Saturday’s Confer Conference on HPC State Regulation brought together the figureheads of key clans active in the UK psy field today.
As we know, clan HPC is not a native psy organisation, but seeks to take control of the practice in order, as it says, ‘to protect the public’. This clan draws its power not from practice or philosophy, nor even from any pressure group or union, but from the Government. It holds a veil over this relationship.
Ultimately, the relation HPC seeks to build is with the individual members of the 50 or so clans in the psy field, yet initial negotiations take place with the leaders of a few of the more powerful tribes. It is with the individual members that the long-term interest of the HPC lies. This is where the tax will be levied, this is where the new rituals of engagement will be played out, this is where the power will be applied. HPC estimate it will ‘capture’ anything between 50,000 and 100,000 members in this new arrangement.
The money raised from the annual levy will pay for the offices, the salaries, the equipment etc etc etc, of the HPC clan, which retains almost absolute control over decisions how to spend it.
There are virtually no mechanisms whereby the members, or registrants as they are known, can call or hold this regulator to account.
As we have already discussed, and as Italian Barrister and Psychotherapist Alex Amicarelli has exposed, the HPC has been put into a position of power by the Government, but without any obvious mechanisms to call forth its responsibility. Like Shakespeare's Measure for Measure, the Duke carelessly hands power to the rectitudinal Angelo then clears off out of the public eye. This fudge makes it possible for the HPC and its supporters to say whatever they like, depending on what is needed to win the argument at any particular moment. The position it holds is the symbolic key that guarantees its immunity.
It is helpful to think in these terms when reading the extraordinary document that the Conference organisers encourage conference participants to read in preparation for the meeting. In Marc Seale’s statement, for instance, we find just two short paragraphs (presented, by the way, for no apparent reason in quote marks). These reveal the sophistication that is necessary to deploy from a man in such a position. In the first paragraph Marc states that Statutory Regulation will make Psychotherapy and Counselling safer. And in the second paragraph he states that HPC regulation has no negative effects.
The position statement issued by the British Psychoanalytical Council, is a little longer (5 pages), but bears a similar declamatory tone. For example, on NICE: “We consider that the establishment of the National Institute of Clinical and Health Excellence (NICE) that carefully weighs the evidence for the effectiveness (and cost effectiveness) of treatments in the UK is an immense social gain.” But goes on to offer the contradictory information that “there is an issue around whether an overwhelming and over-simplistic primacy has been given to randomised controlled trials (RCTs)”. There is no attempt to analyse the conflict.
The BPC Statement pledges support for each area of Government policy – IAPT, NICE, SfH & NOS, and the HPC. It adds that it is also working with NIMHE and its new project NWW. Anyone who wants to know what these acronyms mean is obviously suffering from 20th century syndrome, and should report immediately to their nearest government re-programming centre, or download the do-it-yourself software (perhaps the link will soon be available on the BPC website).
The statements of Darian Leader (speaking on behalf of the Alliance for Counselling and Psychotherapy against State Regulation) and of Andrew Samuels (appearing in his capacity as Chair of UKCP) have yet to be posted to the website. Instead, you can re-read the original Alliance Statement of Intent, or plough your way through the UKCP’s response to the public consultation on the report of the Professional Liaison Group for Psychotherapy and Counselling produced for the HPC.
Also posted for your edification are the BACP response, the HPC Draft Standards of Proficiency, Michael Guthrie’s (HPC Director of Policy and Standards) assimilation of all 1,100 responses to the consultation, and the Government’s White Paper (Trust, Assurance and Safety). There is no mention of the Maresfield Report, nor a link to the Kings College report
For those who still have room for more reading you may be interested in the following background information, taken from evidence submitted to the Select Committee on Health in 2006. These excerpts come from evidence given on 15th June, 2006, by Marc Seale (CEO of HPC), Sarah Thewlis (Chief Executive of the Royal college of Nursing and Midwifery), and Finlay Scott (CEO of GMC). It is included here because it shows a couple of interesting features. First, the real pathway of accountability of the HPC, and second the way this emphasises the fundamental objectives of the government’s regulatory machine in the regulators mind.
The Chair of the committee (who himself happened to be a lay member of the GMC), kicked off by asking: “How are regulators helping to develop a workforce that is fit for purpose for the 21st century, as opposed to just developing more of the same?”
Sarah answered: “…by seeing regulation in its broadest context and not just seeing it dealing with unfitness to practise issues… but I think very much when you are working at workforce planning it is about making sure that people that come on to the register are competent… [and] we have worked very hard with employers about making sure that we can provide a flexible workforce”. [emphasis added]
Scott answered in exactly the same way: we have four functions, not just dealing with impaired doctors, but also “Standards, Ethics, Education and Registration, [which] all help us to contribute to the shaping of the workforce through influencing not only undergraduate medical education and training, but also the attitudes, the ethics and principles that doctors take to their work day by day and, as with the Nursing and Midwifery Council and other regulators, the very direct control over who joins our register from outside the UK and the EEA… we are ensuring that we fully involve representatives of the public, employers, and of course representatives of the profession, to try to ensure that the public's expectations of doctors can be reflected in the way that the doctors of today are educated.”
And Seale said: “The Health Professions Council also has a specific role in advising the Secretary of State of which new professions should become statutorily regulated, and that, I think, is vital in terms of protection of the public. I think the last thing is that all three of us have participated in the Foster and Donaldson Review and we are eagerly awaiting the outcome of that because I think that will that enable the regulators to be fit for purpose as we move forward into the existing century.”
When you look at the place from which the CEO is held accountable, and observe the methods of those who are actually empowered to challenge him, then you might begin to understand how the process gets so badly distorted.
Marc Seale had the last word in that particular sitting of the Committee. It is a little difficult to grasp, but revealing nevertheless. Here is what he said:
Mr Seale: “It might be useful to link this debate back to workforce planning. What is going on—and it is beginning to accelerate this change—is the traditional model of doctors, nurses and physiotherapists is beginning not to work, because I think what is happening is that new skills, new technology, new drugs, et cetera, start off in a very small group of individuals who are skilled in doing that and gradually that skill goes down through the workforce. At the same time you can actually now come into the workforce at a particular level with that new set of skills and what the regulators have to do is to capture those new individuals with the new skills as it trickles down through the system. Currently it is not quite working correctly but I think all the regulators want to see it work effectively. That will mean that as demands are put on the workforce those skills could then flow through the individuals.” [emph added]
Measure for Measure is at the Almeida from Feb 12th, to April 10th.
“To whom should I complain? Did I tell this, who would believe me?”
Thursday, 28 January 2010
Wednesday, 20 January 2010
Interview with Mind CEO Paul Farmer
INTERVIEW WITH PAUL FARMER, CEO MIND, FRIDAY OCTOBER 23, 2009. STRATFORD
Janet: So, my question is to do with centralization – regulation is a form of centralization, state regulation is a form of state centralization – and in this case is having a negative distorting effect. I’d like to start here, because Mind, of all places, is set-up on a grass roots principle and has traditionally argued against crass generalizations, insisting instead on specific local detail, and on ‘keeping things real’.
Paul: Yes, I’ll start by saying how our organisation works. The Mind network, as you correctly say, is what’s called a federated structure. In charity terms we’re like the Citizens Advice Bureau, Samaritans, or RSPCA. We have in effect a ‘parent’ or central body, and the local organisations (each a separate registered charity) affiliate to us (also a separate registered charity). They are all self-governing organisations with their own Trustees. Its a good model for meeting the needs of people who experience mental distress; owned, in the charity sense, by their local stakeholders, by local people, for local people.
We, here in the central office, are an enabler of a network. We bring together a network of people, so they can better understand their experiences, and we use that to help inform our national role. We also help them share their experiences with each other, so it’s not just an up down feed, but also a cross feed. A local association will contact us saying ‘we are setting something up, has anyone else done that?’ and we’ll say ‘yes, Glossop have done it, go talk to them’. Keeping people talking to each other.
JL: So, that involves you running around a lot?
PF: Yes, it’s a key part of what I think I should do, and we have a team of people in LMA (Local Mind Association) services. Not a very big team, but we allocate as much as we can to that network.
The second area is that of Quality. We have a Quality Standards Framework. If an organisation is to become associated, it has to fit this framework. The system is in its second generation. The first generation was begun 5 years ago for a three-year period. We are now in version 2.0 of that structure (laughs). The basic principles behind that framework is not to replicate other regulatory environments but to make sure our organisations are well managed and well governed and that they provide good quality services to people, to their service users.
JL: Did you initiate this?
PF: No I came in half way through phase one.
JL: I’m interested in the rise of what is called ‘audit culture’ and this sounds very much a part of that. Was there a struggle when it began?
PF: I don’t know very much about how people received it, but I do know, having come in at the end, that the general sense coming from local associations is that they found it a positive experience. There were of course some aspects that they found difficult but they found that the process was an enabling one and led to general improvements in the work they were able to do.
JL: What did they find difficult?
PF: Like any system you have to ensure that the areas we put in place, the themes we put in place for people, really match the needs of those organisations. There were some aspects of providing support for people which some local organisations found difficult but others didn’t. We have such a varied network, and different orgs would have found different aspects differently challenging. In a sense our clear ambition is not to prescribe a common offer but to be clear and confident that the services that are provided by local organisations, are provided by people who understand what their responsibilities are. You then have to set up a framework they want to join - given that affiliation is a voluntary act, we don’t ask people to affiliate to us, they ask to affiliate to us. So we are keen to see that they are providing the best possible support for people.
JL: I’m interested by the way the language shifts from what local organisations do and how the network supports them, to what the organisations must do in order to join.
PF: There are environments, and providing mental health services is one of those environments, where there is a requirement on people who provide those services, to have frameworks in place.
JL: Is Mind a mental health service provider?
PF: We share a view that the individual experiences are important, that a community based approach is a good way to go. We have a whole variety of different ways and networks for people to engage with us. We are lucky, we have that local engagement. Local Mind associations don’t solely provide contracted services. Many do because that’s part of the landscape, but many of them also run wholly voluntary support. They provide places for people to gather, opportunities for people to do things, and to share experiences. The relationship that those individuals have with us is very helpful, and very, very important to us and to our whole ethos. Our mission is that people who experience mental distress drive everything that we do. User involvement and participation is the DNA of the organisation, or the words through the stick of rock. Pretty much everything we do is informed by that. Over two thirds of our Trustees and over half our staff are users of mental health services. It is also part of what we do in our day-to-day work.
We have a formal structure called Mind link: a network of people with direct experience. There is a formal link where a rep sits on our Trustee Board, and an informal link - a place to consult and understand what people would like us to do. In our campaigning and policy work, we have people constantly coming to us on a much more informal basis (because people want to) telling us about their experiences. Our aim is to have a multi-layered multi-factorial kind of approach. I’m sure it isn’t perfect, but we are grounded in the here and now experiences and their understanding of things in the past and of what they would like to see in the future. We don’t claim to speak on behalf of everybody but we can promise to be informed by those experiences.
JL: So how did you end up in favour of HPC as regulator?
PF: We’re in favour of a regulatory framework. Yes. We don’t particularly want to get involved in a discussion about the rights and wrongs of the HPC. Our interest in this starts from the position that over many, many years people who have been in and out of mental health services and not in it all have told us that the only option they were given was an anti-depressant and they felt it wasn’t what they wanted. There’s a backdrop of concern about the efficacy and side effects. Mind has been prominent playing a role in that agenda, because people wanted a choice, an options menu was important. When we ask people ask what kind of choice they want, they say ‘some kind of talking therapy’.
Over many years we’ve advocated an increase in access to psychological therapies.
JL: people are asking to be heard as subjects, not treated as objects.
PF: I’d put it in terms of equity. What they want is a framework of recovery dialogue. People generally want to be seen as an equal partner in care. Sometimes that’s about choice of medication, choice of therapy, or support from people. What they were also saying was that people wanted to feel safe, and safety is an issue powerfully articulated in the journey of mental health service users over generations. Many people experienced very unsafe conditions in the asylums, many people still do, sadly, in in-patient units. And, in this context people have also told us about unsafe experiences in therapy, in the NHS. Given the nature of our experience over a very long period of time, we have been campaigning for a better deal for people with mental distress both in favour of greater choice and less institutional care. It was also important that we reflected the concerns that people have about safety, so our twin message around ‘psychological therapies’ (I know it is a contested term, but I hope you won’t mind if I use it, its difficult to know what to call it otherwise) is that we would want to encourage an expansion of the availability of psychological therapies, and an expansion to people who couldn’t afford it, so they become entitled to receive it in an NHS context.
Secondly, in that environment, people have to be confident that the experience and the situation are conducted in a safe and appropriate environment. Therefore, in that context when we were thinking about the issue of regulation, I think we felt that it was important that from perspective of safety there was a framework for people to receive protection of a statutory regulatory framework. That’s how we arrived at our position, informed by strong messages about safety and increasing availability.
JL: what kind of information do you have about the rotten experiences that people had outside of the NHS?
PF: are you saying they did not exist?
JL. No, I understand there to be two different kinds of problem. One is a general enlightenment problem, which would be solved when people better understand the dynamics of power and love, and the other is a problem of, lets call them predators. This requires a different kind of response. How can we make use of the testimonies to better understand the nature of the problem we are confronted with, so we actually solve the problem.
PF: I wouldn’t necessarily want to go into detail. We hear a lot of people talk very positively about their experiences in therapy, very positively indeed. For many people it is their life-line. That’s why we have consistently advocated an increase in access to therapy. If we didn’t think that people fundamentally thought it helpful we wouldn’t advocate it. These documents are driven primarily by a desire to make that more accessible to people. It’s a key part of our ethos. If there is an approach that people find helpful, it’s that.
So, yes, we know that lots of people are very supportive of this counselling and psychotherapy. But, because we are the network we are, we also hear of experiences of abuse. When you hear about those experiences, you know they are very painful, and that it is very difficult for the individual to speak about it. These are not frequent experiences. The vast majority, and we’ve said this publicly many times, the vast majority of therapists are doing a perfectly good job and they are absolutely understanding of the appropriate boundaries they should use. BUT there are some people whose experiences are telling us that this is not the case. If you’ve got your two categories those are - in your language - the predators. They are few and far between but it is not in the interests of therapists (though this is not our concern) and it is not in the interests of those who could benefit from therapy, particularly in the NHS environment: it is not safe. Something has to be done. There are not many of them. But in an environment where the very nature is intense and exclusive – private – it is really important that there is a mechanism that enables individuals to be able to pursue their concerns about individual therapists.
JL: Yes, predators are a pest. But, one of the most difficult things to bear in this press towards regulation, is the obfuscation of the facts. Do you have any sensible straightforward information about these predators?
PF: No. But there’s a slightly circular problem. It is the regulatory framework that will generate that data.
JL: There is already much reason to question that assumption. What is needed at this stage is to be able to ‘touch the source of information’, to gain confidence in it, to be at ease with it, before setting up a hugely expensive and elaborate bureaucratic machine that could as easily exacerbate the problem (this is a point made both by Ken Pope and Daniel B Hogan). What happens at the moment, in the absence of sensible data, is that a Bogey Man appears, reason is obliterated and the bureaucratic machinery gains speed – it is an effect of the discourse of security.
PF: The evidence gathered is testimony. But because there are so many therapists delivering so many different kinds of therapy, all differently linked to different organisations, it is difficult to see how that can be easily sewn up, sorry, joined up (laughs). But you know, the way we shape our decisions is based on individual testimony. We take a broad view about what research would be, but we do have a basic view that if one therapist oversteps the mark it is one too many . That should be the starting point. Inevitably, there are thousands of people practising a variety of different modalities, and I think that there is a chance that sometimes a very, very small number of people will be overstepping the line, and so there should be a system to address that.
JL: So, is there anything we can say about the volunteer sections in Mind?
PF: It’s an important point to make. We are a provider. Local associations are, I think, running about 60-70 services across the country. They are differently structured. There’s a wide range of approach. This is sometimes to do with the locality, the nature of commissioning, or the nature of service. But quite a lot of people run counselling services, which are staffed by people undertaking training. A lot of people who are currently active as therapists, have found that a very helpful and valuable experience in their training. It is actually very difficult to find environments to get this kind of experience, and its great then that people who qualify have had a good experience at a local level with us at Mind.
In the context of a new framework, the local Mind associations, in the main, are quite used to operating in a regulatory framework. In fact they are used to operating in several regulatory frameworks [laughs]. If you’re in housing environment or other services, eg, dementia, they each have a set of frameworks, so for a local association the prospect of a regulatory framework is something that they are reasonably used to. So, I think they will respond to that and work with it. I do think, and this is the only thing I’m prepared to say about the HPC and their proposed regulatory framework, I do think that there is a need to ensure that the framework is not overly bureaucratic.
JL: In Mind’s experience of providing counselling, have you had difficulties to deal with between client and counsellor?
PF: the structure that we have is that local associations administer a complaints procedure, and we are a third party that might intervene in certain circumstances. I am not aware that we have intervened in a particular case. I’m not saying no-one ever complained about our service, but I’ve certainly seen evidence, testimony, about problems in other places.
JL: Thank you very much for your time.
Foot Notes
1 We Need to Talk, a report commissioned by 5 leading mental health charities to make the cause for greater access to psychological therapies on the NHS. ISBN 9781903645918
While We Are Waiting, experiences of waiting for and receiving psychological therapies in the NHS, by Emily Wooster, MIND July 2008
2 When I sent the transcript in for approval I mentioned that the structure of this argument, ‘if one x does something wrong, then all x must be controlled” is something that Mind usually has to struggle against (“if one schizophrenic abuses someone, then all schizophrenics must be put on a register and controlled more carefully”). The logic of the argument is pernicious, and trades on an impossible idealisation which effectively brings a sub-class into existence.
Janet: So, my question is to do with centralization – regulation is a form of centralization, state regulation is a form of state centralization – and in this case is having a negative distorting effect. I’d like to start here, because Mind, of all places, is set-up on a grass roots principle and has traditionally argued against crass generalizations, insisting instead on specific local detail, and on ‘keeping things real’.
Paul: Yes, I’ll start by saying how our organisation works. The Mind network, as you correctly say, is what’s called a federated structure. In charity terms we’re like the Citizens Advice Bureau, Samaritans, or RSPCA. We have in effect a ‘parent’ or central body, and the local organisations (each a separate registered charity) affiliate to us (also a separate registered charity). They are all self-governing organisations with their own Trustees. Its a good model for meeting the needs of people who experience mental distress; owned, in the charity sense, by their local stakeholders, by local people, for local people.
We, here in the central office, are an enabler of a network. We bring together a network of people, so they can better understand their experiences, and we use that to help inform our national role. We also help them share their experiences with each other, so it’s not just an up down feed, but also a cross feed. A local association will contact us saying ‘we are setting something up, has anyone else done that?’ and we’ll say ‘yes, Glossop have done it, go talk to them’. Keeping people talking to each other.
JL: So, that involves you running around a lot?
PF: Yes, it’s a key part of what I think I should do, and we have a team of people in LMA (Local Mind Association) services. Not a very big team, but we allocate as much as we can to that network.
The second area is that of Quality. We have a Quality Standards Framework. If an organisation is to become associated, it has to fit this framework. The system is in its second generation. The first generation was begun 5 years ago for a three-year period. We are now in version 2.0 of that structure (laughs). The basic principles behind that framework is not to replicate other regulatory environments but to make sure our organisations are well managed and well governed and that they provide good quality services to people, to their service users.
JL: Did you initiate this?
PF: No I came in half way through phase one.
JL: I’m interested in the rise of what is called ‘audit culture’ and this sounds very much a part of that. Was there a struggle when it began?
PF: I don’t know very much about how people received it, but I do know, having come in at the end, that the general sense coming from local associations is that they found it a positive experience. There were of course some aspects that they found difficult but they found that the process was an enabling one and led to general improvements in the work they were able to do.
JL: What did they find difficult?
PF: Like any system you have to ensure that the areas we put in place, the themes we put in place for people, really match the needs of those organisations. There were some aspects of providing support for people which some local organisations found difficult but others didn’t. We have such a varied network, and different orgs would have found different aspects differently challenging. In a sense our clear ambition is not to prescribe a common offer but to be clear and confident that the services that are provided by local organisations, are provided by people who understand what their responsibilities are. You then have to set up a framework they want to join - given that affiliation is a voluntary act, we don’t ask people to affiliate to us, they ask to affiliate to us. So we are keen to see that they are providing the best possible support for people.
JL: I’m interested by the way the language shifts from what local organisations do and how the network supports them, to what the organisations must do in order to join.
PF: There are environments, and providing mental health services is one of those environments, where there is a requirement on people who provide those services, to have frameworks in place.
JL: Is Mind a mental health service provider?
PF: We share a view that the individual experiences are important, that a community based approach is a good way to go. We have a whole variety of different ways and networks for people to engage with us. We are lucky, we have that local engagement. Local Mind associations don’t solely provide contracted services. Many do because that’s part of the landscape, but many of them also run wholly voluntary support. They provide places for people to gather, opportunities for people to do things, and to share experiences. The relationship that those individuals have with us is very helpful, and very, very important to us and to our whole ethos. Our mission is that people who experience mental distress drive everything that we do. User involvement and participation is the DNA of the organisation, or the words through the stick of rock. Pretty much everything we do is informed by that. Over two thirds of our Trustees and over half our staff are users of mental health services. It is also part of what we do in our day-to-day work.
We have a formal structure called Mind link: a network of people with direct experience. There is a formal link where a rep sits on our Trustee Board, and an informal link - a place to consult and understand what people would like us to do. In our campaigning and policy work, we have people constantly coming to us on a much more informal basis (because people want to) telling us about their experiences. Our aim is to have a multi-layered multi-factorial kind of approach. I’m sure it isn’t perfect, but we are grounded in the here and now experiences and their understanding of things in the past and of what they would like to see in the future. We don’t claim to speak on behalf of everybody but we can promise to be informed by those experiences.
JL: So how did you end up in favour of HPC as regulator?
PF: We’re in favour of a regulatory framework. Yes. We don’t particularly want to get involved in a discussion about the rights and wrongs of the HPC. Our interest in this starts from the position that over many, many years people who have been in and out of mental health services and not in it all have told us that the only option they were given was an anti-depressant and they felt it wasn’t what they wanted. There’s a backdrop of concern about the efficacy and side effects. Mind has been prominent playing a role in that agenda, because people wanted a choice, an options menu was important. When we ask people ask what kind of choice they want, they say ‘some kind of talking therapy’.
Over many years we’ve advocated an increase in access to psychological therapies.
JL: people are asking to be heard as subjects, not treated as objects.
PF: I’d put it in terms of equity. What they want is a framework of recovery dialogue. People generally want to be seen as an equal partner in care. Sometimes that’s about choice of medication, choice of therapy, or support from people. What they were also saying was that people wanted to feel safe, and safety is an issue powerfully articulated in the journey of mental health service users over generations. Many people experienced very unsafe conditions in the asylums, many people still do, sadly, in in-patient units. And, in this context people have also told us about unsafe experiences in therapy, in the NHS. Given the nature of our experience over a very long period of time, we have been campaigning for a better deal for people with mental distress both in favour of greater choice and less institutional care. It was also important that we reflected the concerns that people have about safety, so our twin message around ‘psychological therapies’ (I know it is a contested term, but I hope you won’t mind if I use it, its difficult to know what to call it otherwise) is that we would want to encourage an expansion of the availability of psychological therapies, and an expansion to people who couldn’t afford it, so they become entitled to receive it in an NHS context.
Secondly, in that environment, people have to be confident that the experience and the situation are conducted in a safe and appropriate environment. Therefore, in that context when we were thinking about the issue of regulation, I think we felt that it was important that from perspective of safety there was a framework for people to receive protection of a statutory regulatory framework. That’s how we arrived at our position, informed by strong messages about safety and increasing availability.
JL: what kind of information do you have about the rotten experiences that people had outside of the NHS?
PF: are you saying they did not exist?
JL. No, I understand there to be two different kinds of problem. One is a general enlightenment problem, which would be solved when people better understand the dynamics of power and love, and the other is a problem of, lets call them predators. This requires a different kind of response. How can we make use of the testimonies to better understand the nature of the problem we are confronted with, so we actually solve the problem.
PF: I wouldn’t necessarily want to go into detail. We hear a lot of people talk very positively about their experiences in therapy, very positively indeed. For many people it is their life-line. That’s why we have consistently advocated an increase in access to therapy. If we didn’t think that people fundamentally thought it helpful we wouldn’t advocate it. These documents are driven primarily by a desire to make that more accessible to people. It’s a key part of our ethos. If there is an approach that people find helpful, it’s that.
So, yes, we know that lots of people are very supportive of this counselling and psychotherapy. But, because we are the network we are, we also hear of experiences of abuse. When you hear about those experiences, you know they are very painful, and that it is very difficult for the individual to speak about it. These are not frequent experiences. The vast majority, and we’ve said this publicly many times, the vast majority of therapists are doing a perfectly good job and they are absolutely understanding of the appropriate boundaries they should use. BUT there are some people whose experiences are telling us that this is not the case. If you’ve got your two categories those are - in your language - the predators. They are few and far between but it is not in the interests of therapists (though this is not our concern) and it is not in the interests of those who could benefit from therapy, particularly in the NHS environment: it is not safe. Something has to be done. There are not many of them. But in an environment where the very nature is intense and exclusive – private – it is really important that there is a mechanism that enables individuals to be able to pursue their concerns about individual therapists.
JL: Yes, predators are a pest. But, one of the most difficult things to bear in this press towards regulation, is the obfuscation of the facts. Do you have any sensible straightforward information about these predators?
PF: No. But there’s a slightly circular problem. It is the regulatory framework that will generate that data.
JL: There is already much reason to question that assumption. What is needed at this stage is to be able to ‘touch the source of information’, to gain confidence in it, to be at ease with it, before setting up a hugely expensive and elaborate bureaucratic machine that could as easily exacerbate the problem (this is a point made both by Ken Pope and Daniel B Hogan). What happens at the moment, in the absence of sensible data, is that a Bogey Man appears, reason is obliterated and the bureaucratic machinery gains speed – it is an effect of the discourse of security.
PF: The evidence gathered is testimony. But because there are so many therapists delivering so many different kinds of therapy, all differently linked to different organisations, it is difficult to see how that can be easily sewn up, sorry, joined up (laughs). But you know, the way we shape our decisions is based on individual testimony. We take a broad view about what research would be, but we do have a basic view that if one therapist oversteps the mark it is one too many . That should be the starting point. Inevitably, there are thousands of people practising a variety of different modalities, and I think that there is a chance that sometimes a very, very small number of people will be overstepping the line, and so there should be a system to address that.
JL: So, is there anything we can say about the volunteer sections in Mind?
PF: It’s an important point to make. We are a provider. Local associations are, I think, running about 60-70 services across the country. They are differently structured. There’s a wide range of approach. This is sometimes to do with the locality, the nature of commissioning, or the nature of service. But quite a lot of people run counselling services, which are staffed by people undertaking training. A lot of people who are currently active as therapists, have found that a very helpful and valuable experience in their training. It is actually very difficult to find environments to get this kind of experience, and its great then that people who qualify have had a good experience at a local level with us at Mind.
In the context of a new framework, the local Mind associations, in the main, are quite used to operating in a regulatory framework. In fact they are used to operating in several regulatory frameworks [laughs]. If you’re in housing environment or other services, eg, dementia, they each have a set of frameworks, so for a local association the prospect of a regulatory framework is something that they are reasonably used to. So, I think they will respond to that and work with it. I do think, and this is the only thing I’m prepared to say about the HPC and their proposed regulatory framework, I do think that there is a need to ensure that the framework is not overly bureaucratic.
JL: In Mind’s experience of providing counselling, have you had difficulties to deal with between client and counsellor?
PF: the structure that we have is that local associations administer a complaints procedure, and we are a third party that might intervene in certain circumstances. I am not aware that we have intervened in a particular case. I’m not saying no-one ever complained about our service, but I’ve certainly seen evidence, testimony, about problems in other places.
JL: Thank you very much for your time.
Foot Notes
1 We Need to Talk, a report commissioned by 5 leading mental health charities to make the cause for greater access to psychological therapies on the NHS. ISBN 9781903645918
While We Are Waiting, experiences of waiting for and receiving psychological therapies in the NHS, by Emily Wooster, MIND July 2008
2 When I sent the transcript in for approval I mentioned that the structure of this argument, ‘if one x does something wrong, then all x must be controlled” is something that Mind usually has to struggle against (“if one schizophrenic abuses someone, then all schizophrenics must be put on a register and controlled more carefully”). The logic of the argument is pernicious, and trades on an impossible idealisation which effectively brings a sub-class into existence.
Friday, 15 January 2010
An appeal for the Fighting Fund from the organisers
Make 2010 the Year that Psychotherapists and Counsellors Reclaim their Profession
Fighting Fund for the Talking Therapies
As you may know, the Government plans to introduce statutory regulation for psychotherapists and counsellors via the Health Professions Council (HPC). The initial consultation concluded that HPC was the wrong regulator, as it applies medical-style models of healthcare management to a field which, for a large part, does not subscribe to these models and values.
The talking therapies have always offered a system of values that is independent of those of the State, and if the current proposals are pushed through by government, it will no longer be possible to practice psychotherapy and psychoanalysis in the way they have been practised for the last 100 years. HPC regulations would effectively destroy psychotherapeutic practice and deprive each individual of their free choice as to which therapist they could consult.
If you’d like to know more about what’s going on, please look at The Maresfield Report which is available at www.psyreg.co.uk and also have a look at the websites www.coregp.org or www.allianceforcandp.org.
We are fighting here for the heart and soul of our profession and for the ability to offer a wide variety of approaches tailored to the individual, rather than imposing mechanistic ‘treatments’ applied to passive recipients, with false promises of public protection. Psychotherapy and counselling involve relationships between people and cannot be reduced to the model of a business transaction or a medical intervention like the prescription of a drug.
We have been lobbying now against HPC for more than a year and several groups have decided to take this further via legal action. We’re organising a fighting fund to instruct a top constitutional law firm with a leading QC to fight these plans. HPC were required to assess the 'regulatory needs' of the field and its own suitability as a regulator, yet they have neglected both of these tasks. Legal challenge will hopefully make a proper consultation on these issues necessary, which would include all stakeholders. While nothing is guaranteed, at the very least we would hope to achieve delay, rethinking and proposals more suited to our profession. The best case scenario is that we can make the Government – especially the NEXT Government – think again about taking forward proposals which have unprecedented levels of objection and opposition from our field.
We are seeking to raise money for this fund from individuals and organisations in our field. If you care about the talking therapies and want to help, please ACT NOW. Any donation, however small, will help. We already have many pledges towards the £200,000 we may need to raise. You can pay by instalments or give us a single sum.
Here are the details:
Transfer is the best method of payment: please send to:
JR Fighting Fund, Lloyds Bank
Sort Code 30-00-04, Account 02101964
or send cheques made out to:
‘JR Fighting Fund’
to Pine Cottage, Thornden Wood Road,
Herne Bay, Kent CT6 7NZ.
Hoping that you’ll be able to support our campaign.
With thanks and best wishes
Christopher Bollas, Julia Carne, Anouchka Grose, Dorothy Hamilton, David Henderson, Darian Leader, Haya Oakley, Susie Orbach, Adam Phillips, Werner Prall, Andrew Samuels (personal capacity), Joe Suart, Jason Wright .
Fighting Fund for the Talking Therapies
As you may know, the Government plans to introduce statutory regulation for psychotherapists and counsellors via the Health Professions Council (HPC). The initial consultation concluded that HPC was the wrong regulator, as it applies medical-style models of healthcare management to a field which, for a large part, does not subscribe to these models and values.
The talking therapies have always offered a system of values that is independent of those of the State, and if the current proposals are pushed through by government, it will no longer be possible to practice psychotherapy and psychoanalysis in the way they have been practised for the last 100 years. HPC regulations would effectively destroy psychotherapeutic practice and deprive each individual of their free choice as to which therapist they could consult.
If you’d like to know more about what’s going on, please look at The Maresfield Report which is available at www.psyreg.co.uk and also have a look at the websites www.coregp.org or www.allianceforcandp.org.
We are fighting here for the heart and soul of our profession and for the ability to offer a wide variety of approaches tailored to the individual, rather than imposing mechanistic ‘treatments’ applied to passive recipients, with false promises of public protection. Psychotherapy and counselling involve relationships between people and cannot be reduced to the model of a business transaction or a medical intervention like the prescription of a drug.
We have been lobbying now against HPC for more than a year and several groups have decided to take this further via legal action. We’re organising a fighting fund to instruct a top constitutional law firm with a leading QC to fight these plans. HPC were required to assess the 'regulatory needs' of the field and its own suitability as a regulator, yet they have neglected both of these tasks. Legal challenge will hopefully make a proper consultation on these issues necessary, which would include all stakeholders. While nothing is guaranteed, at the very least we would hope to achieve delay, rethinking and proposals more suited to our profession. The best case scenario is that we can make the Government – especially the NEXT Government – think again about taking forward proposals which have unprecedented levels of objection and opposition from our field.
We are seeking to raise money for this fund from individuals and organisations in our field. If you care about the talking therapies and want to help, please ACT NOW. Any donation, however small, will help. We already have many pledges towards the £200,000 we may need to raise. You can pay by instalments or give us a single sum.
Here are the details:
Transfer is the best method of payment: please send to:
JR Fighting Fund, Lloyds Bank
Sort Code 30-00-04, Account 02101964
or send cheques made out to:
‘JR Fighting Fund’
to Pine Cottage, Thornden Wood Road,
Herne Bay, Kent CT6 7NZ.
Hoping that you’ll be able to support our campaign.
With thanks and best wishes
Christopher Bollas, Julia Carne, Anouchka Grose, Dorothy Hamilton, David Henderson, Darian Leader, Haya Oakley, Susie Orbach, Adam Phillips, Werner Prall, Andrew Samuels (personal capacity), Joe Suart, Jason Wright .
Tuesday, 12 January 2010
Two characters in search of an author - the tragedy of anxiety and depression
The National Audit for Psychological Therapies for Anxiety and Depression is tucked under the wing of … The Royal College of Psychiatry (tag line: ‘let wisdom guide’) and is launched with a video podcast from the comedian Stephen Fry who “explains why the National Audit of Psychological Therapies is so important”. Of course he does.
Within the Royal College of Psychiatrists is something called the CC QI – a centre for quality improvement – the which has been carrying out national audits for … yes, the last 10 years.
The flimsy ground for this trivial pursuit is covered up by the names of no less than 15 corporate bodies, which lend their credibility to the project. But, the list also shows signs of self-replication in so far as at least one of them (The New Savoy Partnership) is itself a corporation made up of almost all of the others already on the list. In what precise practical ways the BACP, the UKCP and the BPC are partners in developing this particular audit is left unremarked. But it is worth noting that the first Savoy Partnership conference (Nov 2007) saw Prof David Clark unveiling his dream of data collection with the new IAPT (increasing access to psychological therapies) scheme. This plan involved questionnaires at the beginning and end of every session whereby what he called ‘evidence’ could be collected and entered onto a national database whence a cunning algorithm would ascertain where people were achieving their government’s quality targets for happiness
Perhaps there is a quotient of intelligence lying behind the choice of Stephen Fry to launch this project. Writing about his own QI show Fry says “There’s not been anything quite like it before. The questions are designed to be impossible to answer, so points are awarded for interesting answers rather than correct ones and points are taken away for dull or obvious blather …”
What points would the psychiatrists and economists win or lose? Their CCQI proudly displays its political correctness and thus the central characteristic of its programme – it is reaching all demographic areas, rich and poor, black and white, old and young, etc. This is not about the specifics of anguish, nor the dynamics of humour, but about the mental hygiene of the general population.
But what are psychological therapies? Although Fry mentions Psychotherapy in his podcast, this word is completely absent in the rest of the blurb. Instead we have inter alia computerised CBT, IAPT (which is a government spending programme, not a practice), Art Therapy, and group therapy, all lumped together as ‘services’ which have been ‘invited’ to participate in this audit.
IAPT is not a bright new idea of a hardworking practitioner, but a political expedient fed by centralised planners. Here's what they say: “People referred to psychological therapies for depression and anxiety should be assessed and treated promptly by a therapist, who delivers appropriate therapies in an acceptable manner and achieves an outcome that compares favourably with those of other comparable therapists”. The process is depicted in the literature as a never ending circle: establish standards, collect data on practice, compare this to the pre-written standards, plan necessary change, implement change and then … re-audit!
The questionnaires that are being administered reveal what is thought necessary to inform the national policy makers, on this vital work:
1 Thinking about your current treatment, how long approximately did you have to wait for your talking treatment to start? (ie referred by your GP)
2 I feel the waiting time for my treatment to start was reasonable. Y/N
3 I was given an option about different days/times available when scheduling my appointment. Y/N
4 I was able to get to my appointment location without too much difficulty. Y/N
5 I received enough information about my talking treatment before it began. Y/N
The second questionnaire asks
Thinking about today’s meeting, please circle your answer to each statement.
1 This talking treatment helps me to understand my problem. Y/N
2 I feel that I am getting the right kind of help. Y/N
3 If I have similar difficulties in the future, I would take up this talking treatment again. Y/N
4 I believe this talking treatment helps me to cope with my problem. Y/N
A third questionnaire asks practitioners to give details of their professional background and their qualifications – thus by-passing the role of local management, and ignoring the importance of experienced supervision.
There are also fourth, fifth, and sixth questionnaires but …
In case anyone would accuse the questionnaire designers of bias, carelessness, or anything at all, they declare quite openly that they didn’t actually design them themselves but used focus groups – of course they did – to come up with these ‘rigorous analytic tools’.
There is a confusion between admin and, well, science. What is the thinking behind offering these new ‘talking therapies’ as a cure? Reading these questionnaires the idea seems to be that punctuality, promptness and neat data entry is a cure for anxiety and depression. A bonus point from Stephen Fry and the QI team?
The politicians have not noticed they are perpetrating a joke. Lord Layard does not realise that he has been cast as the jester. We need to return to his 2006 Depression Report and read it with this new insight; we need to see if that's the way to relieve some of these symptoms.
If all the word were a stage, and all the men and women merely players, then Lord Layard and Prof Clark must be two characters in search of a half way decent author…
“Hello there, it’s Stephen Fry, I’m sorry I can’t be at the launch of this fantastic new initiative, but I just wanted to show my support for it.
“It seems rather odd that an audit should be important in the world of psychotherapy and mental health, but actually of course without the knowledge that these audits give it’s very, very difficult to formulate proper policy and to get the treatment to where it’s most needed. So, any inequalities in service, and any problems that people have, and any needs that they foresee, or imagine, in the field need to be pulled together, and the Royal College of Psychiatrists, of which I have the honour to be an honorary fellow, is putting this together with its usual expertise and commitment. So I hope everyone can support this.
“Mental Health, as I’m sure you all know, is one of the biggest problems facing Britain at the moment. You can’t have general health without mental health, and without general health you can’t have any kind of prosperity.
"So, em, thank you very much indeed [vigorous nod of the head] for helping to support this great initiative, and I’m proud to be doing the same myself. Many thanks.”
Within the Royal College of Psychiatrists is something called the CC QI – a centre for quality improvement – the which has been carrying out national audits for … yes, the last 10 years.
The flimsy ground for this trivial pursuit is covered up by the names of no less than 15 corporate bodies, which lend their credibility to the project. But, the list also shows signs of self-replication in so far as at least one of them (The New Savoy Partnership) is itself a corporation made up of almost all of the others already on the list. In what precise practical ways the BACP, the UKCP and the BPC are partners in developing this particular audit is left unremarked. But it is worth noting that the first Savoy Partnership conference (Nov 2007) saw Prof David Clark unveiling his dream of data collection with the new IAPT (increasing access to psychological therapies) scheme. This plan involved questionnaires at the beginning and end of every session whereby what he called ‘evidence’ could be collected and entered onto a national database whence a cunning algorithm would ascertain where people were achieving their government’s quality targets for happiness
Perhaps there is a quotient of intelligence lying behind the choice of Stephen Fry to launch this project. Writing about his own QI show Fry says “There’s not been anything quite like it before. The questions are designed to be impossible to answer, so points are awarded for interesting answers rather than correct ones and points are taken away for dull or obvious blather …”
What points would the psychiatrists and economists win or lose? Their CCQI proudly displays its political correctness and thus the central characteristic of its programme – it is reaching all demographic areas, rich and poor, black and white, old and young, etc. This is not about the specifics of anguish, nor the dynamics of humour, but about the mental hygiene of the general population.
But what are psychological therapies? Although Fry mentions Psychotherapy in his podcast, this word is completely absent in the rest of the blurb. Instead we have inter alia computerised CBT, IAPT (which is a government spending programme, not a practice), Art Therapy, and group therapy, all lumped together as ‘services’ which have been ‘invited’ to participate in this audit.
IAPT is not a bright new idea of a hardworking practitioner, but a political expedient fed by centralised planners. Here's what they say: “People referred to psychological therapies for depression and anxiety should be assessed and treated promptly by a therapist, who delivers appropriate therapies in an acceptable manner and achieves an outcome that compares favourably with those of other comparable therapists”. The process is depicted in the literature as a never ending circle: establish standards, collect data on practice, compare this to the pre-written standards, plan necessary change, implement change and then … re-audit!
The questionnaires that are being administered reveal what is thought necessary to inform the national policy makers, on this vital work:
1 Thinking about your current treatment, how long approximately did you have to wait for your talking treatment to start? (ie referred by your GP)
2 I feel the waiting time for my treatment to start was reasonable. Y/N
3 I was given an option about different days/times available when scheduling my appointment. Y/N
4 I was able to get to my appointment location without too much difficulty. Y/N
5 I received enough information about my talking treatment before it began. Y/N
The second questionnaire asks
Thinking about today’s meeting, please circle your answer to each statement.
1 This talking treatment helps me to understand my problem. Y/N
2 I feel that I am getting the right kind of help. Y/N
3 If I have similar difficulties in the future, I would take up this talking treatment again. Y/N
4 I believe this talking treatment helps me to cope with my problem. Y/N
A third questionnaire asks practitioners to give details of their professional background and their qualifications – thus by-passing the role of local management, and ignoring the importance of experienced supervision.
There are also fourth, fifth, and sixth questionnaires but …
In case anyone would accuse the questionnaire designers of bias, carelessness, or anything at all, they declare quite openly that they didn’t actually design them themselves but used focus groups – of course they did – to come up with these ‘rigorous analytic tools’.
There is a confusion between admin and, well, science. What is the thinking behind offering these new ‘talking therapies’ as a cure? Reading these questionnaires the idea seems to be that punctuality, promptness and neat data entry is a cure for anxiety and depression. A bonus point from Stephen Fry and the QI team?
The politicians have not noticed they are perpetrating a joke. Lord Layard does not realise that he has been cast as the jester. We need to return to his 2006 Depression Report and read it with this new insight; we need to see if that's the way to relieve some of these symptoms.
If all the word were a stage, and all the men and women merely players, then Lord Layard and Prof Clark must be two characters in search of a half way decent author…
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