IPNOSIS: a journal for the Independent Practitioners Network

Before detailing specific comments on the report by the HPC Professional Liaison Group on the proposed statutory regulation of psychotherapists and counsellors, it is helpful to make some general points about the report and the draft standards of proficiency which are attached to it. All of these general points have been made repeatedly in meetings with the HPC as well as in written correspondence over the last three years:

The Government White Paper on Trust, Assurance and Safety had given the Health Professions Council the task of assessing the 'regulatory needs' of the field and 'ensuring that its system is capable of accommodating them'. These two briefs have simply not been met by the HPC consultation or by the work of the PLG. There has been both an absence of sustained rational debate on the central issues and an exclusion of critical voices, a fact which has been brought to the attention of HPC and of MPs repeatedly.
Many practitioners of talking therapies do not see their work as constituting in any way a health profession, and their traditions have been critical of the received notions of health, illness and wellbeing that the HPC consultation and the PLG report take as given. Despite the fact that this point has been made innumerable times, it is not reflected in either the content of the report or the standards of proficiency.
The view of therapy presupposed in many parts of the report and in the standards of proficiency is at odds with many traditions of therapy over the last century. Therapy is not conceived as an intervention to be applied to a patient, but rather as an activity which the patient him or herself engages in, facilitated by the therapist. It is thus not a question of the transmission of knowledge or skills from one party to another, just as it is not in any way comparable with a medical style intervention such as the administration of a drug or any other form of predetermined procedure.
The report and the standards of proficiency presuppose a concept of self that is radically rejected by many schools of psychotherapy. This is the modern idea that the self is reducible to a set of skills and competencies which must be forever improved. On this model, the human being is seen as a business which has to better itself, making it an ever more viable competitor in the marketplace. Although there may be some therapists who subscribe to this view, it is totally opposed to many therapeutic traditions which base the very work of therapy on a critique of socially accepted notions of selfhood. For these therapies, the self is not there to be 'improved' or 'bettered', but rather to allow its history to be explored, and its fractures, frustrations and disappointments to be recognised. The growth and change that may follow do not constitute an 'improvement' or 'bettering', as this would suggest a normative view of what people should be. The standards of proficiency thus presuppose the very idea of self that thousands of therapists work every day to undermine in their practice. There is thus both a contradiction and an absurdity in trying to force therapists to frame their work within standards of proficiency that uphold the very values that the therapeutic process aims to put in question.

Comments on HPC Draft Document on the Statutory Regulation of Psychotherapists and Counsellors.

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The constitution of the PLG is described here as including "individuals representing professional bodies, education and training providers, a qualification awarding body and organisations representing the interests of service users". It is not pointed out that the choice of the 17 members rigorously excluded all those who had critical views of HPC regulation who had been nominated by their organisations or who had nominated themselves for the PLG. It was thus a highly biased collection of individuals, which also excluded the service user group the Association of Psychoanalysis Users. Instead HPC chose the advocacy group Witness, which is funded partly by the Department of Health and which has worked closely with HPC. It is also incorrect to state that the PLG included "organisations" representing service users, as there was only one, if Witness can be so described.

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The report states that 'the responses to the [HPC's] Call for Ideas informed the discussion and recommendations of the PLG'. In fact there has been a remarkable failure to respond to any of the critical responses to the Call for Ideas aside from noting which groups had made which points in a previous HPC document. After this cosmetic registering of some criticisms, HPC has failed to respond in any detailed or serious way to the points made in response to the Call for Ideas. It was pointed out several times to the HPC that the PLG meetings had failed to include adequate discussion of the majority of the points that had been made.

Paragraph 19 and 20 refer to the stakeholder events held in Manchester in March 2009. There is no mention of the criticisms made of the HPC project there or of the HPC's refusal to hold a further meeting in response to the request from stakeholders and members of the public who attended and saw an absence of any engagement with the points that were made. The Manchester event was simply there as an airbrushing exercise to create the false impression that HPC had 'listened'.

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Paragraph 26 It is stated that 'the role of the PLG was to discuss and make recommendations about how psychotherapists and counsellors might be regulated in light of the conclusions in the White Paper'. Yet the White Paper had required the HPC to assess the 'regulatory needs' of the field and whether it was suited to 'accommodate' this field. Neither of these crucial questions was in fact taken up in any sustained or serious way by the PLG meetings, the minutes of which are publicly available.

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Voluntary registers to be considered for transfer to HPC require that members demonstrate a commitment to CPD. Although many therapists would accept this idea, there are also important traditions in psychoanalysis and psychotherapy which do not accept the idea of CPD. Becoming an analyst or therapist, according to these traditions, involves profound psychological change which is not the result of knowledge or anything that can be taught in a course or learning environment. Such change can be more accurately compared to losing a limb than to memorising a handbook of information. For these traditions, that is what allows the person to then be open to working with the unconscious of other people. Given this view, it makes little sense to argue that the practitioners need to update their knowledge and skills on an annual basis. This would be like making the person prove on an annual basis that their limb hadn't miraculously re-grown. These traditions also hold that the result of any serious analysis or therapy is a questioning of the vanity of human knowledge. This is completely at odds with the modern mentality of CPD in which an 'expert' is brought in to dispense the latest knowledge to those who wish to better or improve themselves. Psychoanalysis and many forms of psychotherapy do not have a cumulative model of knowledge, but rather sees the loss of knowledge as decisive. Freud, for example, said that the analyst must forget everything they know each time they see a patient. Taking this seriously, CPD would involve ensuring that the practitioner is able to not know anything. The paradoxes of this form of assessment are also well known, with clinicians feeling that they have to prove themselves to some external authority: This, indeed, is exactly the kind of dynamic that many forms of therapy aim to collapse.

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Point 9 Here, and at several other places in the document, there is a reference to clinicians only being able to practice 'in those fields in which they have appropriate education, training and experience'. On the surface this may seem a very reasonable obligation, but it introduces important political factors which have an impact on how the fields are defined for which such education, training and experience are relevant. There is a very real danger here that models of diagnosis and categorisation of human distress - such as that provided by DSM - will be used here as benchmarks, despite the fact that many traditions in psychoanalysis and psychotherapy have their own classificatory systems which disagree with those of DSM, or indeed, which object to the very notion of the classification of human beings into groups through the process of dividing them via external symptoms. The danger is that notions prevalent in modern healthcare, such as 'best practice', 'evidence based research' and 'mental illness' will be used uncritically in order to tell therapists who they can and cannot work with.

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The document states that if a registrant's competence is called into question, the 'standards of proficiency set by HPC are taken into account in deciding whether any action is necessary'. Since the standards of proficiency proposed are so dramatically incompatible with many long established traditions in psychotherapy, it puts registrants at great risk of having their practices adversely affected by the application of frameworks which are unsuited to assess or evaluate them.

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There are several paragraphs here which state the requirements of certain standards of proficiency in English language to enable a therapist or counsellor to be able to practice. This is a rather absurd requirement as there is no intrinsic reason why a therapist should have to speak a certain level of English: this may be for the obvious reason that the patients they receive would wish to speak in their own mother tongue, shared with the therapist which is not English but also, and more fundamentally, because language is itself a psychological variable which will form part of the transference. If someone has been brought up by a parent who couldn't speak the language of the country they happen to be in they may well seek out later in life a therapist who clearly has difficulty speaking a language. As long as the therapist does not claim to have standards of proficiency which they do not in fact possess it is surely the choice of the patient who they wish to speak to. Insisting on a certain proficiency in English language removes that freedom of choice from members of the public.