|REGULATION OF THE TALKING THERAPIES
The College of Psychoanalysts was a driving force in the judicial review which beat back the last attempt at state regulation of our practice, and we need to be ready now for new government initiatives. Members of the College will be participating in the conference called by Psychotherapists and Counsellors for Social Responsibility and the Alliance for Counselling and Psychotherapy in London on 26 September 2015, which reviews the new challenges we will face after the election. An indication of what is to come can be seen in the proposals to link psychotherapy with assessment of welfare rights. We will update members of the College as soon as we know of the next steps, and as we prepare our response.
21 May 2012
So far, all attempts to regulate have been voluntary. A major breakthrough was the formation of The United Kingdom Council for Psychotherapy (UKCP) as an umbrella-organisation of training-bodies for all mainstream modalities of psychotherapy and psychoanalysis. UKCP administers a voluntary register of psychotherapists trained by all member-organisations of UKCP. These were originally grouped together within Sections, according to their modality of working. They included the Analytical Psychology - Psychoanalytic and Psychodynamic Section (AP-PP Section), concerned with psychoanalytically-oriented practitioners.
In 1992 some training-organisations from the AP-PP Section withdrew from UKCP and formed a splinter-group: The British Confederation of Psychotherapists (BCP) which has since changed its name to The British Psychoanalytic Council (BPC). That organisation administers a similar voluntary register of psychoanalytic psychotherapists.
Early in 2009 the Council of Psychoanalysis and Jungian Analysis (CPJA) was launched to replace the AP-PP Section as a much more loosely affiliated component of UKCP. The principal difference is that, whereas membership of the AP-PP Section comprised only the relevant member-organisations from that particular modality, membership of CPJA is open to individual practitioners who are either registered with or who are eligible for registration with UKCP and who have trained with one of the member-organisations of the CPJA.
Over the last few years, there have been moves for psychoanalytic practitioners, as well as psychotherapists, counsellors and psychologists, to be regulated pursuant to statute. Under those plans, regulation would have remained in the hands of the professions themselves, though fully backed by statutory powers. The present government was unwilling to sanction this form of regulation. Instead, the Department of Health decreed that practitioners from the professions for the talking therapies should be treated as health professionals, whether practising in the NHS or privately, and directed that regulation shall be by a regulatory agency of the state, viz the Health Professions Council (HPC). Such a form of regulation would override the present regulatory functions of UKCP and BPC, as well as the other voluntary regulatory bodies for the other categories of practitioner referred to above. Regulation of each profession would, as a result, be removed from the professions concerned and all regulatory power would be transferred instead to public servants who are unfamiliar with the nature of the clinical work carried out by, in particular, psychoanalytic practitioners.
However, there was much disquiet amongst many in the psychotherapy and psychoanalytic community over the plans of the HPC, how it intended to regulate the psychotherapies and the consultation process that was carried out (e.g. see Maresfield Report).
Subsequently, six psychoanalytic organisations launched a legal challenge to the HPC’s consultation process and its plans concerning the regulation of the talking therapies.
The culmination of this legal challenge arrived on the 10th of December 2010. Mr. Justice Burton gave the six organisations permission to proceed with what he described as an “important” judicial review challenge to the HPC’s proposals.
This was a momentous day, in which the groups’ barrister Dinah Rose QC argued that the HPC had unlawfully evaded important questions, one of which was whether the HPC itself were fit for purpose, given its focus on measurable outcomes similar to medical style interventions. Mr Justice Burton criticised the misleading nature of the HPC statements, in particular those causing the organisations to be led to believe that the HPC would be considering and reporting to the Department of Health as to whether it should be the regulator, in circumstances where this was apparently never planned or done. In other words, the HPC has not actively questioned whether it can regulate psychoanalytic groups or made much of an effort to consult with these groups.
During the course of the litigation the Department of Health maintained a neutral stance and put plans to introduce legislation on hold to await the Court’s decision. The HPC at the time of the December court hearing had five weeks to file further evidence before the case was listed for a full hearing in the spring. This never occurred as other plans were being formulated for the regulation of psychotherapy.
In many ways, the job of regulating psychotherapists has been taken out of the HPC’s hands (at the very least for the time being). Early on in 2011, the government released a command paper stating that HPC statutory regulation of psychotherapists was now off the cards, (unless in the future it could be shown that psychotherapists are a danger to the public); they obviously did not feel that psychotherapy is a sufficient threat to warrant statutory regulation. Ironically, the government charged the existing regulator of the HPC (Centre for Health Regulatory Excellence, CHRE; to be renamed the Professional Standards Authority, PSA), to be set up as an approver of voluntary registers of psychotherapists (i.e. UKCP, BACP, etc). There would be no compulsion to join these registers. However, if one became part of a voluntary register, one would be kite-marked, much like plumbers are kite-marked as Corgi registered plumbers.
With these voluntary registers, there would be no legal protection of title as would have occurred under statutory regulation by the HPC. This has been called light touch regulation, and many feel it would be a good system, whereby the way we practice psychotherapy/psychoanalysis would not be adversely affected as it would under the HPC (e.g., fitness to practice hearings, adhering to medico-scientific paradigms of mental distress, etc.).
What is of concern to some practitioners is the standards the PSA will set the UKCP (and other organisations) to be kite-marked. Also of concern is that the government has allowed the possibility for the HPC to set up its own voluntary register for psychotherapists, believing that competition between voluntary registers would be healthy. In such circumstances the HPC could disseminate propaganda that its register is superior to the PSA register, and the NHS for example may choose to employ HPC voluntary registered psychotherapists as opposed to PSA voluntary registered practitioners. It is unclear how this would stand legally, but it may be a difficulty on the horizon.
The planning and organisation of what the PSA voluntary registers will entail is still very much in the consultancy and planning phase. Recently (November 2011) a consultation document was published by the CHRE outlining plans for the voluntary registers, which it is hoped will be launched in July 2012. You can access the paper here:
Here are some excerpts from the consultation document:
The aim of the Professional Standards Authority’s accreditation scheme is to enhance public confidence in unregulated health and care occupations by creating a reliable and effective assurance scheme for voluntary registers, promoting quality in education and training, registration, and standards of conduct.
There is a confusing phrase in 2.1 which seems overly totalitarian (italics/underline added).
2.1 Being accredited by the Professional Standards Authority will be seen as a mark of quality. We will seek to operate a scheme that becomes ‘mandatory through choice’, attracting people to it because it is seen to offer positive benefits and to deliver positive outcomes.
To be accepted onto a voluntary register the CHRE states in 2.4.
2.4. ... that they (psychotherapy organisations) are removing people who are unsafe to practise and ensuring that all reasonably practicable steps are taken to restrict their future practise e.g. publishing removal, referrals to the Independent Safeguarding Authority and other relevant authorities; recognizing decisions by statutory regulators or other accredited register holders.........that they are vigorously applying their standards of good practice including refusing entry to those who do not meet them, requiring and supporting continuous professional development, placing conditions on registration to limit practise that falls below the standards.
Also on the CHRE website (http://www.chre.org.uk/satellite/425), the CHRE make clear that they will be setting up themselves (and those on their registers) to be more attractive to prospective employers and that they will be responsible for setting the standards of entry and striking people off their registers if organisations do not meet their criteria:
2.7 The registers of organisations that have been accredited by us will be known as assured (or approved) registers. Accreditation will provide additional assurance to employers, commissioners, patients and the public that standards are being applied robustly; and that they can reasonably expect health and social care professionals and workers on a quality assured register to be competent and to behave ethically and compassionately.
2.8 In summary we:
Will set accreditation criteria and may accredit a voluntary register where we are satisfied that the criteria are met
Must publish the accreditation criteria we set; and may publish a list of accredited registers.
May carry out periodic reviews of the operation of the registers accredited
May remove, or suspend, or impose conditions on, the accreditation of the register
May refuse to accredit a register, or to continue to accredit it unless the person who maintains the register pays a fee of such an amount as the Authority may determine
Before accrediting a register the Authority must make an assessment of the likely impact of doing so, and must consult such persons as it considers appropriate.
The CHRE’s agenda is reiterated by Carmen Ablack, former UKCP Advisor and Regulatory Lead, who has been involved with negotiations with the CHRE. In her commentary on the UKCP website, she says:
‘Our impression is that CHRE has taken on board people's anxieties that the Government's insistence on voluntary registration being expanded and enhanced should not put psychotherapists and psychotherapeutic counsellors at a disadvantage with any therapists and psychologists registered statutorily with the Health Professions Council (HPC). In other ways, CHRE is also taking steps to make sure that being a registrant on a PSA approved register will be advantageous in an employment situation, for example, NHS jobs. In this, they have the full backing of the Department of Health.’ (22nd November 2011)
There is much in the CHRE document, like the previous HPC model, that has a medical model feel to it which may not be to many people’s tastes. Further, the plans for monitoring of voluntary registers does have a “Big Other” authoritarian edge which sounds similar to the HPC model. The plans include the publicising of their registers as superior, the publishing of negative information about organisations that do not meet their standards, and the enforcement of regulations whereby psychotherapy organisations may not accept registrants who have been struck off other registers. More importantly, the drive to get employers (i.e. the NHS) to favour people kite-marked by the PSA is quite an ominous prospect. In essence, all psychotherapists, counsellors, and psychoanalysts and organisations should think carefully of what the CHRE/PSA entails. The Health and Social Care Bill will soon become law and then the CHRE/PSA plans will be operational. It remains to be seen how successful they will become or how they will be welcomed.