Regulation

Regulation of Psychotherapy in the UK and Europe

Unlike medicine, nursing or psychology, psychotherapy and counselling in the UK and many parts of Europe are professions that are not regulated or licensed by government as they may be in some other countries. A few years ago the UK government declined to assert State control over psychotherapy and counselling in response to a petition signed by individuals who wanted the State to do so. Many professionals in the field vehemently objected to external control of their work.

Private trade organisations have set themselves up as systems of over-sight and management of professionals who choose to become paying members. Membership with them is neither a legal nor professional requirement in the UK, but is purely voluntary. Some fully qualified practitioners take out membership and other fully qualified practitioners choose not to, as is their right to do so. I operate within the code of ethics, goodwill policy and professional boundaries laid out in my agreement, and put both the welfare of my patients and customer service first in my practice, operating in life according to personal responsibility, accountability, autonomy, transparency and fairness. I currently choose not to take out annual membership with any private organisation whilst it remains voluntary. However, if it is important to you that you see a practitioner who is governed by a private trade organisation then please seek help via one of their membership lists, which contain the details of thousands of counsellors and therapists who choose to be affiliated with them.

For and Against

Opinion is divided between those who favour regulation and over-sight of professions by government or private organisations, and those who object to such control and interference. Many believe that centralising power and asserting even more control over individuals under the threat of scrutiny, penalty or loss of career, is simply allowing citizens to further submit themselves to a 'Nanny State' culture of fear and taxation, with citizens already suffering the daily loss of civil liberties and freedoms that countless agencies impose upon us all in return for our paying for the privilege of being dictated to, managed, controlled and sometimes punished by them for non-conformity. Others believe that without over-sight and regulation patients and clients could be easily harmed or exploited by unscrupulous practitioners, the implication being that adult citizens are not competent enough in themselves to recognise and address any problems they encounter. The 'nanny position' is one of the main arguments used by advocates of so-called 'regulation'.

Whilst there are valid points and arguments on both sides, it is also true that unscrupulous and incompetent practitioners continue to exist in every field whether professions are regulated or not. I have personally witnessed toxic individuals who remain members of regulatory organisations e.g. psychologists, counsellors, doctors etc, manage to remain within the rules and ethical codes prescribed by their institutions, and who still slip through the cracks and loopholes in policy manuals and arbitration panels, whilst being permitted to practice in incompetent or objectionable ways.

Institutional Injustice

Furthermore, I have also seen with my own eyes such individuals escaping penalty from their regulatory bodies e.g. the British Psychological Society, even when substantial evidence existed against them. Breaches of the spirit of ethical codes can still be interpreted favourably in terms of the letter of those codes, thus allowing toxic practitioners to evade accountability of such breaches with the aid of bias and favour brought by committees of bureaucrats. These bureaucrats are serving their own interests, and where membership fees fund the entire organisation there is a clear conflict of interest in any institution that purports to police the membership that funds it. A similar situation exists in courts of law around the world, whereby the guilty escape justice every day of the week based on technicalities, clever argument, and the absence of common sense, all the while making fortunes for those who operate within the system.

Abuse of Complaints Procedures

A small minority of highly toxic individuals who go to therapy with an axe to grind attempt to use complaints procedures to indulge their own desire for cruelty and destruction, seeking to ruin the lives and careers of competent, caring and genuine practitioners who did them no harm whatsoever (READ: The Toxic Victim article in Resources). People who are Toxic Victims may have suffered in their lives, but instead of facing their suffering, taking responsibility for change, and evolving beyond it, they act out whatever darkness they carry from their past by exploiting or abusing the innocent around them in the present. These individuals may have already attracted the attention of the police by their habit of creating drama and controversy in one form or other, and play the victim card in life, using medical and psychiatric diagnoses to demand sympathy or meet entitlement needs at the expense of other people. Typically, they become vengeful if their behaviour is challenged in any way and are often barred from NHS and mental health services as a result. Even when offered help, honesty, kindness, fairness, discounts, or refunds such individuals will still act out histrionic or destructive impulses with little shame or insight, defying fairness or reason, sometimes years after they formed their original grudge. Complaints to authorities become the convenient vehicles by which such individuals are permitted to wreak vengeance on people who have done nothing to them, often in long, drawn-out proceedings spanning months or years. The worry and stress caused by this can be ruinous to the health, reputation and livelihood of a practitioner and his family, which is the poisonous aim that Toxic Victims strive to achieve. Writing negative online reviews is another example of this form of increasingly common hatred and vitriol, vented towards practitioners whose only mistake may have been to engage with the patient at their request.

Human Being

Lastly, I have been a patient (during my training years) to therapists who were 'registered' with private organisations and those who were not. The most helpful, insightful and 'human' therapists I saw either chose not to be members of such institutions, or had the personal integrity to put common sense before institutional policy when required, thus breaking rules that defy and defeat common sense. By contrast, one extremely abusive, manipulative practitioner I saw very briefly (before I had the good sense not to return to her) not only trumpeted such membership, or 'registration', but also occupied executive and teaching positions in a well-known therapy training centre in London.

Despite the culture of suspicion that has developed around questions of 'registration' (a quasi-medical-sounding culture created by those who wear membership as a badge of honour and who typically treat detractors with suspicion), there is nothing sinister, shameful or criminal about non-affiliated practice. Membership of a trade organisation guarantees very little in terms of real practitioner competence or real protections for the public, since complaints are made after any damage has been done. In my experience there is no direct relationship between registration and skill or competence, or the absence of skill or competence with non-registration.

Indeed, it could be argued that membership of any organisation that has the power to rake you over the coals, stress you for months of your life, or take your career away from you, necessarily introduces some degree of background fear into a member’s way of working, which is one of the worst influences upon anyone who wants to work creatively, intelligently, spontaneously and confidently. Rote conformity under fear of making a mistake is why many of the helping professions become homogenous copies of one another that are risk-averse, defensive and ultimately aligned with the establishment.

Personal Responsibility and Working Philosophy

Having been a member of a regulatory body for many years as a requirement of my employment at the time (employers are often compelled by the demands of insurance companies), my current position on the question of whether or not to impose more bureaucratic control over individuals errs towards the recovery and preservation of individual autonomy. I'm passionately supportive of the individual's power of self-determination, liberty and responsibility, whilst also building into my professional practice sufficient practical safeguards - fully declared upfront - to preserve and empower patients to protect their own interests as competent adults, session by session, in the form of, for example:

A full psycho-social and risk assessment of patient needs and history prior to any work
A Goodwill Refund policy that provides free sessions, no questions asked, to anyone at any stage of the work who is dissatisfied with the support they receive in any psychotherapy session
Numerous guides and written guidance on how best to use therapeutic support
A common sense complaints process based on caring, fairness and compassion that allows patients to discuss difficulties for the purposes of modifying approach, clearing up misunderstandings or ending the work amicably
Continuous review and reflection with my patients during sessions, with regular invitations to patients to monitor whether they are getting what they want from sessions; and encouragement to ask for anything they may feel is missing.
A detailed Agreement setting out boundaries that are designed to make my practice transparent, secure and safe
A full disclosure policy regarding who I am as a person, the way I work in sessions and my intervention rationale, and my professional status and qualifications
A substantial Resources section containing psycho-educational material designed to empower patients to make informed choices about their care, encouraging self-support, understanding and self-reliance, thus discouraging long-term dependence on therapy
A core therapeutic philosophy that values and develops personal authenticity, autonomy and responsibility, which are philosophically opposed to the authoritarian and paternalistic controls asserted by institutions over the free individual, akin to parent over child
Continuous personal and professional development as a feature of my vocational interest in developing my skills, knowledge and competence in the service of my patients

Your Freedom to Choose

As with plumbers, joiners, roofers and other trades, the world does not lack therapists and it is very likely that you have many dozens, hundreds, if not thousands of them within travelling distance of your location. If it is important to you that you see a practitioner who is a member of a private trade organisation or if you are in any doubt whatsoever about seeing an independent practitioner, then please seek help via one of the many membership lists available. These lists contain the contact details of counsellors and therapists who want to be advertised, marketed and managed by private organisations that act as their regulatory bodies.