It is hard to separate HPC regulation completely from the raft of changes currently promoted by the Department for Health. The interconnections are many and varied, not least because policy makers and managers absorb and act upon half baked understandings, often from media sources.

HPC regulation will highlight and reinforce the belief, contradicted by research, that counselling and psychotherapy are to be thought of as medical interventions. This presupposition also underlies NICE Guidelines, the Improving Access to Psychological Therapies initiative and much of the thinking underpinning the re commissioning of GP counselling services at PCT level. As things stand, the clearest unintended side effects are these -

Hogan put the unintended negative consequences only a little differently in relation to America 30 years ago. In his four volume study He argued that regulation has the effect of -

My own belief is that, if HPC regulation goes ahead, the biggest impact will be due to the fundamentally corrosive effect consequent upon undermining respect for evidence and argument. Neither the Registrar, Marc Seale, nor Professor Diane Waller, appear to appreciate this, since I understand both have gone on record dismissing the relevance of the arguments against the medical model. Furthermore both argue - contrary to my own conversations with colleagues - that arts therapists, who are already HPC regulated, are all perfectly happy with HPC regulation and that there have been no significant unforeseen negative consequences.

Shortcomings in relation to protection of the public

First there are the obvious shortcomings, which are due to the nature of this kind of regulation -

Marc Seale, the Registrar and CEO of the HPC, has gone on record to say he is confident that HPC regulation of counsellors and psychotherapists will be effective1 (NB he is making this assertion whilst the consultation process is still in mid-stream - which is interesting, given that we are variously told that the purpose of referring the matter to the HPC is to determine either whether HPC regulation is desirable or even what the best form of regulation for counselling and psychotherapy might be). How can Marc Seale possibly know HPC regulation will be effective, given that it is not at all clear what HPC regulation is designed to protect the public from?

Popular debate tends to focus on the assertion that, "Anyone can put a brass plaque up on the wall, claiming to be a counsellor or psychotherapist.But the only person ever known to have done this is the comedian Bernard Manning. He successfully submitted an application to join what was then the British Association for Counselling (BAC) - now the British Association for Counselling and Psychotherapy (BACP) - and was filmed by the BBC Watchdog programme screwing his plaque to a wall.

A great deal of play has subsequently been made of this episode, but the following observations are perhaps pertinent -

A more sophisticated analysis might take issue with this interpretation of events on the grounds that the attack on BAC was justified because BAC was abusing its position as an educational charity: it was claiming that the case for professionalisation is entirely coterminous with the public interest, whereas a substantial element of this case is to do with practitioners' pursuit of power, status and money. No one identified this line of argument at the time, however, and the Bernard Manning case has fuelled the wider public debate ever since.

In short - a judgment cannot be made about the effectiveness of HPC regulation unless distinctions are made between -

Meanwhile much of the argument, even in the pages of BACP's house journal, is anecdotal and along the lines of - "such and such happened to client X, there isn't statutory regulation, therefore there should be- often without any attempt to show how, precisely, any particular form of regulation might have prevented what happened to client X from happening. Last week's report on the BBC's Radio 4 programme, 'You and Yours', which featured a client who had been sexually exploited by her counsellor, is a case in point. HPC regulation would simply have meant that, if he had been found guilty, he would have been struck off but would still have been free to practice, for example, as "a life coach".

What needs detailed analysis is the nature and extent of the problem that statutory regulation is designed to address. The Department of Health has been challenged on this score to present something more than anecdotal evidence. On pages 244 to 245 of his book Regulating the Psychotherapies Denis Postle gives an account of how the Department blustered when pressed on this.

The HPC has been challenged similarly. Notes from a recent meeting with representatives of the HPC begin as follows -

The College of Psychoanalysts-UK meeting with HPC 27.2.08

Darian Leader and Andrew Hodgkiss met with Diane Waller, Michael Guthrie and Marc Seale.

We started by bringing up the claim made at the last PLG meeting that therapists pose a public threat, with their figure being 5%. Seale and Waller admitted that they had no hard data on this, and that their only statistics came from Witness and Fonagy, not based on any published studies, and that HPC had done no research themselves. So, we put it to them that this was anecdotal, reminding them that the recent Washington State discussion of therapy had insisted that claims about threatened public harm could not be based on tenuous argument or anecdotal evidence. Seale said that the "proofwas that all professions regulated by HPC showed 1.8-2% malpractice. This is the figure then to be expected from the therapies. We pointed out that this was circular and could be an artefact of the HPC framework itself. Social scientists, we suggested, could not take such an argument seriously. Seale said "I don't know what a social scientist is".

So the HPC's own data are the best we have. But, if we look as closely, another problem with HPC regulation of counselling and psychotherapy emerges. The most recent figures from 2007/8 show that no less than 40% of the matters taken to the HPC were raised by employers (and only 25% of complaints were instigated by members of the public). There is a problem here. The list of professions regulated by the HPC appears to be almost entirely made up of employees, who for the most part work within the NHS.

The HPC claims there are 60,000 or so counsellors and psychotherapists in the UK. Only a small fraction of these are employed - probably less than 10% to 20% - and the rest are either self employed or volunteers. But, if HPC regulation depends for its effectiveness on employers taking matters up with the HPC, a substantial percentage of misdemeanours will not be addressed. In other words - and contrary to the Registrar's assertion, the HPC's own statistics strongly suggest that HPC regulation for counselling and psychotherapy won't be effective.

It has, in fact, been a long-standing concern within the field that too few complaints are made2. More recently Clare Symons at the University of Leicester has been engaged in a research project to find out why people don't complain about poor or harmful experiences of counselling. This, to my mind, is where things get interesting. A colleague has argued that the difficulty with formal complaints systems is that clients of counsellors and psychotherapists tend not to use them because they cut across and disrupt the therapeutic process3. What is needed, he argues is much more emphasis on mediation.

Here the results from a scheme run in recent years by the Association of Humanistic Psychology Practitioners are relevant. Although the total numbers involved are small, AHPP report that around 50% of matters notified as potential complaints are resolved at the very first stage, when a facilitator helps the "complainantidentify both what went wrong and what remedy is being sought. Another 20% are resolved after a different facilitator is allocated to the therapist in order to help in clarifying a response. A further 20% or so are resolved at the formal mediation face to face meeting, and only 10% go beyond this into a traditional complaints procedure.

If these results are an accurate indication of the national picture then just about everyone has got it wrong. BACP has, for a couple of decades or so, run a respected complaints system. But the numbers making use of it have always been much smaller than expected. Although BACP encourages the use of its national procedures only after local ones have been exhausted, it might be much better if it were to develop a framework for mediation along the lines pioneered by the Association of Humanistic Psychology Practitioners. However there is little point in doing so whilst HPC regulation remains on the agenda because HPC procedures appear to have been so written that mediation cannot be undertaken until after formal processes have been exhausted4.

The difficulty with this whole debate is that better alternatives have been on the table for years. Professor Daniel Hogan, for instance, has recommended that, if the problem of serious harm is significant, consideration should be given to tightening the existing law - for in relation to fraud or sexual harassment ("This alone would obviate much of the need for licensing"5). If this was done and coupled with both a public information campaign and much enhanced access to mediation, the public would be substantially better protected than they can ever be through HPC regulation.

Arthur Musgrave
Accredited Counsellor and Supervisor, British Association for Counselling and Psychotherapy
Member, Western Valleys - Full Member Group of the Independent Practitioners Network

[1] D. Postle Regulating the Psychological Therapies (PCCS Books: 2007)

[2] B. Wampold The Great Psychotherapy Debate (Lawrence Erlbaum Associates: 2001)

[3] D. Hogan The Regulation of Psychotherapists (Ballinger: 1979)

[4] D. Hogan ‘Professional Regulation as Facilitation not Control’ in Bates, Y and House, R Ethically Challenged Professions (PCCS Books: 2003)

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