An encounter with a black scorpion is not likely to be problematic; you probably see it before it sees you. It's the transparent ones that are almost invisible which are dangerous and the most poisonous. Household hint, France
All I have is a voice to undo the folded lie.
W.H. Aud font>
eIpnosis is edited, maintained and © Denis Postle 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009

The Health Professions Council Draft Standards of proficiency for Psychotherapy and counselling. July 2009
Scorpion rising
Love Matters pages
Regulation News and Views pages
Archive pages
18 videos and sound tracks
If as seems to be the case with many practitioners, you are sitting with considerable ambivalence about the value of State Regulation for clients, for yourself and for the field, what might you need to know?

As I have long argued, there is an over-arching aspect of the HPC's actions that merits your attention and which should be kept in mind in reading what follows. As an instrument of the state the HPC's values, especially their power relations, are of the 'power over' variety, 'power with' consultations and the PLG meetings have consistently proved to be public relations exercises concerned with ticking the regulators performance criteria boxes.

HPC personnel are amiable, transparent and accessible, their processes exude modernity and reasonableness. However this is a culture of domination and everything that the Professional Liaison Group [PLG] has recommended in the draft standards of proficiency that we will look at here has been produced via a process of collaboration under duress and which can be expected to be enforced by the HPC with matching duress.

Why does this matter? Because as a practitioner I'd be surprised if you didn't follow a way of working with clients that was as far as possible free of duress, and that you'd be aware that the abuse that many clients show up with is in one way and another the result of 'power over' bullying, excessive or unjustified force, manipulation, victimization or discrimination, ie duress. Exactly the qualities that the HPC as a regulator brings to its capture of the psychological therapies. How can such a culture of coercion as the HPC embodies fail eventually to contaminate, restrict or skew the work you do?

Does this seem far-fetched? Let's look first at how your professional representatives have decided that as a practitioner you will be expected to behave. The Standards of proficiency for psychotherapists and counsellors' document is here. (link)

An 11pp catalogue of injunctions, it lists 68 items that begin with 'be able to', 40 that begin with 'understand' 5 that begin with 'recognize', and 3 with 'be aware of'. Not that controversial you might think until you look at how the document frames these items (more on that anon).

On page 2 is a headline that applies to everything that follows - Registrant psychotherapists and counsellors must:

This word 'must' is the key to the whole document. By joining the HPC register you take on a legal obligation to adhere to these 'abilities', 'understandings', 'recognitions' and 'awarenesses'. And if it still isn't clear, you buy into a system of coercion and duress that has at its end point legally binding 'fitness to practice' hearings based on these standards that are sharply adversarial in style.

Keeping this over-arching culture of coercion in mind, let us look into the 'consultation draft' of the 'Standards of proficiency for psychotherapists and counsellors'. I'll add in italics the missing element of duress:
must. Text in blue, as in the original document applies to psychotherapists and counsellors, where it is only applicable to counsellors or psychotherapists I preserve the original red, alongside this I have tried to keep the original bold formatting.

1a.1 - you must understand the need to respect, and so far as possible uphold, the rights, dignity, values and autonomy of every service user including their role in the diagnostic and therapeutic process and in maintaining health and wellbeing

Do you have a 'diagnostic process'? Can you willingly or ethically undertake to 'uphold the values' of every service user?

- you must be able to recognise and manage the dynamics of power and authority

Yes… and might this also include being able to recognize and reject (or at least discuss) inappropriate regimes of power and authority such as that entailed by HPC regulation.

1a.2 - you must be able to practise in a non-discriminatory manner

Yes laudable. The HPC requires it but has consistently demonstrated discrimination against other ways of generating civic accountability in favour of its pre-existing approach to regulation. See this account of the first PLG meeting for how this has been done.

1a.4 - you must understand the importance of and be able to obtain informed consent

Informed consent for what? This seems another indicator of a 'power over' coercive culture in which something is to be done to a client for which informed consent must be obtained. See later the use of the word 'apply'.

1a.6 - you must be able to practise as an autonomous professional, exercising their own professional judgement

you must be able to assess a situation, determine the nature and severity of the problem and call upon the required knowledge and experience to deal with the problem

"Assess a situation?” Many practitioners would see themselves as exploring perceptions of a “situation” (including the naming of it as a “situation”). And then “problem” is a potentially narrow perception of experience: it may be that the extent to which a client sees something as a problem might often interfere with their ability to develop resources to “deal” with “it”.

you must be able to initiate resolution of problems and be able to exercise personal initiative

Again this presumes a practitioner 'managing'/'controlling' the relationship with the client.

- you must know the limits of [your] practice and when to seek advice or refer to another professional
you must recognise that [you] are personally responsible for and must be able to justify [your] decisions.

Why is it necessary to include this? As soon as the imjunction 'you must' is added there is something about these lines that more than hints at a parent talking to an errant teenager.

This suggests that we might usefully look at the potential 'fitness to practice' version - if 
for 'able to, we 'substitute 'failure' :

- you failed to assess the situation, determine the nature and severity of the problem and call upon the required knowledge and experience to deal with the problem
- you failed to initiate resolution of the problems and were unable to exercise personal initiative

Very subtle nuances of the therapeutic alliance are freeze-dried into 'nature and severity' making it an object to which knowhow can be applied as though definition of 'being able to' somehow disposed of what 'failed to' might entail in a fitness to practise hearing.

Lets hold this reversal for a moment and use it to look at 1a.7 and 1a.8 which screws down the generic HPC notion of 'fitness to practise' that as a registrant you would be legally contracted to deliver.

1a.7 - you failed to recognise the need for effective self-management of workload and resources and be able to practise accordingly

This seems to imply that if on occasion you put yourself out in exceptional ways that other practitioners saw as interfering with their status or employment prospects, this could count as a failure of self-management. These standards already appear to have provided a rich field for denunciations based on interpersonal rivalries in other regulated professions.

1a.8 - you failed to understand the obligation to maintain fitness to practise

you failed to understand the need to practise safely and effectively within your scope of practice

Hmm… safely and effectively… no vigorous body work or role play then. And if we go on down this failure road:

- you failed to understand the need to maintain high standards of personal conduct

Did you perhaps fail to adopt and live consistently from the set of cultural values that enable the HPC to present itself as a benign protector that hides the duress which shapes its actions, i.e. no exploratory life-style innovation.

- you failed to understand the importance of maintaining your own health

Well yes… except that ill health is relative and often genetically driven and stressors such as the strong un-negotiated external demands that the HPC entails contribute, as teachers and social workers have found, to undermining health and morale.

- you failed to understand both the need to keep skills and knowledge up to date and the importance of career-long learning

I.e. you may have failed to appreciate that deep in the ideological base of the HPC's approach to regulation is the notion that anything can be reduced to a set of behavioural descriptors. Psychotherapy and counselling are no exception. Not understanding the behavioural descriptors is one thing, not appreciating what is left out, empathy, intuition, nuance, relationship, lived experience, mêtis, touch and emotionality is potentially disastrous. As I have said elsewhere, (link) this amounts to the systematic elimination of love by the HPC.

We might conclude this excursion into failure by noting that could be tempting for practitioners with a humanistic and transpersonal worldview to be very even-handed and acknowledge that in its impersonal detachment this document merely reflects the perceptions of others, an aspect of the diversity of the psychological therapies. This would be a mistake since there is a clearly identifiable cluster of institutions seeking to impose a medical, university psychology, behaviorist paradigm of coercion and control. This behaviourist fundamentalism goes to the heart of the fallacy of the HPC concept of therapy as something external to the client (now patient), to be “done to them” as part of the 'treatment'.

While this section of generic requirements applies to all HPC registrants, there is an add-on for Psychotherapists & Counsellors

they must - recognise the obligation to maintain fitness to practise including engagement in their own counselling or psychotherapy based process in a way consistent with their own theoretical approach
they must - be able to identify and manage their personal involvement in and contribution to the processes of therapy, including recognising their own distress or disturbance and by being able to develop self-care strategies

What would a failure to engage in your own 'counselling or psychotherapy based process' look like? How much supervision would you have had to miss or ignore? How often and for how long would you have to engage in personal therapy? Again, consider what would constitute failure?

Even a modest amount of contact with the evolution of the HPC and the collection of professions that it regulates points to it being something that the NHS needs, stronger than that, has to have.
The standards of proficiency are very obviously shaped by an NHS, ie a thoroughly medical, approach. The medical paradigm of pathology, diagnosis, and treatment stands behind almost everything that you must be able to do, to understand, to recognize and be aware of.

And in 1b.1-b4 this NHS context comes out into the open

1b.1 You must be able to work, where appropriate, in partnership with other professionals, support staff, service users and their relatives and carers.

Oh yes and to go on, even if you are one of the 70% or thereabouts of practitioners who doesn't work in the NHS:

- You must understand the need to build and sustain professional relationships as both an independent practitioner and collaboratively as a member of a team

And even if you have actively rejected a medical mental illness approach to working with clients:

you must understand the need to engage service users and carers in planning and evaluating diagnostics, treatments and interventions to meet their needs and goals

They left out recognizing 'pathologies' here but we'll come to it later. Remember these are legally binding requirement on registrants who sign up to them.

Also under 1b.1 there is an add-on for counsellors and psychotherapists

you must - understand the role of the therapist in the broader social and cultural context

A very necessary requirement, not least in divining in a legally binding context what such a sentence means. Again what would failure look like? Might this requirement imply deference? For instance to how power is expressed in and around organizations such as the NHS, the DoH, NICE and the HPC. Understanding the role of the therapist would appear to require suppressing any sense that a coercive, duress laden cultural context might be antipathetic to the commonplace values of psychotherapy and counselling practice i.e. what you would actually do in the room with clients.

- you must be able to demonstrate sensitivity to organisational dynamics

Again a requirement that perhaps derives from NHS needs. Might it also imply that deference to existing pecking orders should be maintained - that clinical psychologists and counselling psychologists with PhDs who are on salary level 11 should be acknowledged as privileged in the NHS and other hierarchies over MA/MSC psychotherapists on level 7, and no-degree counsellors on level 5. This despite extensive research which shows that para-professionals do as well with clients as highly degreed professionals; due, it might be expected, to their capacity for being present as persons rather than being present as an item of job description.

This NHS multidisciplinary team theme continues in 1.b2 where 'effective and appropriate skills in communication' must be demonstrated.

At the end of this section there is the anodyne requirement that Psychotherapists and Counsellors

You must - be able to build, maintain and end therapeutic relationships with clients

Missing is the notion for many practitioners that therapeutic relationship are always co-created. And how curious that other essential aspects of client work are missing, remembering to collect your fee, paying into the bank, keeping records for the IR… and being sure to always change your socks every day!

In the next section, the medico-scientific ideological position of the HPC becomes more transparent. Therapy is about 'identification and assessment of health (ie mental health) and social care needs'.

2a.2 You must be able to select and use appropriate assessment techniques
You must - be able to undertake and record a thorough, sensitive and detailed assessment, using appropriate techniques and equipment

Counsellor and psychotherapists only:
You must
- be able to devise a strategy and conduct and record the assessment process that is consistent with the theoretical approach, setting and client group
You must - be able to observe and record clients' responses and assess the implication for therapeutic work

2a.3 You must - be able to undertake or arrange investigations as appropriate
You must - be able to analyse and critically evaluate the information collected

You must -
be able to apply a chosen theoretical approach to assess the clients' needs
You must - be able to apply a chosen theoretical approach to assess the suitability of the therapy offered to clients

The problem with this is, as elsewhere, alongside what this ideological stance demands, as what it leaves out. There is later window dressing about 'the chosen theoretical approach', no doubt due to representations from the PLG, but even then, ideological arrogance (and ignorance) shines through in the 'power over' supposition that therapy is something that is applied to clients: A paradigm of entering into a relationship based on rapport, support and challenge and often the long-term waiting and listening for the emergence of a hidden client story, is missing. A Gestalt approach would jointly enquire in a co-created process how the client creates and dissolves his/her preferences or expectations. Making an 'assessment' is problematical since it will impose the therapists preferences or expectations rather than have them be an ingredient in the inquiries.

On page 7 of the draft standards there is an open embrace of NHS-manager speak in the service of a medico-scientific approach to civic accountability.

'Formulation and delivery of plans and strategies for meeting health and social care needs'

Again the medical notion that it is mental health that the standards are talking about is submerged.

2b.1 You must be able to use research, reasoning and problem solving skills to determine appropriate actions

You must - recognise the value of research to the critical evaluation of practice
You must - be able to engage in evidence-based practice, evaluate practice systematically, and participate in audit procedures
You must - be aware of a range of research methodologies
You must - be able to demonstrate a logical and systematic approach to problem solving
You must - be able to evaluate research and other evidence to inform [your] own practice

The positivist view of research in which a passive object is acted upon by an alienated enquirer who is subject to random controlled trial and statistical analysis of data is uncritically embraced here. As though this pharma-driven evidence-based practise driven approach to enquiry had not been subject to decades of critical review and challenge ou of which has arisen the notion that therapy is itself a valid form of research, the outcome of which is significant if the client experiences it as significant.

After 2b.2, a list of anodyne specifics for counsellors and psychotherapists, we hear more of the management paradigm

2b.3 You must be able to formulate specific and appropriate management plans including the setting of timescales

“Management plans” is again NHS-speak, along with the need for “timescales” irrelevant to self-employed majority of practitioners. And below in 2b.4, “treatment” is medical, “done to” stuff.

2b.4 You must be able to conduct appropriate diagnostic or monitoring procedures, treatment, therapy or other actions safely and skilfully

Another long list of 'musts' for counsellor an psychotherapists follows. No one seems to have noticed that some tend to be somewhat or very contradictory of the previous demands, for example:

You must - be able to establish an effective, collaborative working relationship with the client
You must - be able to initiate and manage first and subsequent counselling/psychotherapy sessions by developing rapport and trust

Again, from a non-medical humanistic, educational, gestalt, or transpersonal approach, to name only a few, we don't “manage” sessions. We might facilitate or introduce some other more collaborative, consensual approach. We might use words like “holding” or “being present” instead. And in 2b.4 there is an assumption that the practitioner establishes the relationship, ditto “developing rapport and trust”. The client might have a difficulty with trusting people or trusting life: so how on earth does the therapist become responsible for establishing trust with them?

Another couple of musts:

2b.5 You must be able to maintain records appropriately

You must - be able to keep accurate, legible records and recognise the need to handle these records and all other information in accordance with applicable legislation, protocols and guidelines
You must - understand the need to use only accepted terminology in making records

No listing of what would be accepted terminology appears, and acceptable to whom? The mind boggles at the encyclopaedic extent of what would be required! However, if sadly you should find yourself up before a 'fitness to practise' hearing, keep in mind, as a recent case demonstrated, that what might seem to you adequate notes in terminology which matches the nuances, style, spaces and omissions of the work you do, could be grounds for sanctions if they aren't in the legally required (but unspecified) vocabulary.

On page 9 (only two more to go) we get to the HPC's model of quality assurance.

Critical evaluation of the impact of, or response to, the registrant's actions

you must - be able to monitor and review the ongoing effectiveness of planned activity and modify it accordingly

you must - be able to gather information, including qualitative and quantitative data, that helps to evaluate the responses of service users to their care
you must - be able to evaluate intervention plans using recognised outcome measures and revise the plans as necessary in conjunction with the service user
you must - recognise the need to monitor and evaluate the quality of practice and the value of contributing to the generation of data for quality assurance and improvement programmes
you must - be able to make reasoned decisions to initiate, continue, modify or cease treatment or the use of techniques or procedures, and record the decisions and reasoning appropriately

This probably all sounds very reasonable to a mind entranced by a scientised approaches to validity and thus in a permanent state of genuflection to reason-based medicine and a positivist version of science. And quite insane to practitioners for whom assigning this version of rationality to the sidelines of therapeutic validity has been an developmental task.

Some years ago being part of a team developing an international manufacturing quality assurance [QA] programme, plus my experience over the past 15 years of The Independent Practitioners Network [IPN] has helped me understand how QA matched to the psychological therapies can have value. From this wider perspective the HPC's notion of QA seems an obviously archaic formulation.

The HPC approach to QA is archaic because it entails an 'inspect and reject' form of quality assurance that has long been dismissed in industry as hugely wasteful.

However the HPC don't seem to know this. Probably they have never visited a factory making video cameras or lenses, or for that matter thermostats. In such production processes 'inspect and reject' QA was replaced decades ago by regimes of continuous scrutiny by the personnel closest to the item being produced. As and if the process goes out of spec. immediate action can be taken by them to interrupt production before any faulty item is produced. So far as I am aware IPN is the only example of this level of scrutiny in the psychological therapies.

No amount of shape-shifting of verbiage will prevent the QA process that the HPC embodies from being fundamentally unfit for the purpose of regulating the transferential subtleties and embodied and spiritual realities of the psychological therapies.

To move on, the PLG members appear to have negotiated some caveats local to different theoretical approaches (why is it always theoretical differences, don't any of them employ a bit of metis?) These all apply to checking out the client experience which I suppose is fair enough.

However at this point the infection of government and half the UK by one or another form of audit culture begins to take over the document. Keep in mind it is an 'inspect and reject' regime i.e. action is only taken when there is a case to answer about misbehaviour. Misbehaviour is not prevented, it is punished.

2c.2 You must - be able to audit, reflect on and review practice

You must - understand the principles of quality control and quality assurance
You must - be aware of the role of audit and review in quality management, including quality control, quality assurance and the use of appropriate outcome measures
You must - be able to maintain an effective audit trail and work towards continual improvement

Expect to see a lucrative line in trainings emerging for practitioners to learn the 'use of appropriate outcome measures', how to 'maintain an effective audit trail' and participate in quality assurance programmes following recent political fashion.

You must - participate in quality assurance programmes, where appropriate

But see above, only the paradigm of 'inspect and reject' QA that the HPC mistakenly sees as a match for the psychological therapies.

As though none of the above would have any effect on how they practise, the PLG seem to have managed to get in a couple of line about supervision, a necessary but very limited notion of what is needed to sustain the ongoing capabilities of practitioners.

You must - understand the need for and role of supervision
You must
- be able to make use of supervision, consistent with [your] theoretical approach
You must
- be able to critically reflect on the use of self in the therapeutic process and engage in supervision in order to improve practice

'Self' is something to be 'used', and it is introduced as it had the same commonplace concrete meaning as 'knife and fork'.

The last section of the HPC draft standards of proficiency for counsellors and psychotherapists is devoted to

Knowledge, understanding and skills

In this section the HPC sees the psychological therapies through academic spectacles (they accredit courses at around sixty UK universities) coupled with the familiar medical, mental illness emphasis seen earlier.
The musts in 3a.1 include,
'Key concepts', 'bodies of knowledge', 'health', and 'disease ', 'disorder' and 'dysfunction'.

You must - be aware of the principles and applications of scientific enquiry, including the evaluation of treatment efficacy and the research process

There is some presumption that there is only one paradigm of science, the one that has for the moment made its home in the DoH conceptual universe.

You must - understand the theoretical basis of, and the variety of approaches to, assessment and intervention

A paean to intellectual dominance still with no acknowledgement of the prominent role of metis in the psychological therapies. The PLG appears to have had a few things to say about this but they are just as intellectual in their formulation; seven sentences begin with 'understand', one with 'know about'.

Even more dubious than this academic bias is the open embrace of psychiatric, i.e. DSM4 notions of mental health, as though its notions of 'disorder' were an uncontroversial gold standard of the human condition and not pharma/psychiatric concoctions serving, in their country of origin the US, to structure the health insurance industry's payments and revenue.

Psychotherapists& Counsellors (3a.1)

You must -
be able to recognise severe mental disorder in clients / or - be able to recognise disorder of the mind in clients
You must - understand and be able to work with common / general mental health problems / or – understand and be able to work with mild / moderate mental health problems

Psychotherapists only

You must -
understand typical presentations of severe mental disorder
You must - understand methods of diagnosis of severe mental disorder appropriate to the theoretical approach and be able to conduct appropriate diagnostic procedures
You must - understand and implement treatment methods to address symptoms and causes of severe mental disorder

Counsellors appear to be seen as poor relatives who can't be trusted to get down to the nitty gritty with clients, their 'musts' are less onerous.

Counsellors only

You must - understand theories and research on mental health and well-being and obstacles to wellbeing and be able to use these to facilitate client development
You must - understand theory and research concerning specific life problems, issues and transitions that commonly lead individuals to seek counselling and be able to use these to inform practice

There is a bottom of the page caveat to the effect that 'the views of stakeholders should be sought during the consultation process on alternative forms of wording for these 'standards' in 3a.1., as though it was only a 'wording' rather than a paradigm problem. Not surprising then that as of the end of July the BACP chair made a public rejection of the PLG recommendation that provide for separate titles and thresholds of entry for 'Psychotherapist' and 'Counsellor', plus we should add, different NHS pay scales.

Lastly the consultation document on standards and proficiency pays lip service to diversity:

3a.2 You must - know how professional principles are expressed and translated into action through a number of different approaches to practice, and how to select or modify approaches to meet the needs of an individual, groups or communities

The text goes on to run the HPC version of the national cultural obsession with 'safety', failing to notice how this is likely to contribute to a generally risk-averse practice, as if this were in client's interests.

3a.3 understand the need to establish and maintain a safe a practice environment

You must - be aware of applicable health and safety legislation, and any relevant safety policies and procedures in force in the workplace, such as incident reporting, and be able to act in accordance with these
You must - be able to work safely, including being able to select appropriate hazard control and risk management, reduction or elimination techniques in a safe manner in accordance with health and safety legislation
You must - be able to select appropriate protective equipment and use it correctly
You must - be able to establish safe environments for practice, which minimise risks to service users, those treating them, and others, including the use of hazard control and particularly infection control

Here endeth the lesson, a curious form of employer-led theology that the HPC would have us absorb - that it is possible to make people moral through the use of threat, coercion and duress.

Download Word Document
The PLG report can be found here