|SKILLS FOR HEALTH (SFH)
THE COLLEGE RESPONSE TO SKILLS FOR HEALTH’S DOCUMENT ‘PSYCHOLOGICAL THERAPIES NATIONAL OCCUPATIONAL STANDARD DEVELOPMENT PROJECT - BRIEFING SHEET MAY 2009’
The College was interested to see that there must have been a significant set of concerns put forward to S4H in response to their consultation, and that this briefing sheet was therefore produced in order to ‘address some of the misunderstandings’ associated with the project. We were very surprised, however, to read an account of the consultation process which bears little resemblance to our, and many others’, experience of it. Furthermore, the conflicting and misleading statements about the nature and purpose of the NOS contained in the Frequently Asked Questions update sheet means that any aim of clarification or of reassurance has not been met by this document. The reasons for our views are set out in our response to the briefing. The following links give access to both documents.
To access the Skills for Health’s Briefing, please click here
To access the Response from The College, please click here
PROPOSALS BY HPC FOR REGULATION OF PSYCHOTHERAPISTS AND COUNSELLORS
THE HEALTH PROFESSIONS COUNCIL GETS UNDERWAY
The Health Professions Council has now begun the task of exploring proposals for the regulation of counsellors and psychotherapists. They recently sent to stakeholders within the professions concerned, including The College, a Call for Ideas document to help them in their endeavour by answering ten specific questions. The College has now responded to that Call for Ideas. The document in question may be accessed by clicking on this link.
In addition, representatives of The College have now met with Marc Seale, the Chief Executive of HPC and Sam Mars, Policy Officer. To access the notes of meeting, please click here.
HPC is also expected to announce very soon the composition of the Professional Liaison Group that will be advising them on any proposals to regulate counsellors and psychotherapists. The PLG is referred to in the above meeting.
LETTER FROM THE COLLEGE TO SKILLS FOR HEALTH
To access a letter written by The College to SfH, please click here.
COUNSELLORS AND PSYCHOTHERAPISTS - ROAD MAP TO THEIR STATUTORY REGULATION
To access the comments by The College of Psychoanalysts on the above document published by the Health Professions Council in December 2007, please click here.
THE ROLE OF SKILLS FOR HEALTH IN THE PROCESS TOWARDS STATE REGULATION
As part of the move towards regulation of psychotherapists and counsellors by the state via the Health Professions Council (HPC), the Department of Health has involved Skills for Health (SfH). Skills for Health is the Sector Skills Council for the UK health sector. They claim that their purpose is to help the whole sector develop solutions that deliver a skilled and flexible UK workforce in order to improve health and healthcare. Arising from this, they have set out to specify competences and national occupational standards (NOS) for psychotherapists and counsellors, whether working in the NHS or in private practice. SfH claim that national occupational standards define what a person who is competent at a particular activity is able to achieve and that they also indicate the knowledge and understanding that such a person will need.
The website of SfH may be accessed by clicking this link.
SfH published an initial outline of how they proposed to go about the above project. To access this outline, please click here. (link now dead)
SfH have also published a newsletter regarding development of the NOS. To access this, please click here. (link now dead)
Recently, SfH published some draft NOS for psychotherapists, including those who work in what they have decided to term the psychodynamic modality, which is presumably intended to include psychoanalysts and psychoanalytic psychotherapists for whose ability to practise in the way they have always done so, there are worrying if not fatal implications. To access the draft NOS in Word format, please click here. (link now dead)
The College has now prepared an important appraisal and critique of the above draft NOS. To access this, please click here.
The College has also issued the following Press Release in relation to these matters:
THE COLLEGE OF PSYCHOANALYSTS - UK
Under proposed new government guidelines, most forms of psychoanalysis could become illegal in 2009. The Government aims to regulate talking therapies next year and has already started the process of assessing the field. The Health Professions Council has been given the task of regulating talking therapies, with its partner Skills for Health (SfH) charged with developing National Occupational Standards for therapeutic work. Nearly all the psychotherapy and psychoanalytic organisations protested that HPC was inappropriate for talking cures, yet this has been totally ignored and HPC imposed as the regulator.
The psychodynamic and psychoanalytic organisations in this country are already regulated by two main bodies (UKCP and BPC) which have been developed through the profession over the last twenty-five years. Each of the member organisations of UKCP and BPC has strict codes of ethics, practice and complaints procedures, and is inspected periodically by the regulatory body. Yet the new developments will render the existing regulatory structures for the most part obsolete. With this comes a new vision of what psychodynamic and psychoanalytic work actually is.
For HPC and SfH, psychoanalytic work is seen more as an intervention to be applied - like a drug - TO patients than a long and painstaking work done BY patients. This view of therapy as an external intervention is reflected in the government's plan to 'give' therapy to young Muslims they suspect of harbouring aspirations to terrorism: psychotherapy becomes a tool of social control rather than a choice made by the individual to explore their own life.
A consultation process was begun by SfH in 2007, and the results just published in draft form.More than 450 rules have been listed for psychodynamic and psychoanalytic therapy. They dictate every aspect of how therapists should organise their sessions, how they should 'monitor' themselves and how they should carry out their work. They go into minute detail about the timing of interventions, the setting of the therapy, its aims - and even the expression of appropriate 'feelings'. Such an application of externally-imposed rules - most of which were expressly contraindicated by Freud, Jung and the analysts who followed, such as Klein, Lacan and Winnicott - removes the very foundation on which such therapies are based, namely the freedom of both parties to work together authentically and creatively. If these rules are accepted, then it will no longer be possible for analysts - and many therapists - to work in this country.
The SfH project shows how analytic work is being forced into the current culture of outcomes, where everything can be predicted in advance and evaluated in relation to the expected results. Analysis, however, involves an open-ended relationship, where results may emerge that were never predicted or even thought of by the person in analysis. The very distinction between conscious and unconscious motivation that lies at the heart of analytic work is ignored by the proposed regulations which encourage a 'false self', a box-ticking clinician, always fearful of being watched by the authorities and anxious to please them. If analysis has an aim, it is to help patients free themselves from irrational forms of authority, exactly those that now threaten to constrain the work of analysts.
According to the government roadmap, HPC will establish a list of reputable practitioners, which will mean effectively those who adopt their particular formulations as to what psychoanalysis is about. All the documentation published to date by HPC shows a serious misunderstanding of the nature of analytic work, together with a new insistence on 'good character' defined in highly rigid ways. If this goes ahead, then members of the public will no longer have the freedom to choose their analyst. Rather, they will have to select a practitioner from a list which only includes those who practise a particular form of therapy.
How did this situation come about after the long process of consultation with the profession? The working parties at SfH which have drafted the new rules are made up almost exclusively of members from one single highly partisan grouping, concerned to define psychoanalytic psychotherapy in a very narrow frame. This narrow frame fits a particular technique developed by the Chair of the SfH National Strategy Group together with the Chair of the SfH Working Group known as 'Mentalization Based Therapy' (MBT). Some research shows evidence for the value of this technique for particular NHS patient categories, but it represents a tiny minority of the total psychoanalytic therapy that is undertaken, mostly in the private sector. Its techniques and ethical framework are entirely opposed to most traditional psychoanalytic work.
The Working Group and the National Strategy group, under these chairs, have excluded contributions which do not meet this narrow frame. SfH had promised seats on the working parties to representatives of other groupings, yet these were then withheld and SfH have admitted that they have not chosen to develop their work democratically. Requests for documents about the consultation process obtained under the Freedom of Information Act have shown astonishing failure to follow proper procedures and the hijacking of the consultation by a small and ambitious group of individuals.
Thousands of therapists have been writing to MPs and politicians about the current situation, seeking a recognition of the fact that analytic work cannot be reduced to a set of rules to be mechanistically applied to a patient with predictable outcomes, but involves an exploration of the meaning of an individual's history which can never be guessed in advance. Analytic work, for the majority of analysts, should be regulated by the bodies established by the profession and not by the State.
For more information contact:
Haya Oakley (Site for Contemporary Psychoanalysis) - 07929 559 817
Julia Carne (Psychoanalytic Consortium) - 07774 903204
Darian Leader (Centre for Freudian Analysis and Research) -
Sian Ellis (Association for Group and Individual Psychotherapy) - 07949 088 963
Joe Suart (The Guild of Psychotherapists) - 07772 510 475
Anne Worthington (The Guild of Psychotherapists) - 07904 870 962
Jason Wright (Association of Independent Psychotherapists) - 0793 274 7724
1 July 2008
BCM Box 2629
LONDON WC1N 3XX
Tel: 01799 584231
SOME RECENT DEVELOPMENTS IN RELATION TO REGULATION BY THE STATE
In May 2008 it was made clear that the Government intended to proceed apace with the regulation of the psychotherapies, including psychoanalysis. The regulator would be the Health Professions Council, despite the almost unanimous agreement among professional groups that HPC was not suited to regulate psychotherapy. A great deal of correspondence was sent which set out reasons for the unsuitability of HPC, yet this was not responded to in any substantial way. Before regulation can occur, a number of steps have to be worked through.
Firstly, the definition of what psychotherapy/psychoanalysis is.
In order to establish this, Skills for Health, a Public Authority, on the instructions of the Department of Health, was given the project of consultation. They were supposedly going to set up working groups with representation from various modalities which would arrive at generally acceptable National Occupational Standards for the psychodynamic psychotherapies and psychoanalysis. The College of Psychoanalysts and the Psychoanalytic Consortium both tried to be part of this process. The Consortium was not given the courtesy of a reply; the process simply began without them. The College was promised two places but was subsequently excluded without any explanation. Thus, those who were from the outset voicing their discontent with the nature of the process were excluded from contributing anything to that process, including being able to explain to those participating in it in good faith, that it was from the outset a biased process. It was clear at this point that careful vetting of the political stance of members was more important than a fair distribution of places.
Secondly, the production of National Occupational Standards.
The working group for psychodynamic psychotherapies and psychoanalysis has now met a couple of times and produced a set of National Occupational Standards, drafted first of all by two academics who are known for their work which adopts methodology similar to that used in an attempt to validate CBT. Despite the clear antithesis between the psychoanalytic and the cognitive approach, the acknowledged framework for the production of the analytic standards is that of CBT. If these are accepted, they will probably become part of a manual to which we may all be expected to adhere, despite being excluded from the process. The NOS produced are based upon a very particular view of what constitutes psychodynamic work and psychoanalysis. This is a view that many feel does not bear more than a passing resemblance to the way they have been trained and experienced in working. Thus, at a stroke, different orientations, the training analysis, current trainings, are at risk of being turned into something outside the remit of what will be defined by this brutal process.
Thirdly, wider consultation within the psychotherapy/psychoanalysis organisations for comments on the NOS.
This is the stage at which we now find ourselves. There seems to be a choice of approach: comply with the demand of the organisation which has up to now refused to allow us to participate, and produce the usual rational and well-thought-out arguments as to why this should not be imposed on those segments of the profession who do not recognise their ethics or way of working in this NOS document; or, refuse at this point to participate as we have been offered no part in producing the NOS and will therefore be unlikely to be listened to at this point.
It seems clear that the objectives of this political process were set at the beginning of the project - of course, this is how political process usually works - and clearer still that objections will not be listened to.
So, what can we do if we don't recognise our practice in the NOS as being circulated currently for comment?
- Argue the points in detail and keep trying to assert some influence on the process;
- Make further representations to Skills for Health;
- Form horizontal alliances with other practitioner groups who find the likely outcome of the NOS and Skills for Health process unacceptable (it was said early on that there had to be agreement to regulation by a substantial proportion of psychotherapists);
- Make public statements highlighting the abuse of power apparent in this biased process carried out by a Public Authority.
These questions are currently the subject of debate and a range of documents are being drafted. We are also encouraging anyone concerned about the undemocratic and biased way that this process is unfolding to write to their MP.
If you want to find out who your local MP is then you can go to http://www.writetothem.com and type in your postcode. You can then write to your MP c/o the House of Commons.
STATE-REGULATION: THE FOG BEGINS TO CLEAR
The government has now published its White Paper Trust, Assurance and Safety -The Regulation of Health Professionals in the 21st Century clarifying and setting out its proposals for state-regulation of a number of professions, including psychotherapists, counsellors and applied psychologists. For those with Acrobat Reader, the White Paper may be accessed from the Department of Health website.
The White Paper follows two earlier reports for consultation, published by the Department of Health: The Donaldson Report, Good doctors, safer patients (outlining proposals for the regulation of medical practitioners) and the Foster Review, The regulation of the non-medical healthcare professions (outlining proposals for the regulation of, inter alios, psychotherapists and counsellors).
An outline of the results of the two consultation documents, as well as the circumstances surrounding publication of the White Paper, may be found on the Department of Health website.
Most of the White Paper is concerned with the government proposals for the regulation of medical practitioners, which it is not proposed to refer to here. Specific proposals concerning the future regulation of psychotherapists, counsellors, applied psychologists and others are interwoven with the proposals for medical practitioners at various points in the White Paper. The three professions referred to will be dealt with in the same way, though not at the same time - applied psychologists will be regulated before psychotherapists and counsellors. The main provisions affecting those professions may be summarised as follows:
1. Except for the pharmaceutical profession, there will be no new regulators
2. Psychotherapists, counsellors and applied psychologists will be regulated by The Health Professions Council ("HPC")
3. The council of HPC, along with all other regulators, will be subject to the following changes:
a) it will have fewer members
b) there will be at least parity of professional/lay composition, subject to future review
c) members will be independently appointed by Appointments Commission
d) there will be a duty to deal with the interests of all stakeholders
e) it will be accountable to Parliament
f) meetings will be open to the public
g) it will function more like an executive board and deal only with strategic matters, rather than with operational matters
4. HPC will draw members for its disciplinary tribunals from a central list of those persons who have been vetted and approved to sit on such tribunals
5. Disciplinary procedures will be subject to the concept of fitness to practise
6. The standard of proof in disciplinary proceedings will be that applicable in civil rather than criminal proceedings but on a sliding scale, so that, in the most serious cases (e.g. risk of loss of livelihood) the standard of proof will be virtually identical to the higher standard of proof in criminal proceedings
7. Revalidation of all practitioners at regular intervals by HPC
8. HPC will be responsible for educational standards
9. HPC must make proposals by Jan 2008 concerning the regulation of those in training
10. The government will seek, where possible, to promote common standards across all the professions in question, such as standards of professional conduct and of professional practice relating to areas of practice that require greater harmonisation. While recognising that there needs to be appropriate flexibility to reflect relevant differences between professions, the government believes that all professionals undertaking the same activity should be subject to the same standards of training and practice, so that those who use their services can be assured that there is no difference in quality.
A notable absence in the White Paper, compared with the Foster Review, is any proposal to delegate to existing voluntary regulatory or professional bodies any aspect of regulatory function on behalf of the regulator, save in special circumstances relating only to the NHS. It seems highly unlikely, in such circumstances, that there will ever be any scope for the continued operation, following the introduction of regulation by HPC, of the Independent Complaints Organisation currently being set up by UKCP.
Another consequence of the White Paper is that proposals formerly put forward for the talking therapies, along with applied psychology, to be regulated by a new and separate regulator, such as the proposed Psychological Professions Council, are most unlikely ever to come to fruition.
The government White Paper, while not casting in stone the proposed legislation that must be introduced, in order to effect these changes, makes it much less likely that future developments in this area will differ significantly from what is now proposed in the White Paper.
In the meantime, The Sector Skills Council for Health has launched its consultation of all interested parties, in order to develop an initial competence framework to identify the scope of practice involved in the area of psychotherapy and counselling. The College was invited to contribute its views in that consultation process, which has now closed. To access the College Submission To Skills For Health, please click here.
REGULATION: THE PLOT THICKENS
In order to understand better recent developments in the field of regulation, the following outline of the principal groups of players may be helpful.
At the top are the regulatory bodies of the state, including the Health Professions Council (HPC), and the Department of Health (DoH), which is the branch of government that will promote regulation. Then come those bodies, some of which claim to be professional bodies but which are in fact principally, if not exclusively, concerned with voluntary regulation of practitioners but whose aim is ultimately compulsory regulation. This grouping of organisations is known as the Partnership Group, which currently comprises, amongst others, UKCP and BACP and includes the British Psychological Society (BPS). Finally comes a group of other bodies with an interest in regulation which are not necessarily regulatory bodies and some of which might more accurately be described as predominantly professional bodies. This is known as the Regulation Reference Group. This grouping of organisations arose out of the research and review of the nature of the professions of counselling and psychotherapy, known as the mapping process, carried out jointly by UKCP and BACP under the direction of DoH just over a year ago. The College is a member of this Regulation Reference Group.
The College has secured this position without giving up the right to seriously challenge and question the whole idea of regulation by the state.
The College has always argued the position that, if there is to be state-regulation of the profession, HPC, as it is currently constituted, would not be a suitable regulator. The reasons for this are set out in several documents published on this website. The College has also taken the position that, if regulation by the state does come about, this should be achieved by a body which is specifically oriented towards the psychological therapies, rather than HPC, which is oriented towards professions ancillary to medicine. It is now clear that UKCP and BACP have come to a similar conclusion.
In November 2005, representatives of The College attended the initial meeting of the then newly-formed Regulation Reference Group. The meeting was addressed by Rosalind Mead from DoH, advocating the way forward towards state-regulation and has been reported on in an earlier item in Latest News.
Following this, in December 2005, The College submitted a response to the call for ideas in connection with what has become known as the Foster Review, about regulation of the professions seen by the DoH as ancillary to medicine, including the professions concerned with the psychological therapies. This document is available via the DoH website.
Also in December 2005, The College wrote to the DoH identifying the precise location of The College on the professional scene and requesting an undertaking that we would be assured a place at future discussions concerning regulation. That assurance was forthcoming and access to the correspondence relating to this is also available from a link elsewhere in Latest News.
Consistent with this undertaking, The College, along with other organisations in the field, was notified in July by the DoH that a planning meeting of sector skills councils, qualifications authorities and others with expertise in competence development would be setting up a competence framework covering the practice of psychotherapists and counsellors and that the organisation Skills for Health, which is itself a part of The Sector Skills Council for Health, would coordinate the production of an initial framework to identify the scope of practice involved and that The College would be invited to participate.
The way forward via the determination and specification of competencies for our profession was regarded by many psychoanalytic practitioners, and possibly by most, as bad news for psychoanalysis. Again a critique setting out the arguments against this approach is on this website and is accessible from a link elsewhere in Latest News.
This month, The College has received a formal letter from Skills for Health, inviting The College to participate when the consultation process takes place between 1st December and the end of February 2007. UKCP in particular has already done a great deal of work in this area. Interestingly, however, Skills for Health went out of its way to give an assurance that the work and submissions of UKCP should not be taken as prejudging these issues and that the report already published by UKCP will constitute only one submission in the global consultation process.
Returning to the Foster Review, its findings were published in July 2006, almost simultaneously with the government's new proposals for regulation of the medical profession. As reported previously in Latest News, the two reports were presented very much as a joint bundle. The principal recommendation of the Foster Review was that there should be fewer regulators rather than a proliferation of specialised regulators and that the psychological therapies should be regulated via HPC, as if all practitioners were employed in the public services. It seems very clear from this that the government will not countenance a regulator oriented more specifically to the professions dealing with the psychological therapies. Nevertheless, DoH who published the Foster Review, called for submissions from all interested parties in a consultation process that would end on 10th November.
In order to contextualise the next development, it is helpful to note that, some time ago, BPS completed their own discussions with HPC, designed to lead to state-regulation by HPC of applied psychologists. The conclusion reached by BPS at the end of those discussions was that regulation by HPC would not be appropriate because, according to them, such regulation would not be sufficiently rigorous. Those who want to know more about this will find ample documentation and details on the BPS website.
Under existing legislation, the Secretary of State has to hold a public consultation of proposals for regulation by HPC and, until now, it has not been the practice of HPC to regulate professions that are opposed to regulation. Apparently that could be about to change in legislation currently before Parliament, enabling the government to regulate professions against their will. Furthermore, the government appears to have made it clear that, following these changes, it will regulate, via HPC, not only applied psychologists but also, probably, academic psychologists, who were never intended for regulation under the original discussions BPS had with HPC. It seems that there is an increasing determination by the government to regulate, almost immediately via HPC, psychologists of all descriptions and, ultimately within a few years, all practitioners of the psychological therapies, also via HPC.
At relatively short notice, a meeting of the Regulation Reference Group was convened on 10th October, which was attended by a representative of The College. What emerged was a joint presentation by UKCP, BACP and BPS, calling for the Regulation Reference Group to agree to make, by 10th November, a joint submission with the Partnership Group in the consultation process arising out of the Foster Review. The principal component of this submission comprised a fairly detailed outline for a new Psychological Professions Council (PPC) to regulate those professions allied to psychology, alongside those professions concerned with the psychological therapies. Although a version of this document was published on the BPS website, it subsequently emerged that the document is the result of a collaboration between BPS, UKCP and BACP. It was difficult at this meeting not to feel somewhat steam-rollered by these proposals, arising out of the immediate threat to psychologists at a time when no similar threat to practitioners of counselling and psychotherapy arises in the immediate future.
The College made every attempt to play a constructive role in these discussions and indicated that it might be possible to agree to a joint statement that was sufficiently widely worded and in a manner that would entail no definite commitment of any kind on the part of The College. In the end, the draft statement submitted by the Partnership Group for agreement by the Regulation Reference Group was too specific and insufficiently widely expressed to enable The College to agree to subscribe to it. As there was almost no time for further discussion, The College declined to subscribe but expressed its willingness to continue in constructive discussion about these issues.
In the end, The College made its own submission, under the consultation process arising from the Foster Review. A copy of that submission can be accessed by clicking this link.
The College was not the only body in the Regulation Reference Group to express reservations about these proposals. The AP-PP Section of UKCP in particular, also a membr of the Reference Group, had similar reservations. Furthermore, it is understood that BPC, also a member of the Reference Group (but not the Partnership Group) was not prepared to move away from the principle of regulation by HPC in favour of a body such as the proposed PPC.
Had The College been prepared to go along with what was being proposed by the Partnership Group, it would have been only on the basis of exploring the possibility of setting up a body such as the PPC but certainly not on the terms drafted by the Partnership Group. All aspects of the proposals must remain up for discussion, including the name itself of the proposed PPC.
Discussions within the Regulation Reference Group will continue and it is possible that this body will play an increasingly important role within the discussions for regulation of the psychological therapies by the state. The Partnership Group can now be in no doubt that there is, from some quarters, a degree of opposition to the principle of PPC, as well as wider opposition to the details of some of their proposals in the draft PPC document so far produced.