|July 9 2008 | LEGAL | ARCHIVE | IPN | CONTACT | HOME | CONTENTS.........|
Were you wondering what State regulation [SR] of the psychological therapies might mean for the future of your practice?
This eIpnosis overview looks at what is at stake.
Contradictions and Anomalies
Priorities & Choices
The main accrediting bodies in the UK psychopractice, BACP, UKCP, BPS have long sought SR as a part of sustaining their struggles with each other for market share and this continues very strongly to the present day.
Just as 10 years ago a training organization couldn’t stand aside from UKCP accreditation and still find trainees, so today training organizations are unlikely to choose to stand aside from the promotion of SR.
The government’s decision to extend availability of psychological health care has resulted in funding of ₤173 million over the next three years for the Increasing Access to Psychological Therapies [IAPT] programme. This has further sharpened competition for status and power between the accrediting bodies. Who oversees the IAPT work? Who does the low volume, high status work with clients? Who trains the new occupation of high volume, low status, psychological healthcare assistants who will be the first line of contact with the public?
Alongside this, as the NHS moves towards commissioning, including psychological therapy services, everything has to be cost-effective. To be costed, a service has to be measurable/quantifiable, if only in time and salary/level of expertise of the person delivering the service. And following that, under current policies, standardized across the UK.
The extreme pressure in recent decades on many universities to generate income has meant that they have been eager and willing to sell academic valorization services to training businesses.
Some registrants will undoubtedly earn more under SR but this needs to be set against the costs of administering it which will be born entirely by registrant fees.
In contrast to the current relatively open market place for psychological therapies, SR enforces a legal resolution of the ethical challenges of these economic drivers.
Alongside economics, SR looks to be a part of an unfolding culture of auditing, surveillance and security that has taken root in the UK.1 The London, Madrid and 9/11 bombings, plus the Shipman and Bristol Infirmary scandals, each damaging but very exceptional events, appear to have fermented together to produce an intense national preoccupation with ‘security’.2 This has bred undeliverable expectations that we deserve guarantees of safety, that risk and uncertainty can and should be eliminated.3
The present government response to these concerns includes adopting an approach to psychological care guaranteed, the DoH would have us believe, by scientific research and evidence-based practice. 4 This appears to be why the Department of Health strongly favours clinical psychology and cognitive behavioural therapy [CBT].
While it may seem a tedious and trying political dilemma, SR is important as an indicator of other social concerns. It sits on the cusp of several current psychosocial contests; between ‘treatment’ and personal development; the standardization of NICE protocols and the diversity of dozens of therapeutic modalities; between ‘schooling’ and education; between global knowledge and local experience; between theory and mêtis.5
SR of the psychological therapies means passing to the state ultimate responsibility for the maintenance of ethics, standards and competencies. For day to day purposes this means the Health Professions Council [HPC] (a practitioner will have an individual SR account directly with the HPC just as we all have with the Inland Revenue).
There are strong signs that the intended level of competencies and standards required for registration will be at a low threshold so as to collect the largest group of practitioners. This appears to favour counselling and poses a threat to the status of psychotherapy, with considerable continuing tension around defining the relevant titles.
Even though around 70% of the psychological therapies are outside the NHS, a defining feature of plans for SR has been the extent to which it is being driven by the needs of the NHS and a medical model of psychological care. Skills for Health [SfH] an employer-led organization, has produced industrial workflow analyses of counselling and psychoanalytic psychodynamic therapies.6 Despite widespread objections, such ‘standardized treatment protocols’ for ‘patients’, developed and written by a handful of unelected practitioners, presently occupy the high ground of the SR process.
However the HPC, which holds legal responsibility for delivering regulation, told eIpnosis that they were not committed to the standards and competencies that SfH might deliver.
The HPC’s structures its responsibility for regulation via an administrative model. A population of administrators who may have no experience of psychological therapies manage the task of regulation. Expertise is hired in on short term contracts as necessary. As historic imperial experience suggests, such administering of an entirely foreign domain, in this case psychopractice, will require the use of considerable force and coercion, enough to ensure willing subaltern status from registrants.
Contradictions and anomalies
Despite the high value the DoH gives to research, there have been no systematic studies of the extent of harm due to the psychological therapies.
So far as eIpnosis is aware, none of the mainstream accrediting bodies has conducted a referendum of their members on whether or not they wish to be state regulated.
You might expect the psychological therapies to mount a critique and model alternatives to the social status quo of the corporate capitalism that is increasingly shaping state and client agendas. Their organizational desire for SR suggests that, awarely or not, they are instead committed to reproducing/supporting this status quo.
eIpnosis has long been preoccupied with the contradictions in the use and abuse of power that are characteristic of the moves towards SR. In local practitioner work, ‘power with’ cooperative collaborative inquiries with client-validated outcomes predominate. In the global organizations that their practitioner members pay for, domineering ‘power over’ and undemocratic relations between each other and with their members has been the norm.
The biggest anomaly seems to be the disappearance of the ‘client protection’ agenda, especially from ‘cowboys’ and ‘charlatans’. This now looks to have been a ‘flag of convenience’ for the industrial and status agendas of the DH and the mainstream accrediting bodies.
eIpnosis signed up for the weekly reports from the HPC’s panels adjudicating complaints against registrants. Some of the practitioners undoubtedly deserved to be separated from any form of client contact. However from most of the investigations it has been hard to avoid the view that the HPC protects the public from practitioners previously deemed to be reliably trained, qualified and competent, i.e. they are protecting the public from the professionals they have previously accredited as reliable.
So far as clients and ’service users’ articulate their needs and concerns,7 they seem skeptical of the addition of counselling and psychotherapy to the existing hegemonies of clinical psychology and psychiatry.
Despite diligent inquiries, eIpnosis is still looking for a detailed, substantiated text that argues cogently for state regulation of the psychological therapies.
Priorities and choices
Age, experience, the need to pay a mortgage and other life overheads, whether our engagement with psychological therapies is more of a job than a calling; each of these tend to point to a wide variety of personal priorities re SR. In addition, alongside the NHS and work with agencies, trainings and universities, there is private practice and a huge number of people working part-time or as volunteers. each with divergent local concerns about SR.
In some of these situations saying No to SR will be a very tough and costly choice. However, saying Yes to SR in denial of a No feeling will also have a price not least because it is likely to lead to a subterranean culture of non-, or partial, or false compliance.
For others the ethical compromise of signing up to the HPC will be too great. Some may come to see the registered occupations of ‘psychotherapy’ and ‘counselling’ as anathema and will look for other ways of legally working with the human condition.
And there are other problematic dilemmas, for example, SR as presently planned, makes psychoanalysis impossible.
Finally in this brief overview, Marc Seale, CEO of the HPC, the proposed Regulator, told eIpnosis that if as many as a third of counselling and psychotherapy practitioners didn’t sign up for SR it would be held to have failed.
1 the east-bound platform of eIpnosis local Underground station, Turnham Green, has 24 CCTV cameras.
2 Those of us who lived through the IRA UK bombing campaigns (two bombs within earshot) have been puzzled that a more recent generation should so comprehensively buy into the current politics of fear. Might it be because the collective memories of WW2 were more present in the 70s and 80s?
3 Leaving aside the shadow cast by our attack on Iraq, might not this flight into security and certainty amount to a displacement of anxiety and powerlessness re global warming?
4 The hospitals struggling with high infection rates that appear to be due to over-prescribing of antibiotics provide an example of the futility of demanding from the state guarantees of security while expecting immediate elimination of personal infections through the same antibiotics.
5 mêtis, the physical intuition required for gliding, sailing, playing jazz, making love, etc.,
6 In recent years the purpose of similar taxonomies of training, competency and responsibility in higher education was defining/consolidating status and pay grading.
Birmingham and Solihull Mental Health NHS Trust Userwatch