Maresfield Report

HPC regulation risks impacting the public in a number of adverse ways. As the diverse field of therapies become constrained in the HPC model, members of the public will have less choice as to the kinds of therapies they can access. In particular, many patients choose a therapy precisely because it offers them something different from the framework of modern consumer society. Therapeutic ethics have, for the last 100 years, offered patients a system of values freed from the moral judgments of social authorities, yet now, these systems risk being reduced exactly to the moralistic view privileged by HPC. It is as if being a member of, say, the Socialist Workers Party would now only be legal if one had joined the BNP first.

Many therapies today do not accept the basic concepts of mental health, of wellbeing, of normality, or even of expertise. These concepts, they would argue, are part of a marketbased vision of human life, and not the spiritual, ethical journey of a therapy. They are concepts in the service of a view of human life that many therapies aim to challenge. Some therapies may advocate those values, but many do not, and have historically been characterized by a critique of dominant concepts of health and lifestyle. Many patients seek out precisely these therapists, and HPC regulation would effectively render them obsolete. HPC have stated that they would in fact aim to phase out such forms of therapy from 2012, with the message to the public ‘Don’t use these people’.

Thus anyone who disagrees with the value-laden vision of human life and wellbeing advocated by HPC would be excluded from practice as a therapist. This would leave those members of the public who wished to begin a therapy with a therapist who was critical of the values of HPC without the possibility of help. Society at large would thus be deprived of a unique resource to help those who seek to deal with their suffering outside a narrow medical model of health and illness. Members of the public would no longer have the freedom to choose their therapist, a fact already brought up by user groups. They would have to select a practitioner from a list which only includes those who practise those forms of therapy compatible with HPC’s framework.

Many schools of psychotherapy, likewise, have always been critical of received social policies and ways of framing human suffering. The new regulatory proposals would effectively be collapsing these schools of research and enquiry, with a real loss to the richness and diversity of a democratic society which has a duty to provide a space for alternative and non-conformist views of human life. The HPC-approved practitioner of the future can appear to be a person whose moral character has been officially sanctioned, yet this runs counter to therapeutic ethics which aim to put received morality into question.

To consider psychoanalysis, for example, as a quasi-medical treatment performed by a group of ‘good characters’ threatens to close down the space in which a very particular and valuable form of critical operation can take place, namely, the sustained selfexamination which entails a re-appraisal of what is held to be true and good. This would constitute a grave loss to prospective patients as well as depriving the public of a certain kind of critical social practice which has had a long and fruitful history.

Many patients and prospective patients engage in therapies they know to be critical of socially-sanctioned value systems, and of particular importance for many is the question of diagnostic classification. The DSM system currently used in medical services in the UK is not accepted by many traditions of therapy or by many members of the public. How HPC Regulation Will Affect The Public

A member of the public may receive a diagnosis of some variety of ‘mental illness’ in psychiatric services, yet wish to pursue a therapy with someone they know to reject this system of classification. The new HPC proposals in fact subordinate any therapeutic work to a diagnosis made and communicated in what are clearly the terms of DSM. The therapist is then under the obligation to refer the patient on to the treatment deemed to work best for that diagnostic category, an imperative which would effectively shut down the possibility of the patient’s working in a non-medicalised environment of their own choice.

HPC regulation would also involve a new definition of psychotherapy, as a set of techniques and procedures to be applied to a patient. Yet many psychotherapists would not recognise their work in this way. These future former psychotherapists, if they refuse to come under HPC regulation in order to keep their title, will have to find a different title for the therapeutic work they have been doing in many cases for a very long time. A person looking for psychotherapy as it used to be practiced (i.e. as a non-medical process of self-exploration and questioning) will experience more difficulty in finding the kind of person they can do this work with. The public will have to learn that they might not want a psychotherapist (in the new HPC sense) when they are looking for psychotherapy (in the current usage of the term).

Members of the public in therapy with an HPC-registered practitioner would have further difficulties in the event of a complaint. They might wish to use a process of mediation or informal discussion to resolve the issue in question, yet HPC provides no form of hearing apart from the formal and public complaints hearing. Members of the public will be less likely to engage with this adversarial and off-putting process, especially if their complaint clearly requires informal resolution.

Complainants involved in an HPC investigation may be required to disclose medical records, and, in addition to this, they will be forced to discuss sensitive issues and vulnerabilities in public. HPC hearings take place in front of a public gallery. This will almost certainly discourage potential complainants from pursuing their complaint. Comparison of HPC complaints hearings with those of therapy groups currently shows far more are processed in therapy groups than in HPC, and most of these use mediation and other resolution processes. HPC complaints take an average of at least one year to be heard, with more than 70% of complaints deemed ‘no case to answer’. Members of the public will thus not receive the protection they merit via HPC procedures.

	The Maresfield Report

	How HPC Regulation will Affect the Public

	HPC regulation risks impacting the public in a number of adverse ways. As the diverse field of therapies become constrained in the HPC model, members of the public will have less choice as to the kinds of therapies they can access. In particular, many patients choose a therapy precisely because it offers them something different from the framework of modern consumer society. Therapeutic ethics have, for the last 100 years, offered patients a system of values freed from the moral judgments of social authorities, yet now, these systems risk being reduced exactly to the moralistic view privileged by HPC. It is as if being a member of, say, the Socialist Workers Party would now only be legal if one had joined the BNP first. Many therapies today do not accept the basic concepts of mental health, of wellbeing, of normality, or even of expertise. These concepts, they would argue, are part of a marketbased vision of human life, and not the spiritual, ethical journey of a therapy. They are concepts in the service of a view of human life that many therapies aim to challenge. Some therapies may advocate those values, but many do not, and have historically been characterized by a critique of dominant concepts of health and lifestyle. Many patients seek out precisely these therapists, and HPC regulation would effectively render them obsolete. HPC have stated that they would in fact aim to phase out such forms of therapy from 2012, with the message to the public ‘Don’t use these people’. Thus anyone who disagrees with the value-laden vision of human life and wellbeing advocated by HPC would be excluded from practice as a therapist. This would leave those members of the public who wished to begin a therapy with a therapist who was critical of the values of HPC without the possibility of help. Society at large would thus be deprived of a unique resource to help those who seek to deal with their suffering outside a narrow medical model of health and illness. Members of the public would no longer have the freedom to choose their therapist, a fact already brought up by user groups. They would have to select a practitioner from a list which only includes those who practise those forms of therapy compatible with HPC’s framework. Many schools of psychotherapy, likewise, have always been critical of received social policies and ways of framing human suffering. The new regulatory proposals would effectively be collapsing these schools of research and enquiry, with a real loss to the richness and diversity of a democratic society which has a duty to provide a space for alternative and non-conformist views of human life. The HPC-approved practitioner of the future can appear to be a person whose moral character has been officially sanctioned, yet this runs counter to therapeutic ethics which aim to put received morality into question. To consider psychoanalysis, for example, as a quasi-medical treatment performed by a group of ‘good characters’ threatens to close down the space in which a very particular and valuable form of critical operation can take place, namely, the sustained selfexamination which entails a re-appraisal of what is held to be true and good. This would constitute a grave loss to prospective patients as well as depriving the public of a certain kind of critical social practice which has had a long and fruitful history. Many patients and prospective patients engage in therapies they know to be critical of socially-sanctioned value systems, and of particular importance for many is the question of diagnostic classification. The DSM system currently used in medical services in the UK is not accepted by many traditions of therapy or by many members of the public. How HPC Regulation Will Affect The Public A member of the public may receive a diagnosis of some variety of ‘mental illness’ in psychiatric services, yet wish to pursue a therapy with someone they know to reject this system of classification. The new HPC proposals in fact subordinate any therapeutic work to a diagnosis made and communicated in what are clearly the terms of DSM. The therapist is then under the obligation to refer the patient on to the treatment deemed to work best for that diagnostic category, an imperative which would effectively shut down the possibility of the patient’s working in a non-medicalised environment of their own choice. HPC regulation would also involve a new definition of psychotherapy, as a set of techniques and procedures to be applied to a patient. Yet many psychotherapists would not recognise their work in this way. These future former psychotherapists, if they refuse to come under HPC regulation in order to keep their title, will have to find a different title for the therapeutic work they have been doing in many cases for a very long time. A person looking for psychotherapy as it used to be practiced (i.e. as a non-medical process of self-exploration and questioning) will experience more difficulty in finding the kind of person they can do this work with. The public will have to learn that they might not want a psychotherapist (in the new HPC sense) when they are looking for psychotherapy (in the current usage of the term). Members of the public in therapy with an HPC-registered practitioner would have further difficulties in the event of a complaint. They might wish to use a process of mediation or informal discussion to resolve the issue in question, yet HPC provides no form of hearing apart from the formal and public complaints hearing. Members of the public will be less likely to engage with this adversarial and off-putting process, especially if their complaint clearly requires informal resolution. Complainants involved in an HPC investigation may be required to disclose medical records, and, in addition to this, they will be forced to discuss sensitive issues and vulnerabilities in public. HPC hearings take place in front of a public gallery. This will almost certainly discourage potential complainants from pursuing their complaint. Comparison of HPC complaints hearings with those of therapy groups currently shows far more are processed in therapy groups than in HPC, and most of these use mediation and other resolution processes. HPC complaints take an average of at least one year to be heard, with more than 70% of complaints deemed ‘no case to answer’. Members of the public will thus not receive the protection they merit via HPC procedures.