Information, news and debate about psychoanalytic and psychodynamic psychotherapies
February 2009 Update
Steady progress towards statutory regulation is now underway. The Health Professions Council’s Professional Liaison Group (HPC’s PLG) for Psychotherapists and Counsellors has met twice and the broad contours of regulation are now taking shape.
Structure of the Register and title
The first meeting of the PLG took place in December 2008 and was little more than an introduction to the process. The second meeting on 28 and 29 January 2009 got down to the crucial business of the structure of the register and protected title. Michael Guthrie, HPC’s Head of Policy and Standards, presented a paper summarising the broad options and spectrum of views emerging from the Call for Ideas.
It is important to say that the whole discussion being conducted across the five meetings up until May 2009 is regarded as interrelated. Therefore, any ‘conclusions’ reached within any one meeting will be re-examined in the light of the whole discussion and will be purely tentative until the end.
Protection of title or function?
HPC regulates by the protection of title not by the protection of function. Most regulation in the UK operates in this way, although there are some examples of restricting function, e.g., the fitting of contact lenses. This means that HPC cannot prevent individuals who wish to avoid regulation ‘rebranding’ their services and continuing in practice. The problem with the protection of function is seen as tending to fetter the change and development of professions, and the emergence of new roles and professions. In addition, it is often tricky to define in law the precise nature of an intervention.
Psychotherapy and counselling
The first debate centred around whether to differentiate in the Register between psychotherapists and counsellors. Almost all present acknowledged that there was a large area of overlap between the two activities and that it was difficult to make a hard distinction in practice. Peter Fonagy argued that there were two issues. First, in terms of activity, research could not demonstrate there was any useful distinction between the two fields: in particular, no-one knows what the effective component is within psychotherapy or counselling interventions. However, in terms of perception, two prototypes exist within the public mind. Counselling is seen as a highly approachable intervention without the stigma of mental illness attached.
Psychotherapy comes from a more clinical perspective, tends to assume a disorder and, at heart, is based upon a medical model. The question was whether we wanted to preserve this broad distinction. On balance, Peter Fonagy thought that the distinction would support the continuing accessibility of counselling which might be weakened by lumping them together.
This general approach was broadly supported. The caveat was made that not all psychotherapists considered they operated within a pathology-orientated model, and that not all counsellors saw themselves as operating outside of that. However, all were agreed that counselling had its own strengths and capacities and that it was crucial it was not seen as ‘psychotherapy lite’. Fiona Ballantine Dykes made the point that if, as a result of combining the two groups, the standards of training and education were set too high for counselling, then this would have the effect of decreasing the accessibility of counselling.
The broad conclusion reached was that
• there would be a single part of the Register for both psychotherapists and counsellors
• as well as HPC generic standards of proficiency, there would be profession-specific standards of proficiency common to both
• there would be two separate protected titles: psychotherapist and counsellor
• in addition to the generic and profession-specific common standards, each title would have its own standards of proficiency.
With this structure, someone completing an approved training programme in counselling would be registered in the Psychotherapists and Counsellors part of the Register but only have access to the protected title for counsellors, and not the title for psychotherapists.
It was acknowledged that if, when it came to drawing up standards of proficiency, then insufficient distinction could be made between the two sets of standards then the group might have to reconsider this question.
Differentiation around modalities
The next major discussion was whether a further level of adjectival title based on modality should be introduced. BPC and British Association for Behavioural and Cognitive Psychotherapies (BABCP) both argued that it should. However, the clear view of the majority of the group was that attempting to introduce this level of differentiation was unnecessarily complicated given that, at the last count, there were over 600 types of psychotherapy. The point was made that the promotion of specific modalities was properly left to the professional bodies, and that such a function re-affirmed their role.
Peter Fonagy argued that the evidence was that bona fide psychotherapies based on a theoretically coherent model with an attached body of literature were effective but that those which did not have these features were ineffective. The BPC had also made this point in its Call for Ideas submission. It was crucial that, whether or not there were modality-specific titles, regulation should seek to support effective, bona fide orientations. It was agreed that this issue was important but might be relocated to the discussion around standards of education and training.
Differentiation around client groups
Peter Fonagy also argued that the group should consider the differentiation of the role of child psychotherapist. The Whitley Council had recognised child psychotherapy as a core profession within the NHS, unlike psychotherapy in general. There would need to be very strong reasons for a regulatory structure not to incorporate the distinctiveness of child psychotherapy.
Whilst the group recognised the importance of the specialist training required for child psychotherapy, it felt that this need not be reflected in the structure of the Register. Rather, individuals (or their employers) would need to make judgements about the scope of their practice relative to their skills and training. There were other areas of specialism and other vulnerable groups.
It was generally agreed that this issue could be reconsidered within the discussion around standards of education and training.
Timetable
There are two parts to the work needed before the introduction of the required secondary legislation: the work of HPC’s PLG, now underway, followed by the work of the Department of Health (DH)’s Professional Regulation Branch in drafting the legislation. This will result in a Section 60 Order under the Health Act 1999 which will then need to be passed in the UK and Scottish parliaments. In parallel, the professional bodies will need to liaise with HPC around the practicalities of the transfer to a statutory register. The estimated timetable is now:
Dec 2008 – May 2009 5 meetings of HPC’s PLG
July 2009 PLG’s report to HPC’s Council
July – Oct 2009 Public consultation on HPC’s report
Oct 2009 – April/Oct 2011 DH draws up legislation
2011* Public consultation on draft Section 60 Order
2011* Legislation goes through UK and Scottish parliaments
2011* Professional bodies liaise with HPC around transfer of registers
2011* Opening of the Register
*This is an estimate and it is easy to see how this timetable may slip somewhat.
Membership of the PLG
There are 17 members of the group which is chaired by Diane Waller, an arts therapist and member of the HPC Council. The BPC is represented by Julian Lousada. Peter Fonagy, a BPC registrant, represents Skills for Health. Malcolm Allen, our Chief Executive, attends the meetings as an observer.
The complete membership of the PLG is:
Sally Aldridge – British Association for Counselling and Psychotherapy (BACP)
Fiona Ballantine Dykes – Counselling and Psychotherapy Central Awarding Body
Mary Clark-Glass – Lay member of the HPC Council
Jonathan Coe – We Need To Talk
Mick Cooper – University of Strathclyde
Peter Fonagy – Skills for Health
Julian Lousada – British Psychoanalytic Council (BPC)
Jeff Lucas – Lay member of the HPC Council
Brian Magee – COSCA (Counselling & Psychotherapy in Scotland)
Linda Matthews – British Association for Behavioural and Cognitive Psychotherapies (BABCP)
Rose Mary Owen – Relate Institute
Jean McMinn – Queen’s University Belfast
Kathi Murphy – United Kingdom Council for Psychotherapy (UKCP)
Eileen Thornton – Alternate Physiotherapist member of the HPC Council
Annie Turner – Occupational therapist member of the HPC Council
Graham Smith – Physiotherapist member of the HPC Council
Diane Waller – Arts therapist member of the HPC Council and Chair of the PLG
Future meetings of HPC’s PLG
3rd meeting (3 and 4 March) – education and training standards; standards of proficiency
4th meeting (29 April) – voluntary register transfers; grandparenting
5th meeting (26 and 27 May) - education and training standards; standards of proficiency.
The precise sequence of the subjects for the final two meetings is subject to revision.
Our impressions so far
We have been impressed by the thoughtfulness and non-dogmatic nature of the discussion. This has been aided, in large part, by the calibre of the paperwork provided by Michael Guthrie.
The BPC put a strong case for the consideration of modality-specific titles (as set out in our response to the Call for Ideas).
Nevertheless, we had always appreciated the level of complexity that this was likely to bring to the regulatory framework and we are now going with the grain of what is clearly the majority view on this issue (as outlined above). We believe the point is well made that this position is likely to strengthen rather than diminish the specialised role of the professional bodies. It will be for the BPC rather than HPC to maintain, represent and promote the professional standards associated with the practice of psychoanalytic psychotherapy, particularly at the more intensive end of the spectrum.
We believe our registrants will welcome the distinction between counselling and psychotherapy. There is still much to play for in the forthcoming discussion of standards of education and training.
Opposition to statutory regulation
There are a number of psychotherapists and counsellors who are actively opposed to statutory regulation and, almost certainly, many more who have concerns about this development. Many of our own registrants may have a feeling of unease about the regulatory future.
An Alliance for Counselling and Psychotherapy against State Regulation is now actively campaigning against regulation by HPC. This group has used the BPC’s commercial facility of placing an insert in our mail-out to publicise its cause.
Whilst we respect the views of our colleagues who have taken this stance, the decision to engage constructively with the introduction of statutory regulation, including with the HPC, is a long-settled one for the BPC. There is no intention of reconsidering our long-held position on this issue which was a central assumption of the Strategy Conference last May. Of course, until the final regulatory package is in place, we cannot offer our unqualified endorsement of whatever proposals emerge. However, it would be hard to see what is realistically likely to happen at this stage that would tip us into outright opposition.
But we need to engage with the concerns of our registrants in this area. The BPC Council meeting on 26 September discussed how it could address these and considered this was best done through the BPC’s Member Institutions. Registrants concerned about this issue should contact their Member Institution for information.
We have no desire here to dive too deeply into this ‘debate’. The issues of principle have been around for very many years and have been rehearsed many times over within the BPC. The BPC Executive, Council and May 2008 Strategy Conference have begun to set out a forward-looking strategic vision for the future – one that aims to help create the conditions for psychoanalytic psychotherapy to flourish in the decades to come. At its heart is taking our place in today’s world, affirming the powerful contribution psychoanalytic psychtherapy can make, building a vibrant, more inclusive psychoanalytic community, positioning ourselves as a scientifically-informed, evidence-based practice, and attuning ourselves to the demography of contemporary Britain. It is our own version of ‘the audacity of hope’. A re-heated debate on the desirability of statutory regulation can only serve to divert the progressive energies needed to take this vision forward into a desolate cul-de-sac.
• All the main documents are available at HPC’s website: www.hpc-uk.org/aboutus/professionalliaisongroups/psychotherapistscounsellors/
Download minutes of the January meeting here
Download the PLG documents used at the 28-29 January meeting