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29th March 2000
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There is no clear body of evidence to support the view, or indeed that even suggests support for the view, that the statutory registration of psychotherapy would protect the interests of the public. Indeed in a recent debate in the literature (see Feltham, below) Digby Tantam one of the country's leading proponents of statutory registration doesn't even attempt to argue this case on these grounds. On the contrary, there is an extensive literature, backed up by years of outcome research that clearly points to there being a very strong case against statutory registration (see Mowbray, House, Totton, Bohart, Hogan etc) in this field, and which strongly indicates that the only group whose interests are likely to be enhanced by such legislation would be the psychotherapists thus registered! Naturally enough, this latter group has been loath to protest about the possibility of such an outcome! Since the publication of Mowbray's seminal text 'The Case Against Psychotherapy Registration' in 1995, there has been no serious attempt by the proponents of such registration to counter the evidence on which his work was based. Any impartial reading of the literature and research in this field can, and has come to one conclusion and one conclusion only, namely "statutory registration should be assumed detrimental (to the interests of the public) unless proven to be both necessary and beneficial". There is thus a clear ethical obligation upon the protagonists of professional registration to logically and empirically justify their position (Mowbray). Needless to say the current bill under consideration is accompanied by no such logical or empirical justification. Additionally, if the legislature were looking for a simple way to give the public added protection from unethical psychotherapists - the only plausible basis for considering legislation in this field - it would be far simpler, and less expensive to improve the remedies available at the civil, and indeed at the criminal law, not just for this but for other 'caring' professions. Needless to say, the proponents of statutory registration never propose this because such legislation whilst clearly aimed at 'protecting' the public, provides no fringe benefits at all to the 'professionals' Proponents of statutory registration often argue from the example of other professions, namely, law and medicine. However, it is arguable that psychotherapy and counselling are not professions at all but more like 'vocations' (see Totton) or on a more mundane level simply 'occupations' where the risk to the client is relative small compared to other unregistered 'occupations' and 'trades' (e.g. building, car mechanics) where the public has to make do, and does quite satisfactorily, with the remedies available through civil law. In other words the argument from the example of other professions is a circular and misleading one. Psychotherapy and counselling are attempting to become recognised as 'professions' in the UK today, and one of the main mechanisms for so doing would be via statuary recognition. The argument for being treated like one of the professions cannot therefore stand on the assumption of already being one of the professions. Once again the research evidence is clear the kinds of skills and qualities necessary for the effective psychotherapists/counsellor are more like 'good parenting' skills than they are like those of a surgeon or barrister. As Professor David Howe puts it 'many of the elements of the effective therapist-client relationship appear similar to those of a 'good enough' parent-child relationship. Counselling courses reflect this. They are mainly filled by women who have an experience 'caring'. Entry is not dependent on 'A' level passes, let alone possession of a degree, and courses are part-time and experience based. The recent fashion of linking psychotherapy courses to post-graduate degrees reflects the training institutes desire for kudos (and academic institutions need for numbers) and has little to do with the level of complexity of the skills and theory needed to be learnt by the effective practitioner. Psychotherapists, perhaps because their practice involves hours of self-abnegation and narcissistic denial seem to have an inexhaustible appetite for tokens of status outside their office hours! Needless to say, the momentum towards state recognition of a 'profession' has been driven by those with the strongest of such needs coupled with the 'closet' narcissists in the rest of the field. Put simply, the drive towards registration is fuelled by the unquenchable self-importance of a few 'leading' figures in the field, and invested in, principally by the main training institutes who are working, through statutory registration, to guarantee their monopoly control over training for years to come. The support of some of the therapy bureaucracies for this drive comes from this same 'snout in the trough' mentality and is nothing more or less than the pursuit of self-interest by interest groups set up and joined for that very purpose. Again it may be argued that under the current arrangements anybody can set up a name plate and call themselves a 'psychotherapists'. The reality is that very few do, and 'charlatans' appear in all walks of life not just the therapy field. In reality, in this as in other trades, people vote with their feet - if you set up as a 'builder' and have few building skills, people soon take their business elsewhere, and so it is in the therapy world. In this area of activity the market truly is the best regulator there is. In fact clients/patients are far more likely to be taken in and not trust their instincts by those few 'psychopathic' personalities with books to their names and certificates galore on their wall who haunt every sphere of activity where 'trust' and human relationships are involved. Needless to say, these types are always the first to accredit and 'look' respectable. Regarding the employed sector, employers are able to run a rule over their prospective counsellors ensuring if they wish to that they do have the relevant training and experience. It would be quite simple, if it were deemed necessary, to introduce a licensing system for counsellors and therapists at the local authority level which would enable members of the public to 'inspect' the credentials of their proposed therapists. However, this offers no 'fringe benefits' to the status hungry and no centralisation of training and therefore has no appeal to those who have pushed for regisiration. In sum then, the case for psychotherapy (and counselling) registration is indeed a skimpy one based on a foundation that is far more about self-interest than the interests of the public. I pray therefore that anyone considering this legislation looks at the evidence, the research material, and the relevant articles and books on the subject. If the situation ever arose where the public did need extra measurers of protection, the legislature should look for economic way of so doing that do not involve privileging one set of practitioners at the expense of another. The fact that large numbers of practitioners have responded to the issues involved in this in ways that can only be described as docile, compliant, passive and bored, tells us nothing about the issues themselves but everything about how psychotherapists like any other social grouping behave when vulnerable to promises of ehhanced status at the same time as the threat of marginalisaton and social exclusion. From this point of view the prospect of statutory registration has alreadv done immeasurable harm to psychotherapy creating schisms between psychotherapists, skewing the aecrediting and training organisations towards activities that have little or nothing to do with competent training and practice, and encouraging defensivemindedness in therapists, supervisors , trainers and trainees alike, References Mowbray, Richard : The Case Against Psychotherapy Registration. T.M.P. 1995 Saks, Mike : Professions and the Public Interest. Routledge 1995 House, R & Totton, N (eds): Implausible Professions. PCCS Books 1998 Russell, Roberta : Report on Effective Psychotherapy Legislative Testimony : Lake Placid, New York Hilgarth Press, 1981 (with 1993 update) Hogan, Daniel B: The Regulation of Psychotherapists, 4 vols. Cambridge, Massachusetts : Ballinger 1979 Feltham, Colin: Controversies in Psychotherapy and Counselling: Sage, UK 1999 Bohart, A.C. and Tailman, K (1996) 'The Active Client: Therapy as Self-Help' American Journal of Humanistic Psychotherapy 36 (3) 7-30 See also: Stone, J and Mathews, J (1996) Complementary Medicine and the Law: Oxford University Press Parker, I et al (1998) Deconstructing Psychotherapy. London, Sage Howard, A (1996) Challenges to Counselling and Psychotherapy, London, Macmillan. Davis, R.M. (1994) House of Cards 'Psychology and Psychotherapy Built on Myth' : New York : Free Press Charity Commissions for England and Wales (1997) Political Activities and Campaigning by Charities: CCG London: Charity Commission.
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| a journal for the Independent Practitioners Network |
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