by Phil Dore
For people seeking therapy, there can often be a bewildering array of job titles. What's the difference between a counsellor and a psychotherapist? What's a Jungian analyst? Or a life coach? Is there a difference between a family therapist and a systemic psychotherapist?
And more importantly, how do you know whether your chosen therapist is accountable? Will you be able to make a complaint if things go wrong?
Please note that during this blog post I'll be referring to how things are in the UK, and this may not apply to other countries.
Let's start with some bad news. “Counsellor” and “psychotherapist” are not protected titles, and are not state-regulated. My own job title is “nurse therapist”, and I sometimes get people looking impressed, saying, “Oh, you're a nurse therapist?” But actually the word that has real legal meaning is “nurse”. I had to train for three years to use it, have to maintain my registration, and if someone were to misuse that title they could go to prison. By contrast “therapist” could mean all kinds of things. Play therapist. Beauty therapist. Dolphin therapist (no, I'm not joking). Shamanic therapist (I'm not joking about that one either).
There's a couple of exceptions to the lack of protected titles. Practitioner psychologists (such as clinical psychologists, counselling psychologists and educational psychologists) are regulated by the Health and Care Professions Council. So too are arts therapists, including music and drama therapists. If you engage in therapy with a psychiatrist or mental health nurse, they will be regulated by the General Medical Council or Nursing and Midwifery Council, respectively.
Outside of those professions, it's not entirely a free-for-all. Professional bodies do exist, but membership of them is entirely voluntary and their quality can vary wildly. Under the previous Labour government, there were proposals to bring in statutory regulation of counsellors and psychotherapists, so that they would join their psychologist and arts therapist colleagues on the HCPC register. This was shelved when the Coalition took over, in favour of a form of “regulation-lite” where the existing professional bodies could apply to be accredited by the Professional Standards Authority. This “assured voluntary registration” would be granted to bodies that could show that they meet certain standards, including having effective complaints procedures to deal with allegations of misconduct.
The largest of the professional bodies is the British Association of Counselling and Psychotherapy. They achieved PSA accreditation in February 2013. The second largest, the UK Council for Psychotherapy (UKCP) is still working towards accreditation, and at this point things get complicated and problematic.
The UKCP acts as an umbrella body for 75 smaller psychotherapy organisations. Historically these 75 organisations did their own complaint-handling, with the UKCP acting as an appeals body. The complaints procedures can vary wildly, and some of them are shockingly awful. For example, if you wanted to make a complaint to the Guild of Psychotherapists, then here's their Code of Ethics. Complaints have to be proved to the criminal standard of “beyond reasonable doubt”. The normal benchmark in such matters is the civil standard of “on the balance of probabilities”. If that isn't intimidating enough, take a look at this clause.
1.2 In addition to any such action the Panel shall have the power in its discretion to require that the Respondent shall pay any costs and expenses incurred by the Panel occasioned by the hearing in the event of the complaint being upheld against the Respondent and to require the Complainant to pay such costs and expenses in the event of the complaint not being upheld. [emphasis added]
Yep, if you don't succeed in proving your complaint beyond reasonable doubt, you could be handed a big bill. It's almost as if they want to put complainants off or something.
Still at least the Guild of Psychotherapists have the decency to put their complaints procedure and Code of Ethics online. A surprising number of websites for UKCP member organisations don't provide this basic information.
For those complaints that do succeed, in some cases the sanctions have been totally inadequate. A few months ago it came to light that a UKCP member organisation, the Arbours Association, had suspended a therapist called Geoffrey Pick for one year due to serious sexual misconduct with a vulnerable client. In any other profession such actions would warrant an automatic striking-off. When his suspension ended he was allowed to resume practice, and only resigned his registration when the media started taking an interest. Since then a near-identical case has emerged involving another member organisation. Stuart Macfarlane is currently suspended for two years by the Guild of Analytical Psychologists for the exact same type of misconduct. He could potentially be practising again a year from now.
The UKCP is aware that this is unacceptable, and certainly will not pass muster if they want to be accredited by the PSA. For this reason they have brought in a centralised Complaints and Conduct Process to take over complaints-handling from the member organisations. The difficulty here is that while some member organisations have signed up to the CCP, others have not yet done so. Meanwhile the PSA have made it clear that they will not accredit the UKCP unless the CCP covers 100% of the membership. Until this is resolved, the UKCP's accreditation hangs in the balance.
My advice to anyone seeking a counsellor or psychotherapist is to look into who they are registered with. For preference, employ either a HCPC-registered professional such as a clinical psychologist or arts therapist, or somebody registered with a PSA-accredited body such as the BACP. If considering a UKCP-registered psychotherapist, ask them if they're signed up to the CCP. If people don't fulfil any of these criteria, don't use them.
Phil Dore blogs regularly on Wordpress under the name Zarathustra. You can also follow him on Twitter.
OCTOBER 2014 UPDATE: THE UKCP NOW HAVE AN ACCREDITED VOLUNTARY REGISTER OPERATING UNDER THE PROFESSIONAL STANDARDS AUTHORITY