A newly-formed group, Alliance for Counselling and Psychotherapy, is to campaign against the proposed statutory “regulation” of counselling and psychotherapy by the Health Professions Council. The group outlines its case in a Statement of Intent, but the statement reflects a complicated mixture of issues.
In Pickles, in October, I described some of the background to this revolt against bureaucratic control, and in Character, earlier this month, I reviewed an article about some of the unsavoury consequences of the proposed “regulation”. In that latter article I may have been too hasty in concluding that the deal has already been done. The Alliance hopes to undo it.
The Statement of Intent makes ten main points, which I’ll paraphrase here, using the term ‘therapy’ to mean ‘counselling and psychotherapy’.
There is an inherent risk in therapy. You just don’t know whether it will work or not in any particular case. But there is no evidence of therapy causing actual harm. So introducing new rules to reduce risk makes no sense.
Even if there were any evidence of therapy causing actual harm, there’s no evidence that regulation would reduce that harm. In other professions that do cause actual harm, regulation has not reduced that harm.
Clients have very widely differing needs and preferences, which are catered for by very widely differing styles of therapy. Also, clients are mostly adults who can make their own choices about things.
Regulation would replace variety and choice with the rigid, “we know best”, pronouncements of bureaucrats.
Therapy is based on a growing body of knowledge, which grows because clients and therapists can try new things. It is not like medicine, which addresses issues much more narrowly, and in which most practitioners do not try new things.
Regulation would restrict the body of knowledge and stifle development.
Regulation would restrict training routes for therapists, and the restriction would increase costs. The increased costs would be passed on to clients (through fees and taxes).
Other countries have better arrangements.
In my opinion, the arguments in the statement are good ones but the statement does not explain them well.
The points about safety and risk are part of a wider debate in society. Unfortunately, therapists are well used to seeing through the illusion of safety created by compulsive safety-seeking behaviours. It’s easy for therapists to forget how attractive the illusion of safety is to a proportion of the public, and difficult to explain why realistic risk assessment is far better.
The points about variety and choice for clients are related to safety and risk. Having to make choices makes it seem that there is a risk of choosing wrongly, even if the actual risk is trivial. Reducing choice is another safety-seeking behaviour. Many people find it comforting to imagine that a paternalistic bureaucracy has removed all the wrong choices, leaving only the right choices. It’s difficult to explain that reality might be the other way around — that the bureaucrats might have removed the choice that was right for you, leaving only choices that are wrong for you.
The point about development is again difficult to explain. No one wants to be experimented on, so the idea that therapy is creative and experimental as a profession has to be put across carefully, showing the limitations of rigid and dogmatic approaches.
The argument about cost has surely already been lost. Someone with excellent interpersonal skills gained in their job or in voluntary work can easily pick up the techniques of CBT by reading a few books and trying the techniques informally. Such a person could be a very competent therapist, much more competent than some who emerge from academic courses with little clue about how people’s emotions really work. Yet even now, before regulation, it would be very difficult for that person to work in CBT without spending years and thousands of pounds on book-learning.
I know hardly anything about other countries’ approaches. My vague impression is that in the US, a Master’s degree carries far more weight than any sensible person would give it, but that is only a vague impression.
So it seems to me that the Alliance is entering into a much wider discussion about what government is bad at, what government is good for, and the role of illusion in public discourse. These are very big themes, and the Alliance will have to present its case with meticulous clarity to be heard.
At the same time, there are two sides to every argument and the Alliance will have to be clear about who is on the opposing side. Regulation is in some people’s interest because it will enable them to make money, have power, or perhaps gain in other ways. The Alliance should make it clear who these people are, and explain why more money, power, or whatever, for them is not appropriate.
It will be interesting to see what happens next. The Alliance is planning a conference in April to take things forward, and a wider backlash against the stupidity of governments seems possible this year. On the other hand a general fearful surrender to the paternalistic wisdom of governments also seems possible this year.
Whichever way it turns out, good counselling and psychotherapy are unlikely to go away, but they could be sidelined in the NHS and in private health insurance if the Alliance fails.
What’s that you say? They are already sidelined by diagnosis-driven pseudo-CBT? Well…
There is nothing so bad that politics cannot make it worse.