Dr. Bruce Scott
Philadelphia Association, London.
The title in no way implies wrong doing on the part of the conference organisers, the United Kingdom Council for Psychotherapy (UKCP). It was a very well organised day where the two representatives from the Health Professionals Council (HPC) made very polished presentations and were very willing to talk about the HPC’s initiatives for regulating psychotherapists and counsellors and their training courses. The issue I have is that I feel that if I were to agree to the proposals offered so far by the HPC (and on the day in question) and sign up so to speak, I would, paradoxically be complicit in breaking the HPC’s standards of conduct, performance and ethics. Indeed, if any counsellor or psychotherapist did sign up to be regulated by the HPC (and also let their courses be regulated by the HPC), as the framework for the proposed regulation of counsellors and psychotherapists stands at the moment, then every one of the new registrants would be falling foul by breaching the HPC codes of conduct, performance and ethics. Let me explain why. Firstly, let me quote from the HPC’s website:
“We are a regulator, and we were set up to protect the public. To do this, we keep a register of health professionals who meet our standards for their training, professional skills, behaviour and health.”
Sounds fair enough at a glance; but all is not what it seems and worryingly a vast pro-HPC majority seem either unaware of their blind spots or have another agenda for signing up to the HPC. The fact as it stands is that the HPC have no evidence to back up their claim that they will and can protect the public. The HPC are not protecting the public, but are harming the public by trying to convince us (psychotherapists, counsellors, and the public) that they are.
At the conference during the afternoon session, delegates split up into different groups. I decided to go into a group which had as one of its members Michael Guthrie, the Director of Policy and Standards at the HPC, who would be responsible for setting educational standards of psychotherapy training courses if regulation went ahead. He is the person responsible for setting the educational standards which psychotherapy and counselling trainings will have to abide by if regulation goes ahead. Mr. Guthrie gave a polished presentation in the morning session, but I felt unconvinced as he had not produced any facts how the HPC’s policies would improve the psychotherapy world as it stands.
During the small group meeting I asked him if the HPC standards of education that will be imposed on psychotherapy trainings result in a better and improved education for trainees, and thus better psychotherapists, and therefore a world where the protection of the public is improved; better than what already exists and if there was any evidence to back up these actions and proposed plans.
To cut a long story short, he could not give me any evidence, scientific or anecdotal, and neither could any of the other delegates in the room, whom I felt were all pro-HPC. This was because, as I found out through the conversation we were having, there has been no research conducted to find out if the proposed regulation of psychotherapists and counsellors and their respective training courses will have any effect on improving training, psychotherapists and their conduct, fitness to practice, and would result in better protection for the public.
What was most disturbing was that there seemed to be some kind of unwillingness in my group amongst the delegates and Michael Guthrie to focus upon this important and troubling point (as the HPC’s primary remit is the protection of the public) that there was no evidence. On my asking of the question, Mr. Guthrie was silent, while another delegate broke the uncomfortable silence and protested that the world would be a better place with HPC regulation as her modality of practice would gain recognition within the NHS and thus achieve a more respectability in the world of psychotherapy and all what being in the NHS entails: more opportunities for earning income. Another delegate from the same modality agreed and gushed that she wished it (HPC regulation) would happen tomorrow, followed by another female delegate who lamented that the wait for regulation to happen is unsettling and she also wished it would just go ahead. A gentleman delegate explained how regulation would be good as it would give psychotherapists and counsellors a “seat” at the HPC table alongside the psychologists and would enable to stem the CBT /IAPT bias that is flooding the market and taking away jobs from psychotherapists and counselors form other modalities. He also stated that the psychotherapy and counselling’s image would be enhanced in the public eye if it was regulated by the HPC.
After these comments by my fellow delegates I felt as though my question was being swept under the carpet and I again intervened. I said that I understand what some people in the room were saying in relation to HPC regulation being good for jobs, or even that the image of psychotherapy and counselling might be improved, but that this was not what I had asked. I reiterated to the group that I had asked if there was any evidence for the HPC’s educational policies would result in a more risk free psychotherapy world as per their remit?
At this point I put on my academic psychologist’s hat (my previous life before I trained as a psychoanalytical psychotherapist was involved with studying the cognitive model of depression and the effects of antidepressants) and I said that as a psychological scientist I have to be convinced by evidence if I am to agree with a policy of action, but the HPC has provided no evidence. I then referred to what Peter Fonagy said at one previous PLG meeting during the lunch break ; he said that therapists have to be regulated as one study showed that 5% of therapists do either harm or no good. I then said to my fellow delegates this statistic may fit with remit of the HPC about protecting the public, but even if Fonagy’s statistic is true (I have never seen the paper) it is a deceptive statistic for several reasons. I explained to the group why. Firstly, in any distribution of therapists’ effectiveness, at either end of the distribution you will always have therapists who do not “cure” the patient, and at the other end therapists who do “harm”. I pointed out that it all depends of course what is meant by harm and doing no good or not “curing” a patient and thus we could get into a long discussion about what is harm and doing no good. Nevertheless, I said that regulation would never make this 5% of bad or harmful therapists disappear; you will always have patients who do not get “cured” and patients who feel they have been harmed. Regulation will not stop this statistic occurring so Fonagy’s argument does not hold any weight. Another example of how this is nonsense is when one thinks of antidepressant treatment. Most medical practitioners worth their salt know for a fact that some people will not get better taking antidepressants and some people will get a lot worse and be harmed. The same can be said for clinical psychologists giving CBT to people; some people will never get better and CBT might make them worse; CBT therapists know this fact well. As it stands, both these treatments are regulated as are the practitioners who apply them.
So I said to my delegates in my group that the HPC’s boastful idea that it is protecting the public by regulating psychotherapists is a delusion; a dangerous and futile grasping for a utopian world that can never be realised. The gentleman delegate agreed with my explanation, but reiterated that regulation was not about protection of the public and it never could be; it was about gaining the public’s confidence in psychotherapy. In other words the public will see HPC regulated psychotherapists and counsellors in a better light. Michael Guthrie spoke at this point and said it would be very difficult to do research and thus find evidence to see if the HPC’s regulatory policies for therapists and their training courses do protect the public. I retorted that this was debatable, but that it would be possible to ask the British public what they would think about psychotherapists and counsellors being unregulated by the HPC and regulated by the HPC. However, one would have to include the proviso and let the public be aware, that their safety would not be improved if therapists were regulated by the HPC as the HPC did not have any evidence that it would improve safety or improve protection of the public. What would the public think about this possibility?
What was quite amazing regarding this exchange was that nobody in the room, including Michael Guthrie defended or argued for the HPC’s remit that it was there to protect the public despite the HPC propaganda that this is what it is for. It seemed to not be an issue for anybody in the room that the whole HPC drive for regulation and the willingness of psychotherapists and counsellors wanting to sign up to the HPC may have nothing to do with safety of the public. I could not quite believe what I was hearing. On the one hand, being an anti-HPC regulation kind of guy, such an admission by the HPC representative and its supporters in that room was too good to be true, but on the other hand it is quite worrying that such deception and ambivalence on such an issue is alive and well in the HPC and its supporters. The minute taker who was writing down the questions and aspects of the discussion asked our group if their questions had been answered (by Michael Guthrie and other members) and she stated that she did not think that my question had been answered. I replied (just to double check that I had not been hallucinating) that it had. I said that it seems that the HPC have no evidence that its regulation policy for psychotherapists, counsellors, and training courses will improve public safety, and in fact the HPC and its proposal to regulate psychotherapists, counsellors, and their training courses has nothing to do with public safety. There was no noise of disagreement from the group or Michael Guthrie.
All I can conclude for this is that protection of the public may be a smokescreen for a “jobs for the boys” or a “seat at the table” attitude that fuels the pro-HPC psychotherapists and counsellors motives.
Two other important things that Michael Guthrie explained to the group were related to fitness to practice hearings and a proposed name change for the HPC that was discussed recently at a HPC meeting. I said to Mr. Guthrie and to the group that I was very concerned with the fitness to practice hearings that the HPC run. I told the group that I had been to one and I thought it was horrendous, barbaric, and de-humanizing process and that being there and witnessing the hearing was very upsetting. I asked if the HPC had any plans to have alternative ways of handling complaints made against registrants. Mr. Guthrie replied they there was indeed discussions about alternatives (e.g., mediation) going on within the HPC and that the Fitness to Practice Committee will meet on the 21st October at the HPC’s office in London and that I was welcome to go along to this meeting. I also asked about the possible name change of the HPC to the Care Professions Council and if this was still an option. Note that this would be one way to appease some people who did not like being called or identified as a health professional. Mr. Guthrie was quite sure that such name change plans had been shelved and he was sure that they would not be re-visited.
Now back to my education in misconduct. I feel it might pertinent to visit the HPC’s generic Standard of conduct, performance and ethics which all registrants have to abide by. If a registrant does not meet these standards, to quote the HPC from their website:
“The HPC will take action against health professionals who do not meet these standards…”
Actions taken by the HPC could include being struck off and not being allowed to practice, suspended, or conditions of practice being applied to the registrant. But let us look more closely at the individual standards in light of what I have talked about in this article. I will first outline the standards which I feel the HPC has not met itself and a budding registrant who if he or she signed up today would not meet the standards by the act of signing up, and then I will go on to explain why. I will do this sequentially for each standard I quote. This is not a comprehensive analysis; it just a snap shot and much more could be written about this. From the HPC’s booklet, Standard of conduct, performance and ethics that all registrants own and must live up to:
1. You must act in the best interest of service users.
It goes on to describe:
You are personally responsible for making sure that you promote and protect the best interests of your service users…..You must treat service users with respect and dignity…..You must not do anything, or allow someone else to do anything that you have good reason to believe will put the health or safety of service user in danger. This includes both your actions and those of other people.
From what I learned at this conference, the public are not being treated with respect and dignity. The HPC are deceiving the public with a false message of protecting the public. The HPC therefore are allowing themselves and potential psychotherapists and counsellor registrants (and currently with practitioner psychologists I might add) to put the mental health of members of the public in danger due to this deception. The HPC are also deceiving psychotherapists and counsellors with this deception of standing for the protection of the public. Further, if psychotherapists and counsellors willingly sign up to HPC regulation (as the HPC plans stand) if it goes ahead, then by being part of the HPC organisation, they will be in effect breaking standards by being a member; they will be complicit with the deception if they know that the HPC’s so-called remit for protection of the public is false. If they (prospective registrants) do not know that the public’s best interests are being protected, then it is a duty of the prospective to find out; in other words question the HPC and their false propaganda about protecting the public. Both allowing the HPC to operate in this way (not really being about public safety and having no evidence that their regulatory policies work), and the HPC allowing prospective psychotherapist and counsellor registrants to act in this way (sign up to a hollow and deceiving organisation) is not meeting this standard. For the HPC and prospective psychotherapist and counsellor registrants, fitness to practice is therefore impaired.
3. You must keep high standards of personal conduct.
This standard is described as:
You must keep high standards of personal conduct, as well as professional conduct. You should be aware that poor conduct outside your professional life may still affect someone’s confidence in you and your profession.
Surly deception is poor professional conduct. The HPC’s professional conduct is tarnished due to the fact that they have no evidence that their regulatory policies they want to put onto psychotherapist and counsellors will work or protect the public. Surly it is duty of registrants and prospective registrants to be aware (and/or to find out by questioning the false propaganda of the HPC) that such conduct is un-professional and this knowledge would affect the confidence of the public in the HPC and its registrants. The HPC have not met this standard themselves, and if one signed up to the HPC one would be conducting oneself in a very unprofessional manner. Again fitness to practice impaired for both the HPC and prospective registrants.
4) You must provide (to us and any other relevant regulators) any important information about your conduct and competence.
This entails:
You must tell us (and any relevant regulators) if you have important information about your conduct or competence, or about other registrants and health professionals you work with.
With such a standard the HPC must let the public and Centre for Healthcare Regulatory Excellence (the HPC’s regulator) that it is not fit for purpose. Its conduct is unprofessional due to the deception that continues regarding the lack of evidence that it has of its efficacy and also that it is deceiving the public that its function it to protect the public. This information must be made known for this standard to be met. Thus to sign up to the HPC is in effect a sign of a lack of competence and misconduct.
6) You must act within the limits of your knowledge, skills, and experience and, if necessary, refer the matter to another practitioner.
The HPC do not know if what they are doing or what they want to do (regulate psychotherapists and counsellors) will be or is presently effective (i.e., with practitioner psychologists). They do know, as discussed earlier that there is no evidence that what they do or want to do is not backed up with evidence. The HPC are not acting within their limits of knowledge, they are going beyond it. The HPC have not met this standard; their fitness to practice is impaired. Many prospective and willing psychotherapists and counsellors who sign up to HPC regulation must, if they are to meet this standard, refer the matter of their regulation to somebody else seek help and question their act of signing up to the HPC. This is because a prospective registrant does not know if they are signing up to a “safe” organisation. The HPC have not provided the prospective registrant with information and evidence as to what they do is reliable and the prospective registrant does not have the evidence that being regulated by the HPC will make them more effective and safer practitioners. The prospective registrant by signing up is going beyond the limits of their knowledge and thus would not meet this standard and therefore their fitness to practice would be impaired.
7) You must communicate properly and effectively with service users and other practitioners.
My points above are self-explanatory. The public (service users) are being deceived, and prospective registrants are being deceived by the HPC. Both prospective registrants and the HPC do not meet this standard; fitness to practice is impaired.
14) You must make sure that any advertising you do is accurate.
It explains further:
Any advertising you do in relation to your professional activities must be accurate. Advertisements must not be misleading, false, unfair, or exaggerated. In particular, you should not claim your personal skills, equipment, or facilities are better than anyone else’s, unless you can prove this is true…..Any potential financial reward should not play a part in the advice or recommendations or products and services you give.
This is a biggie! The HPC advertise that (from the HPC website and quoted at the start of this article):
“We are a regulator, and we were set up to protect the public. To do this, we keep a register of health professionals who meet our standards for their training, professional skills, behaviour and health.”
As discussed in this paper, the HPC have no evidence that what they do does protect the public. Is this not gross misleading advertisement from their website? This deception makes the HPC fail this standard; their fitness to practice is impaired. The budding registrant would be complicit in this deception if they signed up to the HPC knowing full well the HPC’s false propaganda about protecting the public. The willing registrants at the UKCP meet the HPC day that were in my group all talked about how it would be good for getting jobs/work/income etc and were well aware that the public safety remit of the HPC was not true (they did not disagree with me). Does this not amount to a potential registrant saying “I have the HPC stamp of approval and I can provide you with “better and safer services”, whilst they know full well that they would be part of an organisation that is deceiving the public regarding the remit of protecting the public as they have no evidence? Such behaviour (i.e., signing up to the HPC), if one knows the facts about the HPC (i.e., false public protection claim), is not accurate professional conduct; fitness to practice would therefore be impaired.
Then at the end of the booklet it defines fitness to practice.
When we say someone is “fit to practice”, we mean that they have the skills, knowledge, character and health to practice their profession safely and effectively.
The HPC are not fit to practice. They do not have the skills or knowledge; they have no evidence that what they do and intend to do with the talking therapies will be effective in protecting the public or make better therapists; thus they do not have adequate knowledge to practice safely in their regulatory function. Likewise, a budding registrant does not have the knowledge that HPC regulation will help them practice their profession safely and effectively. Indeed, by signing up without such knowledge, it may put the profession in grave danger, considering what I already talked about.
What I witnessed and listened to on the 24th of September 2010 at the UKCP meet the HPC day was an education for me; an education in how to fall into the traps of misconduct. How could I sign up to such an organization knowing what I know now? If I signed up as the HPC stands today and what I learned on that fateful Friday in September, I would have to go straight into a fitness to practice hearing. What a thought!
1 Cognitive behavioural therapy
2 Government initiative entitled “Improved Access to Psychological Therapies”. This initiative is mostly based on providing CBT and short term psychotherapy for as low a cost as possible. This initiative takes away work and income from trained counsellors and psychotherapists who do longer-term work and work which is not informed from a logical-positivist and evidence based practice standpoint. One result is that IAPT workers with very little training are employed simply to dish out CBT like a medicine to fix peoples’ negative cognitions (i.e., unemployed people in job centres). The political, social, and moral implications of such an initiative are obvious but beyond the remit of this article. See http://www.iapt-cbt.info/ for articles and critiques of IAPT and CBT/evidence based practice in the psychotherapies.
3 An article I wrote entitled: The professional liaison group meeting for the proposed regulation of psychotherapists and counsellors on the 12th May 2010: An example of how not to dwell in un-knowing. This can be accessed at: http://hpcwatchdog.blogspot.com/2010/06/guest-post-by-bruce-scott-on-plg.html
4 An article I wrote entitled: A case of dialectical disease: A tale of a Health Professions Council fitness to practice hearing of a psychologist. This can be accessed here: http://hpcwatchdog.blogspot.com/2010/03/guest-post-by-bruce-scott-on-ftp.html
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