Government's plans for statutory regulation are furtive, defy research evidence, and let big business carve up the field

Warning
Government's plans for statutory regulation are furtive, defy research evidence, and let big business carve up the field

A major scandal has unfolded over the government's plans to introduce statutory regulation to psychotherapy and counselling in the United Kingdom. Without open consultation or discussion, the Department of Health has used £96,000 of public money to selectively sponsor two of the field's largest trade associations in an attempt to overcome its frustrated efforts to regulate the field. These associations, the British Association for Counselling and Psychotherapy (BACP) and the UK Council for Psychotherapy (UKCP), are effectively being given the power to define job titles and roles, and deem what practitioner training and qualifications will be acceptable. (But note the differing interpretations of their remit.) The government expects statutory regulation by the Health Professions Council (HPC)^* to be possible by 2008. BACP/UKCP's interim report to the Department of Health summarizes their progress to date.

If the government and the Department of Health are as seriously concerned about client safety as they profess:

The question of effective regulation clearly needs to be examined by a disinterested body. BACP and UKCP both have enormous vested interests, and have lobbied government departments long and hard to obtain pre-eminence in the therapy and training markets.
Any form of regulation must sensibly incorporate our current best evidence from research into psychotherapy and counselling. The knowledge base in these fields is now substantial and for several years the National Health Service has proclaimed evidence-based practice to be a central tenet of its work.

The flaws in the approach taken by the government and the Department of Health so far include:

The government's intentions have not been openly publicized or debated, yet "behind the scenes" machinations have evidently taken place for some time between the Department of Health and self-selected organizations such as BACP and UKCP.
The Department of Health has persistently ignored or deflected enquiries about the government's regulatory plans. Indeed, for several months it has refused to even enter into correspondence with individuals or organisations, except BACP and UKCP. Requests under the Freedom of Information Act have been required to extract even basic information. This lack of public accountability is unacceptable in a democracy.
Psychotherapy and counselling are being treated as "health professions", despite the overwhelming research evidence (Wampold, 2001; Bohart & Tallman, 1999; Mowbray, 1995) that psychotherapy is fundamentally a different activity from medicine and allied professions. Also, research shows that there is no well-defined body of specialist knowledge which adequately distinguishes psychotherapy and counselling from other activities.
The level of danger in psychotherapy and counselling has not been objectively assessed, especially relative to other activities for which no demand for regulation exists. The Department of Health does not have statistically significant or even substantive evidence concerning the prevalence and severity of harm caused to clients by psychotherapists and counsellors.
The Department of Health does not have any evidence that the HPC regulatory route is the most likely to improve client safety while having the least restrictive impact on services and practitioners.
The government's assumptions about professional standards defy the longstanding research evidence (for example, Beutler, 1994 & 1997; Berman & Norton, 1985) which shows that a therapist's qualifications, training, experience, and participation in personal therapy are not significantly linked to competence.

The flaws exhibited by BACP and UKCP as exemplars include:

Their members have never been proven to practise more effectively or ethically than non-members.
Their existing approaches to self-regulation fail to satisfy the criteria for credible schemes recommended by the National Consumer Council.
Contrary to their charitable constitutions, they have failed to objectively disseminate key research findings about what makes therapies and therapists effective.
The criteria imposed by their current accreditation and registration schemes are essentially spurious: they cannot determine whether a practitioner is competent or not, according to the research evidence.
As two of the most powerful trade associations, they have already established restrictive trade and training practices in the psychotherapy and counselling fields.
Conflicts of interest between the public good and professional protectionism are inherent in such trade associations.

In conclusion, the above issues cast serious doubts on the probity and efficacy of the proposed form of statutory regulation. Despite government platitudes, vested interests are being allowed to shape the project and lip service is being paid to the importance of research evidence. It is therefore unlikely that the anticipated benefits of statutory regulation will actually be delivered. Indeed, there are precedents elsewhere to suggest that increased professional status, protectionism, and client reliance on invalid practitioner credentials may increase the risk to the public and erode the integrity of the profession generally. As well as restricting the choice of therapists and therapies (the voluntary counselling sector is already struggling badly), it is very likely that clumsy regulation would increase the cost of services and discriminate against the poor and minorities becoming therapists.

Should the case for statutory regulation be properly substantiated by research evidence, sounder and more effective ways of achieving public protection are discussed in the comprehensive works of Hogan (1979-1999) and Mowbray (1995).

If you are also concerned about these developments, either as a practitioner or as a potential client, please write to your MP now and request information from the Department of Health under the Freedom of Information Act. You can also download information (290 kB in PDF format) already obtained from such a request.

^* HPC registration currently costs other practitioners £60 per year. Experienced practitioners who have not undertaken an approved training course can apply to be "grandparented" onto the HPC register but are obliged to pay an additional 'scrutiny fee' of £200. If therapists were regulated through the HPC, many of these costs would be passed on to clients or taxpayers, and the voluntary sector would be devastated by such overheads.