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Coalition Against Over-Regulation of Psychotherapy

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Some years ago, the UK government decided to explore the possibility of establishing state regulation of the talking therapies. A controversial consultation process took place, which involved the exclusion of nearly all critical voices: representatives of training organisations and user groups initially included in draft lists of committee membership were excluded, and the original Department of Health requirement to include representation from the wide spectrum of professional groups was not followed. Instead a small number of people with their own highly specific political agenda gained control of the process and have tried to force the talking therapies into a mould which quite simply won't fit. This is the mould of the medical health professional: that what a therapist does is to correct pathology.

Although there are certainly some therapists who use the medical model as a metaphor of their work the majority do not. For them, therapy is a conversation with the unconscious, an enquiry into an individual's history, a spiritual journey, an exploration of the human condition and the many other forms of enquiry which could be described under the heading: a life examined.

Disregarding these facts, the government ruled in 2007 that the talking therapies would be regulated by the Health Professions Council. In the HPC's brief, following the 2001 Health Professions Order, it is stated that "The occupation [proposed for regulation] must cover a discrete area of activity displaying some homogeneity". With the talking therapies this is simply not the case: some therapies aim to remove people's symptoms, some do not; some involve the application of predetermined procedures, most do not; some offer a set outcome, most do not; some focus on an individual's history, some do not. The list goes on, but the key is the absolute heterogeneity of the field, a fact which those who have gained control of the consultation and regulatory process seek to obscure.

Nearly all psychoanalytic and psychotherapeutic organisations argued at the time that the HPC was the wrong choice, as it promoted a narrow healthcare-based vision of therapy and was intent on applying its generic standards to talking therapy practitioners and trainings. When the government refused to revise its decision, some organisations hastily became supportive of HPC, largely due to the wish to be included in regulation and, for some, the wish for 'status and credibility'.

Unfortunately, HPC regulation will have serious consequences for therapists and their patients alike. Therapy is treated on the model of a service industry, with a defined product being sold to a patient: misery, as it were, becomes a commodity and the therapist the licensed trader. Rigid rules of conduct will block creativity and surprise, and therapy will become a mechanised procedure, with outcome decided on in advance.

The generic standards that all HPC registrants must conform to are based on a very specific view of 'health', 'well-being', personal conduct and 'best practice' that many schools of psychotherapy would not accept. This is a market-based vision in which therapy is a service the therapist delivers to a patient rather than a work that is jointly created and that is unpredictable and risky. The HPC framework is designed for disciplines such as physiotherapy and radiology, and cannot accomodate the complex nature of psychotherapy.

Therapists will have to become artificially model citizens - clinical bureaucrats - or risk being legally prohibited from practising. This contrasts with the recognition that the human dimension - faults included - is the crucial matrix of the therapeutic encounter. The sanitised image of the practitioner demanded by HPC has little relation to the realities of human life that are so important to engage with in therapy.

These developments are part of a wider move today to regulate not simply behaviour but human thought itself: beyond the official policies to respect diversity and difference, there is an ever growing intolerance of belief systems that do not fit a business framework. Human relationships are seen as transactions, and a patient's wish to pursue a particular therapy that does not offer any set outcome will no longer be taken seriously. Instead, they must be protected from their own beliefs, and consult only someone chosen by the State.

The HPC has already declared that it will launch a public advertisting programme to warn the public not to use those therapists who do not sign up to its narrow medical healthcare model of therapy. This has serious consequences, not only for the public, effectively restricting their access to the therapies they might wish to pursue, but to the life of the profession itself, where training will have to teach the new healthcare model of HPC and its partner Skills for Health, who have now proposed a list of 451 rules for analytic work, telling therapists not only what to do but what to feel in their sessions .

Public protection has so far been the main argument of HPC. They claim that many therapists - between 5 and 10% - abuse their patients, and that only HPC regulation will stop that. In fact, the statistics are more or less drawn out of thin air, and not based on any serious literature. Likewise, the argument that only HPC regulation will stop this is contradicted by the fact that in all the cases in which the HPC has prosecuted practitioners, the wrongdoers have actually been registered already with HPC!

HPC also claim that only their regulation will stop anyone putting up a brass plaque calling themselves a psychotherapist. Yet, aside from the fact that it would be very difficult to find an example of someone who has done this (apart from the comedian Bernard Manning), HPC have never, as far as we know, prosecuted anyone for claiming to be a practitioner of any of the 13 health professions they regulate. Their prosecutions are always of practitioners who are already HPC registered and who are usually reported not by patients but by work colleagues or competitors. Their investigations are highly adversarial, and those under investigation are 'named and shamed' on the HPC website and in press releases before the actual case has been heard. In a recent case, a speech and language therapist endured two years of hell before being found not guilty of his 'crime' of having given a handicapped boy extra sessions privately after their NHS contract of 6 sessions had ended: he had charged the family one pound per session.

The other main problem with HPC's claim to protect the public is that if an HPC registered practitioner is struck off, they may still set up a practice under a different title, eg calling themselves a coach or any other title not in the HPC remit. The problem of dangerous individuals is thus not solved by this form of regulation. No psychotherapists are against regulation: it is just regulation under the government-controlled HPC that is problematic. All therapy organisations have codes of ethics and complaints procedures already, and regulatory consultations in many other countries have recognised this, together with the diversity of conceptions of therapy. The most robust model of regulation involves the statutory requirement that all therapists are registered with a list, administered by a peak professional body, giving full disclosure of training and qualifications, together with a public education programme to inform the public about the different varieties of therapy available.

In the UK, there is a growing opposition to HPC regulation. The emergence of the Coalition is one indication of this, together with the newly-created Alliance for Counselling and Psychotherapy, which has brought together more than 2000 practitioners who are against HPC regulation. A meeting held at the end of March by the HPC in Manchester showed the strength of this opposition: careful and rational arguments for other regulatory models were countered by scaremongering and appeals to the 'The train has already left the station'. Hopefully the growing public awareness of the debate will mean that the UK Parliament will not accept the HPC as regulator of the talking therapies. The rumour at the moment is that HPC is now quite fed up with the therapists and wishes that the government would take the task of regulating them somewhere else. Watch this space...

Coalition Against Over-Regulation of Psychotherapy


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Some years ago, the UK government decided to explore the possibility of establishing state regulation of the talking therapies. A controversial consultation process took place, which involved the exclusion of nearly all critical voices: representatives of training organisations and user groups initially included in draft lists of committee membership were excluded, and the original Department of Health requirement to include representation from the wide spectrum of professional groups was not followed. Instead a small number of people with their own highly specific political agenda gained control of the process and have tried to force the talking therapies into a mould which quite simply won't fit. This is the mould of the medical health professional: that what a therapist does is to correct pathology.

Although there are certainly some therapists who use the medical model as a metaphor of their work the majority do not. For them, therapy is a conversation with the unconscious, an enquiry into an individual's history, a spiritual journey, an exploration of the human condition and the many other forms of enquiry which could be described under the heading: a life examined.

Disregarding these facts, the government ruled in 2007 that the talking therapies would be regulated by the Health Professions Council. In the HPC's brief, following the 2001 Health Professions Order, it is stated that "The occupation [proposed for regulation] must cover a discrete area of activity displaying some homogeneity". With the talking therapies this is simply not the case: some therapies aim to remove people's symptoms, some do not; some involve the application of predetermined procedures, most do not; some offer a set outcome, most do not; some focus on an individual's history, some do not. The list goes on, but the key is the absolute heterogeneity of the field, a fact which those who have gained control of the consultation and regulatory process seek to obscure.

Nearly all psychoanalytic and psychotherapeutic organisations argued at the time that the HPC was the wrong choice, as it promoted a narrow healthcare-based vision of therapy and was intent on applying its generic standards to talking therapy practitioners and trainings. When the government refused to revise its decision, some organisations hastily became supportive of HPC, largely due to the wish to be included in regulation and, for some, the wish for 'status and credibility'.

Unfortunately, HPC regulation will have serious consequences for therapists and their patients alike. Therapy is treated on the model of a service industry, with a defined product being sold to a patient: misery, as it were, becomes a commodity and the therapist the licensed trader. Rigid rules of conduct will block creativity and surprise, and therapy will become a mechanised procedure, with outcome decided on in advance.

The generic standards that all HPC registrants must conform to are based on a very specific view of 'health', 'well-being', personal conduct and 'best practice' that many schools of psychotherapy would not accept. This is a market-based vision in which therapy is a service the therapist delivers to a patient rather than a work that is jointly created and that is unpredictable and risky. The HPC framework is designed for disciplines such as physiotherapy and radiology, and cannot accomodate the complex nature of psychotherapy.

Therapists will have to become artificially model citizens - clinical bureaucrats - or risk being legally prohibited from practising. This contrasts with the recognition that the human dimension - faults included - is the crucial matrix of the therapeutic encounter. The sanitised image of the practitioner demanded by HPC has little relation to the realities of human life that are so important to engage with in therapy.

These developments are part of a wider move today to regulate not simply behaviour but human thought itself: beyond the official policies to respect diversity and difference, there is an ever growing intolerance of belief systems that do not fit a business framework. Human relationships are seen as transactions, and a patient's wish to pursue a particular therapy that does not offer any set outcome will no longer be taken seriously. Instead, they must be protected from their own beliefs, and consult only someone chosen by the State.

The HPC has already declared that it will launch a public advertisting programme to warn the public not to use those therapists who do not sign up to its narrow medical healthcare model of therapy. This has serious consequences, not only for the public, effectively restricting their access to the therapies they might wish to pursue, but to the life of the profession itself, where training will have to teach the new healthcare model of HPC and its partner Skills for Health, who have now proposed a list of 451 rules for analytic work, telling therapists not only what to do but what to feel in their sessions .

Public protection has so far been the main argument of HPC. They claim that many therapists - between 5 and 10% - abuse their patients, and that only HPC regulation will stop that. In fact, the statistics are more or less drawn out of thin air, and not based on any serious literature. Likewise, the argument that only HPC regulation will stop this is contradicted by the fact that in all the cases in which the HPC has prosecuted practitioners, the wrongdoers have actually been registered already with HPC!

HPC also claim that only their regulation will stop anyone putting up a brass plaque calling themselves a psychotherapist. Yet, aside from the fact that it would be very difficult to find an example of someone who has done this (apart from the comedian Bernard Manning), HPC have never, as far as we know, prosecuted anyone for claiming to be a practitioner of any of the 13 health professions they regulate. Their prosecutions are always of practitioners who are already HPC registered and who are usually reported not by patients but by work colleagues or competitors. Their investigations are highly adversarial, and those under investigation are 'named and shamed' on the HPC website and in press releases before the actual case has been heard. In a recent case, a speech and language therapist endured two years of hell before being found not guilty of his 'crime' of having given a handicapped boy extra sessions privately after their NHS contract of 6 sessions had ended: he had charged the family one pound per session.

The other main problem with HPC's claim to protect the public is that if an HPC registered practitioner is struck off, they may still set up a practice under a different title, eg calling themselves a coach or any other title not in the HPC remit. The problem of dangerous individuals is thus not solved by this form of regulation. No psychotherapists are against regulation: it is just regulation under the government-controlled HPC that is problematic. All therapy organisations have codes of ethics and complaints procedures already, and regulatory consultations in many other countries have recognised this, together with the diversity of conceptions of therapy. The most robust model of regulation involves the statutory requirement that all therapists are registered with a list, administered by a peak professional body, giving full disclosure of training and qualifications, together with a public education programme to inform the public about the different varieties of therapy available.

In the UK, there is a growing opposition to HPC regulation. The emergence of the Coalition is one indication of this, together with the newly-created Alliance for Counselling and Psychotherapy, which has brought together more than 2000 practitioners who are against HPC regulation. A meeting held at the end of March by the HPC in Manchester showed the strength of this opposition: careful and rational arguments for other regulatory models were countered by scaremongering and appeals to the 'The train has already left the station'. Hopefully the growing public awareness of the debate will mean that the UK Parliament will not accept the HPC as regulator of the talking therapies. The rumour at the moment is that HPC is now quite fed up with the therapists and wishes that the government would take the task of regulating them somewhere else. Watch this space...