice.

Hardy then writes to Richards on 29.10.07, “I contacted the chair of the group with your information and he feels that at this stage, with numbers on the group nearing capacity we really need to give the remaining few places to NHS employed practitioners as they are really underrepresented on the groups”. In fact, it is because, as she writes to Marc Lyall of SfH two hours earlier on the same day, “Rod does not want this guy on the group. However I’m not sure what to say back to him - it’s difficult when we invite people to show an interest and then tell them they can’t join a group. I could say we are now seeking more NHS employed practitioners as they are under represented on the groups? [sic]”.

When a Freedom of Information Act disclosure made these emails available to Richards, and he took them up with SfH, new correspondence was brought forward - not included in the initial disclosure - which it is quite possible and even likely that SfH has fabricated. The College of Psychoanalysts-UK has also written to SfH regarding an item of correspondence which they believe was falsified in order to cover themselves about another issue.

Other irregularities and contradictions in the consultation process are rife. On 1/10/07 Marc Lyall from SfH writes to Anthony Bateman asking him if he will chair the ‘Psychodynamic Reference Group’ when he has already been made chair in September by the UCL team of Roth-Piling. It appears that the Roth-Pilling decisions are just implemented by Lyall.

On 10/10/07 Marc Lyall emails Bateman and Fonagy the list of group members of the Psychodynamic Modality Group for them to review. Then on 16/10/07 the membership list is established. The list is of 11 people, all of whom come from one and the same political grouping (Institute of Psychoanalysis/BPC).

On 9/1/08 Marc Lyall of SfH writes to Bateman that “I am finding out which of the names…were nominated by UKCP and BACP..”. yet if he was in charge of this part of the process it must have been known. It suggests that he just left it to Bateman, Fonagy and their team.


On 23/1/08 Lyall writes to Julia Carne, a stakeholder, that he has asked UKCP for nominations. He states that “Any list that you have seen. will be a list of nominations and does not represent the final membership of the group”. Yet already in November 2007, SfH documents state: “Here is the membership list for the group”.

On 25/1/08 Lyall writes to Prof. Darian Leader from The College of Psychoanalysts-UK; “I am of course aware that the list circulated is not representative of the organisations present within the field, something that we are looking to address”. It is crucial, he writes, that the modality group “represents a cross section of the field” and that the list “has not been through the appropriate membership approval procedures”.

25/1/08 Julia Carne’s name is now on the list of the psychodynamic psychotherapy working group. Of the 20 people in the group listed here, 15 are from the same political grouping. Julia Carne’s name then vanishes. Names of nearly all the other stakeholders not in BPC groups vanish.

19/3/08 CP-UK meet with Marc Lyall and Nadine Singh. They explain the politics of the analytic world, the distribution of analysts and emphasise yet again that the Fonagy-UCL group is not representative of the different analytic groups and orientations in the UK and that it does not speak for the majority of practitioners. They explain the debates around the question of evidence in psychotherapy, and send copies of articles and a bibliography requested by Lyall. They give him information about university departments and the BIOS centre at LSE where work critical of the UCL grouping takes place. The notes from this meeting are written up by Lyall and he confirms here and in a letter of 20/3/08 that representatives of CP-UK will be invited to join the Modality Working Group and that “these will be formally addressed by the Project Strategy Group at its next meeting”. Lyall asks in this letter; “Could you confirm what, if any, further action is reasonable for the Strategy Group to consider to remove the element of bias in the project..”, yet then no further action is taken. CP-UK is excluded from meetings. On 3/4/08 Lyall writes to the College; “..I will get back to [sic] as soon as possible on the points you have made and the information you have provided.” Yet no further correspondence ensues. SfH claim several months later to have asked two therapists in their work group to represent CP-UK, yet the therapists deny that this request was ever made, and CP-UK was never consulted.

03/ 09 The largest group of psychoanalytic psychotherapists in the UK (CPJA) unanimously approve report pointing out severe limitations to SfH NOS documents, and
reject them as misrepresenting the work carried out by the vast majority of psychoanalytic psychotherapists. The report is sent to SfH. It is ignored.

04/09 SfH, ignoring the many critical responses to the NOS, 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 the SfH briefing pointing out errors and misinformation. This is ignored.

07/09 HPC publish draft Standards of Proficiency for Psychotherapy and Counselling. These are greeted with critiques from a variety of organisations across the field. BACP encourage its membership to write to HPC to protest at the arbitrary and false differentiation of counselling and psychotherapy. The Standards would make many forms of therapy impossible to practise.