The Re conceptualising Regulation: the search for innovation and creativity
I want to respond to Andy Rogers’ December 2005 letter and Sally Aldridge’s subsequent piece as they both raise important issues deserving further attention. I am a BACP accredited counsellor and supervisor (individuals and groups) and I belong to a Full Member Group of the Independent Practitioners’ Network. I am also a former member of both the Management Committee (1995 to 1999) and the Standards and Ethics Committee (1996 to 1999).
Enhancing Public Protection
Sally writes that BACP “has always held a commitment to the principle of enhancing public protection”. If read alongside Alan Jamieson’s letter to the Department of Health referred to by Andy, it becomes obvious that BACP’s position on statutory regulation can no longer be caricatured as a fundamentalist belief that brooks no contradiction, irrespective of evidence or argument. This clarity is welcome.
The next point in Sally’s article, that “statutory regulation through the protection of title and fitness to practice processes still appears to be the clearest way to achieve this”, reads well until we look beyond appearances. More than a decade ago Richard Mowbray proposed that we should pursue statutory regulation only if the advantages of doing so demonstrably outweigh the drawbacks. One way of thinking about the stalled discussions about statutory regulation is to wonder whether the confusion exists because we still know too little to be able to proceed in that direction. This was certainly the conclusion Professor Daniel B. Hogan reached in 1979 after undertaking what remains by far the most extensive examination of the regulation of counselling and psychotherapy. He ended his four-volume study by laying down general guidelines and encouraging a flexible, undogmatic attitude of experimentation. His is very much a proactive stance. In brief updates published in 1999 and in 2003 , he applied his findings to circumstances in the UK.
The next couple of paragraphs in Sally’s article rather beg the question, suggesting that there will be regulation, whether or not it’s a good idea, partly because NHS commissioners want a shortcut to deciding whom to employ (though that seems to be a dereliction of the duty on employers to develop sound recruitment policies) and partly because practitioners want better access to power, status and money. Whatever else they are, these aren’t obvious ways of “enhancing public protection”.
Sally argues that members working as volunteers fear they will be prevented from working within a regulatory system. Dan Hogan puts it more strongly: minorities will be excluded as well as paraprofessionals . It seems clear that regulation will reinforce and enhance the power of those who are already more privileged. As training requirements increase, access is harder for the less affluent, resulting in a highly unfortunate reduction in the range of therapists available: it’s difficult to see how this can be in the public interest. Take just one element in this relentless pursuit of qualifications that of undertaking a counselling diploma course. What percentage of the adult population is able to earn enough to support a family, pay a mortgage and pay the fees as well as find a day a week to attend the course, a second day to study and a third to cover a placement, supervision and their own therapy?
Sally suggests that there’s “a concern that regulation will limit the creative freedom of therapists in their work”. Put like this it sounds as though creative freedom is something of an indulgence. But the concern about creativity is more fundamental. First, there is already evidence that prospective students are keener to sign up for well established courses - that is, ones that are already accredited. The consequence is that it is much more difficult to introduce new trainings. In other words, there is a built-in institutional bias towards reproducing the status quo in relation to training, with creativity and innovation being the inevitable casualties a kind of ossifying dumbing down which is the very antithesis of creative therapy at its best. Secondly, discussion amongst new practitioners about regulation is dominated by fear. In my experience, few students are willing to pursue outside supervision the reservations they raise about the hurdles they’re required to jump. This fear is insidious: it undermines the emergence of a critically reflective attitude, so necessary to maturity as a professional.
Sally then suggests that buying therapy is no different from buying other services. The tacit assumption seems to be that there is a defined body of knowledge that can be learned, without mastery of which a practitioner is “unsafe”. But it may be more useful to view the various professions on a spectrum, at one end of which there is verifiable knowledge which can be tested and without which people die (for instance, you cannot design and build bridges safely without an understanding of mathematics and Newtonian mechanics), while therapy lies at the opposite end alongside activities relying heavily on the quality of the interpersonal relationship that is established - sometimes evocatively and tellingly referred to as “the art of the therapist”. In other words, in our field it may not be possible - or appropriate - to identify a sufficient and necessary body of knowledge that can be reliably and scientifically kite marked. How many BACP members rely solely on BACP accreditation when choosing a therapist either for themselves or for someone they care about? Anecdotal evidence suggests that practitioners tend to ask around quite carefully before making a decision. If, then, everyone seeking a therapist is to be on an equal footing, something over and above mere kite marking is essential.
Finally, Sally argues that, while kite-marking “cannot ensure that practitioners will always provide a helpful and ethical relationship, it can ensure that clients will always have recourse to a complaints system should things go wrong”. Two points are pertinent. First, there’s plenty of evidence that recourse to a complaints system is, for many people, a poor substitute for bad therapy, since the process tends to be time consuming, emotionally demanding and, to a greater or lesser degree, unsatisfying to all concerned, including the person bringing the complaint. Secondly, there’s the drawback that, to the extent that kite marking wins public confidence, it encourages people to be that much less vigilant: kite marks only work well when they offer straightforward, unequivocal guarantees of the kind that counselling and psychotherapy by their very nature simply cannot give.
A Conflict of Objectives
Sally’s summary raises a major difficulty, which is to do with the structure of BACP itself “the view is always to the two main objectives: what is best for the public and what is best for members”. This is problematic. BACP is an educational charity and, as such, everything it does must be charitable. Pursuing the interests of its members isn't a charitable objective and is only permitted if there is no conflict with what's in the public interest. Sally effectively admits BACP's twin objectives may be in conflict when she asserts that members want regulation because they believe it will give them access to work, income and status. This leaves BACP open to legal challenge.
In recent years people like myself have had difficulty with the organisational direction taken by BACP and, in particular, with its reluctance to be open about this potential conflict. In 1999 I resigned from the (then) BAC Management Committee because I was unhappy about the way that BAC(P) appeared to be using its educational charity status as cover for a drive towards greater professionalisation that wasn’t necessarily in the best interests of the public, but that was definitely to do with the pursuit of greater power and status for counsellors. I didn’t think we were taking enough account of the debate about statutory regulation going on outside BAC(P). What I said in my resignation letter was:
I believe that, if BAC wants to retain its integrity whilst pressing ahead for government recognition, it should divide into two entities one which pursues professional recognition and the other which focuses on promoting counselling. Some of BAC’s more intractable problems can be traced to its continued existence as a hybrid organisation. Not least, what is in jeopardy is the moral authority it has acquired over the years as the “voice of counselling”.
By not being explicit about its mutually conflicting objectives BAC is perpetuating a long-standing muddle, one consequence of which was the Bernard Manning scam. By pressing hard for government recognition without sorting this out, BAC will add to the confusion and expose counsellors unnecessarily to further media attacks.
In December 2005 Andy Rogers asked why no one within the BACP Executive questioned the move to statutory regulation sooner. When I resigned I sent a letter to Counselling (as it was then) explaining my reasons. It wasn’t published. Some while later, when I told the Chief Executive of BAC(P) about this, he was shocked and encouraged me to resubmit it to what had then become CPJ. But, for a second time, my letter wasn’t published.
In the intervening years other dissenting voices with the solitary exception of Professor Brian Thorne’s - have not been heard either. You wouldn’t know from reading Therapy Today (and its precursors) that, for the past 15 years or so, there has been a growing literature in the UK about the merits and demerits of regulation. Because there has been no discussion on this subject, those BACP members wanting to inform themselves have had to turn to other journals, while the remainder has drifted towards apolitical passivity or impotent resignation. I believe this has had a detrimental impact on the development of our would be profession.
At the same time and precisely because of its preoccupation with pressing the case for regulation BACP has been much less active than otherwise in promoting debate about ways of enhancing public protection. This has inhibited the communication flow further. BACP’s attitude is encapsulated in the summary to Sally Aldridge’s article: future developments are envisaged as deriving from, on the one hand, government reports and meetings and, on the other, debate within the BACP staff, its Board of Governors and its Committees. In short, members will be kept updated, but they are neither expected nor invited to make a contribution themselves.
In recent years divergent thinking and experimentation have taken place outside BACP rather than within it. Take, for example, the impressive track record of the comparatively small number of people active within the Independent Practitioners’ Network. Over the last decade IPN has painstakingly and methodically developed a workable alternative to BACP accreditation, based on direct and ongoing face-to-face peer-group contact, support and challenge. According to your point of view, this can either be regarded as a stand-alone framework or as a way of remedying gaps or weaknesses in BACP’s paper-based accreditation process. IPN has given new impetus to efforts at more mature approaches to mediation when clients are dissatisfied.
The Network has also inspired two journals PIN and IPNOSIS and two important collections as well as a website, www.lpiper.demon.co.uk Richard House has articulated a critical perspective while Denis Postle has developed a detailed proposal for a “non-credentialed registration” procedure based on Dan Hogan’s work, an alternative to statutory regulation that avoids the negative unintended consequences of the latter. Yvonne Bates and others active within IPN have given strong support to clients who want to put forward their own perspective for us to learn from - the so-called “Client Voice Movement”.
Dan Hogan is clear about the present situation and what needs to happen:
“The future of counselling and psychotherapy in the United Kingdom would appear to be at a critical juncture today. If restrictive licensing is adopted, I fear the field will be crippled for years to come.”
“(W)e need to re-conceptualise the entire process of regulation. Instead of an almost exclusive emphasis on control and discipline which restricts practitioners from entering the field, we need to focus on how regulation can help the profession develop.”
He suggests that it is a mistake to focus on inputs (“standards and criteria governing entrance to a profession”) rather than outputs (“licensing should control output, the actual skills, not how they are gained”). There is much here that deserves detailed exploration. Therapy Today, for instance, is the biggest single journal in the field; it can and should be a focal point for creative discussion about how public protection can be enhanced. Meanwhile there is plenty that can be done without waiting for action from government. If, to take just one example, BACP really is serious about enhancing public protection, it could encourage all accredited counsellors to consider participating in IPN to the point of becoming members of Full Member practitioner groups of IPN - or at least embrace the highly effective peer practitioner group procedures that IPN has so effectively pioneered since 1994.
We, that is, BACP the organisation and BACP the members, need to be engaged together in much more informed and inclusive discussion. After all we’re members of an educational charity, not a political party. We claim special expertise in dealing with unconscious material and what isn’t being put into words. On occasion we are even reminded that we are an increasingly mature body of practitioners. What kind of credibility and self respect can we have if we do not properly and fully examine and debate key questions about our own future?