At the second meeting on the PLG (Professional Liaison Group) for Counselling & Psychotherapy, 28 and 29 January 2009, members were asked to consider the questions raised in the Call for Ideas (Oct 08) which were gathered together under the heading "Conscientious Objection". The arguments and concerns were condensed by administrator Michael Guthrie to a few lines, reproduced below.
Coincidentally, members of the PLG had also recently received a lobbying letter from the College of Psychoanalysts-uk, and a member of the public had placed copies of the Statement of Intent on the table from the Alliance for Counselling and Psychotherapy against State Regulation.
There were, then, a considerable number of objections, each laid out with substantial argument, presented to the PLG to consider. What follows is a small playlet, written from my notes made at the time (I was a silent observer at the back of the room), which presents the way these serious concerns were handled by the meeting:
First, the section from Michael Guthrie’s Summary of Responses to the Call for Ideas, Oct 08
3.2.2 (p37) relating to Conscientious objection.
Summary.
- The Register should be structured to provide for a list of 'conscientious objectors'. A list of 'non-licensed', 'non-certified' psychotherapists exists in the US State of Vermont.
More Information/points for discussion
- The PLG may wish to consider whether such an approach would be meaningful to either members of the public or the profession and achieve the public protection aims of statutory regulation. No known arrangement similar to that in Vermont exists in professional regulation in the UK
MICK: Is Principled Non Compliance a practical option in your opinion?
MICHAEL: I cannot foresee the government being able to accommodate it.
BRIAN: There is a possibility of several different registers springing up all simultaneously with HPC - have you thought of that?
MICHAEL: [nonplussed]
MARY: I’ve looked carefully at the arguments - that people choose willingly to go private and so on. But that’s the same with dentists, and they can do a lot of damage, or estate agents - they can rob you blind. If you are in a position where someone comes to you and you can do harm, then, well, I’m afraid I cannot support it.
ANNIE: Why are they asking the regulator to hold their names on the register if they don’t want to register and be regulated? You can’t have your cake and eat it too you know.
NICK: Are they the registered non-registered?
JONATHON: What is the purpose of regulation? Without statutory regulation people who are known to be harmful will continue to practice. People need to be prevented from practicing. Either it is the regulator or the law, and the law can’t be different for one person than another.
PETER: They could get taken off the Non Register
NICK: Or sent to Vermont
JULIAN: We must not ridicule them - they hold their position seriously, and hold it well.
JONATHON :Not ridicule, but put the facts. The evidence base is clear that there is harm. Best outcome of this process is the vast majority will continue to practice in the way they’ve done before, but bad practitioners will be removed. We have to come back again and again and again to the public protection issues. We are in a New World now. Professional led self-regulation is dead. The Health & Social Care Bill last year said there must be an equal number of lay people on the board as professionals.
PETER: I totally agree. These people - we should take a very firm view. Compared to other professions, psychotherapy is definitely potentially harmful. Five per cent of practitioners cause damage.
[voices off: says who - where's this published? what is the source the paper? what is the evidence? what grounds do you have for that? etc]
… The public is ill-served, the present situation is in-effective. We hope it will become more Evidence Based. A little bit more notice of what is known in general will lead to an improvement in client care. Registration is not new. The medical profession was against regulation. It is an urgent issue for public protection.
LINDA: We should not mock or ridicule these people. But, the public needs protection and therefore we need regulation. Professionals need protection too. I think it is a good move for the profession.
JULIAN: We are a victim of our own rhetoric. Public Protection - we are part of the public, the clinical community is part of the public. Care providers are vulnerable. The public is at risk from us, yes, but we are vulnerable to them too!
CARMEN: It is a philosophical position that these people are taking. It’s not about a ‘them’, there are several different groups. I would not choose the HPC if I had any choice.
JEFF: Other aspirant groups have had this problem.
DI (Chair): We have all been lobbied, lets be frank, but the letter is philosophical. They point to the confusion between State and Statutory Regulation, and raise the question of totalitarianism. [sigh] Look, I've lived in an eastern bloc country, oh, for many years, I know what totalitarianism is, and this is not that. It might look like it from the outside, but it doesn't feel like it inside the HPC. Also they talk of the medical model... No, no [shakes her head slowly from side to side] oh dear...
FIONA: We must take this seriously. They have a petition, and it had 1600 names on it at the beginning of the week, a lot of names on it that I respect. I’m not willingly part of this process. Perhaps I am willingly dragged into it, but only because I believe I decided I had to join in order to try to influence it.
VOICE: The HPC gives public protection. It protects the registrant. It helps with credibility. There is really nothing to do but pay the fee and gain status and credibility.
MARY: And upholding public confidence. It’s a matter of pride to have been recognised by the HPC, to get external validation.
DI: Oo, things are getting a little bit heated. Shall we take a short ten minute break and come back to finish it off?
....... [fade out… and back ]
DI: Right, now, we need to move on.
MICHAEL: Which protected titles do you want to have. We protect titles, rather than function, but we have to police mis-use of title, and we do that through the ‘intention to deceive’. If people don’t register, we won’t have public protection.
CARMEN: Registered counsellor, ok, but what about a registered life coach? I’m quite frightened by that. We need to look after, preserve, make clear, how to deal with the widespread use of the word.
MARY: If we think its right, we’ll do it, and ignore what goes on elsewhere.
CARMEN: If they are not doing it well enough, and they are using my professional title, well...!
MARY: [vehemently] We’ll get them on ‘if you go beyond your skills and competence’. [recovering herself] Prevention is the better protection of the public.
JULIAN: We’ve parked a difficult issue.
DI: But we can be seen to have done justice to the question.
Thursday, 22 October 2009
Wednesday, 21 October 2009
A note on centrism (aka centralisation, and utopian holistic planning)
As you know, my interest in the 'new style auditing' (boosted here in the UK in the 1980s, with the Thatcher/Heseltine innovations in 'new public management') is the way it feeds into a more and more centralised system, giving more and more power to the utopian holistic planner and taking it away from the local folks who not only know what's going on in detail, but who are better placed to do something about a problem in a properly measured way.
So, yesterday's news story about the way that prison inspections led local prison managers to do the unthinkable (move prisoners around in order to second guess the inspectors, and secure a good result in the audit) is shocking but comes as no surprise. The excess of power in the centralist hand produces a contortion at the local level.
What is perhaps more disappointing is the way that those holding the centralised power absolve themselves of the responsibility. Dame Anne Owers was on the BBC saying that the moved would have had no effect on the inspection. Centralist utopian planners are as easily hoodwinked by the system they enjoy, as those who are subjected to it.
To parody it: the centralist thinks that the resulting perversion of duty amongst the local managers is a confirmation of their own prejudice - these guys need tough inspections to make sure they don't step out of line. A rather stupid but effective vicious circle is set up, exactly like the one that informs the HPC: 'those local practitioners need to be watched, in order to protect the public' is soon followed by, 'ooh, look what they are doing, I told you they had to be watched'.
As long as the centralist refuses to subject him or herself to even a little bit of self reflection, the system can carry on ad infinitum, and produce more and more horrendous results. A self fulfilling prophecy, and the destruction of a once pretty decent country.
So, yesterday's news story about the way that prison inspections led local prison managers to do the unthinkable (move prisoners around in order to second guess the inspectors, and secure a good result in the audit) is shocking but comes as no surprise. The excess of power in the centralist hand produces a contortion at the local level.
What is perhaps more disappointing is the way that those holding the centralised power absolve themselves of the responsibility. Dame Anne Owers was on the BBC saying that the moved would have had no effect on the inspection. Centralist utopian planners are as easily hoodwinked by the system they enjoy, as those who are subjected to it.
To parody it: the centralist thinks that the resulting perversion of duty amongst the local managers is a confirmation of their own prejudice - these guys need tough inspections to make sure they don't step out of line. A rather stupid but effective vicious circle is set up, exactly like the one that informs the HPC: 'those local practitioners need to be watched, in order to protect the public' is soon followed by, 'ooh, look what they are doing, I told you they had to be watched'.
As long as the centralist refuses to subject him or herself to even a little bit of self reflection, the system can carry on ad infinitum, and produce more and more horrendous results. A self fulfilling prophecy, and the destruction of a once pretty decent country.
Monday, 19 October 2009
Psychotherapy Organisations Poised to Challenge Health Professions Council in the Courts
This press release was sent out from psychoanalytic organisations yesterday from The College of Psychoanalysts-UK, Association for Group and Individual Psychotherapy, Association of Independent Psychotherapists, Centre for Freudian Analysis and Research, The Guild of Psychotherapists, The Philadelphia Association
The Government’s plans to regulate counselling and psychotherapy under the Health Professions Council faces a further setback this week with the threat of legal challenge by six leading psychotherapy organisations (Association for Group and Individual Psychotherapy, Association of Independent Psychotherapists, Centre for Freudian Analysis and Research, The College of Psychoanalysts-UK, The Guild of Psychotherapists, The Philadelphia Association) and the publication of a report from Kings College London and Royal Holloway, University of London, which questions the suitability of HPC as regulator. Only a week ago the publication of 'The Maresfield Report on the Regulation of Psychotherapy in the UK' showed serious problems with the Government project and with the HPC's attempts to impose itself as regulator.
The Kings College and Royal Holloway study, 'Statutory Regulation and the Future of Professional Practice in Psychotherapy and Counselling', http://www.kcl.ac.uk/content/1/c6/06/35/90/StatutoryRegulation1.pdf, funded by the General Medical Council and the Economic and Social Research Council, warns of over-regulation failing to provide the best model of patient care. A focus on high-profile 'media spectacles' creates a regulatory climate 'obsessed with blame', leading to regulatory practices which fail both clinicians and patients. The HPC is criticised for its failure to address political forces at work in its consultation process, with certain stakeholders battling for 'position and influence'. It concludes that HPC-style regulation may well be less effective at public protection than a profession-based mandatory regulation, with an emphasis on mediation and interpersonal processes such as supervision. Current regulatory proposals fail to recognise the complexity and subtlety of the therapist-patient relationship.
These conclusions echo those of The Maresfield Report, http://www.psychoanalysis-cpuk.org/PDF/MaresfieldReport.pdf, which also highlights HPC's expensive and adversarial system of complaints, with a growing backlog of unheard complaints and a exceptionally high rate of dismissing complaints from members of the public as 'no case to answer' (more than 70% compared to 10% in therapy organisations' existing procedures). Complainants may be required under HPC to disclose medical history and hearings take place in front of a public gallery, undermining basic principles of confidentiality. The Report also finds that although there have been several European projects to introduce statutory registration of therapists, Britain is the only European country to propose regulation for the actual content of therapy sessions.
Many of the organisations which published The Maresfield Report have also threatened a legal challenge to HPC this week via the well-known London law firm Bindmans. HPC were given the brief to assess the 'regulatory needs' of the field and to explore its own suitability as a regulator, yet proceeded as if there was simply no question that the field required regulation and that they, in fact, would be the regulator. There is concern that one motivation here may be financial: HPC budgets are growing each year, and the registration fees of counsellors and therapists would be the single largest source of income the HPC would receive from one profession.
HPC's failure to make a proper evidence-based case for regulation, ask itself critical questions as required by the statutory regime and conduct proper consultation means that its actions are open to challenge in a judicial review claim. The psychotherapy organisations involved will decide whether to issue one in the next few weeks, depending on the HPC's response to Bindmans' submission. The new reports and the legal challenge will be a major embarrassment to HPC at a time when it has begun actively lobbying both Conservative and Lib-Dem policy makers, anticipating a change of government before the proposed legislation can be introduced. It will be particularly embarrassing to HPC’s CEO Marc Seale, who is trying to push through this controversial regulation while many politicians are becoming critical of the once received wisdom of the project.
Sunday, 18 October 2009
My response to the HPC Consultation on the regulation of Counselling & Psychotherapy
Submission to the HPC Consultation on the State Regulation of Counselling & Psychotherapy. Oct 2009.
Janet Low, MA PhD. Clinical Associate (CFAR), MBACP. Visiting Honorary Fellow at Manchester Metropolitan University.
Author: HPCwatchdog.blogspot.com
When Professor Richard Gombrich spoke at the Rally of the Impossible Professions (September 2008) he quoted from Karl Popper’s 1940s essay, Piecemeal Social Engineering. Since then, I have found myself dipping into this old essay and finding much of interest and use for understanding the predicament we face today. I have decided to kick off this submission with a quote from that essay, in which he considers the virtues of the piecemeal social engineer as opposed to the recklessness of the idealistic holistic planner. I hope that his words might find an echo in the soul of the person delegated to read my submission, and that some of the Popper’s wisdom and experience might help to redirect us back onto a more practical path.
“while the piecemeal engineer can attack his problem with an open mind as to the scope of the reform, the holist cannot do this; for he has decided beforehand that a complete reconstruction is possible and necessary. This fact has far-reaching consequences. It prejudices the Utopianist against certain sociological hypotheses mentioned which state limits to institutional control… For example expressing uncertainty due to the personal element, the ‘human factor’. By a rejection a priori of such hypothesis, the Utopian approach violates the principles of scientific method. On the other hand, problems connected with the uncertainty of the human factors must force the Utopianist, whether he likes it or not, to try to control the human factor by institutional means, and to extend his programme so as to embrace not only the transformation of society, according to plan, but also the transformation of man. ‘The political problem, therefore, is to organise human impulses in such a way that they will direct their energy to the right strategic points, and steer the total process of development in the desired direction."
It seems to escape the well-meaning Utopianist that this programme implies an admission of failure, even before he launches it. For it substitutes for his demand that we build a new society, fit for men and women to live in, the demand that we ‘mould’ these men and women to fit into his new society. For those who do not like living in it only admit thereby that they are not yet fit to live in it; that their ‘human impulses’ need further ‘organising’. But without the possibility of tests, any claim that a ‘scientific’ method is being employed evaporates. The holistic approach is incompatible with a truly scientific attitude.” p311 of A Pocket Popper, edited by David Miller, andpublished by Fontana in 1983
Responses to the consultation questions:
1. Do you agree that the Register should be structured to differentiate between psychotherapists and counsellors? If not, why not?
No. The HPC has not grasped the difference between counselling and psychotherapy and it would be irresponsible to blunder in and impose the distinction without an intelligent and realistic explanation as to why. There are many differences, not only between counselling and psychotherapy but amongst those that would go under each name. Without an appreciation of the reality of the work, the effect of HPC regulation will almost certainly distort and obfuscate the situation which will in turn actively not protect the public. It is possible that the men and women charged with putting the system to work in the real world may succeed in overcoming this tendency to distort, but this would be a strange thing to expect people to do, and unrealistic to expect them to do it for long.
2. Do you agree that the Register should not differentiate between different modalities? If not, why not?
Q2 Yes. The complexity of reality will be damaged and should not be contemplated by the HPC, who have no obligation to understand the reality or experience of the field.
3. Do you think that the Register should differentiate between practitioners qualified to work with children and young people and those qualified to work with adults? If yes, why? If not, why not?
No. To attempt this is to fundamentally misunderstand the nature of regulation as practiced by the HPC. The request to split the register in this way will simply result in a false segmentation in the market for training.
4. Do you agree that ‘psychotherapist’ should become a protected title? If not, why not?
No, the prospect of state, statutory, and HPC regulation on this field has already distorted it to the point where the words psychotherapy and counselling have been and continue to be detached from any meaningful subject. A mixture of entrepreneurial politics, and a failure to really address the meanings and uses of the titles has led some members of the field to fudge the labels and use them as marketing tools with an eye to possible pay differentials in a post regulation world. This is a good example of the distortion that can happen when statutory regulation looms large on the horizon. Unless and until sensible, level headed, cool and calm thinking is allowed to happen around this question, the title should not be protected. The confusion cannot foster an enlightened public, and will leave members quite vulnerable to misunderstanding. Daniel P Hogan’s work (1978) concludes that unless there is a well defined body of knowledge to define a practise, statutory regulation should be avoided.
5. Do you agree that ‘counsellor’ should become a protected title? If not, why not?
No. The generality and normality of the word is the value of the word. To bring it within the jurisdiction of the HPC or statutory power will set up all kinds of unexpected difficulties in unexpected places. It has already been noted by the HPC that changes in law will be necessary to make it possible to protect the title. This is a good example of the way labyrinths of bureaucratic structures become necessary when the centralised planner does not recognise the truth of reality. In extreme cases this can lead to the application of force, as the powerful structures try to force reality to fit, rather than admit defeat. A point made succinctly by Popper, in the quote that preceding this response.
6. Do you agree with the approach to dual registration outlined in the report? If not, why not?
No. Dual registration threatens to get out of hand (as the recent Council discussion on Sonography testifies). The power of good regulation emanates from the fact that the practice in question can be clearly defined and known. The idea of a profession is that of something a person dedicates their life to. Whereas this is true for some who engage in counselling and psychotherapy, it is also true that many do so alongside other occupations (and don’t forget, many people work voluntarily). The life experience, and the open mindedness of this is itself a valuable resource, which prevents counselling and psychotherapy from mistaking themselves for discrete and immutable objects. There is little indication that the HPC process will be able to distinguish well enough between the various practices to know whether or not someone is doing one thing or another. Arts Therapy and Counselling Psychology are good examples of this. They are currently used to justify the inclusion of psychotherapy and counselling in the HPC register, yet this argument holds within it a logical contradiction. There may also be difficulties arising from the practice of body psychotherapy and some other parts of the register. Border disputes might be another unintended consequence of the process. The beauty of the wide field of counselling and psychotherapy is that it draws from such a diversity of experience in society. The fact that almost anyone can in principle speak and listen is a reason for not regulating it via the HPC. The practice is distinct in this way, and poses special problems for HPC regulation. The true nature and extent of trouble caused by this state of affairs is not known in any useful way. For those who are particularly animated by this, may I recommend some level headed and objective research be done into the literature before a careful and sensitive inquiry be opened up in the actual time and place that presents the most concern.
NB. On several occasions during the course of the PLG I heard members of the HPC advise their new colleagues to ‘forget what happens in practice at the moment, and invent a totally new profession’ (Prof Annie Turner was the most consistent proponent of this view). This advice is wrong and puts in question the whole direction of HPC regulation for the field. A similar line was also articulated by Jonathan Bracken at the HPC Council meeting when the groups within the Psychologists were arguing for PhD entry level criteria. Bracken reminded Council members that they had decided upon the correct standards for practice and should not give in to ‘what currently happens in reality’. This is highly questionable, and throws serious doubt on the ability of the HPC to regulate any practitioners. It appears to belie an underlying cynicism which would predict perverse consequences. I shall return to this in due course.
7. How appropriate are the draft criteria for voluntary register transfers?
Inappropriate – it is the way that an organisation puts them into practise that is the most valuable criteria, and this can vary over time. The system in use by the HPC does not afford the time or skill to forge the kind of relations that are necessary to make a judgment on the quality of the various registers.
8. Do you have any comments on the outline process for identifying which registers should transfer?
The very large number of registers being considered by the HPC is cause for much concern. HPC cannot make a relationship with each register, and is therefore in a very difficult position to trust and judge. If the HPC must rely on answers from a questionnaire such as this, we should all be very worried about the quality of data entering the system.
9. What evidence might an organisation holding a voluntary register provide in order to support their submission?
Unfortunately, over the last 10 years or so, the word ‘evidence’ has been distorted to such a degree that in many contexts it has become almost meaningless (there are of course exceptions to this, but in general, unless the discursive space is carefully protected, the word tends to becomes a political weapon rather than a valuable way of transmitting information). This is, to put it mildly, a pity. However, it does furnish us with another good opportunity to observe the way that political power can twist and pervert the ordinary course of things (the phrase Evidence Based Medicine was invented as a political slogan by Archibold Cochrane back in the 70’s, it only became popular after the new Labour Government promoted it as a policy for ‘modernising’ the NHS, and for solving the BSE/CJD problem.).
In the ‘old days’, before the capture of ‘evidence’ by politics, it would be possible to think that your question included an idea of a real human being looking for a variety of information from a number of sources and weighing up reality in order to make a judgment. Here we can also draw on the parallel field of law, where evidence takes part in a complex system of investigation, prosecution, defense, cross examination, review and assessment by jury, and, finally judgment. In other words, evidence must always be weighed up in relation to the social arrangements that are made around it. In answering this question, then, I must make an assumption about the way that the ‘evidence’ will be used – ie, what is the context in which information will be turned into evidence, and what is the quality of the personnel that will interpret the information and form judgments. I think there is rather a high chance that the computerized context of the HPC will favour an automatic reading of evidence which will reduce information to little more than ticks in boxes. In other words, I strongly recommend you reflect seriously on what you are asking for here.
10. Do you agree that the grand-parenting period for psychotherapists and counsellors should be set at two years in length?
If the HPC cannot avoid becoming the regulator of this field, the grand-parenting period should surely approach infinity to allow conscientious and serious practitioners to remain safe from the threat of the distorting effects of its power until a proper solution is found. Even those who are actively seeking HPC regulation know that there are very many problems indeed to be sorted out before regulation will be functioning effectively. It is sensible to leave a very large margin in order to reduce what is likely to be inadvertent damage, and thus to increase the possibility of protecting the public. In doing this, the HPC would also gain a realistic view of the opinions of those in practise as to the quality of the regulation it proposes. At present the HPC cannot hope to gauge a measure of success as the regulation already comes with the force of law. At this year’s Annual Meeting I heard Mr Seale laugh cheerfully and say that many professionals are embarrassingly positive about being regulated by the HPC – this ‘evidence’ could be interpreted in a number of ways, not all of which would be flattering to the HPC. The presence of statutory power can easily distort the context in which information is produced. To be embarrassingly cheerful could as easily parody a highly distorted relation not unlike that between a cheerful slave and its cruel or stupid master.
11. Do you think that the standards support the recommendation to differentiate between psychotherapists and counsellors?
No.
12. Do you think the standards are set at the threshold level for safe and effective practice? If not, why not?
No. The vast majority of the standards are completely irrelevant (the generic standards), and are almost certainly going to set up a distortion in this particular field of work. This will actively not protect the public – ie, will make the public less safe. Secondly, those standards which have been written specifically for counselling and psychotherapy were cobbled together from a variety of other aborted attempts, and are only here presented as a finished item to fit in with an arbitrary time table. There has been no testing out in pratise of these standards, and no attempt has been made to think through the possible negative consequences in the various practices and modes of training that exist up and down the country.
There is something crucial to say at this point. Those who have been engaged in this process have revealed a lot of different motives and justifications for their participation. For one, it is to prevent certain specific others from practicing (a personal motive), for another it is to make sure that they have some say in whatever happens, the better to make a buffer to protect their members from the worst effects of the new system. A third says openly that these standards will have no effect whatsoever on practice, so for him they are a façade to be erected behind which ‘business can carry on as usual’. Several of those PLG members drawn from the counselling and psychotherapy field have also openly said that they would not chose the HPC as the regulator, but were participating in a process they didn’t agree with, because they had no choice. One even said she was dragged to the table, though she conceded she had been willing to be dragged but only in order to influence things from inside the system.
From those PLG members who were there from other parts of the HPC, two thought they should persuade the counsellors and psychotherapists to actually invent a brand new profession so that the HPC would be able to regulate it! Another thought that the variety and diversity in the field of counselling and psychotherapy was a ‘mess’ and intended to use HPC mechanisms ‘to tidy it up’. A third, or rather, fourth, was preoccupied with bringing professionals into fitness to practise procedures in order that the HPC triumph over it’s rival the GMC in an imaginary competition of ‘show trials’. Yet another member of the PLG held up proceedings for almost half an hour to consider how to prevent people from practising who had ‘a boy scouts badge in counselling’ thus insulting the institute of boy scouts!
The list of examples goes on. The process was not set up in such a way to ‘bring out the best’ from its constituents. The chairing of the meeting was insipid, un-inspiring, not rigorous, and became famous for a set of phrases: ‘we’ll park that for the moment’, ‘put that in the pot’, ‘we’ll come back to it later’. Each of those phrases might be put to good use in such a context, but here they signified stalling, avoiding, postponing and almost completely succeeded in preventing any serious sensible discussion from taking place at all.
This, however, was no ordinary incompetence and even seems possible to signify an underlying cynicism. From the beginning of the process the chair and other practitioner members of the HPC Council emphasized that the meeting was not one in which decisions should be made, but that it should be thought of as a place to ‘keep it vague, and make a sketch’. This somewhat extraordinary aim was made especially clear when the Chair brought the meeting to a ‘false close’ at the end of a very short first meeting, and again in the second meeting after a short and largely sneering discussion on the question of ‘conscientious objections’. She said: ‘we can be seen to have done justice to the question’ presumably because a small amount of time could be recorded in the minutes. Being seen to do something, here, sounds remarkably like ‘pretending to do something’ and in fact this latter would be a better description in this case.
This is a strong claim, and one not to be made lightly. However, the constant prevarication also meant that at the 11th hour the PLG had to resort to the extraordinary measure of asking Peter Fonagy and Mick Cooper to ‘get together over lunch’ to come up with a differential to settle the tricky question of distinguishing counselling from psychotherapy. Kathi Murphy objected strongly but was pretty much ignored as Diane Waller eagerly took up the suggestion (made by Julian Lousada). This meant that, for those of us watching from the back of the room, the complexities of the matter were being taken out of the hands of those who had knowledge of the realities of this distinction and were given to two individuals. That is, Mick Cooper was there as Professor of Counselling, and to Peter Fonagy whose place on the PLG has been obscured and left ambiguous.
It is important now to say something of this. Peter Fonagy has very many titles, but probably it is an important aspect of many of these that he is, or at least has been, a training analyst in the British Psycho-Analytical Society, now known as the BPC. Julian Lousada is openly attributed as a member of the BPC and this is further confirmed when his absence draws forth a substitute, the BPC CEO Malcolm Allen. This leaves Peter Fonagy as the ‘representative’ of Skills for Health. The Chair of the PLG therefore took advice from the BPC (Julian Lousada) to allow another member of the BPC to define psychotherapy, and overruled objections from the UKCP (UKCP rep Kathi Murphy later said she would not dispute the definition at the meeting because she knew that this would go out to public consultation). The history of psychotherapy in the UK makes this move an extremely controversial one, and exposes Diane Waller as, at best, extremely naïve.
A second reading of the same scenario is also left wide open – that the chair of the PLG delegated the defining of psychotherapy to Skills for Health. This is the official line, given the official designation of Fonagy to that organisation in all the HPC paperwork. This is an extraordinary thing to do in any case, but is made worse but the frequent plaintive cries of the HPC (Waller and Guthrie for example at the Manchester Stakeholder Event) that the SfH has no influence on the HPC.
It is not unreasonable, of course, to invite someone from one place (is Fonagy an employee of SfH?) and to make use of his wide-ranging skills while he is there, but in the interests of transparency, an effort must be made to explain the logic, reasons, rationalities of such a decision. What is clear in all this is that complex and difficult issues were rushed, squashed, collapsed and condensed, and their consequences were not given much consideration.
13. Are the draft standards applicable across modalities and applicable to work with different client groups?
No.
14. Do you think there are any standards which should be added, amended or removed? To begin, all of the generic standards should be removed. To follow, all of the specific standards are contentious, disputable and highly partial. None of them has been tested out in practice, or at least no attention has been given to any knowledge or experience of this.
15. Do you agree that the level of English language proficiency should be set at level 7.0 of the International English Language Testing System (IELTS) with no element below 6.5 or equivalent? (Standard 1b.3)
No.
16. Do you agree that the threshold educational level for entry to the Register for counsellors should be set at level 5 on the National Qualifications Framework? If not, why not?
No. The NQF is not appropriate to this field. It is the mix of people that is important, rather than creating a homogenized ‘army’ of workers. The revolution in education in the UK at present is a further problem here. This was discussed many times at the PLG without coming to any useful conclusion. Again we have the dispiriting situation where people working in the real world are having to stretch the truth extremely thin in order to make the centralist planners dream appear to come true.
17. Do you agree that the threshold educational level for entry to the Register for psychotherapists should be set at level 7 on the National Qualifications Framework? If not, why not?
No. See above.
18. Do you have any comments about the potential impact of the PLG’s recommendations and the potential impact of statutory regulation?
There is good reason to believe that HPC regulation of this field will produce - has already produced - perverse unintended consequences which will not only destroy important knowledge and experience within the field, create divisions and conflicts, and damage the experience of those who wish to consult someone in order to overcome their difficulties, but will create an illusion of public protection which indeed then constitutes a clear and imminent danger to the public.
19. Do you have any comments about the potential implications of this work on the future regulation of other groups delivering psychological therapies?
There is good reason to think there will be many negative implications of HPC regulation within the field as well as beyond it. There are good reasons to be very cautious indeed when approaching the regulation of talking and listening.
20. Do you have any further comments?.
The HPC stands to gain at least £4m a year in fees by regulating this field and is hardly disinterested. The HPC is not answerable to its constituents: it is undemocratic. The HPC has repeatedly ignored difficult questions which threaten to contradict its belief system. The HPC has allowed itself to be used as an agent of aggression against those who question it (eg by circulating the letter of Jonathan Coe after the Manchester Stakeholder Meeting in March 09, and not then circulating the responses to that letter). The HPC has shown no evidence that it engages in serious self reflection, but conducts itself on the belief that it alone knows what is best for the good of society. I recommend a rereading of Karl Popper’s interesting and pertinent essay: piecemeal social engineering. Those more up to date and are already able to take on ideas from further a-field, might wish to turn directly to the work of Michel Foucault.
Post Script
Having closely observed the proceedings of the HPC over the course of the last year, I have very little reason to believe that my work here will be given proper consideration. Since the Call for Ideas (Oct 2008) I have been repeatedly dismayed at the way the HPC and its agents have waived aside ideas and arguments that don’t coincide with their own. It is true that I have been given the opportunity to sit silently at the back of the room and watch all the proceedings, thank you for that, but I have seen much to make me doubt the wisdom of placing my trust in the organisation.
My investigations into the history and workings of this organisation have shown how the flawed logic of the HPO2001 coupled with the lack of proper debate caused by a government’s reliance on secondary legislation has produced a thoughtless apparatus in which even minor amounts of self interest and blind prejudice are easily magnified and go on, inevitably, to cause harm.
I am very concerned by the cavalier use of the political slogan ‘to protect the public’ which without due consideration amounts to little more than scaremongering and goes on to produce cynicism.
During the course of my observations I have seen a Council member punch the air in joy to hear the ‘good news’ that registrants will be subject to higher costs if they appeal decisions of the HPC. I have heard a HPC Solicitor maliciously interpret a practitioner, and by implication, all those who have worked along side him, as long time liars who have got away with sloppy practise for twenty or more years (FTP of Paul Manktelow, Registration Number: PA08359, Allegation Number: FTP01149). I have myself been subject to ridicule in front of the Annual Meeting when the CEO Marc Seale laughed at the idea that my writing on the HPC might be useful or interesting to the organisation.
None of this can be dismissed as one off chance events when seen in the context of the advertising campaign used to launch the organisation a few years ago: the picture of ‘stupid white people’ dressed up in false noses, joke moustaches and villainous eyebrows revealed the disrespectful attitude that makes up a fundamental part of this organisations culture. Incidentally, I was pleased to see the relics of this removed from the walls of HPC HQ in the summer (where they had been displayed ‘proudly’ as art works, framed and displayed on a busy corridor), but when I asked the HPC for copies of the art work from that campaign, I was stonewalled by the administrators.
I have traced the thread of this idea (‘that behind the mask lies a charlartan’) to Ian Kennedy’s 1980 Reith Lectures. The book produced as a result appeared a year later as The Unmasking of Medicine, and the cover carried the picture of a medical man who was indeed wearing a mask. The simplistic idea of Kennedy was that the mask worn by the medic was not so much done for the good of the work and the safety of all those involved, but to disguise the truly villainous nature of the man behind it. Although Kennedy said this was not his thesis, it is not difficult to read it on every page of the book. We all know that Kennedy went on to be invited by Lord Levy (on the strength of this Reith lecture work), to chair the Bristol Royal Infirmary Inquiry whose conclusions led directly to the creation of the HPC.
This is not to say that an ‘evil conniving’ man is responsible for this mess, but that a man’s prejudice has entered unchecked and has left an indelible mark. I have already mentioned the lack of proper debate surrounding the invention of the HPC (I refer to the process that allows secondary legislation to be passed that constitutes the structure of this organisation). The continual lack of proper space to think and talk through the issues is leading us towards a disaster. This is why I have chosen to bring Karl Popper into the picture.
Such a centralisation of power cannot but make fools of all of us. Anyone who gallantly enters the process and tries to make it work better, almost qualifies as a modern Sisyphus. There is, however, at least one important difference. Though Sisyphus was destined to watch his work constantly be undone, those engaged in the HPC have no such friendly enemy! The work they do is mangled, yes, but that then goes forward to become law. It then could easily then go on to be used to distort and even destroy the work of all those who are then obliged to sign up to it. Professor Micheal Power has been documenting an aspect of this process (dubbed Audit Culture) since 1994.
One important and possible good thing to come out of all of this is that those of us actively thinking about all this may learn first hand just how easy it is to turn a good thing bad. The mundane mechanisms and bland rhetoric that supports the process of HPC regulation of counselling and psychotherapy can easily pervert the good intentions or ordinary people and end up manufacturing foul deeds.
I’ll end this response by recounting something I witnessed at the final PLG meeting. One well educated and experienced professional was forced to agree to something that went against his wisdom, experience, and intellect. He said ‘ok I’ll accept it, but I may give up the will to live” (Julian Lousada on the PLG for C&P).
It does not augur well.
Wednesday, 14 October 2009
The Maresfield Report
The College of Psychoanalyts UK publish damning report of state endorsed regulatory processes: Here is the press release accompanying the Maresfield report, issued on October 7 2009
The Maresfield Report on the Regulation of Psychotherapy in the UK
"A new report [published 09 Oct] delivers a devastating critique of the Government’s flagship Health Professions Council. HPC are vaunted as the most efficient and robust route to protection of the public in the health sector, yet the report finds persistent failings in public protection, excessive and wasteful expenditure, and evidence of a policy of privileging employer complaints over complaints from members of the public.
The Maresfield Report, which focuses on the proposed HPC regulation of counselling and psychotherapy, finds that:
* Since 2006, around 30% of complaints made to HPC each year have not been processed, creating a growing backlog and placing undue stress on all parties involved.
* Although its complaints expenditure is the largest part of HPC’s budget, with £4.66m spent in 2008-9, only 17 complaints from the public heard by HPC were deemed to have a case to answer.
* Of all complaints to the HPC from the public, more than 70% are deemed ‘no case to answer’ by HPC, compared with only 10% deemed ‘no case to answer’ by the UK’s largest psychotherapy umbrella organisation UKCP.
* Employer complaints about employees constitute the largest part of HPC complaints hearings, yet these are financed by registrants of the individual health professions that HPC regulates. Registrants are thus effectively financing employment tribunals that ought to be funded by NHS Trusts and other employers.
* In 2008-9, more than 80% of complaints from employers were deemed ‘case to answer’, compared with only 22% from members of the public.
* All HPC hearings take place in front of a public gallery, depriving complainants of the confidentiality that the details of psychotherapy cases may require. The formal and adversarial parameters of HPC hearings will discourage potential complaints.
* HPC does not offer any mediation or informal processes of complaint resolution, in contrast to the psychotherapy organisations which resolve more than 60% of cases via mediation.
* Most forms of psychotherapy do not fit the criteria of health professions set out by HPC and cannot be made to fit them without changing the very definition of psychotherapy itself.
* Although there have been several projects to ensure that therapists are registered and subject to complaints procedures, Britain is the only European country to propose regulation for the actual content of therapy sessions.
The report will be a major embarrassment to HPC at a time when it has begun actively lobbying both Conservative and Lib-Dem policy makers, anticipating a change of government before the proposed legislation can be introduced. It will be particularly embarrassing to HPC’s CEO Marc Seale, who is trying to push through this controversial regulation while many politicians are becoming critical of the once received wisdom of the project.
You can read the Maresfield Report in full on www.psychoanalysis-cpuk.org"
The Maresfield Report on the Regulation of Psychotherapy in the UK
"A new report [published 09 Oct] delivers a devastating critique of the Government’s flagship Health Professions Council. HPC are vaunted as the most efficient and robust route to protection of the public in the health sector, yet the report finds persistent failings in public protection, excessive and wasteful expenditure, and evidence of a policy of privileging employer complaints over complaints from members of the public.
The Maresfield Report, which focuses on the proposed HPC regulation of counselling and psychotherapy, finds that:
* Since 2006, around 30% of complaints made to HPC each year have not been processed, creating a growing backlog and placing undue stress on all parties involved.
* Although its complaints expenditure is the largest part of HPC’s budget, with £4.66m spent in 2008-9, only 17 complaints from the public heard by HPC were deemed to have a case to answer.
* Of all complaints to the HPC from the public, more than 70% are deemed ‘no case to answer’ by HPC, compared with only 10% deemed ‘no case to answer’ by the UK’s largest psychotherapy umbrella organisation UKCP.
* Employer complaints about employees constitute the largest part of HPC complaints hearings, yet these are financed by registrants of the individual health professions that HPC regulates. Registrants are thus effectively financing employment tribunals that ought to be funded by NHS Trusts and other employers.
* In 2008-9, more than 80% of complaints from employers were deemed ‘case to answer’, compared with only 22% from members of the public.
* All HPC hearings take place in front of a public gallery, depriving complainants of the confidentiality that the details of psychotherapy cases may require. The formal and adversarial parameters of HPC hearings will discourage potential complaints.
* HPC does not offer any mediation or informal processes of complaint resolution, in contrast to the psychotherapy organisations which resolve more than 60% of cases via mediation.
* Most forms of psychotherapy do not fit the criteria of health professions set out by HPC and cannot be made to fit them without changing the very definition of psychotherapy itself.
* Although there have been several projects to ensure that therapists are registered and subject to complaints procedures, Britain is the only European country to propose regulation for the actual content of therapy sessions.
The report will be a major embarrassment to HPC at a time when it has begun actively lobbying both Conservative and Lib-Dem policy makers, anticipating a change of government before the proposed legislation can be introduced. It will be particularly embarrassing to HPC’s CEO Marc Seale, who is trying to push through this controversial regulation while many politicians are becoming critical of the once received wisdom of the project.
You can read the Maresfield Report in full on www.psychoanalysis-cpuk.org"
Tuesday, 13 October 2009
duplicity, politics and the destruction of knowledge & ethics
Overheard on the grapevine.
"there has not been one defender of the principle of State Regulation, who does not smile sheepishly and admit that those within the field who have sought regulation have done so for reasons of power, prestige and presumed financial gain; client protection is a ruse to legitimise their position."
"Some come up with anecdotes of so and so practicing down the road, and calling themselves a Psy/Counsellor and that with State Regulation, they can be made to stop.
"Whatever happened to going and speaking to someone whose practice you find so objectionable...? Whatever happened to taking a stand in one's community, and to risk being sued, if necessary... Even writing a letter to the local papers, speaking about the practice, if not the person, and warning people not to fall for scams (if scams they be)"
"This SR route favours a world of scoundrels and cheap cowards"
"there has not been one defender of the principle of State Regulation, who does not smile sheepishly and admit that those within the field who have sought regulation have done so for reasons of power, prestige and presumed financial gain; client protection is a ruse to legitimise their position."
"Some come up with anecdotes of so and so practicing down the road, and calling themselves a Psy/Counsellor and that with State Regulation, they can be made to stop.
"Whatever happened to going and speaking to someone whose practice you find so objectionable...? Whatever happened to taking a stand in one's community, and to risk being sued, if necessary... Even writing a letter to the local papers, speaking about the practice, if not the person, and warning people not to fall for scams (if scams they be)"
"This SR route favours a world of scoundrels and cheap cowards"
Monday, 12 October 2009
The consultation nears its deadline, much begins to happen
This just received via email from a colleague: This month’s Therapy Today contains the news that BACP is rejecting the HPC proposals on the grounds of amongst other things “the implicit medical model of the HPC’s generic and proposed psychotherapy SOP’s”, “the integrity of the process; there appears to be an underlying assumption of difference and hierarchy in the HPC and PLG”, “lack of evidence” in a number of areas, “HPC’s anomalous position with regard to setting academic threshold levels”, “lack of any consideration of the impact on the delivery of services”, and my favourite, creating: “a division in the therapeutic field that does not exist in the workplace. BACP believes this is in the interests of power and status rather than the public good”. Ouch. They also openly question the PLG chair’s capability to be unbiased given that she is already an HPC registered art therapist (see page 56).
I read the message just as I was leaving the house to cycle up to Kennington with a little package from the Alliance for Counselling and Psychotherapy against State regulation. I had been designated Hermes for the mission: to get the new book (Compliance? Ambivalence? Rejection?) into the consultation process before Friday’s deadline. The TT news put the wind in my wheels.
As I arrived at HPC HQ, I saw a DHL biker fiddling with his panniers on the pavement, and I wondered if he had just delivered the amazing Maresfield Report.
The young woman on the desk actually opened the door before I reached the top of the stairs, and (this really did surprise me) gave me a welcoming smile. (I have to admit that over the months she and I have rarely hit it off.)
I said that I had a gift for the Policy and Standards department, and could she call someone down to receive it from me.
She jumped to her feet and ran to the inner door, and yelled "Grace! Can you come back! There's another one!"
Grace duly returned, and took me into the little cubby-hole, recessed in reception, and I offered her my hand.
She had to remove the little blue rubber finger-stall that was stuck on the end of her finger, before greeting me in the accustomed way.
I told her I had a gift from my tribe to hers, and asked her if she was able to receive it with the dignity it deserved.
Just for a moment she dissolved into giggles before rallying to say she would try.
The letter enclosed in the envelope, and wrapped around the book said:
Enclosed please find our book containing essays and responses to your consultation request. Many of these submissions have also been sent individually. We hope that you recognise that this work represents a sustained and serious effort by a few who have drawn on the support of many un-named others. Those who signed the book represent many of those others.
It is a symbolic act that we make in giving you this gift, which we trust you to treat with the respect that it deserves.
The 103 signatures were collected at a conference in London yesterday, which was organised to consider taking up the position of principled non-compliance with the regulation as proposed by your process.
The conference drew around 220 people, about 90 of who are registrants with the UKCP and 130 with BACP (as well as those from other organisations).
The Alliance for Counselling & Psychotherapy against State Regulation.
info@allianceforcandp.org
www.allianceforcandp.org
I read the message just as I was leaving the house to cycle up to Kennington with a little package from the Alliance for Counselling and Psychotherapy against State regulation. I had been designated Hermes for the mission: to get the new book (Compliance? Ambivalence? Rejection?) into the consultation process before Friday’s deadline. The TT news put the wind in my wheels.
As I arrived at HPC HQ, I saw a DHL biker fiddling with his panniers on the pavement, and I wondered if he had just delivered the amazing Maresfield Report.
The young woman on the desk actually opened the door before I reached the top of the stairs, and (this really did surprise me) gave me a welcoming smile. (I have to admit that over the months she and I have rarely hit it off.)
I said that I had a gift for the Policy and Standards department, and could she call someone down to receive it from me.
She jumped to her feet and ran to the inner door, and yelled "Grace! Can you come back! There's another one!"
Grace duly returned, and took me into the little cubby-hole, recessed in reception, and I offered her my hand.
She had to remove the little blue rubber finger-stall that was stuck on the end of her finger, before greeting me in the accustomed way.
I told her I had a gift from my tribe to hers, and asked her if she was able to receive it with the dignity it deserved.
Just for a moment she dissolved into giggles before rallying to say she would try.
The letter enclosed in the envelope, and wrapped around the book said:
Enclosed please find our book containing essays and responses to your consultation request. Many of these submissions have also been sent individually. We hope that you recognise that this work represents a sustained and serious effort by a few who have drawn on the support of many un-named others. Those who signed the book represent many of those others.
It is a symbolic act that we make in giving you this gift, which we trust you to treat with the respect that it deserves.
The 103 signatures were collected at a conference in London yesterday, which was organised to consider taking up the position of principled non-compliance with the regulation as proposed by your process.
The conference drew around 220 people, about 90 of who are registrants with the UKCP and 130 with BACP (as well as those from other organisations).
The Alliance for Counselling & Psychotherapy against State Regulation.
info@allianceforcandp.org
www.allianceforcandp.org
Tuesday, 6 October 2009
Report on the Manchester 'HPC Recall Meeting'
Department of Psychology
Manchester Metropolitan University Elizabeth Gaskell Campus
Hathersage Road Manchester M13 OJA UK
Tel 0161 247 2573 Fax 0161 247 6364 Email I.A.Parker@mmu.ac.uk
Ian Parker BA PhD AFBPsS CPsychol FRSA Professor of Psychology
5 October 2009 OPEN LETTER
Anna Van der Gaag
Chair, Health Professions Council, UK
Park House, 184 Kennington Park Road,
London, SE11 4BU
Dear Anna van der Gaag,
On Saturday 3rd October 2009 in Manchester the ‘HPC Recall Meeting’ took place and discussed where counsellors and psychotherapists are up to with the government plans to have them regulated by the Health Professions Council (HPC). The HPC now already includes professions that are not actually ‘Health Professions’, and many psychologists (who were brought into the HPC in July 2009) have made it clear that it is inappropriate to include them under that heading). This 3rd October recall meeting was organised after the failure of the HPC itself to follow up a ‘stakeholder’ consultation meeting it held in Manchester in March earlier in the year. At this stakeholder meeting, probably to the surprise of the HPC, there was a good deal of opposition to their idea of what regulation is and the work so far of their ‘Professional Liaison Group’ (PLG). There was no report and discussion of the issues raised at the stakeholder meeting at the following PLG, and the HPC has not either organised any further open consultative meetings or engaged with the questions raised in March. HPC staff and PLG members were invited to the Recall meeting but declined to attend, adding insult to injury by suggesting that it would be possible to meet privately after the current consultation period is over.
At our meeting we noted the absence of the HPC and the PLG, and then reviewed progress, or lack of it, so far. We noted that the division between counselling and psychotherapy is quite artificial, and that there is an impossible paradox at work when we expect counsellors not to engage in (what the PLG recently termed) ‘mental disorder’ (as many counsellors working for MIND have to do, for example) or psychotherapists not to be concerned in their practice with ‘mental health and well-being’. This paradox highlights the absurdity of the attempt to press those in different modalities to conform to standard covering definitions of ‘counselling’ and ‘psychotherapy’. There is, of course, a deeper problem at work in the pressing of all involved into standardised models and procedures (those favoured, it is clear, by those leading this process in the PLG). There is a particular threat to ‘patients’ (clients, service users) in that the HPC regulation will give an illusion of security in which those who have been obedient and conform to the HPC register will then have even more licence to abuse their power, and this regulative process will close down one of the few spaces in culture in which people can attempt to speak freely and reflect on what they have said.
We noted that high-profile cases in disciplinary procedures will still actually be able to practice, and that ‘protection’ of the public would be better served by recourse to the law (and resources that are being put into the HPC be put instead into good legal advice and support for those who are often, for good reason, shy of approaching lawyers for help). HPC regulation will also lead to defensive practice by counsellors and psychotherapists anxious that they are going beyond the remit of work defined by their place on the register, refusing to take on ‘difficult’ clients perhaps, and so access to counselling and psychotherapy will actually be severely reduced. We noted that there is no place for mediation in disputes (until after a hearing is over), and that the HPC PLG has chosen to ignore a large body of evidence on this kind of process as an alternative approach. We spent some time discussing threats to practice, but it should be clear so far that the meeting also explored practical alternatives.
We appreciate that the HPC has a difficult if not impossible task, and now would be the time, already late but not too late, to conclude that they are not the organisation to undertake regulation of counselling and psychotherapy, and to tell the government this. In the meantime it was clear at the 3rd October Recall meeting that many counsellors and psychotherapists will refuse to join the HPC register – not because they are against regulation as such but against this state regulation – and Principled Non-Compliance is an option some of us can pursue to defend our practice against the HPC process which threatens to destroy it.
Yours sincerely
Ian Parker
Manchester Alliance (Alliance for Counselling and Psychotherapy against State Regulation: www.allianceforcandp.org
Manchester Metropolitan University Elizabeth Gaskell Campus
Hathersage Road Manchester M13 OJA UK
Tel 0161 247 2573 Fax 0161 247 6364 Email I.A.Parker@mmu.ac.uk
Ian Parker BA PhD AFBPsS CPsychol FRSA Professor of Psychology
5 October 2009 OPEN LETTER
Anna Van der Gaag
Chair, Health Professions Council, UK
Park House, 184 Kennington Park Road,
London, SE11 4BU
Dear Anna van der Gaag,
On Saturday 3rd October 2009 in Manchester the ‘HPC Recall Meeting’ took place and discussed where counsellors and psychotherapists are up to with the government plans to have them regulated by the Health Professions Council (HPC). The HPC now already includes professions that are not actually ‘Health Professions’, and many psychologists (who were brought into the HPC in July 2009) have made it clear that it is inappropriate to include them under that heading). This 3rd October recall meeting was organised after the failure of the HPC itself to follow up a ‘stakeholder’ consultation meeting it held in Manchester in March earlier in the year. At this stakeholder meeting, probably to the surprise of the HPC, there was a good deal of opposition to their idea of what regulation is and the work so far of their ‘Professional Liaison Group’ (PLG). There was no report and discussion of the issues raised at the stakeholder meeting at the following PLG, and the HPC has not either organised any further open consultative meetings or engaged with the questions raised in March. HPC staff and PLG members were invited to the Recall meeting but declined to attend, adding insult to injury by suggesting that it would be possible to meet privately after the current consultation period is over.
At our meeting we noted the absence of the HPC and the PLG, and then reviewed progress, or lack of it, so far. We noted that the division between counselling and psychotherapy is quite artificial, and that there is an impossible paradox at work when we expect counsellors not to engage in (what the PLG recently termed) ‘mental disorder’ (as many counsellors working for MIND have to do, for example) or psychotherapists not to be concerned in their practice with ‘mental health and well-being’. This paradox highlights the absurdity of the attempt to press those in different modalities to conform to standard covering definitions of ‘counselling’ and ‘psychotherapy’. There is, of course, a deeper problem at work in the pressing of all involved into standardised models and procedures (those favoured, it is clear, by those leading this process in the PLG). There is a particular threat to ‘patients’ (clients, service users) in that the HPC regulation will give an illusion of security in which those who have been obedient and conform to the HPC register will then have even more licence to abuse their power, and this regulative process will close down one of the few spaces in culture in which people can attempt to speak freely and reflect on what they have said.
We noted that high-profile cases in disciplinary procedures will still actually be able to practice, and that ‘protection’ of the public would be better served by recourse to the law (and resources that are being put into the HPC be put instead into good legal advice and support for those who are often, for good reason, shy of approaching lawyers for help). HPC regulation will also lead to defensive practice by counsellors and psychotherapists anxious that they are going beyond the remit of work defined by their place on the register, refusing to take on ‘difficult’ clients perhaps, and so access to counselling and psychotherapy will actually be severely reduced. We noted that there is no place for mediation in disputes (until after a hearing is over), and that the HPC PLG has chosen to ignore a large body of evidence on this kind of process as an alternative approach. We spent some time discussing threats to practice, but it should be clear so far that the meeting also explored practical alternatives.
We appreciate that the HPC has a difficult if not impossible task, and now would be the time, already late but not too late, to conclude that they are not the organisation to undertake regulation of counselling and psychotherapy, and to tell the government this. In the meantime it was clear at the 3rd October Recall meeting that many counsellors and psychotherapists will refuse to join the HPC register – not because they are against regulation as such but against this state regulation – and Principled Non-Compliance is an option some of us can pursue to defend our practice against the HPC process which threatens to destroy it.
Yours sincerely
Ian Parker
Manchester Alliance (Alliance for Counselling and Psychotherapy against State Regulation: www.allianceforcandp.org
Monday, 28 September 2009
Unfit for practise because you don't hit your targets!
Yet another astonishing example of how the HPC mistakes Britain for a factory, and itself for the Factory Mananger.
The latest HPC hearing:
Date: Friday 9 October 2009
Name of Registrant: Xxxxx Xxxxxxx
Profession: Occupational therapist
Area of practise: Xxxxxxxxxx
Hearing Location: Park House, 184 Kennington Park Road,
Kennington, SE11 4BU, London
Committee: Conduct and Competence Committee
Allegation:
In the course of your employment as an Occupational Therapist by
xxxxxxxxxxxxxxxxxx between 2006-2008 you:
1. Failed to maintain accurate filing.
2. Failed to maintain adequate patient records and notes.
3. Failed to adequately manage your case load in particular that you did
not:
a) pick up referrals at a sufficient rate;
b) review cases within an adequate time frame;
c) close cases within an adequate time frame; and
d) submit two Disabled Facilities Grant applications, in a timely manner
in June 2006 and June 2007.
4. Failed to use I.T. systems as required.
5. Required support and guidance over and above that expected of a
qualified Occupational Therapist.
6. Failed to sufficiently meet the improvement targets as set by your
employers.
7. The matters set out in particulars 1-6 constitute misconduct and/or
lack of competence.
8. By reason of that misconduct and/or lack of competence, your fitness
to practise is impaired.’
The latest HPC hearing:
Date: Friday 9 October 2009
Name of Registrant: Xxxxx Xxxxxxx
Profession: Occupational therapist
Area of practise: Xxxxxxxxxx
Hearing Location: Park House, 184 Kennington Park Road,
Kennington, SE11 4BU, London
Committee: Conduct and Competence Committee
Allegation:
In the course of your employment as an Occupational Therapist by
xxxxxxxxxxxxxxxxxx between 2006-2008 you:
1. Failed to maintain accurate filing.
2. Failed to maintain adequate patient records and notes.
3. Failed to adequately manage your case load in particular that you did
not:
a) pick up referrals at a sufficient rate;
b) review cases within an adequate time frame;
c) close cases within an adequate time frame; and
d) submit two Disabled Facilities Grant applications, in a timely manner
in June 2006 and June 2007.
4. Failed to use I.T. systems as required.
5. Required support and guidance over and above that expected of a
qualified Occupational Therapist.
6. Failed to sufficiently meet the improvement targets as set by your
employers.
7. The matters set out in particulars 1-6 constitute misconduct and/or
lack of competence.
8. By reason of that misconduct and/or lack of competence, your fitness
to practise is impaired.’
Insidious creep of the 'protection' discourse.
At a party of artists on Saturday night, I spoke to a man who looked very glum. He is the head of department in a higher ed institute, one which is well regarded around the world for its artistic and talented craft-makers.
Before he even knew my particular interest he was telling me about a recent trip he had arranged to take a group of his mature students to Wales to exhibit their work. The health and safety administrator insisted that he discover the medication that each of his students were on and what time of day they should take it. He also had to nominate a student to ask him the time and the tablets he takes so that they could make sure each one didn't forget when they went on their weekend away.
Absolutely true. Right here, right now, in London.
I asked him why he didn't tell the administrator where to stick his stupid idea. He replied: there are so many fiddly petty fogging things to do these days, just to get the trip organised, that he didn't want to upset anyone who could prevent him even going.
I think he then felt embarrassed at his powerless position, because he added 'I wouldn't have minded but I had to design the form as well, myself!'
He should have minded, shouldn't he. The students aren't babies and can take their own tablets, and he certainly didn't want any of them intruding into his own body's failings. Just what was the administrator going to do with the information? Lord only knows!
How come nervous administrators wield such an amount of power?
Does this qualify one or both or all of them (the head of department, the health and safety administrator, the nominated student) as a Modern Health Professional?
Before he even knew my particular interest he was telling me about a recent trip he had arranged to take a group of his mature students to Wales to exhibit their work. The health and safety administrator insisted that he discover the medication that each of his students were on and what time of day they should take it. He also had to nominate a student to ask him the time and the tablets he takes so that they could make sure each one didn't forget when they went on their weekend away.
Absolutely true. Right here, right now, in London.
I asked him why he didn't tell the administrator where to stick his stupid idea. He replied: there are so many fiddly petty fogging things to do these days, just to get the trip organised, that he didn't want to upset anyone who could prevent him even going.
I think he then felt embarrassed at his powerless position, because he added 'I wouldn't have minded but I had to design the form as well, myself!'
He should have minded, shouldn't he. The students aren't babies and can take their own tablets, and he certainly didn't want any of them intruding into his own body's failings. Just what was the administrator going to do with the information? Lord only knows!
How come nervous administrators wield such an amount of power?
Does this qualify one or both or all of them (the head of department, the health and safety administrator, the nominated student) as a Modern Health Professional?
Sunday, 20 September 2009
HPC Council Meeting 10 9 09
The Council members sit round the table and have a 2" block of papers in front of them. Marc Seale laughed and apologised for the weight of paper they all faced at each meeting. He seemed to think the problem would be solved when he issued them each a laptop. Has he presumed that they don't read the papers? This is the real problem, surely.
From a mythical point of view, it might be said that the written word dominates the men and women. A friend of mine said 'it is speech that is under attack'.
The HPC staff speak very quickly, and in a kind of tone that makes it almost impossible for someone like me to follow. Someone not already practiced and versed in the language that is spoken here, someone who is interested in the meaning of what is being said.
This theme of speed and quantity is what catches my attention as the discussions progress through the enormously long and complicated agenda. What follows is drawn from the notes I jotted down as the meeting played out.
Annie Turner mentions that there are over 500 new programs to consider (post psychologist registration), and asks about the peak in complaints received in May.
These complaints are not about fitness to practice, but are complaints received from physiotherapy registrants trying to re-register themselves on time and proving too much for the administrators responsible for answering the phones.
Mary Clark Glass wondered whether the targets should be increased because the staff usually met them so easily.
Annie Turner mutters that the volume of work has risen hugely since the BPS programmes have been handed over for regulation.
Marc Seale said there had been a 'sea change in Fitness to Practice' that would require something new from the organisation. I wonder what he meant.
And someone else said that Michael Guthrie was building the evidence base of risk in connection with revalidation.
Anna van der Gaag - ah, someone who speaks slowly and clearly! - said, oh, I don't know what she said, perhaps it was she who mentioned Michael's evidence base of risk.
Mary Clark Glass wondered out loud how it could be possible to address behaviour through competencies, and Eileen Thornton said that 'we can't have a single model, but need a research base to base our decisions on." Jeff Lucas was happy that things were moving towards an evidence base, and said something about men of a certain age posing a risk group for the HPC.
Anna van der Gaag said that CPD was vital here, and Joy Tweed asked how long someone could be out of practice before 'they become a risk for us - we need research into this', then added 'how about patient feed back into CPD?' She wants to 'future proof' things, she said, adding that the professions were low risk right now, but 'we've 50 new professions in the pipeline'. FIFTY? Could I have possibly have heard that right? I think Joy who was still speaking as I wrote down: 'the longer you are in the profession, the greater risk you pose, so risk proofing would have to be done via supervision.'
Writing this now makes me chuckle and think about Karl Popper's central planner. The idea that the more experienced a professional is, the greater risk they pose to the HPC is hilarious from this perspective. The idea that the HPC will fight against such free thinking individualism by insisting on life-long supervision brings with it the spectre of a battle between the administrators backed by government legislation, vs the wit of wizened experience.
Back to the notes - Conduct. I've written it to emphasise the first syllable because each person who mentioned it stressed it like that as if trying to beat it into stone. The word seemed saturated with meaning, with something in excess of what could be articulated, something urgent trying to make itself heard. I've written down 'more fundamental revalidation, not just fitness to practice' to note the words of a Council member whose name I didn't catch. There was quite a concentrated piece of discussion here, which seemed to crystallise the interest of the whole group. Anna van der Gaag said 'there are people operating just below the level you would want, but they would not be subject to fitness to practise. How do we address that?" and Julia Drown said that revalidation methods should be compared with systems working around the world.
Marc Seale spoke of the struggle that the GMC were currently having, and said 'if we can crack it when no-one else has ... FTP ... CPD ... Self Correcting CPD... It is the Holy Grail," he said "can you come up with a system where a registrant self-corrects?"
Self corrects! I remember thinking of Prince Hal at that point, and turning towards the window. Anna van der Gaag's soothing voice brought me back into the room: "we are using well validated tools... it would be wrong to invent a scale ourselves that we thought would do the trick..." Eileen Turner was saying 'we know about this - lack of initiative, self direction, and motivation' and trailed off leaving Marc Seale free to say 'we are talking about a 4-5 year project - no-one has cracked it yet'.
Cracked what? How to tell if a student in university is going to commit a crime as he approaches middle age? I imagine that these things will have acquired the status of crime by then. The crime of not keeping neat and proper notes.
Apparently the Department of Health is funding some research that might relate to this. Somehow that does not bring me relief.
The business moved on to the CHRE review, and I came back into focus as Julia Drown is saying 'we don't want to be seen to protect the registrant, we are here to protect the public. It's about the message we send out to do that." I find myself smiling - she was a government spokesperson for health in her time as a Labour MP.
Marc Seale is saying something about the CHRE not having a comparison to judge good and bad practice, and Michael Guthrie said "we don't know what all the other regulators do" (goodness me, I think, you don't know what your own registrants do, perhaps you shouldn't you concentrate on that?)
Very often as I sit listening to these meetings I think about the reference points that people use. From my inquiry into the subject, it seems clear that they have no genuine point of reference. This is the natural consequence of Ian Kennedy's genius - to split the administration off from the practice, and then make the administrators responsible for the practice. This vacuum that they face is the logical consequence of Kennedy's prejudice. Tho, not just of Ian Kennedy.
My attention is brought back to the meeting by Anna van der Gaag's reassuring voice: "our school report is actually pretty good" she is saying "whatever we think of our head master, we actually have a good report."
Post Script: I've drawn a line in my notebook at that point, and probably left the room to get a glass of water. But when I returned they were talking about Sonographers, who I understand to be anyone who carries out those amazing technological tricks that reveal a tiny foetus sucking its thumb and wriggling around in the womb. Apparently, a sonographer is anyone who is using a sonograph, but not for long! A 200 page document was laid in front of the meeting from the Society and College of Sonographers who ask for HPC registration. Jeff Lucas said: "it appears to be a collective noun that not only overlaps different parts of the HPC register (ie lots of different professionals can use a sonograph, and even people who are not already in another profession), but is also shared across different regulators...'. But someone else, with an eye on expansion, said 'public protection' and blustered on: 'so a member of the public can know if someone is qualified to use the technology'. I nearly snorted, what a nice little earner the HPC are on. Every new piece of technology might inadvertently create a new profession for regulation. Now I understand how there could be another 50 in the queue already. Tell me, why would a member of the public need to know someone was qualified? Have we really reached the point when no-one trusts anyone in the NHS to know what they are doing? Maybe. Or, if not now, then probably sometime real soon.
From a mythical point of view, it might be said that the written word dominates the men and women. A friend of mine said 'it is speech that is under attack'.
The HPC staff speak very quickly, and in a kind of tone that makes it almost impossible for someone like me to follow. Someone not already practiced and versed in the language that is spoken here, someone who is interested in the meaning of what is being said.
This theme of speed and quantity is what catches my attention as the discussions progress through the enormously long and complicated agenda. What follows is drawn from the notes I jotted down as the meeting played out.
Annie Turner mentions that there are over 500 new programs to consider (post psychologist registration), and asks about the peak in complaints received in May.
These complaints are not about fitness to practice, but are complaints received from physiotherapy registrants trying to re-register themselves on time and proving too much for the administrators responsible for answering the phones.
Mary Clark Glass wondered whether the targets should be increased because the staff usually met them so easily.
Annie Turner mutters that the volume of work has risen hugely since the BPS programmes have been handed over for regulation.
Marc Seale said there had been a 'sea change in Fitness to Practice' that would require something new from the organisation. I wonder what he meant.
And someone else said that Michael Guthrie was building the evidence base of risk in connection with revalidation.
Anna van der Gaag - ah, someone who speaks slowly and clearly! - said, oh, I don't know what she said, perhaps it was she who mentioned Michael's evidence base of risk.
Mary Clark Glass wondered out loud how it could be possible to address behaviour through competencies, and Eileen Thornton said that 'we can't have a single model, but need a research base to base our decisions on." Jeff Lucas was happy that things were moving towards an evidence base, and said something about men of a certain age posing a risk group for the HPC.
Anna van der Gaag said that CPD was vital here, and Joy Tweed asked how long someone could be out of practice before 'they become a risk for us - we need research into this', then added 'how about patient feed back into CPD?' She wants to 'future proof' things, she said, adding that the professions were low risk right now, but 'we've 50 new professions in the pipeline'. FIFTY? Could I have possibly have heard that right? I think Joy who was still speaking as I wrote down: 'the longer you are in the profession, the greater risk you pose, so risk proofing would have to be done via supervision.'
Writing this now makes me chuckle and think about Karl Popper's central planner. The idea that the more experienced a professional is, the greater risk they pose to the HPC is hilarious from this perspective. The idea that the HPC will fight against such free thinking individualism by insisting on life-long supervision brings with it the spectre of a battle between the administrators backed by government legislation, vs the wit of wizened experience.
Back to the notes - Conduct. I've written it to emphasise the first syllable because each person who mentioned it stressed it like that as if trying to beat it into stone. The word seemed saturated with meaning, with something in excess of what could be articulated, something urgent trying to make itself heard. I've written down 'more fundamental revalidation, not just fitness to practice' to note the words of a Council member whose name I didn't catch. There was quite a concentrated piece of discussion here, which seemed to crystallise the interest of the whole group. Anna van der Gaag said 'there are people operating just below the level you would want, but they would not be subject to fitness to practise. How do we address that?" and Julia Drown said that revalidation methods should be compared with systems working around the world.
Marc Seale spoke of the struggle that the GMC were currently having, and said 'if we can crack it when no-one else has ... FTP ... CPD ... Self Correcting CPD... It is the Holy Grail," he said "can you come up with a system where a registrant self-corrects?"
Self corrects! I remember thinking of Prince Hal at that point, and turning towards the window. Anna van der Gaag's soothing voice brought me back into the room: "we are using well validated tools... it would be wrong to invent a scale ourselves that we thought would do the trick..." Eileen Turner was saying 'we know about this - lack of initiative, self direction, and motivation' and trailed off leaving Marc Seale free to say 'we are talking about a 4-5 year project - no-one has cracked it yet'.
Cracked what? How to tell if a student in university is going to commit a crime as he approaches middle age? I imagine that these things will have acquired the status of crime by then. The crime of not keeping neat and proper notes.
Apparently the Department of Health is funding some research that might relate to this. Somehow that does not bring me relief.
The business moved on to the CHRE review, and I came back into focus as Julia Drown is saying 'we don't want to be seen to protect the registrant, we are here to protect the public. It's about the message we send out to do that." I find myself smiling - she was a government spokesperson for health in her time as a Labour MP.
Marc Seale is saying something about the CHRE not having a comparison to judge good and bad practice, and Michael Guthrie said "we don't know what all the other regulators do" (goodness me, I think, you don't know what your own registrants do, perhaps you shouldn't you concentrate on that?)
Very often as I sit listening to these meetings I think about the reference points that people use. From my inquiry into the subject, it seems clear that they have no genuine point of reference. This is the natural consequence of Ian Kennedy's genius - to split the administration off from the practice, and then make the administrators responsible for the practice. This vacuum that they face is the logical consequence of Kennedy's prejudice. Tho, not just of Ian Kennedy.
My attention is brought back to the meeting by Anna van der Gaag's reassuring voice: "our school report is actually pretty good" she is saying "whatever we think of our head master, we actually have a good report."
Post Script: I've drawn a line in my notebook at that point, and probably left the room to get a glass of water. But when I returned they were talking about Sonographers, who I understand to be anyone who carries out those amazing technological tricks that reveal a tiny foetus sucking its thumb and wriggling around in the womb. Apparently, a sonographer is anyone who is using a sonograph, but not for long! A 200 page document was laid in front of the meeting from the Society and College of Sonographers who ask for HPC registration. Jeff Lucas said: "it appears to be a collective noun that not only overlaps different parts of the HPC register (ie lots of different professionals can use a sonograph, and even people who are not already in another profession), but is also shared across different regulators...'. But someone else, with an eye on expansion, said 'public protection' and blustered on: 'so a member of the public can know if someone is qualified to use the technology'. I nearly snorted, what a nice little earner the HPC are on. Every new piece of technology might inadvertently create a new profession for regulation. Now I understand how there could be another 50 in the queue already. Tell me, why would a member of the public need to know someone was qualified? Have we really reached the point when no-one trusts anyone in the NHS to know what they are doing? Maybe. Or, if not now, then probably sometime real soon.
Sunday, 13 September 2009
Annual Meeting - 10 Sep 09
Thursday, 10th September 2009. The HPC annual meeting.
It is not immediately clear what status this meeting has - ie it is not the AGM of a charity, nor that of a registered company - there are no votes taken, and no body of people who have any power to bring to bear on the organisation. Formally, the HPC is answerable to Privy Council - and none of them was present, as far as I could tell.
In the absence of any legal framework within which to understand the meeting (in the absence of any statutes or formally written rules) we are left to deduce the meaning from the work that it does on the day, the way this enters the daily business, and of course, the way it describes itself on the website: "Our annual meeting is the Council's opportunity to reflect on the last year's business in a public setting... a short talk given by the President, followed by a question and answer session."
Two of us had submitted questions ahead of time, me and the woman from MIND. First, Chairwoman Anna van der Gaag made her brief reflections, then we were invited to pose our questions.
MIND wanted to know whether there had been any problems arising from the regulation of the psychologists (1 July), and in particular whether anyone had made use of Principled Non-Compliance to reject the HPC.
The question was an informed and an intelligent one, and opened a welcome window onto the real world for the HPC. There is a tendency for things to get caught up in political (and Political) rhetoric so this question from the grass roots campaigning mental health user network was a great opportunity for the HPC spokesman Marc Seale (CEO) to make some real political capital.
I'm not really sure what he said, however. There were a lot of words, and he was smiling a great deal - this is what I wrote down at the time: "when you talk to professionals who are regulated, they are very proud, and embarrassingly positive ..." Chairwoman Anna van der Gaag (an expert in speech and language therapy) later summarised the answer: "it is too soon yet for any of us to know".
The question that I had sent in was on behalf of a colleague: "If a therapist is registered with the HPC, how does this affect the use of other unregulated therapies within their practice? For example an HPC registered psychotherapist using life coaching, hypnotherapy or other styles of therapy with their client."
This question has often been asked by those turning their attention for the first time to the HPC - I hear it asking: if I submit to your power, register my name, and pay the annual fee, will I be able to carry on practicing in the way I always have? If it were just a tax raised to fund the fitness to practice machinery, then the answer would be yes. It is not just a tax, however, but a whole new system of belief.
What did Marc Seale say? "This is a question about scope of practice. If you are regulated, and a complaint is made against you in one of your unregulated practices, we would still deal with that."
In her opening reflections, Anna van der Gaag mentioned that some of the professionals joining the HPC could rejoice in a reduction of fee from £667 to £76pa. With this, Anna let slip that, for her, the HPC is an alternative to registration with the existing practice based organisations - it is a rival to the existing professional bodies, and one that ultimately wants to replace professional bodies. She went on to say that the HPC represented a new kind of regulatory body, specifically 'a change from the paternalistic method' which she fleshed out with a quote from Don Berwick's John Hunt Lecture 2008 (entitled: Epitaph of a Profession !):
"we professionals are not our patient's partners. We are guests in their lives. We are not hosts. We are not priests in the cathedral of technology."
Well, leaving aside the irony that she must refer to a great man, speaking in the name of another great man in order to undermine a system based on great men, and forgetting for the moment the limitations of the metaphor of guest, what Anna seems to be arguing for is a change in attitude, conduct, and behaviour. She is calling, I think, for humbleness, whilst claiming that the HPC knows how to bring everyone to their knees.
It is not immediately clear what status this meeting has - ie it is not the AGM of a charity, nor that of a registered company - there are no votes taken, and no body of people who have any power to bring to bear on the organisation. Formally, the HPC is answerable to Privy Council - and none of them was present, as far as I could tell.
In the absence of any legal framework within which to understand the meeting (in the absence of any statutes or formally written rules) we are left to deduce the meaning from the work that it does on the day, the way this enters the daily business, and of course, the way it describes itself on the website: "Our annual meeting is the Council's opportunity to reflect on the last year's business in a public setting... a short talk given by the President, followed by a question and answer session."
Two of us had submitted questions ahead of time, me and the woman from MIND. First, Chairwoman Anna van der Gaag made her brief reflections, then we were invited to pose our questions.
MIND wanted to know whether there had been any problems arising from the regulation of the psychologists (1 July), and in particular whether anyone had made use of Principled Non-Compliance to reject the HPC.
The question was an informed and an intelligent one, and opened a welcome window onto the real world for the HPC. There is a tendency for things to get caught up in political (and Political) rhetoric so this question from the grass roots campaigning mental health user network was a great opportunity for the HPC spokesman Marc Seale (CEO) to make some real political capital.
I'm not really sure what he said, however. There were a lot of words, and he was smiling a great deal - this is what I wrote down at the time: "when you talk to professionals who are regulated, they are very proud, and embarrassingly positive ..." Chairwoman Anna van der Gaag (an expert in speech and language therapy) later summarised the answer: "it is too soon yet for any of us to know".
The question that I had sent in was on behalf of a colleague: "If a therapist is registered with the HPC, how does this affect the use of other unregulated therapies within their practice? For example an HPC registered psychotherapist using life coaching, hypnotherapy or other styles of therapy with their client."
This question has often been asked by those turning their attention for the first time to the HPC - I hear it asking: if I submit to your power, register my name, and pay the annual fee, will I be able to carry on practicing in the way I always have? If it were just a tax raised to fund the fitness to practice machinery, then the answer would be yes. It is not just a tax, however, but a whole new system of belief.
What did Marc Seale say? "This is a question about scope of practice. If you are regulated, and a complaint is made against you in one of your unregulated practices, we would still deal with that."
In her opening reflections, Anna van der Gaag mentioned that some of the professionals joining the HPC could rejoice in a reduction of fee from £667 to £76pa. With this, Anna let slip that, for her, the HPC is an alternative to registration with the existing practice based organisations - it is a rival to the existing professional bodies, and one that ultimately wants to replace professional bodies. She went on to say that the HPC represented a new kind of regulatory body, specifically 'a change from the paternalistic method' which she fleshed out with a quote from Don Berwick's John Hunt Lecture 2008 (entitled: Epitaph of a Profession !):
"we professionals are not our patient's partners. We are guests in their lives. We are not hosts. We are not priests in the cathedral of technology."
Well, leaving aside the irony that she must refer to a great man, speaking in the name of another great man in order to undermine a system based on great men, and forgetting for the moment the limitations of the metaphor of guest, what Anna seems to be arguing for is a change in attitude, conduct, and behaviour. She is calling, I think, for humbleness, whilst claiming that the HPC knows how to bring everyone to their knees.
Thursday, 27 August 2009
Open letter to practitioners in the field of counselling and psychotherapy, from the psychoanalytic consortium
Reproduced here is an letter from 8 psychoanalytic institutions, openly addressed to anyone who considers themselves a colleague. It is one of three docs they have written in response to the HPC consultation on regulating counselling and psychotherapy. The other two docs can be accessed through the web-link embedded in the title of this blog and downloaded (HPC response to PLG and HPC Response to SoP). Taken together - or indeed separately - they are a tremendous rebuttal of the ideas put forward by the HPC. It remains to be seen whether the HPC is capable of tackling the points raised, or whether it will simply rely on the governmental power to ignore the opposition and carry on regardless.
Dear Colleague,
The Health Professions Council have now published their Draft Standards of Proficiency for Psychotherapy and Counselling. Although they have been working on the proposed regulation of the talking therapies for the last three years, the Standards will surprise many therapists and counsellors. They apply more to medical processes than to therapies, and will be unrecognisable to many practitioners. Indeed, they seem to apply more to a surgical team preparing a patient for an operation than to the open-ended relationship-based work of a talking therapy. The Standards dictate that practitioners should:
- know how to operate equipment and minimise the risk of infection.
- know how to select appropriate hazard control and risk management, reduction or elimination techniques.
- have a knowledge of health, disease, disorder and dysfunction.
- be able to evaluate and implement intervention plans using recognised outcome measures.
- know how to use protective equipment.
- know how to formulate and deliver plans and strategies for meeting health and social care needs.
- understand the principles of quality control and quality assurance and conduct audits correspondingly.
- maintain an effective audit trail, participate in audit procedures and work towards continued improvement.
- be able to formulate specific and appropriate management plans including the setting of timescales.
- demonstrate a logical and systematic approach to problem solving and be able to initiate problem solving techniques.
- observe and record client's responses.
-be able to demonstrate effective and appropriate skills in communicating information, advice and instruction.
- understand the need to engage service users and carers in planning and evaluating the diagnostics, treatment and interventions to meet their needs and goals.
- understand the importance of maintaining their own health.
- know how to meet the needs of the client.
A detailed critique of the Standards is [downloadable from the resource page linked to the heading of this blog: Response to HPC], together with a response to the HPC Professional Liaison Group's Report on the proposed regulation of psychotherapy and counselling [click header to download both docs]. Accepting the HPC Standards threatens the talking therapies with the same fate that has met other professions: practice simply becomes a technique of risk management, with the prime concern less the work undertaken with the client than the avoidance of litigation or complaint. Complaints, indeed, would be much more likely given the definition given by HPC of a 'service user': this no longer simply refers to the client, but to "anyone who is affected by the services of a registrant", including a client's relatives or spouse, thus encouraging third party complaints.
Therapists, on the HPC model, would be obliged to act in exactly the ways they may be encouraging their clients to escape from: submission to rather than questioning of internalised authority, and a conformity to socially-agreed expectations, rather then the fostering of creativity and uniqueness that therapies have traditionally aimed at. Whereas the system of values that the talking therapies have always offered was freed from the moral judgements of social authorities, it is now made to conform to exactly these moral judgements. It will no longer be psychotherapy as we know it.
All trainings in the field will, according to HPC, be obliged to meet the Standards of Proficiency, and the hearing of complaints and fitness to practice cases will use the Standards as a benchmark. Aside from the obvious problem of medicalising the talking therapies, the therapists of the future, in such a climate, may feel they are perpetually under a judgmental gaze, the private space of the therapy becoming the stage for an internalised judge or examiner. The consequences of this on therapeutic practice cannot be underestimated, and there is an irony here that many traditional descriptions of psychotherapy define it as the effort to find freedom from the internalised observer-judge that may be at the root of the client’s unhappiness.
While we unreservedly support codes of ethics and practice that ensure the practitioner's accountability, we do not believe that HPC's approach is suited to our field and so urge you, should HPC regulation take place, to adopt with us a position of principled non-compliance. If enough therapists and counsellors do not register with HPC, Government will realise the enormous mistake it is making, and our field may not face such a grim future.
Arbours Association
Association for Group and Individual Psychotherapy
Association of Independent Psychotherapists
Centre for Freudian Analysis and Research
The College of Psychoanalysts-UK
The Guild of Psychotherapists
Philadelphia Association
The Site for Contemporary Psychoanalysis
Dear Colleague,
The Health Professions Council have now published their Draft Standards of Proficiency for Psychotherapy and Counselling. Although they have been working on the proposed regulation of the talking therapies for the last three years, the Standards will surprise many therapists and counsellors. They apply more to medical processes than to therapies, and will be unrecognisable to many practitioners. Indeed, they seem to apply more to a surgical team preparing a patient for an operation than to the open-ended relationship-based work of a talking therapy. The Standards dictate that practitioners should:
- know how to operate equipment and minimise the risk of infection.
- know how to select appropriate hazard control and risk management, reduction or elimination techniques.
- have a knowledge of health, disease, disorder and dysfunction.
- be able to evaluate and implement intervention plans using recognised outcome measures.
- know how to use protective equipment.
- know how to formulate and deliver plans and strategies for meeting health and social care needs.
- understand the principles of quality control and quality assurance and conduct audits correspondingly.
- maintain an effective audit trail, participate in audit procedures and work towards continued improvement.
- be able to formulate specific and appropriate management plans including the setting of timescales.
- demonstrate a logical and systematic approach to problem solving and be able to initiate problem solving techniques.
- observe and record client's responses.
-be able to demonstrate effective and appropriate skills in communicating information, advice and instruction.
- understand the need to engage service users and carers in planning and evaluating the diagnostics, treatment and interventions to meet their needs and goals.
- understand the importance of maintaining their own health.
- know how to meet the needs of the client.
A detailed critique of the Standards is [downloadable from the resource page linked to the heading of this blog: Response to HPC], together with a response to the HPC Professional Liaison Group's Report on the proposed regulation of psychotherapy and counselling [click header to download both docs]. Accepting the HPC Standards threatens the talking therapies with the same fate that has met other professions: practice simply becomes a technique of risk management, with the prime concern less the work undertaken with the client than the avoidance of litigation or complaint. Complaints, indeed, would be much more likely given the definition given by HPC of a 'service user': this no longer simply refers to the client, but to "anyone who is affected by the services of a registrant", including a client's relatives or spouse, thus encouraging third party complaints.
Therapists, on the HPC model, would be obliged to act in exactly the ways they may be encouraging their clients to escape from: submission to rather than questioning of internalised authority, and a conformity to socially-agreed expectations, rather then the fostering of creativity and uniqueness that therapies have traditionally aimed at. Whereas the system of values that the talking therapies have always offered was freed from the moral judgements of social authorities, it is now made to conform to exactly these moral judgements. It will no longer be psychotherapy as we know it.
All trainings in the field will, according to HPC, be obliged to meet the Standards of Proficiency, and the hearing of complaints and fitness to practice cases will use the Standards as a benchmark. Aside from the obvious problem of medicalising the talking therapies, the therapists of the future, in such a climate, may feel they are perpetually under a judgmental gaze, the private space of the therapy becoming the stage for an internalised judge or examiner. The consequences of this on therapeutic practice cannot be underestimated, and there is an irony here that many traditional descriptions of psychotherapy define it as the effort to find freedom from the internalised observer-judge that may be at the root of the client’s unhappiness.
While we unreservedly support codes of ethics and practice that ensure the practitioner's accountability, we do not believe that HPC's approach is suited to our field and so urge you, should HPC regulation take place, to adopt with us a position of principled non-compliance. If enough therapists and counsellors do not register with HPC, Government will realise the enormous mistake it is making, and our field may not face such a grim future.
Arbours Association
Association for Group and Individual Psychotherapy
Association of Independent Psychotherapists
Centre for Freudian Analysis and Research
The College of Psychoanalysts-UK
The Guild of Psychotherapists
Philadelphia Association
The Site for Contemporary Psychoanalysis
Counselling and Depression as remedies to FTP
From another case recently posted up on the HPC web, of a paramedic :
"you were referred to an independent counsellor by the Occupational Health Department. You told the Panel that the period of counselling has had a significant effect on your health, that your depression is well controlled and your relationship with your wife is now stable."
Well, three things stand out. First, in what way is it useful for the HPC to post this information up on the public domain? It smacks of 1984.
Second, the counselling is presented as a remedy prescribed by Occupational Health which rather begins to beg the question about another profession that might be regulated by the HPC.
Later in the announcement we find a letter from the GP validating the fact that the counselling has contained the depression. This effectively turns it into a medical condition under control, ultimately, of the GP. This is the third point, and is contentious, to say the least. The HPC and its staff operate within an unenlightened medical paradigm which brings 'counselling' into the frame as a solution, like a drug, to inefficient or ineffective workforce issues.
It is the legal frame, the centralised operation of the HPC, and the close proximity of a government agenda, that distorts the general human condition into a specific public spectacle. Even if this is an unintended consequence, it appears highly normal to those within the frame.
I think it is something that many people will be amazed to see blossoming in the UK today.
"you were referred to an independent counsellor by the Occupational Health Department. You told the Panel that the period of counselling has had a significant effect on your health, that your depression is well controlled and your relationship with your wife is now stable."
Well, three things stand out. First, in what way is it useful for the HPC to post this information up on the public domain? It smacks of 1984.
Second, the counselling is presented as a remedy prescribed by Occupational Health which rather begins to beg the question about another profession that might be regulated by the HPC.
Later in the announcement we find a letter from the GP validating the fact that the counselling has contained the depression. This effectively turns it into a medical condition under control, ultimately, of the GP. This is the third point, and is contentious, to say the least. The HPC and its staff operate within an unenlightened medical paradigm which brings 'counselling' into the frame as a solution, like a drug, to inefficient or ineffective workforce issues.
It is the legal frame, the centralised operation of the HPC, and the close proximity of a government agenda, that distorts the general human condition into a specific public spectacle. Even if this is an unintended consequence, it appears highly normal to those within the frame.
I think it is something that many people will be amazed to see blossoming in the UK today.
Tuesday, 25 August 2009
Learning from our mistakes
"it is difficult enough to be critical of our own mistakes, but it must be nearly impossible for us to persist in a critical attitude towards those of our actions which involve the lives of many men and women. To put it differently, it is very hard to learn from very big mistakes." Karl Popper, 1944 (Piecemeal Social Engineering)
The longer the HPC is allowed to continue with its large scale utopianist experiment, the less likely it is to learn from it. It has recently been noted that the ambulance drivers are disproportionately victimised by the FTP process - they are turning up far more than any other group on the HPC register. Also, more men are pushed into the process, even tho the majority of people on the register are in fact women. The HPC has commissioned some 'research' to discover whether the former fact is significant (I don't think they are worried about the second fact yet). I wonder what the outcome will be of that piece of work.
The point that Popper makes here is that there are two reasons for the difficulty to learn. The first is that, because of "the scale of a utopianist experiment, it is impossible to say which particular measure is responsible for any of the results.... Even the greatest efforts to secure a well-informed, independent and critical statement of these results are unlikely to prove successful. But the chances" he goes on to say "that such efforts will be made are negligible; on the contrary, there is every likelihood that free discussion about the holistic plan and its consequences will not be tolerated."
The passage from which I draw these words gets more and more interesting. Written in 1944 - before the end of the second world war, a whole lifetime ago - it seems amazingly relevant to the question before us today:
It will not be tolerated, because: "every attempt at planning on a very large scale is an undertaking which must cause considerable inconvenience to many people (to put it mildly) and over a considerable span of time. Accordingly there will always be a tendency to oppose the plan, and to complain about it. To may of these complaints the Utopian engineer will have to turn a deaf ear if he wishes to get anywhere at all; in fact, it will be part of his business to suppress unreasonable objections. But with them he must invariably suppress reasonable criticism too. And the mere fact that expressions of dissatisfaction will have to be curbed reduces even the most enthusiastic expression of satisfaction to insignificance. Thus it will be difficult to ascertain the facts, ie, the repercussions of the plan on the individual citizen; and without these facts scientific criticism is impossible.'
Popper uses the word 'scientific' to mean critical thinking, and speaks often of its many different forms. Not for him the unified 'gold standard' that we find ourselves bogged down with under the 'evidence based' experiment of today.
The longer the HPC is allowed to continue with its large scale utopianist experiment, the less likely it is to learn from it. It has recently been noted that the ambulance drivers are disproportionately victimised by the FTP process - they are turning up far more than any other group on the HPC register. Also, more men are pushed into the process, even tho the majority of people on the register are in fact women. The HPC has commissioned some 'research' to discover whether the former fact is significant (I don't think they are worried about the second fact yet). I wonder what the outcome will be of that piece of work.
The point that Popper makes here is that there are two reasons for the difficulty to learn. The first is that, because of "the scale of a utopianist experiment, it is impossible to say which particular measure is responsible for any of the results.... Even the greatest efforts to secure a well-informed, independent and critical statement of these results are unlikely to prove successful. But the chances" he goes on to say "that such efforts will be made are negligible; on the contrary, there is every likelihood that free discussion about the holistic plan and its consequences will not be tolerated."
The passage from which I draw these words gets more and more interesting. Written in 1944 - before the end of the second world war, a whole lifetime ago - it seems amazingly relevant to the question before us today:
It will not be tolerated, because: "every attempt at planning on a very large scale is an undertaking which must cause considerable inconvenience to many people (to put it mildly) and over a considerable span of time. Accordingly there will always be a tendency to oppose the plan, and to complain about it. To may of these complaints the Utopian engineer will have to turn a deaf ear if he wishes to get anywhere at all; in fact, it will be part of his business to suppress unreasonable objections. But with them he must invariably suppress reasonable criticism too. And the mere fact that expressions of dissatisfaction will have to be curbed reduces even the most enthusiastic expression of satisfaction to insignificance. Thus it will be difficult to ascertain the facts, ie, the repercussions of the plan on the individual citizen; and without these facts scientific criticism is impossible.'
Popper uses the word 'scientific' to mean critical thinking, and speaks often of its many different forms. Not for him the unified 'gold standard' that we find ourselves bogged down with under the 'evidence based' experiment of today.
The Utopianist planner must make man fit society
I'm reading Karl Popper's 1944 essay 'Piecemeal Social Engineering' in which he constantly compares the piecemeal social engineer with the utopianist holistic planner. One of the many distinctions he makes is that the PSE tries, bit by bit, to make society fit the real men and women who happen to live there, but the UHP tries to make his fellow men and women fit the society he dreams of.
By way of a break, I clicked over to the hpc website and had a look at some of the FTP allegations coming up in the next few months, and straight away found this one:
1. In the course of your employment as an Occupational Therapist by Super-Duper Hospital NHS Trust, between 19 March 2007 and 14 June 2007, you undertook work elsewhere whilst on long term sick leave and whilst receiving statutory sick pay.
It's not that I think that someone who works for money whilst receiving stat sick pay should go un-remarked, but I do think that it is silly to say that it means, ipso facto, they are not morally fit for the work they are qualified to do. It's clumsy, brutal, and out of proportion with reality - Utopian, in a cold, harsh, petty, nasty sort of way.
By way of a break, I clicked over to the hpc website and had a look at some of the FTP allegations coming up in the next few months, and straight away found this one:
1. In the course of your employment as an Occupational Therapist by Super-Duper Hospital NHS Trust, between 19 March 2007 and 14 June 2007, you undertook work elsewhere whilst on long term sick leave and whilst receiving statutory sick pay.
2. The matter set out in Paragraph 1 constitutes misconduct.
3. By reason of that misconduct, your fitness to practice is impaired.It's not that I think that someone who works for money whilst receiving stat sick pay should go un-remarked, but I do think that it is silly to say that it means, ipso facto, they are not morally fit for the work they are qualified to do. It's clumsy, brutal, and out of proportion with reality - Utopian, in a cold, harsh, petty, nasty sort of way.
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