HPC PLG C&P 12 May 2010

Here is a report edited from my verbatim notes of the first part of last week's meeting. This group has already 'worked' on the 'problem' for over a year, but nevertheless seems to be approaching something vague and anomalous almost for the first time. After a brief intro, the dialogue is presented to reveal the chaotic character of the meeting.

HPC President Anna van der Gaag closed the meeting at 2pm on the dot (as predicted in the plan) with the words:

“Thank you, we’ve got a huge amount from you today”

None of the members of the PLG seemed to notice, but one or two in the public seats repeated the words while looking completely stunned.

The last time we all met in this neutral venue (Avonmouth House) Chair Di Waller had opened the meeting with a small lecture to the effect that members of the PLG were not there to represent anyone other than themselves. They had been recruited as individuals. This message was deemed necessary in order to counter the mounting criticisms that the PLG did not represent ‘the field’.

Today, at 10.30am on the dot Gaag opened the meeting (Di Waller being unwell) by going round the table inviting reflections on progress to date. What follows is edited from my verbatim notes. My comment is at the end.

FBD: Fiona Ballantine Dykes (who happens to work for the CPCAB): the landscape is different on many levels, and it raises questions: for example, what does this group need to do carry the confidence of people we represent. There are still some fundamental questions about the function of regulation, and we need a discussion about how regulation under HPC will be acceptable to the field. The details are secondary to that.

JC: Jonathan Coe (coincidentally, CEO of Witness – whose charity status ceased to be recognised by the Charities Commission 10 Feb 2010): generally there has been a good degree of progress, and I share Fiona’s view that we need to get collective backing of decisions made by the group.

BM: Brian Magee (COSCA): The time it has taken! HPC need to keep the information flowing and keep people on board. The December Council meeting raised expectations that things would move faster than they have.

AT: Annie Turner (an occupational therapist on the HPC Council): Standards of Practice - a lot of work still needs to be done on these. But I’m pleased with the work HPC have done on Generic Standards, which will move us forward. It will move the whole thinking in HPC forward from past paradigms, it will keep professions thinking forward. Any disagreement is second to that. We have a mountain to climb, and must make a leap forward, and we must do the background work.

LM: Linda Matthews (BABCP): There have been lots of discussions, people have anxieties, some are indifferent, and some are looking forward to HPC regulation. There has been a lull, and we need the HPC to take us forward while we try to take our members with us. The time-table leading to Feb 2011 is daunting [pause] but we are hanging on in there. It’s a joint approach and we are happy to be part of that.

MC: Mick Cooper (a Counselling professor who works in Scotland): I was struck by the responses to the consultation; there were meaningful, clear responses in a number of areas, decisions where people are comfortable and happy. I feel optimistic about moving forward. The consultation was useful.

JM: Jean McMinn (a counselling teacher, who works in Northern Ireland): [very quiet] … whether we have got both titles and levels of entry right?

PB: Peter Bell: This looks different depending where you are, I’m with BASRT, Relate, and a practising counsellor. Relate is not a professional body but a deliverer of services. Each of these positions has a different view, because there are different consequences. But what about the external forces – they will have their influence, the change of government, for example, what will that mean?

SA: Sally Aldridge (the Director of Regulatory Policy at BACP): we still need to convince some people out there to trust the HPC. SoPs go some way to do that, and we’ve used this to define the profession. But we must remember to set standards to protect the public, and not to protect the profession.

PF: Peter Fonagy (Skills for Health, BPC, UCL): This has been an interesting process for me personally, and I’m extremely grateful to have been able to participate. It has taught me things I didn’t know before. In the meantime we’ve [DH] managed to determine the NOS for Psychoanalytic/ dynamic Psychotherapy and the world did not immediately cease to turn on its axis! Out of controversy we gained a consensus that people were able to sign up to. So, here, it is critical that questions are raised about the competence of the regulator. We need to see what criteria are used to judge whether HPC is actually working. This will only work if it is voluntary. Is this group representative? Are we checking back to see it has validity beyond the people here. It can only work if it is voluntary. A sub group is saying that it won’t play, so we need to address this, we need to actually listen, and produce documentation to show the HPC as willing and flexible… We can be the arbitrator between the profession and the HPC.

JL: Julian Lousada (Chair of BPC): I was wondering how the PLG thought it would acknowledge those opposed to its project. Some of us have tried to engage with them but it’s not easy – but we shouldn’t give up. How can we ensure as we proceed that the Professional Organisations see themselves as central to the process. HPC doesn’t exist in a vacuum, but in a vacuum that has a relationship with the organisations [sic]. The Profession will not be strengthened if there is a weakening of the organisations.

CA: Carmen Ablack (a body therapist with the UKCP): I’d like to name the small elephant in the room: Opposition. Out there are different levels of opposition and anxiety. There are those who oppose the idea that this is a HEALTH profession, those opposed to aspects of HPC operations in the past (which we can see change attempts). Those who need clarity and assurance. Different kinds of concern and opposition – it’s not all one thing. If Kathy were here she would stress the importance of the partnership with professional organisations. I guess we do need to name the reality of changes [Chair of UKCP? Government? Who knows, they weren’t named]. Also, it is important to note that the responses to the consultation took very different forms – we in UKCP asked our members to respond to us, then we made one response to HPC, this distorts the statistics of response kept by HPC as not all organisations did the same thing. The responses are not equal and can’t be represented as such.

PF: I’d also like to congratulate Michael [Guthrie] on the rigorous, robust, transparency of his documents, and to tell him I would be happy to offer him a job at UCL. Ha, ha, ha, ha, ha.

AvdG: In the words of Nelson Mandella, our strongest weapon is dialogue. We must not be distracted from the work we must do in this group. It’s a difficult balance, we must bring more voices in to the debate.

MC: Mick Cooper then got the discussion to focus on how to include more Users in the process: “this is a major omission,” he said. This passed the conch to Jonathan Coe who said: the purpose of Statutory Reg is public protection. What is the nature of protection here? We need to talk to people who’ve been harmed. There’s been a survey by Mind, and Witness has run Focus Groups. We need a range of different ways to sample this group, and we need to be sensitive to the information, which cannot be given in public [sic].

PF: We need to say what HPC FTP has to offer here that is better than what already exists.

AvdG: We offer Statutory Regulation.

PF: We need a detailed Qualitative Inquiry on the impact of the system; and we need to acknowledge that this is the project of protecting people against human frailty. P&C are different in terms of regulation - do the HPC mechanisms meet the needs of therapists or not? It can be tested.

CA: There’s a diversity of clients, we need to understand the impact of regulation on these different populations.

LM: Is regulation suitable for C&P – are the public getting what they need from us if we are not regulated.

AT: a question for Peter: you say that psychotherapy and counselling are different. Different from what, different to what? We all work with vulnerable people you know.

PF: to me, it is the relationship that is the service.

[MC, LM both vigorously disagree and SA says she doesn’t understand.]

FBD: You need service providers to buy into the service of the HPC.

AT: what difference does it make to us, that you are different? [as this is delivered as a rhetorical question it elicits no answer]

PB: People these days are being sent by social care, GPs, the courts, other elements of the statutory centre, they are not coming to us of their own accord, they come with a message from the other which says ‘fix me’, get me back to work, make me a better parent. It’s different today. We need to consider the different kinds of service user we treat these days.

MC: independent focus groups need to look at this.

JC: What is the nature of risk in this sector? Private practice?

AvdG: what can we do practically to resolve this [can of worms]?

FBD: What impact will this have on services?

SA: It’s a big project

LM: it’s a huge project

AT: We need to look at the public we aim to protect. Not everybody, obviously, but what do we want to learn from the people that we talk to? And we need to know how sufficiently representative they are.

JL: How can we say to users this is why we think HPC will be an improvement?

BMcG: What about the International perspective? What can we learn from Australia, Europe?

AT: Will the Bolognia protocol affect you? [Stunned silence]

PF: It will turn British Higher Ed upside down [Stunned silence]

FBD: The quality of relation cannot be captured in SoP.

MC: Shall we invite an educationalist to advise whether entry level will impact on Standards?

AT: We should probably own that [sigh] well the usefulness of SET1 [pause], how it is used, [pause], well, if its used divisively in the profession then that is not good for public protection. This challenges council members. Considerable concern is coming to the Education and Training Committee. There is no wide consensus. We need more work to remove that Standard. [Brightens] It is almost a red herring, really, but [pause] what does it actually mean? [dipping again slightly] We’ve all been challenged by this.

FBD: The relationship is important.

PB: The relationship

AvdG: We are broader than health now, we can do it.

AT: I think this could be said for any practitioner.

AvdG: we won’t agree today, as we didn’t before, but we might in the future.

MC: No!

CA: I’ve witnessed the unfolding of issues over the last year, you’ve already done this. Lets name it.

SA: Should we look at the curriculum of all the training orgs? This will tell us what is going on out there.

AvdG: Who do we need at the table?

Voice: GOD

LM: Yes, I said that before too.

JL: So many presentations, its too much! We need to battle this out.

PB: what about employers? What about the opponents? [my neighbour asks me to note that it is now 12.10.]

MC: What for?

FBD: The HPC has proved itself open and willing to listen.

LM: They could give us stuff we are missing, though this is not a forum against HPC. We have emails from people with concerns about this, and we can help them through it.

PF: we need to hear the objections. We are the mediators between the field, and the HPC.

AvdG: Shall we have some lunch?

After lunch Gaag asked for outstanding questions. Julian Lousada tried to get the group to acknowledge the uniqueness of the relationship in this kind of work. He failed. Again, he tried. “How do we expose people to the clinical work?” he asked, before summoning the courage to add “do they have personal therapy?” then collapsed and added “Can we ask users whether they think they’ll get a better service if the practitioner they see has gone through their own therapy?” Sally Aldridge said “no matter how important it is, is it relevant here?” This, of course, is an excellent question, drawing attention to the fact that this meeting is about writing HPC documents which have no relevance to current practice except to sound its death knell. No-one indicated they heard, let alone understood what Sally said.

The discussion was degenerating by the minute and ended up discussing whether to meet in large or small groups, whether to have 5 minute or 50 minute presentations, and finally whether to meet at 10am or even 9.30 in order to get through the huge amount of work implied by their discussion. Gaag resisted all of this and said that 10.30 was fine and then concluded in a very calm voice, saying: “Engaging with those who oppose is very much about providing public meetings in all four countries to discuss all aspects of regulatory framework. Each aspect of regulatory practice will be presented and there will be lots of opportunity for Q&A, and within that there will be those who express strongly held views.”

I think it was Brian Magee who said – “and what will happen then? This is what happened in Manchester, and we were never given the opportunity to discuss it afterwards.”

Gaag smiled pleasantly and drew the meeting to a close. “Thank you, we’ve got a huge amount from you today”

COMMENT: The opening hour of the PLG let the members voice their concerns that the HPC process does not meet the needs of C&P. The rest of the meeting saw Gaag slowly override those comments and return to her business, ie to get what she needs to do in order to present the HPC as one that has ‘consulted’ with the appropriate people, ie 'users' . This idea comes 18 months after the HPC process began.

In the workplan (hardly discussed in the meeting), the business of constructing SETs and SOPs is scheduled for after the S60 is written. The DH is not interested in these, so HPC doesn't need to show that work is progressing - DH trust them to know what they are doing! However, as the HPC is staffed by administrators who know nothing of the practice they want to regulate, they delegate this work to a few people in the profession who in turn need the HPC to tell them how to do it because, as Annie Turner frequently says: they do not reflect current practice, but must invent something totally new.

If the HPC doesn’t properly define the profession (one of the major problems for this PLG is to maintain the impression that they are all from the same practice) and then does not allow the right Professionals sufficient time and resources to do the job then it can only succeed in laying the ground for imposing a set divisive and stupid standards. They are now no longer able to maintain ignorance on this: Annie Turner mentioned the growing concern in the Ed & Training Committee, where the Standards of Ed & Training are already showing signs of producing divisive fighting in the field it is supposed to regulate.

Group members raised some interesting points in their discussion, but the implications of their questions, had they followed any one of them through to its conclusion, would have upset the HPC if only because they would recognise the real time and work implied. Hence no meaningful discussion was allowed to establish itself - this is typical of these PLG meetings.

Constructing the proposed new generic standards

This is based on the HPC Council meeting of March 25th 2010 (attended by Bruce Scott, from the PA). The long list of dense documents pertaining to this meeting can be accessed here:
http://www.hpc-uk.org/aboutus/council/councilmeetings/index.asp?id=523)

A private meeting followed in the afternoon (public excluded), which dealt with the Judicial Review.

Marc Seale (CEO of HPC) opened: registrant fees would probably be increased to fund the rising volume of fitness to practice hearings. In the accompanying papers the fitness to practice budget for 2010/2011 is estimated at £7,145,823! “That’s a lot of lawyers” thought Bruce to himself.

Seale also talked about launching a media campaign to create/push for the professionalism of the guys at football matches with buckets and sponges who run on to the pitch when a player gets injured. The HPC only want “professional helpers” who will then have be HPC registered!

He also wants to capture golf coaches and sports psychologists/coaches, saying ‘we have got to get them because some are not trained psychologists or sports coaches’.

Will the insidious nature of HPC regulation make its way into the Sunday kick-about with the boys or girls? Will “coaches” have to be regulated? Bruce used to be a racing cyclist: “I had several “unqualified” coaches throughout my career - they did it for free because they loved the sport and wanted to give something to the community: they were ex-cyclists, boxers, or just keen on endurance sport. Under the proposed HPC system my coaches would be not be allowed to get involved in sport coaching at all.”

The volume of papers the Council is faced with is overwhelming. I shall focus on only one, The Generic Standards of Proficiency Review Group – Executive summary and recommendations, http://www.hpc-uk.org/assets/documents/10002CED20100325Council-enc06-genericSoPsreview.pdf

These standards are applicable to ALL registrants across the 15 professions already regulated. They were shown to be wholly inappropriate for counselling and psychotherapy in the recent public consultation.

In brief: the Group recommended:
1) The generic standards applicable to all registrants should be kept.
2) But they should be BROADENED.
The council agreed.

The Group comprised:

Eileen Thornton (Physiotherapist)
Joy Tweed (Lay, Lecturer Health & Social Care)
Di Waller (Arts therapist)
Arun Midha (Lay, MBA)
John Donaghy (Paramedic)
Annie Turner (Occupational Therapist)
Penny Renwick (Chiropodist).

They met twice: on 28 September (ie before the end of the consultation on C&P) and then on 27/8 January 2010, after a ‘survey’ of 20 professional bodies. They were specifically advised (presumably by the invisible Legal Adviser mentioned in the report last week): “not to make changes specifically in response to the feedback received through the psychotherapists and counsellors consultation as these professions are not currently regulated by the HPC.”
In September 2009, HPC wrote to TWENTY professional bodies asking for feedback on the generic standards of proficiency. SEVEN responded: FOUR said they had nothing to say, ONE commented on the intro, not the standards, and TWO commented in detail about eight of the 25 or so standards. The Group thought this might indicate that on the whole most of the professional bodies covered by the HPC were satisfied with the standards. It would be interesting to know which two bodies gave the detailed comments.

Why is the HPC reviewing them if none of the existing Groups is unhappy with them? Is it because they want to capture C&P? But they are advised not to consult C&P in the process of revision.

Attachment B of the Review Group’s Recommendations summarises the additional information available to the Group and considered at their second meeting. Most of this information came from the consultation on regulating counselling and psychotherapy, and the rest relates to concerns raised by the psychologists. Neither of these Groups are allowed to be involved in re-writing the generic standards. The legal implications of any new standards for the time-table of work means that it will take years before the psychologists can re-write their specific standards (because the grand-parenting period has to be allowed to play out under the current, agreed, standards). If the PLG for P&C begin writing their specific standards before the new ones are finalised (they are due to reconvene on 12th May 2010, the new generic standards are predicted for January 2011); they too will also have to wait at least three years before re-writing can begin.

It is not noted that the huge number of concerns coming from these two Groups indicates the inappropriateness of including them in the domain of the HPC. Everyone in this field expressed forthright opposition to regulation by the HPC before the White Paper (Trust, Assurance and Safety) was published in 2007, an inconvenient truth that HPC tends to bracket off and ignore.
The report is presented with numbered sections suggesting an orderly progression of logic. However, on close reading one is forced to conclude that the numbering exists mainly for reference, much like page numbering. Could it be also that the numbers function to separate sentences from each other in order to ignore the flow of meaning and logic that some of them might present.

For example in para 2.2 the Group “[agree] that standards 2a.1-2a.4 are examples of when rewording the standards would still not make them applicable for all professions” because they do not apply to Arts therapists. The inconvenient truth that Arts therapists have not met these standards for 8 year is isolated in a numbered paragraph and ignored.

Meanwhile, the Group reflect on the history of the generic standards in the HPC. These were introduced when the HPC was created in order to identify commonalities across the professions. That this was only achieved by ignoring the anomaly of the Arts therapists is not noted.
It is again ignored in Paragraph 2.4, where “the Group agreed that the principle of having a set of generic standards of proficiency is important as they recognise that the professions regulated by the HPC do have commonalities.” To make the professions conform is the single most important task of this Group. But, apparently incapable of referring to real aspects of the work involved in the professions, the Group relies on generalised moral guidelines apparently of their own invention.

First, it is worth noticing how the re-write is justified. To recap, the Group must retain something called generic standards in order to justify the existence of the HPC as the single entity capable of regulation. But they know that these must be substantially rewritten if they are to succeed in capturing C&P. The existing professions have never complained, and don’t see the need to change. But the Arts therapists have taken this opportunity to say that, after more than 8 years, have never complied with these generic standards. As the HPC likes to justify its competence to regulate C&P by reference to its success with Arts therapists, this constitutes a considerable weak point.

This is probably why the admission is made, separated in a numbered paragraph, and then simply ignored.

So how will seven people rewrite the generic standards applicable to more than 205,000 people in 15 different professions? First they acknowledge that they can’t simply reword the current standards, because “some concerns go beyond wording” (2.1, p2). But this means that all other standards will also have to be rewritten, as the generic standards function as section headings in the overall document of standards.

In order to justify this huge project, the Group present three possible options and then choose one. This is prefaced with:

“The Group therefore agreed that generic standards should be retained, but that they should be as CONCISE as possible and applicable to the increasing diversity of professions and professional philosophies regulated by the HPC.” [emphasis added]

Note the use of the word ‘therefore’, which implies a logical argument, where in fact there is none. This small Group of people, meeting on two separate occasions, interspersed by a failed ‘survey’ of 20 professional organisations, are of course unable to do the job they have been tasked with. But instead of saying so (as the generic standards indeed would command) they seem to be creating a smokescreen behind which they are improvising wildly.

Preceding the word ‘therefore’ are four numbered paragraphs bluntly restating the imperative that HPC must have generic standards. The 5th preceding paragraph was the one that said Arts therapists have never conformed to 4 of these.

The word CONCISE has no meaning in the text, but seems instead to signal the Group’s anxiety at the amount of work, time, money and effort that this project will entail. All but the Arts therapists, apparently, are happy with the current standards.

What about the words BROADEN and EXPAND in the next section – what might they mean? Having recommended CONCISE new standards, the Group set out three options.
1. To make concise the old standards – rejected.
2. BROADEN the consultation of old generic standards to include principles and STRUCTURE of standards - rejected.
3. EXPAND the review of generic standards to include STRUCTURE of standards – accepted
This option (3) was chosen ‘because’
1. It would allow the HPC to engage with those who have an interest in the generic standards;
2. The HPC would be seen to be listening and responding to external feedback.
3. It would ‘future proof’ standards for potential new Groups;
4. A BROADER review would stand up to public scrutiny;
5. The work already done can feed into the BROADER review. (P. 4)

The rationale is blatantly political – if there is any sign of any other logic in the text, I couldn’t find it.

The Group goes on to consider a few different options for structuring the new BROADER generic standards:

1. Remove the generic standards, and allow each profession to compile their own. Rejected!
2. Group the generic standards under BROAD headings (eg Psychological Therapies, Scientists and Allied Health Professionals). Rejected ‘because’ it would be ‘complex and superficial’!
3. Change the structure to OVERARCHING, BROAD standards. Accepted because: it would give a set of OVERARCHING standards applicable to all; it would provide headings under which each Profession could then write its own SUB-STANDARDS (sic); the standard ‘be able to select appropriate personal protective equipment and use it correctly’ is likely to be retained for biomedical scientists, but is less likely to be needed for Arts therapists.’ Well, well, well – what a pitiful state of affairs.

Paragraph 2.19 lists six bullet points in an attempt to justify why this option is the most appropriate. These points are an object lesson in how to rob words of any meaning and muddle and confuse the reader to force through the forgone conclusion. Here they are in condensed form:

1. Keep generic standards;
2. There are 14 [sic] diverse professions but there are some commonalities that the generic standards recognise;
3. The OVERARCHING generic standards can be interpreted by individuals;
4. It solves terminology problems allowing difference to be expressed within the professions, own standards; the new structure can be rolled out, beginning with the most problematic professions; new professions will fit.

This meaningless jumble of words leads directly to RECOMMENDATION 3: to adopt OVERARCHING generic standards with profession specific sub-standards underneath. Sub-standards?

The proposed 15 new overarching generic standards (yet to be tweaked by executive and legal advisor) can be winkled out of the HPC website here. http://www.hpc-uk.org/assets/documents/10002CED20100325Council-enc06-genericSoPsreview.pdf

Last Friday saw the first full read through of Josh Appignanesi’s new play Therapy! at London’s Vaudeville Theatre. Matthew Lloyd directed the cast

Richard Schiff – The Shrink
Alex Jennings – The CBT
Jessica Raine – The Analysand
Amanda Drew –Wife
Tom Goodman-Hill –Husband

Particularly impressive were Richard Schiff, instantly believable as the psychoanalyst, and Jessica Raine (the analysand trying to get the best of both worlds by also having CBT). Food provided the linking theme, and the action shifted between consulting rooms and dining room, presenting political points, sexual politics, problems of identity and rivalry, hilariously. It was a real privilege to watch five professionals turn our dilemma into a satirical workout for their talents. (Thanks to Julia Carne, CFAR, for contributing to this.)

A moment of truth - the PLG from a 'users' perspective

With permission of Betty Bertrand:

The true nature, or rather the true endeavour, of the HPC has finally been revealed in what initially I would have called a moment of grace. They want to invent a new profession.

During the debate on the standards of proficiency, Jeff Lucas, after much heavy silence, expressed his reservation regarding the relevance of the statutory regulation for Psychotherapists and Counsellors, at which point a whoop and applause broke out in the gallery and three people were warned against being thrown out.

The task of regulating the field of Counselling and Psychotherapy is indeed an impossible one, and the PLG had admitted it! But instead of holding on to this and facing up to the truth, the group carried on as if in the grip of obscure forces, and CREATED a new one! One that they thought they could regulate!

This new one has a vocabulary that fits perfectly with the 100 legal words allowed by the HPC solicitor. One member of the PLG said "we are creating a benchmark for the future, defining what counselling and psychotherapy is".

I am scared. I recognise myself neither as practitioner nor analysand in the standards created by this group. This Frankensteinian process will undoubtedly have serious consequences beyond even practice and ethics. The group, many of whose members' views I may respect individually, has themselves spawned a monster.

Sorry, but I did not share Annie Turner's enthusiasm when she said "until we [Occupational Therapists] laid down the Standards of Proficiency, we were unable to define ourselves as a profession".

I am sure that we do not need the HPC and/or friends of the government to tell us who we are – and not only because we constantly evolve. That is the nature of the work we do, of people, and their impact on the practice.

Day 2: and for the first time the muffled attendees sitting in the gallery were given colour handouts of the Standards of Proficiency. I wonder why. Was it some kind of gift? We were even thanked at the end by Diane Waller, apparently relieved that all the messy profession has been "tidied up" and ignoring for the moment the untidy fact that two more days in November had been scheduled.

The picture is not at all rosy - far from it. The past two days are only the beginning. The drafted papers will be circulating for wider consultation and everybody - in the profession OR NOT - should read the proposal and comment widely. Be warned - it is tedious and sickening. Meetings must take place, practical resistance should be organised. A moment of truth must be faced...

The new PLG (half of the members are liable to be replaced in the forthcoming Council appointments) will meet for two more days in November. Until then, we have some work to do.

By Betty Bertrand-Godfrey

The relation between the process and the appearance of the process: the MHTP

The question of whether Counsellor could be a protected title raised barely a mutter at the meeting, and will be dealt with by solicitor Jonathan Bracken at some future date.

It is such a general word that it seems very likely that capturing it will cause a catastrophe. There are around 30,000 counsellors on the BACP books for example. It would be amazing if the HPC took these 30,000 counsellors into its care yet this seems to be the image that BACP wants to create.

I wonder what is actually happening at these meetings. The process seems specifically designed to addle the mind. Much that is said seems irrelevant - the Chair often openly contradicts herself, many issues are parked for future debate, put into a pot, or just 'left there' for a moment but no-one is holding a list. The agenda seems to hover over the content, the minutes don't name anyone in particular. With so much vagueness and lack of direction the PLG process appears to float over something that is moving according to its own will.

The meeting generally stops around about 3.30 but there was still no mention of the discussion expected on protecting the title of 'child psychotherapist. So it was a big surprise when at about 3pm Diane Waller invited Jonathan Coe to put forward some unexpected business. He wanted to know, for no particular reason, and a very angelic smile, whether the group might wish to consider whether or no to protect the title Psychoanalyst. What was that about?

BPC and Skills for Health slapped the suggestion down. BPC vaguely implied that to practise as a psychoanalyst one would first have to enter the register as a psychotherapist - "these are the minimum standards" he said "you are free to go higher if you wish". And SfH sort of backed this up.

At 3.15 or thereabouts the PLG finally came back to the question of whether to protect the title of Child Psychotherapist (an idea thrown out several times over this six month process). Eileen Thornton for the HPC said she could see nothing convincing in the paperwork submitted to support the demand. BPC and SfH both piped up again and began bellowing. The most incoherent stream of nonsense issued forth from the SfH foghorn about the physical nature of a child's brain, and BPC said that because he personally wasn't competent to practise as a child psychotherapist the title must be protected (from him we must suppose).

At 3.29 the doormouse woke up and declared some dates for the next PLG - 17th and 18th November. Nothing seemed to be settled. And, just when they thought it was all over two more days are pulled out of the hat.

In the meantime, Anna van der Gaag has been recruiting her new HPC Board, due to meet on July 6 to consider the PLG's recommendations. Only 3 of the original Council will be reappointed, so Diane Waller, Jeff Lucas, Mary Clark Glass, Annie Taylor, Eileen Thornton, and Graham Smith are unlikely to be around for the November PLG. The original programme of consultation and review has been muddled, but the Draft Standards of Proficiency (SOP) are going to be circulated for another round of consultation - after the new Council has heard the 'group's recommendations'. Will there be a second set of recommendations to Council and a second consultation? Not if the HPC want to rush this through parliament before the next general election.

The UKCP member (Kathi Murphy) specifically said that she was unhappy with the definitions distinguishing Counselling from Psychotherapy (cooked up in half an hour over yesterday's lunch by Mick Cooper and Peter Fonagy - an idea from Julian Lousada which was eagerly put into play by Di Waller, who over-rode the loud protestations from Kathi Murphy), but would accept them for now knowing that they had to go for consultation. Lousada later said he could accept the phrase 'mental health well being' as a definition for counselling, but would then want to give up the will to live - thus evidencing the hypothesis that depression follows moral cowardice.

There is a barely spoken knowledge that everyone involved in this process will have to fudge and force things to fit in order not to lose face. I heard the Counselling Professor (Cooper) mutter his amazement over tea that the UKCP had not contested the definition of Psychotherapy in the meeting. I heard myself wonder why no-one screamed when someone said that the DSM IV was the therapist's bible. Another member of the silent gallery confessed her great discomfort at having to remain mute at this process. I wonder why we all obey the rules. I remember those films and plays and books where someone finally stands up says 'look here, this is all nonsense'. You will ask me why I didn't say it myself.

Look here this is all nonsense.

Protecting the public from the intellectuals

In each PLG meeting the BACP Director of Regulatory Policy has cast aspersions on some other training organisation. For the most part she has been content to leave the accusation vague and nameless and just convey that 'those people out there are doing bad things and we need to police them, and to know what they are up to'. Yesterday however, she actually named one. She named Middlesex University. Middlesex University run a Masters in Psychoanalysis which has no clinical component - 'and we don't know what these people go on to do once they've been given their certificate' she said, with her eyebrows shooting high on her head. The implication was clear.

We don't know what these people go on to do? Well, I suppose they go to Mornington Crescent.

In this month's BACP magazine, Therapy Today, Sally Aldridge responds point by point to the Statement of the Alliance for Counselling and Psychotherapy against State Regulation. One of these points is that the HPC is a symptom of a suspicious state that increasingly grants itself privileges to intrude into its citizens' lives. Sally's response there in writing, was, yes, we do live in suspicious times, and yes we do need to know what these people are up to. "Quis custodiet ipsos custodies?", as they say on the MA at Middlesex University.

Mornington Crescent

Up to a year ago, it was quite common to hear people say that all this state regulation was to prevent another Harold Shipman. There is practically nothing you can say to this because it is beyond reason. Straight forward nonsense. It has been a relief over the last year to notice that his name has been dropped off the register. Another empty phrase came to circulate as justification for all these new jobs, these plush offices, these new procedures ... they are for 'public protection'. But, today, at the HPC PLG for C&P, over the finger buffet lunch, the Ghost of Shipman reappeared.

I was asking why the HPC board was being replaced. I was told: because of Harold Shipman.

There is a long running radio-show the game called Mornington Crescent which has people screaming with laughter for no apparent reason but that the phrase and game is engaged in so seriously, and yet is totally meaningless.

Regulating counselling and psychotherapy via HPC

At yesterday's PLG meeting at the HPC a very frosty silence opened up the day. Soon there were red faces and blustering interventions, and it seemed clear that something had happened outside the meeting. Suspicion and resentment bubbled up as it became more open that the 'big boys' had been cutting deals and manoeuvring for position to get the best deal in this power-sharing mess.

This group of practitioners - Counsellors and Psychotherapists - did not approach the HPC and ask to be regulated. The field has not organised itself into a centralised unified body that could be readily transferred across. So the HPC is going to have to force it to fit, with a force powered by an act in Parliament.

Professor Jeff Lucas ('lay member' of the HPC Council, and University VC many of whose graduates will end up on the HPC register), had showed himself capable of breaking through the 'group atmosphere' in January's meeting to point out the inconvenient truth that this field will involve taking on something like 40 different registers rather than the usual One. In yesterday's meeting he managed to say that this so-called field of counselling and psychotherapy was a mess and that it would be impossible for the HPC to regulate it.

Yes. The only possible outcome of forcing this impossible profession to fit is to destroy it and invent something new. Only then will you get a government sanctioned efficient programme of orderly, obedient, therapists.

A user's perspective on the HPC process

Betty Bertrand-Godfrey very kindly agreed to my posting this here on the blog:

Report on the Manchester ‘Stakeholder’ Meeting organised by the Health Professions Council for UK stakeholders in Counselling and Psychotherapy. 31 March 2009.
By Betty Bertrand-Godfrey, a 'user' of psychoanalysis

As planned I went to the Manchester stakeholder meeting. Clearly the HPC's intention was to make us believe that statutory regulation is good for us - but they must be deluded and desperate.

Deluded first.
Prof Di Waller (HPC Council member, Chair of the Professional Liaison Group for Counselling Psychotherapy, and Arts Psychotherapist registrant of the HPC) opened the day with a very positive statement: " We have got a pretty good start on the work", she said.

I have observed two PLG meetings and I didn't think so. This was confirmed by the discussion we had at the end of the day when the PLG (at last) asked the floor's views on the matter. It was felt strongly that even the split between titles was a problem and suggested that everything was to be put on hold until the HPC finds a better way of dealing with this mammoth tasks. So not a "pretty" but an "ugly" start then!

One highlight of the day for me was Di Waller being genuinely surprised that the "fear of NOS keeps cropping up" (National Operating Standards). At the break I had a quiet word with an HPC representative and told him that having the Chair of NOS from Skills for Health on the PLG certainly does help this "cropping up". I also said that HPC wants to gain our "trust" but how can we do this when we think Prof Fonagy has been pushed in. I must say that the representative looked uneasy with this issue and I sensed almost agreed with me.

HPC denies categorically that it will refer to the NOS guidelines for setting their standards of proficiency and said that "it will actually be quite unhelpful" (Michael Guthrie, Acting Director of Policy and Standards). But in my little chat I also mentioned that if HPC registration goes through then we know it is an open door for further rules to be implemented that will damage the core of most therapeutic work.

Desperate now.
At 11:40, we had the most incredible power point presentation I have ever seen. Mary Smith (Royal College of Speech and Language Therapists, and HPC registrant) put together images and words destined to five-year-olds. She seemed to want to make us believe that registration is fantastic and that we should all go for it with all our hearts and souls. The way she operated was weird, very weird indeed, and clumsy. I felt she was trying to hypnotise the whole room but all she managed to do was irritate us by taking up precious space that could have been dedicated to proper grown-up debate.

In substance she said we should (I am quoting now) "abandon ourselves to the process and leave the professional bodies behind. You need to pass it all over to the HPC. There will be a moment of bereavement and we ourselves (SLT) felt that we were handing stuff away but we need to have that clear blue water (here was the soothing image of a lake on her power point presentation at the same time!) that can only allow the transition". Basically, she said: go to sleep - resistance to HPC is futile! A shame she had to go and could not reflect on Prof Parker's (Manchester Met University) beautiful intervention: he urged people to be cautious, but most of all to THINK.

At last in the afternoon we broke out into rooms. I happened to be with Sally Aldridge (BACP), Jonathan Coe (Witness) representing HPC but more interestingly the stakeholders Prof Darian Leader (College of Psychoanalysts, UK), Dennis Greenwood (Universities Psychotherapy and Counselling Association) and some serious opponents to this process. This is how it should have been right from the beginning. Darian reminded us that the White Paper (Trust Assurance and Safety) says "whether the HPC can accommodate the profession" not how. The "whether" has had no space to be discussed so far.

Then at 2:40pm (after only 40 min of intense discussions in small groups) we got back to the wider group where at last something more real was debated and animosity, fear and anxieties were emerging (which I think surprised the HPC-PLG people). I must say Janet Low (representing the Philadelphia Association), Ian Parker, and Nick Totton (from the Independent Practitioner’s Network) were brilliant and inspirational. The quality of their interventions allowed more people to join in to challenge HPC.

On departing I asked Michael Guthrie if he had the intention to feed back to this group by setting another meeting as people were anxious as to what was going to become of all that was said during the day. I emphasised the need for a real meeting and not some feedback on the HPC website because this is where it all happens.

He said he will have to think about it and thanked me.

Centralisation in action: The Manchester Stakeholder Meeting

Yesterday (31 March 2009), in Manchester’s Thistle Hotel, the HPC staged a meeting for those who are not quite engaged in the process to draw counsellors and psychotherapists into state regulation. It was a well organised meeting in a nice venue with a lovely lunch. The acting Director of Policy and Standards (Michael Guthrie), the Director of Fitness to Practise (Kelly Johnson), Director of Communications (Jacqueline Ladds), Policy Officers (Sam Mars and Charlotte Urwin), the Secretary, Education Manager (Osama Ammar), Events Manager (Susan Carini), and some other employees were present: young and charming people, all (about 8 or so people).

The HPC elders were represented by the practitioners (or their close associates): President Anna van der Gaag, Di Waller (chair of the PLG), and Annie Turner (Council Member representing Occupational Therapists), then there were the PLG professionals: Fiona Ballantine Dykes (CPCAB), Sally Aldridge (BACP), Peter Fonagy (Skills for Health), Malcolm Allen (BPC), Brian McGee (Counselling and Psychotherapy in Scotland), Kathi Murphy and Carmen Ablack (UKCP), Nick Turner (Relate) and Jonathan Coe representing Witness (formerly POPAN – a user complaints organisation), about 11 people. The other 30 or so in the room included representatives from NICE, IAPT, Universities, NHS, Umbrella organisations for counselling, psychotherapy and psychoanalysis. An analysis of who was there, and what kind of experience they represented and what their positions and questions were would itself be a work involving some considerable effort and time.

The process, however, will squash the difference and reduce the experience to a size that the HPC can manage. This is very small indeed, and is one of the most straightforward destructive effects of intense centralisation. A second effect will follow: in order to show that they have heard everyone, a document will be produced which captures a sentence here, a phrase there, enough to prove in an imaginary (though possible) future thoughtless court of law that consultation has taken place. The meaning of what has been said will have to be sacrificed – it is simply not possible to understand and take it all on, and it will not be possible to write this up in a way that dignifies truth. The process will force the HPC to manufacture a representation that shows that they have consulted, but that can barely hope to benefit directly from the experience.

However, given that human beings are involved it is at least possible that someone could change the course of this infernal machine. That person would have to be a hero, and an unlikely one at that: “the holistic planner overlooks the fact that it is easy to centralize power but impossible to centralize all knowledge which is distributed over many individual minds, and whose centralisation would be necessary for the wise wielding of centralised power. But this fact has far-reaching consequences. Unable to ascertain what is in the minds of many individuals, he must try to control and stereotype interests and beliefs by education and propaganda. But this attempt to exercise power over minds must destroy the last possibility of finding out what people really think, for it is clearly incompatible with the free expression of thought, especially of critical thought.” (THES editorial, quoting Popper’s Nightmare, 8 June 1984) emphasis added.

In the morning were three presentations, first from Di Waller who wants to paint a rosy picture and said ‘We have got a pretty good start on the work" [see previous blogs for another point of view]. She couldn’t understand, tho, why people ‘outside’ kept asking about the relationship of the HPC to the NOS of the SfH. It would be helpful if she, Anna Van der Gaag, and Michael Guthrie explained their reasons for inviting Peter Fonagy, chair of NOS at SfH, to sit on the PLG – that would aid the understanding.

Jonathan Coe was next up, and delivered a horror story of a relationship gone wrong between a therapist and a client. Jonathan, backed up by Peter Fonagy, has been circulating an unsubstantiated statistic that 5% of therapists represent a serious threat to the safety of the public. In the absence of serious research, Jonathan was reduced to ‘bigging it up’ with a story about a poor woman victimised by an evil greasy man and had to resort to bringing the actual woman with him in lieu of proper proof. Many people in the room found this un-ethical, and Darian Leader (President of the UK College of Psychoanalysts) pointed out that in using this story for his own aims, Jonathan was unwittingly repeating elements in the structure of abuse that the substance of the story represented. The presence of the woman in such a context made any discussion of the case impossible: another nail in the coffin of enlightenment, another point offered up to the bogey-man.

After Jonathan, there were two women representing the Royal College of Speech and Language Therapists. They had evidently been briefed – consciously or not – to reassure the stakeholders in this new profession that everything would be alright. Mary Smith kicked off with a power-point presentation that many thought was pitched at the wrong level, and she went on to recount something akin to a fairy story: there had been a lot of worries expressed by members of the SLT profession when it had been their turn for hpc-ification, but in the end they gave in and left their professional concerns behind, passing control over to the HPC. She said there had been a moment of bereavement when they felt that they were giving important things away, and then she said something mysterious: ‘we need to have that clear blue water [here she had a lovely photo on a power point slide presenting the soothing image of a lake] that is necessary for the transition". What on earth does that mean? The message received by some at least was in the form of a bribe: if you shut up and go with the flow, you will get your hands on some power. For Mary this meant access to the corridors of Whitehall, and a chance to influence government. The kind of mind-numbing effect of the HPC process has left its mark on Mary who wondered why her predecessors hadn’t become arch lobbyists. When I suggested that this was because England had not always been a highly centralized system and that it hadn’t been necessary before, she could only respond vaguely about the devolution of Wales, NI, and Scotland, as if this somehow proved a point.

Her colleague Kamini Gadhok might have produced her talk out of a manual of politically-sanctioned phrases. She said: robust regulation, enhanced protection, raised standards, support for the profession, raised profiles, fit for practice, keeping our agenda on the government’s radar, influencing the commissioners, bringing added value, protecting our practice against pressures, enhancing CPD, in line with government policy, improving outcomes, getting up there with the GMC, being invited to the top table, building our capacity. Newspeak? Or a hidden attempt to hypnotise? Nevertheless her power-point slide showed that over the years the Royal College was losing members to the HPC. I asked Kamini what her organization was doing to protect its members from the HPC. This caused a ripple of laughter in the room, but if you check out the case study of Mr R [see side panel index] you will see a staggering example of how the thoughtless process of HPC FTP hearings ride rough shod over perfectly decent practitioners. Kamini said that this had been discussed in their recent AGM. I look forward to the HPC publishing the apology soon.

In the effort to establish a congenial relationship the professional bodies can easily forget that the HPC has in fact been set up on a prejudice against them. Read Ian Kennedy’s book The Unmasking of Medicine (1981), trace his influence in the Bristol Royal Infirmary Inquiry Report, read the HPO2001, and the Section 60 currently before parliament. Instead of the good old fashioned English presumption that people are innocent until proven guilty, we have the idea that professionals constitute a danger that only HPC can overcome. This is why the HPC is made up of administrators without any experience, and why the difficult questions that relate to reality get squeezed out onto the edge and beyond. Professions are made up of people who are forced by their work to face up to the impossibilities that arise in practise. In reality, administrators can only imagine this, or subordinate themselves to the practice. In fantasy, administrators emerge as the only true pure and innocent.

Some of the stakeholders present knew nothing at all about HPC-ification, and had come hoping to be enlightened. They will have to work a lot harder if they want proper, useful, practical information about what the process will mean to them. Others had clearly done some homework. Ian Parker (Manchester Metropolitan University), for example, has read the Government White Paper Trust, Assurance and Safety more carefully than the HPC. In the detail the documents asks "whether the HPC can accommodate the profession" not how it could. He also asked what evidence there was that the form of regulation proposed by the HPC would actually achieve increased protection of the public. These two sensible questions are incredibly difficult to maintain.

Why?

In the afternoon came the ‘breakout groups’ in which the voices of the visitors could be heard. The chair of each group had been briefed to take back three things to the final plenary session. To their credit, all of them took back more. The assumption behind the construction of this meeting was that simple messages and supportive comments wouldn’t take long to deal with. But for those interested in reality and who have the tenacity to tangle with the truth and the conflicts involved, something more is needed.

Throughout the PLG process, difficult issues have emerged only to be ‘parked’ until some mythical future date. Tricky issues are constantly postponed and left in the mist of imagination. In my break-out group I said I was alarmed that the PLG (who are 2/3 of the way through their predefined life) don’t even know whether it will be possible to legally protect the title of counsellor (Michael Guthrie is supposed to be checking this out with the solicitors). All of the discussion so far in those PLG’s presupposes that they can legally own this title. From my point of view this is another sign that the process is rushed and ill-thought through. The expression of my alarm caused alarm and provoked an effort of suppression. John Nightingale (Association of Christian Counsellors) rescued the situation, and returned to it later to get things said straight.

Adrian Rhodes from the European Association for Psychotherapy also expressed an alarm. He said a constant stream of people was hammering on his European door asking what on earth was happening in the UK. Unfortunately, this was condensed into the rather simplistic idea that Europeans felt that ‘standards were being lowered’ which was more or less translated by Di Waller to mean Europeans are ‘elitist’. This rhetorical move needs unpacking. Elite, etymologically, means simply ‘elected’ - those few who are elected to represent the majority who cannot be present themselves. The HPC group is an elite. However, the word has been totally submerged by a wholly pejorative meaning, which effectively brings all conversation to a halt. So, the letter written by European Psychoanalysts expressing their great concern that NOS and HPC will kill off psychoanalysis didn’t get mentioned at all.

Fiona Ballantine Dykes managed to distil 7 sensible points of concern from the discussion in our group, and the HPC admin staff pledged to write this up in a document. The next PLG meeting is due to debate it again, where several of us will be sitting in silence, waiting to hear what they make of it.

Ian Parker’s point from the morning needs to be brought back here – is the HPC process actually paying attention to the question “can it accommodate this profession?” If it has sped forward to “how shall we force it to fit?” (which is what is articulated time and again by those in strategic positions in the process), then the work and the words of the day will have been in vain and the stakeholders meeting will be reduced to a cosmetic event and questions will crumble away. In the plenary session at the end of the day I asked Michael Guthrie directly how the HPC manages dissension within its structures. He said that the professional partners and groups discuss these things outside the main structure, and this is where the difficult issues must ultimately be dealt with. Within the HPC they are confined to act in ways that Government can accommodate. I heard this as a confirmation of Popper’s Nightmare. Someone else said she heard the exact opposite. Two more people tended to agree with me. It will be proved in the future action: will the machinery simply grind on? Or will human beings gain some control over the action?

On Sunday 5th April a meeting will be held in the ULU building on Malet Street London W1, staged by the Alliance for Counselling and Psychotherapy against State Regulation. It will be an important occasion which might load the dice in favour of the human factor. Here is the link to the web-site - click here.

PLG C&P March 3rd meeting - day 2

What wasn't talked about yesterday: the threshold for entry onto the register. What wasn't talked about today: how to distinguish counsellors from psychotherapists.

What was talked about today was the number of voluntary registers that are known to exist (33 according to Sally Aldridge) and the traumatic effect this will have on the HPC. The Section 60 designates a legal date of transfer when a cd-rom is handed over, popped into a slot and dragged and dropped into a brand new folder. Usually there is one cd.

Here's a paragraph quoted from the web site of the Alliance for Counselling and Psychotherapy against State Regulation which introduces the problem:

"The therapeutic field is a rich and complex ecology, built up of many different approaches. This diversity is intrinsically valuable – since clients and their issues are equally varied – and is part of what we want to protect; however, from a regulatory point of view it is awkward and inconvenient, and needs to be ironed out. Good training helps the practitioner to develop their own unique style of work, rather than making them conform to a supposed ‘best practice’. The proposed regulation bids fair to flatten this rich ecology into a monoculture, with devastating consequences for the profession and for its clients."

The fact is that this profession is based on conversation, includes aspects of conversation that can't be put into words, and is a conversation that really must be made in private. You can see why the centralised planner might be uncomfortable with that.

Today someone suggested that the HPC would have to take this profession in 33 different registers. The room laughed, and Michael Guthrie spluttered, then said the Department of Health couldn't cope with that.

It occurred to me then that in swallowing this profession, the HPC might risk choking to death.

PLG C&P March 3rd meeting

18 uniformed officers were waiting at the gate of the station tonight when I returned from the 1st day of this 3rd meeting of the HPC PLG for C&P. 18 uniformed officers to check the validity of our train tickets. Such a concentration of power for such a silly job is a rather stark example of how out of balance stuff is in the UK today. Perhaps they are protecting the public from leaving the station quickly. 18 uniformed officers (half of them wearing padded flack jackets over already portly tummies) rather choke the little underpass to the street.

Meanwhile in a bland office in a back street near Elephant & Castle 11 non-representatives of the counselling and psychotherapy world met together with about 20 other people in order to say nothing of importance from 10.30am till 3.30pm. They will meet again tomorrow, and I can only hope that they manage to muster the courage to utter a coherent and definitive sentence between them at least once in the meeting.

To be fair, two or three people did make valiant attempts to keep it real, but they were swimming against a tide of platitudes, point scoring and polite snipes.

The 11 non-representatives from the world of counselling and psychotherapy were selected by Diane Waller (an arts psychotherapist) in conversation with Anna van der Gaag (a speech and language therapist) and Michael Guthrie (an administrator). There had been 40 or so applications, some from individuals, some from organisations. A little list of criteria had been written down and Di, Anna and Michael made their longer list with this. Since then, they have been bombarded with emails and letters and visits about the non-representative nature of the 11 they selected. Today, at the opening of the meeting Diane Waller set out to make a statement. She wanted to set the record straight: the 11 non-hpc people round the table should know that they had not been selected to represent their particular group, but were simply there to ... err, to, well, the only specific thing I heard her say was to hold onto Wales as an idea (because not one amongst them was Welsh).

This is just one example of the mad rules that the group are supposed to abide by. How can Sally Aldridge not represent the BACP? She is their paid Director on precisely this question. They have several thousand members. If she has anything sensible to say, it would be from her experience in that job. Surely she should restrict herself to this, not exclude herself. She should inform the rest of the group about the real practical issues at stake in transferring this particular membership onto the HPC register - this is her specialist subject. What about Mick Cooper? He is a professor of counselling (a relatively new breed of professor, the evolution of which would be very interesting to track) from Strathclyde University. He does not represent the University. So he can speak from a different position, and people can hear him in his capacity of intellectual and scholar, or whatever indeed he is. Peter Fonagy? He is there under the auspice of the Skills for Health - he can restrict himself to talking about the National Operating Standards that are his responsibility to coordinate. Each member of the group has a specific position from which they can speak authoritatively, what's the problem? They have been chosen according to those criteria, haven't they? So why does Diane begin today's meeting by describing the rationality of their selection, then forbidding them to be precisely that? She ended her little lecture by strongly emphasising that those 11 non-representatives should Reinforce and Remind people of their non-representativeness, 'that would be helpful' she said.

Mad.

Difficult questions get parked, reparked and parked again. Topics are constantly left for another day. Another day? There are only 4 days left for this group of people to come up with something that is destined to be turned into law. LAW. Do we need any more laws in this country? There are already more laws than Parliament knows what to do with, and a handful of politicians at Saturday's Convention on Modern Liberty were even pledging to repeal dozens at a time. What is the point of turning this mess into a legal document? The field we know as counselling and psychotherapy is so diverse, so rooted in relationships and places, so firmly fixed amongst ordinary people that the wish to legislate it into a neat standardised package should rather be written into next DSM as a sectionable mental illness.

It is so difficult to sit silently watching this process. It feels like being forced to watch a child being drowned, and forbidden even from throwing a rope.

It is extremely difficult to report on anything of substance. Nothing of substance emerged. However, two things are worth passing on. In the moments before the meeting started this morning one of the HPC lay members on the PLG suddenly came over to show us a CHRE document. This was one of the documents that teach doctors not to have sex with their patients. This document was offered to us in answer to the question raised at the last meeting about the source of the data that Fonagy and Jon Coe were trumpeting that 5% of C&P practitioners constitute a real and present danger. Here is a great example of the real trouble that this group has. A group of eminent and intelligent people are unable to think clearly in this process. We were offered this document as the evidence that 5% of therapists and counsellors were dangerous. I thought she meant that the reference to the paper that produced the statistic would be in there. But no. What was there was the fact that some doctors have sex with or marry their patients. This is absolutely barmy. Well meant, but barmy.

The second notable moment came at lunch time: three of us 'public' were eating lunch together when one of the 11 non-representatives came and sat down beside us. She asked us for our advice - what would we say if it were us who had landed at that powerful table? This was a real live thinking human being and it was a massive relief to discover it. So what would we say? Keep it Real. And she did - after lunch she tried and tried and tried again to keep reality in the picture. I'm not talking about anecdotes - she was furnishing the meeting with real information about things that she knows about, that are actually happening out there. What a relief. I'm going to start a collection to raise a statue for her if she carries on like this.

March 3/4: PLG C&P 3rd meeting. Preparation

The Professional Liaison Group for Counselling and Psychotherapy is due to meet for the third time (3rd and 4th of March). There are 320 pages of reading in preparation for this meeting, all down-loadable from the HPC-uk.org website.

The (draft) minutes for the last meeting continue to refer repeatedly to The Group, and avoid being specific about what different people say at certain times (see blogs preparing for January meeting). The minutes give the overall impression of a set of people who are all of one mind, and who constantly agree with one another as they note this, receive that, and feel or discuss the other.

After the last meeting, I took the trouble to note down specifics that were said by particular people in a short spat that was unusually energetic. Eg, after coffee, before lunch, on day two, when the meeting considered the section of a report summarising responses to the call for ideas (in 7 lines of text) under the title point "3.2.2 Conscientious objection" (p37).

If you check the blog entry you will see several different responses to this question, which represented several different positions and some misunderstandings. You will also notice that a level of aggression was expressed which led some people to remind their colleagues to respect the positions of those who did not agree with them. These comments seem to have fallen onto the deaf ears of the minute taker (p5). Instead, he takes the opportunity to blandly restate the ideological position of the HPC before misrepresenting those with other opinions and then dismissing the point and throwing doubt on the intellectual ability of those oponents.

It was Annie Turner, Occupational Therapist Panel member of the HPC, and who said 'these people can't have their cake and eat it', which been translated by the minute taker into: the Group questioned why 'conscientious objectors' to statutory regulation [sic] would wish to be included on a list maintained by a statutory regulator and if the individuals concerned would be prepared to be subject to the HPC's processes and procedures.

One of the most persistent comments made by those with a different opinion to that of the HPC is that they are simply not heard (eg see the letter from IPN members, blogged on 10 Feb). The process of HPC-ification is not one of conversation, nor even that of debate. No doubt discussions at such a centralised level can tend to drift into vague generalisations - a few people have been asked to consider a lot of diversity in very little time. But why present a false front - what can be gained from this masquerade?

The HPC 'call for ideas' produced hundreds of pages of response. These were reduced to a 36 page document for consideration at the curtailed first meeting (enclosure 1, 4 Dec). One of these pages contained a bit more detail of the matter and clearly shows there was no intention of anyone to smuggle themslves onto the HPC register. Instead, it was suggested that another register would be drawn up. Bear in mind that the HPC notoriously state on their 'Road Map' to regulation Counselling and Pscyotherapy (Council Meeting, 13 Dec 2007, accessible if you click this link) that anyone not on the HPC register is a lesser human being:

"It should be noted that whilst there are many who will welcome [HPC regulation] there might be "a small but vocal minority of individuals and organisations who may want to avoid [HPC regulation] for a variety of reasons." which include: those who are unable to meet competence standards and ethical standards; or who are reluctant to pay the registration fees. The HPC has made a pre-emptive rhetorical strike by labelling those who don't agree with it as incompetent, unethical, and miserly.

This should help Annie Turner to understand why some people might want to construct a list outside the HPC - in order to dispell the negative image created by the HPC.

The people around the table do not all agree with one another, and some of them even made plain their own reservations about the outcome of the process (see Being Dragged Willingly, blog, 29 Jan). The thrust of the disagreement with HPC-ification is a genuine concern that the kind of regulation being proposed may well have long term catastrophic consequences. My observations at the FTP hearings already suggest that damage is being done and there is some good reason to pause and to engage in some genuine and critical thinking. Pretending that everything is easy and simple and nice isn't going to protect anyone. Who really believes that it does?

HPC PLG C&P day 2, pm

Towards the end of the HPC PLG for C&P last week the group started thinking about their next meetings. According to the work plan written down by Mr Guthrie, most of these meetings will be taken up with the question of Education and Training/standards of proficiency.

As the group approached this they revived something that Diane Waller had mentioned and parked a bit earlier. It was the question of 'life coaches' and people using other titles but doing similar work. Mr Guthrie had reminded the group that the process was about Protecting Titles, not function. This left the difficult question of figuring out how the HPC could guarantee anyone on its register without recourse to training and validation of practise. There is also the question of what they would do if people simply invented a new title for their work.

This is the way the nightmare works. Having invented a name, they now have to invent a new practise that fits the name and that they can police, otherwise they have no power whatsoever. It is a where the twist in the law is most obvious. The mistake Ian Kennedy and his followers made was to imagine a group of people who were the exception to the rule. The rule was that professionals were not to be trusted, the exception to this rule could alone solve this problem. The exception to this rule is the HPC. When Ian Kennedy said so casually 'why should they [the medics] have the power over life and death' he implicitly also said 'it should be us, who are better'. Which is, of course, nonsense.

What follows is a compact and incomplete account of some of the discussion. I've given it like this as an antidote to the anodyne minutes which reduce all the differences in the group to a single unanimous voice. I have also included their names so that anyone reading this blog might decide to engage in a conversation with any of these people (simple to figure out how through google) on some of the points that they make.

Jonathan Coe (Witness CE) said "The need for standards in professional training is what will protect the public."

Graham Smith (HPC Panel, Physio) linked this to the 'intention to deceive'.

Karen Ablack (UKCP standing in for Kathi Murphy) remarked that 'if people are not doing it [therapy] well enough and they are using my professional title then ...' she left it to her body language to indicate what she would do (flush them down the loo, I guess, she seemed to
indicate poo).

Mary Clark Glass (HPC Panel lay member) said 'we'll get them on it - if you go beyond your skills and competence, you will be called to account'.

Someone said "Prevention is the better protection of the public"

Finally Julian Lousada (BCP) remarked 'we've parked a difficult issue' to which

Diane Waller (chair) replied 'we can be seen to have done justice to the question'.

Sally Aldridge (BACP) then offered to exhume a dead and buried report done by the big 5 some years ago [UKCP, BACP, BPS, BCP, BABCP I think] which had tried and failed to synthesise competencies across the board. Someone else offered another similar dead and buried document, and Peter Fonagy (SfH) offered his NOS. All were eagerly accepted as fodder for the next few meetings.

In this way the work done in these other places by these other people for those other purposes are going to emerge into this tight schedule and could easily be taken up for want of the time to make something more suitable. This is how bad laws get made, and its other people who are going to suffer the consequences without any idea how it happened to them. That's why I'm writing this blog.

The Lobbed letter: a few home truths

In yesterday's PLG C&P meeting there was a section devoted to the question 'conscientious objection'. This matter had been reduced to 3 lines in Michael Guthrie's report for the group, but it turns out that some members of the PLG had also received a letter from the College of Psychoanalysts UK. Perhaps not everyone had received it, and it wasn't actually mentioned by anyone on the day. But the letter has now been published on the website of the College of Psychoanalysts-UK (click heading for link).

Dear PLG Member,

We are writing to you as a member of the HPC Professional Liaison Group because we believe it is valuable for all those on this important committee to have equal access to information concerning the question of the proposed HPC regulation of talking therapies and the consultation process so far. This process, unfortunately, has failed to remain faithful to the original Department of Health remit to include representation from the breadth of the professional field and to respect the difference and diversity of the stakeholders concerned. Documents recently released under the Freedom of Information Act, which will be detailed below, make this clear and give us serious concern about the parity and transparency of the consultation to date.

There are three main issues here:
. Misunderstandings about the commitment of all psychotherapy groups to appropriate regulation of the profession in the interests of public protection and the vitality of psychotherapy.
. The importance of explicitly reflecting the particular and differing nature of the psychotherapies in the mechanisms of regulation.
. The hijacking of the process by a minority section of the profession to the exclusion of others.

From the first PLG meeting held on 4/12/08 it seemed apparent that the scope for discussion of these difficult issues is likely to be very limited, with the danger that they will be treated as inconveniences to be given an airing and then ignored. We believe it is important that you are aware that they are not minor details and that thousands of clinicians, as well as academics, intellectuals and public figures, across the country are gravely concerned about the high risks involved in a hasty and ill-informed consultation process. A major media campaign will begin later this year which will draw public attention to these problems.

We understand that it is not the HPC's task to assess whether it is fit for the undertaking the Government has given it, yet that it is within the scope of the PLG to comment on the appropriateness of HPC regulation of the talking therapies and to understand and reflect on the relevant arguments. These arguments relate specifically to the issue of the effectiveness of any future register, the protection of the public and the concern that the action of the HPC in carrying out the task of regulation be proportionate to the requirement that the public be protected. 

Commitment to Regulation

We, and all psychotherapy organisations of which we are aware, have been actively committed to regulation for many years. The self-regulatory systems which have been developed over the last 20 years have grown in sophistication and effectiveness and are continuing to do so. When critiques of the proposed HPC regulatory framework are formulated, the response is often that this is because the clinicians in question just don't want regulation. This is a major misunderstanding. The concern is not with regulation, which already exists, but that the proposed process of HPC regulation will narrow the broad practice of psychotherapy, making much of what currently takes place in reputable psychotherapy consulting rooms illegal in the near future. We are also concerned that the Government's insistence that all psychotherapies be subsumed under the Health Professionals' umbrella will inevitably impose on psychotherapies the same framework as fits the health professions but does not translate to a non health-care profession such as ours.

To date, neither HPC nor Skills for Health have published a risk analysis of the field of psychotherapy, nor research into appropriate forms for its regulation. In Australia, the government aimed initially to regulate psychotherapists and counsellors under a healthcare model, yet after a three year consultation period, they accepted that counsellors were best left to self-regulate, and the same result looks set to happen for psychotherapy. The government there has recognised that statutory self-regulation works better for the protection of the public and for the life of the profession itself. The Australian consultation demonstrated that:

. Counselling and psychotherapy are fundamentally different from the majority of health professions.
. The focus of 'talking therapy' is the relationship and the process of therapy, rather than the performance of certain definable procedures.
. It is difficult and even unhelpful to define competences and scopes of practice in a narrow legalistic sense.
. A diversity of training bodies, professional associations, and theoretical approaches is both a strength and a weakness and requires a model that respects diversity while being clear about standards.
. The profession would be best managed within a self-regulatory model based on professional colleges, which will have the necessary expertise to link training standards and practice.

It seems important to us that the question of the regulation of talking therapies which explicitly claim not to be health-related be given proper consideration. Many clinicians see their work as an exploration of the human condition, a journey in the same sense that becoming a Buddhist monk involves a long process of questioning one's life, ideals and expectations. Like a Buddhist training, this long process of psychotherapy cannot be identified with a set of techniques or procedures to be applied to a human being, but forms rather a strange kind of relationship which operates in unpredictable and unexpected ways. One cannot know what will happen in advance, and change often takes place through surprise, bafflement, shock and disappointment. 


The Particularity of the Talking Therapies

The results of the Skills for Health consultation on psychoanalytic/psychodynamic therapy were published recently in draft form. These are the so-called National Occupational Standards (NOS). They list 451 criteria and guidelines for psychodynamic and psychoanalytic therapy. They dictate every aspect of how therapists should organise their sessions, how they should 'monitor' themselves and how they should carry out their work. They go into minute detail about the timing of interventions, the setting of the therapy, its aims - and even the expression of appropriate 'feelings'. Such an application of externally-imposed rules - most of which were expressly contraindicated by Freud, Jung and the analysts who followed, such as Klein, Lacan and Winnicott - removes the very foundation on which such therapies are based, namely the freedom of both parties to work together authentically and creatively.

If these rules were to be accepted, then it would no longer be possible for many clinicians to work in this country. Although the HPC has been keen to point out their independence from Skills For Health (SfH), it has also been made very clear that the work done by SfH on National Occupational Standards will 'inform' the work carried out by HPC. The NOS draft is an extremely controversial document and the process by which it was arrived at has been shown to be highly partisan, an issue we will come to presently. If the HPC has to gain a full understanding of the profession it hopes to regulate, this understanding risks being biased by the influence of the SfH project.

The SfH project has attempted to shoehorn analytic work into the current culture of outcomes, where all variables must be predicted in advance and evaluated in relation to expected results. Analysis, however, and many forms of psychotherapy, involve an open-ended relationship, where results may emerge that were never predicted or even thought of by the person in analysis. The very distinction between conscious and unconscious motivation that lies at the heart of analytic work is ignored by the proposed regulations which encourage a 'false self', a box-ticking clinician, fearful of being watched by the authorities and anxious to please them. If analysis has an aim, it is to help patients free themselves from irrational forms of authority, exactly those that now threaten to constrain their work within the therapy.

According to the government roadmap, HPC will establish a list of reputable practitioners, which will mean effectively those who adopt their particular formulations as to what talking therapy is about. All the documentation published to date by HPC shows a serious misunderstanding of the nature of analytic work, together with a new insistence on 'good character' defined in highly rigid ways. If this goes ahead, then members of the public will no longer have the freedom to choose their analyst, a fact already brought up by user groups. They will have to select a practitioner from a list which only includes those who practise a particular form of therapy. Practitioners who are totally opposed to the idea of their work as 'healthcare' will have to adopt a healthcare model and become 'model citizens', when the whole of the analytic tradition emphasises that the practitioner's human failings are essential for the analysand to recognise and work with.

Nearly all of the professional groups in the field have agreed that HPC is not suitable as a regulator for a variety of reasons, yet one in particular stands out regarding analytic work. In this work, the analyst puts themself in the place of the object of all the projections of the analysand. Powerful feelings of hatred, disappointment and rage that had once been directed to one's caregivers and then repressed or negated may emerge and now be directed to the analyst. These are features of the phenomenon known as 'transference'. The analysand will not be aware that this is happening, and hence a long, difficult and painful period may follow when these feelings are clarified and worked through. At the same time, the analysand may realise that the analyst is no expert but just a fallible and weak human being. The sanitised image of the practitioner aimed at by HPC cannot fit this model, just as the complaints procedures they adopt are not sensitive to the crucial question of transference. Analytic work requires, in a sense, that the analyst should become a scapegoat, and at the same time, act unpredictably or even shockingly. How else, after all, to overcome the defensive system that someone may have spent their whole life constructing? Change in analytic work rarely comes about by the polite communication of some hypothesis ('When you were a child, X must have happened..'), but through interventions that may seem, or indeed may be, totally unacceptable to the analysand. This is how analysis works, and it is unlikely that HPC complaints panels would be well-suited to assess the complexity and often hidden nature of such issues within a culture where complaints against practitioners by their patients are openly encouraged by the regulator. An extensive literature exists on this question, which has been totally absent from all bibliographies published to date during the consultation process.

Hijacking of the Consultation Process

The consultation process initiated by the Department of Health was intended to assess the feasibility and suitability of state regulation through dialogue with all of the professional field. However, Skills for Health allowed their consultation to be monopolised by a very small number of people with both a narrow and restrictive view of psychoanalytic practice and, arguably, a clear agenda to further their own particular brand of therapy which they endeavour to promote within the NHS. The task of drafting psychodynamic/psychoanalytic competences was given by Skills for Health to Tony Roth and Steve Pilling, employees in the UCL Sub-Department of Clinical Health Psychology run by Peter Fonagy. Fonagy, in fact, chaired the Executive Group and the Strategy Group of the SfH project and also sits on the Reference Group. These researchers, aside from having the link to Fonagy, are known for their work on CBT, a set of therapies which are totally at odds with psychoanalysis and most psychodynamic therapies. It is extraordinary that the work was given to them rather than to one of the many university departments of psychoanalysis in the UK. It raises the question of how the UCL department managed to secure this contract.

This bias was continued in the composition of the project Expert Reference Group and the Modality Working Group, both of which were chaired by Anthony Bateman. Bateman is a close colleague of Fonagy and the two have co-authored a treatment manual for a form of therapy (MBT) which they endeavour to promote within the NHS. Fonagy is Director of the Anna Freud Centre, which holds courses on MBT in conjunction with the UCL Sub-Department of Clinical Health Psychology. These courses are held for those working in the NHS and generate revenue for the institution concerned. There is thus a clear line of economic benefit here. It is perhaps no accident that the competences produced for psychodynamic/psychoanalytic therapy fit MBT remarkably well, but not psychoanalytic work.

It is important for the PLG to be aware here of some history. The BPC is a network of organisations centred around the British Psychoanalytical Society, also known as the Institute of Psychoanalysis - of which Fonagy, Bateman and Julian Lousada are members - an organisation which for many years claimed to be the only psychoanalytic training body in this country. They repeatedly published statements that only their own members were psychoanalysts, and even wrote to newspapers claiming that those who pursued other psychoanalytic trainings were deceiving the public. Over the years many other psychoanalytic organisations were established, attracting trainees who were not drawn to the Institute's practices, their theoretical orientations or the ethics of their selection procedures: gay trainees were not accepted until quite recently. As the absurdity of this position became clear, they moderated their claim to a monopoly, yet there is still a real tension between the Institute - and hence the BPC groups - and the other non-BPC psychoanalytic training organisations in the UK. This is a major political factor in the current regulatory landscape.

The composition of the Expert Reference Group and the Modality Working Group is biased quite radically in favour of BPC - Fonagy and Bateman's organisation - with nearly all members coming from there. The list for the Psychodynamic Modality Group established on 16/10/07 consisted off 11 people, all of whom come from the BPC. Another list sent by SfH to Fonagy in January 2008 received the reply that it "goes slightly too far in the direction of UKCP", yet this list of 16 people included 2 from UKCP compared with 11 from BPC. UKCP, moreover, had pointed out to SfH in Jan 08 that it represented the majority of psychoanalytic practitioners in the UK. Documents released under the Freedom of Information Act show how the lists for the work groups were made up almost exclusively of those from BPC and that, when other names of organisations or user groups that had actually been invited to participate were proposed or added to the lists by SfH, they mysteriously vanish. When further information on these disappearances was requested by The College of Psychoanalysts-UK under the Freedom of Information Act, SfH replied by sending hundreds of pages of totally irrelevant documents relating to the CBT groups and then claimed that they could not help further as they were only obliged by the Act to perform a certain number of hours work collating documents.

We also believe that some BPC groups may have failed to inform their members of developments in the consultation process, with a handful of those on the relevant committees making claims for their membership without proper consultation. It is remarkable how nearly everyone involved in the SfH working groups either comes from BPC or the Fonagy UCL Department. In the list of PLG members that HPC have published, Fonagy's institution is listed as Skills for Health, an extraordinary claim given that, as far as we know, he is not an employee of SfH and is in fact associated with the British Psychoanalytic Council, the same organisation as the person preceding him on the PLG list. If Fonagy's affiliation had been stated correctly, it would obviously have shown a bias in the PLG composition. HPC has thus not acted with transparency in this matter.

Fonagy, likewise, has been relied on in a wholly unprecedented way by SfH: in an email of 19.10.07, Linda Hardy of SfH writes re Fonagy "I sort of feel I don't want to ask him everything". The PLG should be aware that Fonagy is a highly controversial figure in the world of psychoanalysis. He has advocated genetic testing as a guide to focus psychotherapy intervention and brain scanning to 'test' the results of psychodynamic work. He has termed the traditional neuroses 'disease processes' or 'weaknesses in brain function', and even encouraged brain scanning of two year old infants to determine whether psychotherapy intervention is necessary (as reported in The Times 12/5/07). For many, probably most psychotherapists, these are extreme views. There are also other questions here: in an email to SfH he states (incorrectly) that The College is a "largely Lacanian organisation" and then follows this with : "French psychoanalyst - Lacan - intellectual superhero but clinical and ethical problem, ultimately dismissed from the rank of the international psychoanalytic movement". Yet the very same Fonagy can refer on the dustjacket of a recent analytic book to "the intellectual sparkle of Lacanian psychoanalytic scholarship" and "the highest quality Lacanian thinking, creating a firm bridge between two forms of psychoanalytic theorisation that have for too long been separated by inadequate understanding". 

In September 2007 the UCL department apparently sent out a letter inviting participation in the expert reference group for psychodynamic therapy, yet this letter was not received by any psychotherapy organisation that we aware of. It stated that the general framework would be that used for CBT, a fact which would have caused a great deal of protest in the profession had it been known. The methodology of the work is stated as "identifying manuals published in the UK, the US and elsewhere and building the framework from these sources". This would also have caused a great deal of protest in the field for the simple reason that there are no manuals of psychoanalysis, a fact which Fonagy himself points out in a minuted SfH meeting of 11/4/08. On 5/2/08, Roth and Pilling claim to have sourced "the psychoanalytic treatment manuals" for the criteria they have formulated, yet in the list supplied by them in May 2008 to accompany the NOS there are no psychoanalytic texts at all!

The result of the dominance of Fonagy and his colleagues in the consultation process has been the exclusion of other voices : professional groups and user groups have been excluded, despite initial inclusion in draft documents, and the Skills for Health team have even conspired to lie directly to an accredited therapist seeking representation in one of the work groups who had been invited to participate. Steven Richards, Chair of the British Society for Clinical Psychophysiology, contacted SfH on 18.10.07 requesting involvement in the cognitive and psychodynamic work groups. Linda Hardy of SfH writes to Rod Holland, who Fonagy had recommended to SfH to chair this group, on 25.10.07, that "We need not have him on the group if you are not happy - I'll rely on your superior knowledge of the therapies here!". This illustrates SfH's failure to do their work properly, leaving the process open to political manoeuvering. Holland writes that Richard's school of therapy "is at variance with most concepts of CBT", yet SfH do not assess this claim or even object to the exclusion of a diverse practice. Hardy then writes to Richards on 29.10.07, "I contacted the chair of the group with your information and he feels that at this stage, with numbers on the group nearing capacity we really need to give the remaining few places to NHS employed practitioners as they are really underrepresented on the groups". In fact, it is because, as she writes to Marc Lyall two hours earlier on the same day, "Rod does not want this guy on the group.However I'm not sure what to say back to him - it's difficult when we invite people to show an interest and then tell them they can't join a group.I could say we are now seeking more NHS employed practitioners as they are under represented on the groups? [sic]".

When a Freedom of Information Act disclosure made these emails available to Richards, and he took them up with SfH, new correspondence was brought forward - strangely not included in the initial disclosure - which it is quite possible and even likely that SfH actually fabricated (further details available on request). The College has also written to SfH regarding an item of correspondence which we believe was falsified in order to cover themselves about another issue.

SfH appear to have failed to conduct the appropriate research for themselves, relying almost exclusively on 'outsourcing' opinion about what is legitimate and what isn't: this means emailing one of a handful of 'experts' to ask if an academic or clinician that SfH had themselves invited to be part of the consultation process should in fact be 'invited'. These distortions to the consultation process have effectively ruled out a rational assessment of the feasibility and suitability of state regulation.

We very much hope that this has been of use to you in laying out some of the detail behind this difficult issue, and to assure you of our good faith in our effort to ensure that you all have full access to the information that is available. The College would be pleased to meet with you to discuss any of these issues further.

Yours sincerely,
Prof. Darian Leader
President, College of Psychoanalysts-UK