UK COUNCIL FOR PSYCHOTHERAPY

DRAFT DOCUMENT FOR CIRCULATION TO DELEGATES AND MOs

ORGANISATIONAL DEVELOPMENT ISSUES FOR THE
UNITED KINGDOM COUNCIL FOR PSYCHOTHERAPY FOLLOWING THE
AGM 2003.

This is a discussion document that has been considered by the Governing Board following the AGM 2003.

In considering the way forward the Governing Board focused on three options:

1.	To continue to manage the existing structure of the UKCP as effectively as we can.
2.	To develop individual registration under the Registration Board.
3.	To develop institutional membership based on individual registration.

The Governing Board was unanimous in rejecting the first option. It was agreed that it is essential to work towards the development of an alternative structure

It recommended the exploration of the third option. There was an agreement that developing institutions based in most cases on the present Sections offered a way forward that might address some important problems and create valuable new opportunities. This does not foreclose the exploration or development of other options or represent a firm commitment to the third option.

The Governing Board recognised the need for feasibility studies on any future organisational development. It agreed that it would be valuable to examine the experience and practice of other regulatory organisations.

Most importantly it agreed that it was essential to consult the Member Organisations at an early stage about the outlines of the proposed developments.

It is for this reason that the Governing Board thought that it would be helpful to circulate this paper to encourage debate in the Member Organisations and the Sections.

1. Strategic & Structural Review

At the AGM in 2002 it was agreed that the organisation needed to conduct a strategic and structural review of its activities. There was further discussion of these issues at the Chair's Day and at the AGM.

It is important in reviewing the current situation to note that alongside the discussions to take forward the review process many issues that have strategic and structural significance are being addressed.

This discussion paper starts by noting some of these developments (Section 1). The paper goes on to consider some of the issues that form the context for the review (Section2). The paper then turns to the issue of individual registration (Section 3) and the impact of individual registration on Member Organisations (Section 4).

The paper then considers the role of the sections and raises the possibility that the UKCP might be re-organised on the bais of a number of indiviudal member-based institutions. These would in many cases be derived from the exisiting Sections.

1.1.	The Registration Board and Labels.

The AGM of 2002 agreed that through due process the UKCP should take decisions on the contentious issues concerning the labels used in the Register to describe the form of psychotherapy a particular registrant offers. This is one of the decisions that involved the UKCP, and the Registration Board in particular, in developments of strategic and structural significance.

1.1.1. The UKCP has had to develop a stronger capacity to take decisions on contentious issues in a thoughtful way.

1.1.2. Self-regulation creates many difficulties for decision making. One is the problem of designing decision-making processes that are professionally informed but effectively serve the public interest. Steps that have been taken to ensure that the public interest is served include the creation of carefully thought out processes, the identification and management of conflicts of interest, and an increase in lay involvement.

1.1.3. The decision of the 2002 AGM has important implications for the status of the Register. With this decision the AGM made it clear that the Register belongs to the UKCP as a whole and that while individual Sections or MOs make proposals and contribute to the debate they are not the arbiters of what ultimately appears in the Register. Arguments that only the Sections were capable of understanding the meaning of their own labels have been set aside. This was a necessary step if the Register is to be an authoritative document.

1.1.4. A particular problem is that because of the voluntary nature of the regulatory process organisations within the UKCP may leave if decisions are taken that they dislike. The UKCP already has experience of this and it is a continuing threat. The implications for this of the 2002 AGM decision were twofold. Firstly it is recognised that the UKCP should take careful account of the position of minorities (hence the commitment to due process). Secondly it is recognised that the UKCP cannot be held to ransom by threats to the point that it is immobilised.

1.1.5. It is clear that label issues have the potential to be highly divisive. The current controversies are not likely to be the last. The consequence of the approach that has been adopted is that in theory the Registration Board should over time, review all the labels and establish their meaning, the specific practice to which they refer, and the training standards that apply. It is not clear that the UKCP should concern itself with the very wide variety of labels currently used in the Register.

1.1.6. The implication of this is that a different more generic labelling process for the psychotherapies should be considered. See below.

1.2. Clarity about the existing structure

A second consequence of the debates at the 2002 AGM and the implementation of the commitment to due process has been a greater clarity about the structure of the UKCP as it stands at present.

1.2.1. The AGM is the ultimate authority within the UKCP. However, the AGM does not run the UKCP. The AGM is specifically charged with electing a Governing Board to do that and most of the powers and responsibilities connected with governing the UKCP rest with the Governing Board.

1.2.2. The Governing Board constitutes the Trustees of the organisation and is legally responsible for its management. A historic difficulty has been created by the use of the AGM as a consultation forum. This has given rise to confusion about the proper roles of the Governing Board and the AGM. With the example of the Registration Board's consultation process on labels leading the way, the UKCP is beginning to develop consultation mechanisms appropriate to the different issues that have to be addressed. The decision by the 2003 AGM to accept the Registration Board's report, and thereby not to seek the reversion of the label issue to the AGM for decision, represents an important development in the clarity of the organisation's processes.

1.2.3.	Certain committees, in particular the Registration Board and the Professional Conduct Committee have important areas of delegated authority. In the course of 2002/3 steps were taken in both cases to clarify the balance between the necessary level of independence of these committees and the Governing Board's responsibility for the organisation as a whole.

1.3. Ongoing management

1.3.1.	Much needed to be done in 2002/3 in relation to the ongoing management of UKCP. Out of this work certain decisions of strategic and structural significance were taken.

1.3.2.	The Governing Board reaffirmed the decision to appoint a Chief Executive and recognised, in so doing, that the Chief Executive would play an important leadership role in the organisation and that there would be a transfer, over time, of important areas of responsibility to paid staff.

1.3.3.	For this to be achieved it is essential to have a CEO able to develop a sophisticated understanding of the UKCP which, while not a large organisation, is a complex one. Secondly it is essential to assemble a staff team with appropriate job descriptions and to have appropriate personnel in place to deliver the service that is required. This work is still in progress.

1.3.4.	At the Chair's Day the issue of volunteer input to UKCP was discussed. This was also the subject of various resolutions to the AGM some of which fell due to lack of time.

1.3.5.	Some easing of one restriction was agreed at the AGM through the agreement to a third delegate for MOs whose delegates become officers (i.e. members of the Executive and Finance Committee).

1.3.6.	A second step was taken with the agreement of the AGM to the possibility of a lay Treasurer.

1.3.7.	A third step has been taken with discussions with the Charity Commisioners over the limited employment of former members of the GB for work on specific projects. It has to be recognised that these will remain very exceptional cases. In general it is not possible to pay members of the Governing Board despite the heavy demands on some of its members. The organisation will remain heavily dependent upon voluntary efforts for a long time to come.

1.3.8.	An issue that has been mooted, but not progressed, is the size of the Governing Board. Management theory suggests that the GB is too large. At present the GB does indeed function as a council for psychotherapy, or at least that part of it which is organised within the UKCP. Reducing the size of the GB therefore raises major issues about the representational nature of the UKCP.

1.3.9.	To attempt to manage the difficulties created by the existing structure (see the section on registration below) the Governing Board agreed to create a Regulatory Liaison Group. This is led by the Secretary who is also the Chair of the Membership Committee. Under the present structure it is the MOs that have the direct relationship with the UKCP.

1.4.	Aims of the UKCP

A background theme to all of the above has been to clarify that the aim of the UKCP is protection of the public through the regulation of the profession and the promotion of good practice. Benefits to the profession itself are real but incidental. This is even more the case in relation to benefits to the professionals.

Some of the anxieties about the ability to maintain this balance are real and need to be always kept in mind. However, in the course of debates this sometimes led to claims that it was not possible to keep a balance. This is not the position of the Charity Commissioners although they are aware of the difficulties inherent in organisations such as our own and have an expectation that we will be aware of them also.

This is far from being a legal technicality. It goes to the heart of what the UKCP is for. Whether it is concerned with promoting the art and science of psychotherapy, or with training standards and regulation, or with research, the UKCP is concerned with these things for the public benefit. Reform of the UKCP needs to serve this purpose.

2.	The Review in Context

The strategic and structural review needs to take account of many elements which form the context for the UKCP's activities.

2.1.	Voluntary and Statutory Regulation

2.1.1	The debate about Statutory Regulation is now opening up in an interesting way. Important issues about the process have been clarified as a result of discussions with the HPC, in the Advisory Group on the Registration of Psychotherapists, and in two meetings organised by the BACP.

2.1.2.	The developing debate about the implications of regulation is leading to stronger articulation of reservations about regulation in principle. It is important to consider the reservations carefully. However, it is important that the discussion is framed by reference to the public interest, not the interests of the professionals involved.

2.1.3.	The public interest argument for the regulation of any profession revolves around the protection of the public from misrepresentation and from exploitative, abusive, or negligent practice, and also to make possible more adequate delivery of the benefits of psychotherapeutic treatment through the establishment of a fully recognised profession. For all professions the regulatory process is a necessary burden.

2.1.4.	It is likely that regulation of professional activities in general will become more extensive rather than less and that it will become increasingly difficult to have credibility in offering a professional service in the field of mental health outside of an adequate framework of regulation.

2.1.5.	The Government, through the Department of Health (DOH) and the Health Professions Council (HPC), is disposed to register psychotherapy but it is not a high priority and is dependent upon improved voluntary organisation across the profession.

2.1.6.	The HPC has expressed a provisional view that it would be entitled to act against non registered individuals practising a registered profession even if those individuals operated under a different professional title. This has major implications. The debate to date has focused on indicative registration (protection of title) rather than functional registration. This may also have implications for the proposal that the psychologists should be registered by the HPC separately, and in the not too distant future.

2.1.7.	Ultimately there is pressure for all health professionals to be placed on a single register with appropriate professional advice being obtained at each point of the various processes. Resistance from established health professions has blocked, or at least deferred, that vision. In the meantime it is not clear what arrangements will be in place to link registers, whether statutory or voluntary, or to deal with the problem of double jeopardy.

2.1.8.	There is a widespread, although not universal, acceptance that a statutory register will incorporate some system for distinguishing between different forms of psychotherapy. Representatives of the DoH and the HPC have expressed a strong preference for simplicity believing, with some justification, that the distinctions that are so important within the profession are lost on the general public.

2.1.9.	One possibility is that the mapping of the profession into modalities may not in the end be done on technical criteria alone. The only way to secure agreement may be to permit existing institutional, and therefore historical and political, factors to shape the divisions that are recognised within the register.

2.1.10. 	A statutory register will be a register of individuals with a centralised process for professional, health and conduct issues. Organisations offering professional training would be accredited by an education committee. This would have sub-divisions for different modalities. This is one factor to be considered in relation to the possibility of individual registration within the UKCP.

2.1.11. 	Were statutory registration to be introduced the UKCP would potentially have a role, if the Member Organisations and Registrants wanted it, as a body to function as a representative organisation and professional association.

2.1.12. 	In the likely event that it will be a considerable time before statutory regulation is implemented it is important to make the voluntary system effective. The challenge remains, as it has always been, to develop effective systems that respect and encourage the diversity of the profession.

2.1.13.	An effective system of voluntary regulation needs to strengthen a number of elements compared to the present system. It requires:

2.1.13.1 a clear differentiation between organisations responsible for regulatory functions and organisations directly involved in the provision of training and assessment/referral services;
2.1.13.2 the management of professional conduct issues by organisations large enough to carry the burden of them and to build up expertise and case law;
2.1.13.3 a higher level of lay involvement.

2.2.	Relationships with NHS, other employers, private clients, and other professions.

2.2.1. The DoH maintains that its concern in these discussions is the protection of the public. However it is also evident that it has a powerful concern with the implications of any proposals for the NHS.

2.2.2. The UKCP includes, in addition to registrants working in the NHS, a large body of practitioners working directly for private paying clients and a further smaller body working for other organisations.

2.2.3. Within the NHS there is a tendency in employment practice to see psychotherapy training as one component alongside training in a "core profession" and experience in the NHS. At one extreme there is a view that psychotherapy is a competency that might be developed by a range of professionals rather than a distinct profession. In many NHS trusts there is a lack of a support structure and senior staff for psychotherapy, or particular modalities of psychotherapy.

2.2.4.	The UKCP needs to move towards having a view on the development of psychotherapy as a core profession. At present senior positions within the NHS tend to be held by psychiatrists. The most significant challenge to this is coming from clinical psychologists.

2.2.5.	The UKCP is now an active participant, once again, in the European Association for Psychotherapy. A significant element to the European dimension as the single labour market develops is the requirement in some EU countries for either psychiatry or psychology as a basic qualification for psychotherapy.

2.2.6.	If psychotherapy is considered a supplementary training this gives rise to the need to consider the value of prior training and experience in other areas of life not formally recognised as health professions. It is likely that the growing popularity of psychology as a subject of study for first degrees will have an impact as this generation moves into employment.

2.3.	Counselling, Psychoanalysis and Analytic Psychology

2.3.1.	The UKCP shares many of the concerns identified above with the British Association of Counsellors and Psychotherapists (BACP) and the British Confederation of Psychotherapists (BCP).

2.3.2.	The BACP a few years ago agreed to move away from claiming to represent counsellors only. From a position of institutional separation this has given a rise to a potential for understating the distinctions between psychotherapy and counselling. Were it possible to develop a dialogue which moved towards a shared understanding of the relationship between counselling, in its different forms, and the different modalities of psychotherapy, there might be significant opportunities for co-operation with the BACP.

2.3.3.	The decision of the UKCP AGM 2003 to approve the creation of a Psychotherapeutic Counselling Section represented a recognition of the commonalities and an important strategic step towards engagement with the debate about the relationship between Counselling and Psychotherapy

2.3.4.	With the BCP also there are possibilities for co-operation but these are not likely to be realised until there is some resolution of the issues surrounding the nature and training requirements for psychoanalysis, psychoanalytic psychotherapy and analytic psychology. It may be that this resolution will take the form of no more than an agreement to disagree.

2.3.5.	It is the complexity and intractability of the issues at stake with a range of organisations that point to the need for the development of an umbrella group that accepts the significance of institutional factors and identities.

3.	The nature of registration and individual registration

3.2.	Registration with the UKCP is for many registrants the basis of their standing as a professional. Maintaining the integrity and value of this registration is critical to the UKCP's aim to protect the public and promote high standards.

3.3.	Registration with the UKCP is likely to carry different significance for a registrant who holds an alternative professional registration to one who does not.

3.4.	Not only are there issues of jurisdiction and double jeopardy for professionals registered on multiple registers but those working in the NHS or for other institutional employers are subject to employment based complaints and disciplinary procedures.

3.5.	At present there is a difficulty over the position of members of Member Organisations (MOs) who are not registrants. This group falls into two categories. Some are registered as professionals with another professional register. Others are not registered beyond their membership of the MO in question. This is one factor in the debate over individual registration.

3.6.	At present the UKCP has the powers to remove a registrant from the register. However the position of a registrant as a member of an MO is less certain. The UKCP ultimately relies upon its power to take action against an MO which fails to act in accordance with a decision of the UKCP.

3.7.	The most significant step that the UKCP could take towards addressing many of these problems is to introduce individual registration. Many of the regulatory functions would then fall directly under the Registration Board. The composition, form of election, powers and procedures of the Registration Board would all have to be considered as part of such a change.

3.8.	One option for future development would be to develop two parallel organisations: a registering body and a promotional body. The first would be based on individual members, have a purely regulatory function, and would cease to exist were statutory regulation to be introduced. The second would be based on member organisations as at present and have ongoing functions post statutory regulation.

4. Individual Registration and the Member Organisations

4.2.	Individual Registration could relieve Member Organisations of the burden of hearing complaint/disciplinary and health related issues. Member Organisations would be free to concentrate 6n the development and promotion of their own particular vision of psychotherapy.

4.3.	It is likely that the great majority of each MO's members will value their membership of their MO and want to continue to support it. The continuing affiliation of registrants to MO's would be dependent upon the registrants valuing the connection, wanting to support the organisations work, and appreciating the services that the MO offered. It is not right that there should be a coercive element in the retention of membership of training organisations by linking this membership to the maintenance of professional registration.

4.4.   There will be a need for continuing professional development and it may be the case that member organisations will have a role in that.

5. The Sections of the UKCP

5.1	There are continuing difficulties about the relationship between the Sections and the centre within the UKCP. The issue of the management of the register has already been referred to. Beyond that issues continually arise including:

5.1.1.	Administrative arrangements for the Sections 
5.1.2.	Financial responsibility and reporting quality assurance in relation to the Sections monitoring activities
5.1.3.	Public statements by Sections
5.1.4.	Communications from Sections to other MOs or Registrants

5.2.	It is clear that many in the UKCP continue to value the modality-based structure of the UKCP. This structure is incorporated into the UKCP through the Sections.

5.3.	The structure of the Sections varies greatly. In two cases where Sections are dominated by one large MO, the MO in question has indicated an interest in becoming a sectional or institutional member of the UKCP

5.4.	It is likely that a move towards individual registrationlmembership would have stronger support if the transfer of authority from MOs that is involved were to organisations with individual memberships based on the Sections rather than to the UKCP centrally.

5.5.	This would have a number of advantages:

5.5.1: It would strengthen the identity of the Sections
5.5.2. It would allow the Sections to develop a public voice without appearing to speak for the UKCP
5.5.3. It would clarify the Section's responsibility for their administration and finances.
5.5.4. Institutions in the place of Sections would provide a stronger base for considering professional conduct issues. This would not be enmeshed with the training process, would not have to be carried out within the confines of a small organisation in which there is usually a dense personal network, and would build up a body of experience and professionalism.
5.5.5.	There would be a professional voice in the regulation of training which would be organised independently from those immediately involved in the provision of training. It is likely that the new institutions will develop structures to incorporate both perspectives.

5.6.	There are many issues to be considered. These include

5.6.1. The viability of each of the Member Institutions based on the present Sections needs to be considered possibly on a case by case basis.
5.6.2. The cost of the Member Institutions needs to be assessed. This will need to be considered in relation to the division of functions between the new Member Institutions and the UKCP.
5.6.3. There may be a risk of encouraging fragmentation of institutions away from the UKCP. This may be greater or it may in fact be less.
5.6.4. The relationship between the common core held at the centre and the modality-based variation held by the Section/Member Institution will still have to be negotiated. The identity of the modality-based institution will have been strengthened.
5.6.5. There may be a risk of Member Institutions becoming more internally intolerant of diversity. It is important to note that one of the developmental factors that might make this step possible is that a range of diversity has been established in each of the sections by the practice of the last ten years. This includes the limits of that diversity. It is likely that this range will be carried over to the new institutions. It is also the case that the organisations that currently form the MOs will continue to have a strong influence on the climate in which the new Member Institutions will operate.
5.6.6. There would need to be arrangements for joint working between the Member Institutions and the training organisations on training standards.
5.6.7 Arrangements would have to be made for CPD. An MI could look after CPD itself or it could have a policy that registrants must be affiliated to an approved organisation for CPD.

5.7.	A possible approach to achieving this is to move towards a single category of "Institutional Member". The implications for the existing "Special Members" and "Institutional Members" would need to be carefully discussed.

5.8.	All Institutional Members would have the right to place registrants on the register subject to the various processes that already exist. The position of members of Member Institutions not on the Register would still have to be addressed. An important element in addressing this will be to consider the double jeopardy problem separately from the problem of the individual who does not otherwise hold a professional registration.

5.9.	The modality of registrants would primarily be indicated by their institutional membership. Consideration could be given to what further information should be indicated on the register.

5.10.	This would be consistent with a movement towards a more generic labelling model touched upon above.

5.11.	It might be possible through such a process to reassert the original aim of the UKCP to be an umbrella organisation for the whole of psychotherapy in the UK.

5.12.	Contact across the whole of the UKCP could be maintained through the organisation of professional conferences and other events. This professional activities of the UKCP need to be expanded and more thought will be given to their development. The creation of an effective system of regulation is important but the development of the understanding ot the theory and practice of psychotherapy should be at the heart of the coming together of the profession.

6.	The way forward

6.1.	There are three options currently identified:

6.1.1.	Continue to manage the existing structure as effectively as we can.
6.1.2.	Develop individual registration under the Registration Board.
6.1.3.	Develop institutional membership based on individual registration.

6.2.	The Governing Board in May 2003 agreed as follows:

6.2.1.	It was unanimous in rejecting option (1) and wishing to develop an alternative structure.
6.2.2.	It recommended the exploration of option 3 but this does not foreclose the exploration or development of other options or represent a firm commitment to it.
6.2.3.	It recognised the need for feasibility studies on any future organisational development.
6.2.4.	It agreed that it would be valuable to examine the experience and practice of other regulatory organisations.
6.2.5.	It agreed that it was essential to consult the Member organisations at an early stage about the outlines of the proposed developments.lt agreed that it would be helpful to circulate this paper to encourage debate in the Member Organisations and the Sections.

JP
18/7/2003