BACP backtrack on audit consultation

Counsellors and psychotherapists following the controversy around BACP’s audit consultation survey might be aware that the organisation has issued an apology: ‘We are really sorry. We’ve messed up!’ they say. But what precisely are they sorry about?

‘Our intention with the survey is not simply to introduce all or any of the ideas it contains, but rather to gather opinion and inspire debate. We recognise that we haven’t been at all clear on this point and that this has caused some members considerable concern. We’re very sorry that we didn’t make things clear from the outset.’

Let’s break that down a little. The intention of the survey (and its proposals for mystery shoppers, practice inspections and a fundamental shift in the nature of the supervisory relationship) was only ‘to gather opinion and inspire debate’?

If that was the intention, then an email survey to members with a mostly multiple-choice tick-box format and limited space for longer responses seems a less than ideal way to gather opinion. As for inspiring debate, the space for that was limited, not least because hardly anyone seemed able or willing to make a reasoned case for the proposals, not even BACP themselves, who made no meaningful attempt to articulate a substantive argument, beyond the fact that such measures are used by ‘other [non-therapy] professional bodies and regulators’. And let’s not forget that BACP initially responded to those writing to the BACP journal, Therapy Today, to say they would not publish the letters, which would be forwarded instead to the consultation team (a decision they have now reversed). If the intention was to inspire open debate within the organisation, this seems a strange way to go about it.

Now BACP have apologised – but, if we look at the text of the apology, what they are sorry for is a lack of clarity about their intentions: ‘we haven’t been at all clear on this point and… this has caused some members considerable concern.’

In this version of the furore around the consultation, it is as if members’ concerns were generated by a miscommunication about, and misunderstanding of, the purpose of the survey, which BACP says was ‘not simply to introduce all or any of the ideas it contains’. So BACP simply misspoke, as an on-the-ropes politician might put it, and members then misunderstood their benign intentions. They are sorry for upsetting people, in other words, but not for being wrong.

This spin on events demonstrates a convenient misunderstanding of the disquiet the survey created. BACP members who got in touch with the Alliance certainly thought that the survey was an inappropriate tool for the kind of questions being asked, but mostly they were disturbed by the fact – unchanged by the apology – that BACP would seriously consider such measures as appropriate for the therapy field.

The frantic backpedalling, then, distracts from the deeper concerns raised by the survey, which the apology does little – if anything – to address. Why would BACP ask for members’ views on specific changes to the audit process unless they consider those changes, or something like them, to be a) possible or workable, and b) of some potential value? Someone somewhere at BACP must think such methods could be a runner, or why bother asking members about them? And even if these specific proposals get (temporarily?) binned, we are still left with BACP’s apparent desire for more surveillance and control in an effort to pull therapy into line with ‘other professions’, regardless of the gaping absence of evidence that such a move would either enhance therapeutic work or ‘protect the public’.

Whatever is happening at BACP HQ, the executive agenda seems to be drifting further and further from both the realities of actual practice and the values of its members. The feeling in communications we’ve had around this issue is that the survey was something of a last straw for many practitioners; that they have already tolerated much from BACP that is incongruent with therapeutic principles and that this is just a step too far. There are already huge demands placed on practitioners attempting to sustain the unique qualities of the therapeutic space in the face of toxic cultural trends but it becomes intolerable when these efforts are betrayed by their own professional bodies.

Might the PR disaster of the survey nudge BACP’s leaders into supporting its members by articulating what’s different – and therefore so valuable – about therapy, rather than attempting to homogenise, control and rebrand the field?

Why is BACP stifling discussion and debate?

Recent days have seen something of a furore in response to BACP’s 2017 Audit Consultation, which is being run to a very tight deadline – it closes at 5pm on Monday 30th January. Find the survey here: https://www.surveymonkey.co.uk/r/BACPAudit

We know from anecdotal evidence that BACP members are checking out whether they can join another professional body.  Others have resigned or are threatening to do so. Reactions are fiercer than over proposals for either the regulation of counselling and psychotherapy by the Health Professions Council in 2009/10, or BACP’s review of its Ethical Framework in 2014.

These BACP members clearly appreciate the seriousness of the situation. Yet the deadline for responses is very much shorter than in 2014’s Ethical Framework consultation – in this case, just three weeks. This timescale strongly suggests that BACP are trying to pre-empt proper discussion.

Members are telling us they have written to BACP’s journal, Therapy Today, but have been informed that – instead of publishing the letters – BACP wants all correspondence about the survey to be forwarded to the register department, which is where responses to the consultation are being collated. In any event, due to the publication schedule, no letters on the issue could have been appeared in Therapy Today before the consultation closed – but BACP are still preventing members’ concerns reaching the pages of the next issue.

Why? Is BACP determined to present its own conclusions before wider concerns about context or implications have been properly aired? What’s going on?

The questions in the survey don’t invite comment about these wider implications – the final question is a narrow one that simply asks for suggestions on how ‘the audit process’ could be improved. No space is provided where any questions about the underlying rationale can be put, or where any reservations about the process as a whole can be expressed. It’s as though each and every suggestion is regarded as a potential incremental ‘improvement’ on the status quo. The fact that a major change of direction for BACP is being proposed is not acknowledged. That there is no opportunity to make any observations about this raises the possibility that the organisation is trying to slip major change through without proper input from its membership.

At the very least BACP needs to undertake a thorough analysis that weighs up the potential benefits of any proposed changes and set these against any possible unintended negative consequences. This should be done with transparency and with full membership participation – not after BACP managers have already presented their views and their interpretation of the survey results.

“the impression is that BACP regards its members as inherently untrustworthy”

As the Alliance has pointed out, what BACP is proposing is a regulatory framework based on distrust. During the 2014 review of the Ethical Framework, it was emphasised time and again that clients have to be able to trust BACP registrants. Indeed, BACP placed trustworthiness at the very heart of the new Ethical Framework:

‘Therefore, as members or registrants of BACP, we take being trustworthy as a serious ethical commitment’, it says in the opening pages.

Yet the impression from this consultation survey is that BACP regards its members as inherently untrustworthy, so much so they are badly in need of extra monitoring and surveillance. When the Ethical Framework was first introduced in 2001 as a replacement for the previous Code of Ethics, it was argued that the time had come to treat counsellors and psychotherapists as mature professionals. The impression in 2017 is that BACP members are not grown-ups at all but a bunch of potentially naughty schoolchildren who constantly need someone looking over their shoulder.

It beggars belief that such fundamental change is being presented via what is essentially a tick-box survey with further boxes in which comments can be added but which are hard to revise – both because so little text is visible in the space available and because scanning back to revisit earlier comments is so tedious. It’s as though obstacles have been deliberately placed in the way of anyone wishing to make more than perfunctory observations. We were told this survey ‘should take no longer than 20 to 25 minutes’, but a thoughtful response requires much more time than that.

In short, have we already witnessed a managerial coup at BACP HQ that is eager to suppress proper discussion and debate about these matters?

 

BACP: Masterminding the Death of Trust

What is going on at the British Association for Counselling & Psychotherapy (BACP)? As many of its members are now all too aware, the organisation has recently revealed that it is considering introducing ‘mystery shoppers’ and ‘practice inspections’ into its audit processes for practitioners on the BACP Register.

In an email on Monday 9th January, BACP Chair Andrew Reeves invited BACP members to respond to a survey on changes to the organisation’s register audit processes and CPD requirements. ‘We feel that it is time to make changes to strengthen our commitment to both safeguarding the public and protecting the reputation of the profession’, he writes.

The survey questions say that BACP are considering the use of mystery shoppers and practice inspections to assess members’ policies and procedures, particularly around confidentiality. It also proposed asking supervisors to complete forms confirming ‘frequency and duration’ of their supervisees attendance at supervision and that they have ‘gone through the ethical framework’ with them. If that weren’t enough, supervisors will be sent forms asking if they have any concerns about their supervisees, while registrants could face a ‘revalidation’ process involving some kind of ‘assessment of outcomes of practice’.

“a fundamental shift in the ethical relationship between therapists and their organisations, to a values incongruent one of surveillance and control”

Within hours of the survey being sent out, BACP members were sharing with the Alliance and across social media their deep concerns at such a huge change in policy and procedure; crucially that the proposals represented a fundamental shift in the ethical relationship between therapists and their organisations, from a supportive and challenging one to a values incongruent relationship of surveillance and control.

We wonder whether anyone at BACP has any awareness of the many devastating critiques of this kind approach, not to mention the personal experiences of practitioners from other professions who already work in this kind of culture and can attest to the toxic influence it has upon both their practices – which become increasingly defensive and distorted by the threat of surveillance – and themselves as persons, who become increasingly anxious and burnt out.

Surely of all professions, we would expect those in the field of counselling and psychotherapy to be attuned to these issues, to understand that relationships of trust – such as therapy – are not fostered in a context of suspicion or excessive external controls, and that these proposals would be harmful to both practitioners and clients.

How, then, does BACP imagine such procedures will ‘safeguard the public and protect the reputation of the profession’, as they put it? What is driving its desire to police the field in this way, completely ignoring the possibility that an uncritical over-estimation of its ‘public protection’ function might have a range of unintended negative consequences?

BACP, it would seem, are increasingly keen not to differentiate psychotherapy and counselling from other activities, to celebrate and articulate its uniqueness, nor to embrace and encourage the diversity of thought and practice within its own ranks, but instead to homogenise and take greater control of the field in an attempt to align it with ‘other healthcare professions’, as if it were undisputed that therapy is a ‘healthcare profession’ and should therefore mimic the cultures and practices of its claimed professional neighbours. This drive can also be seen in BACP’s efforts to standardise practice via ‘competency frameworks’ but the survey proposals expose its agenda even more starkly.

What’s the prize here? Winning the battle for influence in the corridors of power? Jobs for members in State agencies and institutions?

As they are keen to point out on social media, BACP are ‘listening’. But to whom and to what ends? What has happened to the largest therapy organisation in the UK that it would even consider proposals that would be the death knell for trust as a core principle in the practice of therapy?


Check out our first blog on the issue here, with one BACP registered member’s responses to the survey. And there’s an interesting analysis of the issue here noting BACP’s ‘ethical blind spot when it comes to practising institutionally what it preaches for its members individually’.

BACP Audit Consultation: An Inspector Calls?

bacp-audit

BACP – an Ofsted for Therapy?

In an email on Monday 9th January, BACP Chair Andrew Reeves invited BACP members to respond to a survey on changes to the organisation’s register audit processes and CPD requirements. ‘We feel that it is time to make changes to strengthen our commitment to both safeguarding the public and protecting the reputation of the profession’, he writes.

But BACP members are telling the Alliance that they are deeply concerned about the survey, which you can find here, and the major changes it proposes. The deadline for completion is Monday 30th January, leaving just a couple of weeks to digest the proposals. The Alliance has received a copy of the survey and one member’s responses, which we share with you below.

The proposals envisage changes that go far beyond those made to BACP’s Ethical Framework, which involved a consultation process stretching over a period of more than 18 months. This consultation, in contrast, is a tick box one and has to be completed in less than three weeks. Why the rush?

Many BACP members are concerned about the proposed Ofsted-style inspection regime. BACP is considering introducing ‘inspections’ and ‘mystery shopper’ calls in order to assess practitioners’ policies and procedures, as well as to look at ‘the practice setup’. They want to know about members’ confidentiality policies (aren’t those supposed to spelled out in the ‘commitment to clients’ in the recently revised Ethical Framework?) and about their cancellation policies, when previously it would have dealt such matters via the Ethical Framework or the associated guidance documents.

The proposals also envisage a new role for supervisors as part of BACP’s line management of registrants. Altering supervisors’ responsibilities was rejected as a result of the consultation on the first draft of the revised Ethical Framework, which drew heavy criticism, but here it is again with supervisors to be encouraged to use a form to report any ‘concerns’ they may have about supervisees direct to BACP. This in addition to supervisors having to report on their supervisees’ attendance at supervision and confirming in writing that they have gone through the Ethical Framework with them. There are also proposals for a kind of ‘school report’ from BACP, ‘with more detailed and personal feedback, including… suggested areas for development’, but it’s unclear whether supervisors’ feedback to BACP will be communicated to supervisees through this process.

Demands for information, then, are linked – rather vaguely – with somehow enhancing ‘public protection’. And this is before we get on to ‘third party feedback’, a concept which isn’t explained but which is presumably to do with other people’s views (i.e. the views of people other than the therapist and their client) about the value of the therapy. In the middle of this conceptual mish-mash there’s a hint that BACP is contemplating ways of assessing individual therapists’ ‘outcomes of practice’, an exercise that is fraught with difficulty.

As an increasingly exasperated accredited BACP member articulates below, the proposals highlight the deep incongruence between therapeutic values and BACP’s apparent goals for the future of the field.


 

The erosion of trust: The BACP audit survey and one member’s responses

  1. Are you responding as a… ?

BACP registered accredited member.

 

  1. We are considering the introduction of online continuing professional development (CPD) modules that deal with specific issues relating to good practice – for example understanding of the Ethical Framework or obligations in relation to the use of social media. These would be linked with registration and introduced on a voluntary basis initially. Do you agree with the proposal?

No.

This proposal sounds muddled. If online CPD is to be initially on a voluntary basis, the logical implication is that eventually it will be compulsory. Compulsory CPD would be a new departure for BACP and something of a slippery slope, I fear.

 

  1. We are considering the addition of a reflective paragraph about future continuing professional development (CPD) and thoughts on the previous year’s CPD. This would be in addition to the present requirements. Do you agree with this proposal?

No.

This would represent an artificial constraint. Not everyone works in this kind of way and I think it would be wrong to encourage such a way of thinking as “best practice”. Some of my greatest CPD gains have come from sudden decisions when I have become aware of an opportunity to which I have responded on the basis of a gut feeling. I would prefer BACP to encourage diversity and not impose what to my mind would be an unnecessary straightjacket on members.

 

  1. The continuing professional development (CPD) requirements currently state that Registrants must record a range of (CPD) activities relevant to current or future practice. We are considering making the CPD requirements more specific by asking Registrants to record five relevant CPD activities. Do you agree with this proposal?

No.

Once again I fear you are seeking to force the diversity of practice into boxes that won’t suit everyone. Why? There’s a nasty flavour about all this – it feels very controlling. If you want to go down this path I think you should make out a rigorously argued case for doing so and not use an internet poll of this kind that risks skimming over the surface of some important philosophical differences.

 

  1. Currently our selection for audit is random. We are considering more targeted risk-based audit such as selecting those who have previously failed twice or who work in more high risk contexts. This would be in addition to the current random sample. Do you agree with this proposal?

No.

I think you need to consider very carefully what you are suggesting here. You propose moving from a form of monitoring that seeks to check the validity of BACP’s procedures to one whose purpose is to monitor therapists themselves. One could argue that a much more fundamental approach is required since, from an outside perspective, perhaps the most glaring flaw in BACP’s overall approach is that it seeks to assure the public that therapists are able to build relationships of trust without ever meeting them face to face and testing this. Before embarking on such a radical new direction I think you need to demonstrate clearly that the benefits of doing so outweigh any potential drawbacks.

 

  1. We are currently considering introducing a form to be sent to members’ supervisor/s for them to confirm the frequency and duration of supervision and to confirm they have gone through the Ethical Framework with their supervisee. This would be in addition to the present requirements. Do you agree with this proposal?

No.

Certainly not! You are proposing a change in the role of supervisors requiring them to undertake a managerial function on behalf of BACP. This paragraph in the revised Ethical Framework is pernicious if interpreted in this fashion and enforced in this manner. When the Ethical Framework replaced the previous Codes of Ethics in 2001 it was sold to us as a mark of our maturity as professionals. This proposal infantilises BACP members and indicates a lack of trust in them. It does nothing so much as encourage a culture of compliance. You need to present a rigorously argued case in favour of doing so before seeking to impose such fundamental change.

 

  1. We are currently considering introducing a form to be sent to members’ supervisor/s to ask if they have any concerns about their supervisee. This would be in addition to the present requirements. Do you agree with this proposal?

No.

You are proposing piece of bureaucratic interference that may be superficially appealing, but which is likely to create muddle. The existing situation is that supervisors have to get a grip on situations of this kind and “telling tales to teacher” after this fashion doesn’t help – the issue has to be confronted within the supervisory relationship itself.

 

  1. We are considering introducing a report style card alongside the standard pass letter, providing Registrants with more detailed and personal feedback, including areas completed well and suggested areas for development. Do you agree with this proposal?

No.

This sounds muddled too. Do you mean feedback from BACP on how compliant the answers to questions are, or do you mean feedback from registrants’ supervisors too? This is a repellent, patronising suggestion. By what right does BACP believe it is capable of giving registrants ‘personal’ feedback, including areas for development, when its relationship with the overwhelming majority of the membership is anything but personal?

 

  1. We are considering introducing different standards of audit requirements for accredited and non-accredited members. Do you agree with this proposal?

No.

I think you need to be specific about what you are aiming to achieve before consulting on how to do it. There needs to be agreement on the former before consulting on the latter – otherwise consultation is in danger of becoming a charade.

 

  1. Some professions have introduced revalidation to ensure members continue to be fit for practice and remain up to date. This goes beyond continuing professional development (CPD) audit requirements and usually includes assessment of outcomes of practice. We are currently considering introducing revalidation for members after being on the Register for five years. Do you agree with this proposal?

No.

How precisely do you envisage assessing “outcomes of practice”? There are many contentious issues here that deserve detailed, serious attention and frankly I find it rather disturbing that you are using a set of questions like these to help formulate fundamental changes in policy and direction.

 

  1. Some professions have introduced mystery shopping as part of their audit process. We are currently considering mystery shopping telephone calls to members as part of a separate audit procedure to gain statistical information and to enhance public protection. This could include asking questions about members’ confidentiality or cancellation policies. If this were to be introduced all members would be informed in advance. Do you agree with this proposal?

No.

What on earth do you mean by “mystery shopping”? This sounds more like a “mystery question”! Stop hiding behind slick marketing jargon and explain exactly how you anticipate significantly enhancing public protection by making phone calls to members. And surely you need to explain what statistical information you will be seeking and for what purpose before you expect a proper response from me here?

Furthermore, why do you need to ask about members’ confidentiality policies – aren’t these laid out in our commitment to clients as specified in the new Ethical Framework? And why ask about cancellation policies? Surely BACP is capable of producing a set of practice guidelines if this is needed? What’s going on here? You have yet again rolled up several questions into one.

 

  1. Some professions have introduced inspections as part of their audit process. We are currently considering inspections as part of a separate audit procedure to gain statistical information and to enhance public protection. This could include assessing policies and procedures in place and looking at the practice set up. If this were to be introduced all members would be informed in advance of the visit. Do you agree with this proposal?

No.

This gets worse and worse. Why not come out openly and say you are keen to ape Ofsted? This whole tick-box survey sounds more and more an underhand way of introducing major changes through the backdoor. The proposals sketched out in this survey are much more fundamental than those introduced via the recent review of the Ethical Framework. You need to put together a reasoned argument as to what exactly the advantages will be of the changes you propose and weigh these up properly against any potential drawbacks, which I suspect may be considerable.

 

  1. Do you have any further suggestions for other third party feedback?

Yes.

Yes, just stop it! In the first place please don’t count my reply here as approval for third party feedback. Secondly, you need to explain precisely what you mean by this phrase. Feedback from whom? To whom? About what? And for what purpose? Please get a grip before circulating such questions.

 

  1. Do you have any further suggestions on how the audit process could be improved?

Yes.

I am struck by the contrast between this survey and the extensive consultation undertaken when the Ethical Framework was reviewed. Many poorly conceived changes to the Ethical Framework were eventually rejected after a lengthy process of consultation – and a few slipped through the net. These seem to be the springboard for what to my mind are an ill thought through set of proposals here that deserve to be thoroughly interrogated over an extended period. I think it would be rather foolish of BACP to conclude, as the introductory letter says, that “with your help we can see exactly how our existing register audit processes and CPD requirements can be improved”. Is BACP willing to consider the possibility that, by going down this route, it may neither be safeguarding the public nor protecting the reputation of the profession? In any case please try to answer the question, in whose eyes would the public be better safeguarded or the reputation of the profession be better protected?

 

Nothing about us without us? Are you bonkers?

In May this year, I joined members of the Mental Health Resistance Network at an event at the Old Vic. It was a panel debate on the state of mental health provision in the UK, one of their Voices Off events linked to the production of Harold Pinter’s The Caretaker. The original panel was Luciana Berger MP, Shadow Minister for Mental Health; Paul Farmer, CEO of Mind; and Simon Wessely President of the Royal College of Psychiatrists. MHRN members protested that there were no service user speakers, and eventually Peter Beresford and Alice Evans were invited onto the panel.

Inspired by the desperate lack of service user voices, mental health activists rapidly got together a zine to distribute at the meeting – a passionate collection of first-hand experiences of living on the sharp end of mental health disability in the UK. Jay Watts of the Alliance contributed a cartoon strip. I promised a short piece but couldn’t finish it for the deadline. Here it is – my belated contribution.

Read the full zine here


What’s wrong with people wanting to talk in public about other people’s mental health without including them in the conversation?

We psychotherapists definitely like to talk about our clients in the third person, though we don’t usually do it when they might be in the room. We do it behind their backs.

We like to exchange anecdotes about how difficult so and so is; about the terribly interesting unconscious meaning of what so and so said; about the clever little interpretation we were ‘able to offer’; about how narcissistic, borderline, dissociated, manic, aggressive, negative or just plain bonkers… so and so is.

So and so is not usually there when we speak about them, which is a good thing. If they were, we wouldn’t feel quite so free to show off how clever we are to our colleagues, or our students, or our partners and friends. We might feel a little inhibited, just a little caught out. A little wanting in ethical authenticity.

For the Mad Old Vic panel, the rationale for talking about, not talking with, is surely that three of the panel members have professional authority in the field.

A senior psychiatrist, the CEO of Mind, and the shadow Minister for Mental Health surely have something intelligent and authoritative to say about people who suffer psychologically. Could it be they have their own psychic pain somewhere tucked away inside them? Better not to ask. We are here to talk about people with mental health problems, not to talk about our own problems.

If you ask me, an awful lot of people are scared shitless by madness. Like they are terrified of poverty. Poverty and mental illness – handmaidens of hell. What they have in common is their contagion. You know, if you get too close the lurgy spreads from you to me. We psychotherapists are scared of this. We fend it off with the technologies of our trade, our magic words like ‘countertransference’ and ‘projection’ – spells we cast to keep the horrors at bay. They make it clear that it’s your problem not ours.

Sitting up there on their panel’s rostrum, I am hoping our trio of professional experts will be able to make a few basic facts clear.

First, that there has been a growing epidemic of mental ill-health in the UK from the 1980’s onward, as evidenced by the massive increase in anti-depressant prescriptions and the need for a huge expansion of primary care psychological therapies to millions of citizens. Thank goodness for pharmaceutics and CBT.

Second, that there is no connection between increasing mental ill-health and the introduction of neoliberal economic and social policies by Mrs Thatcher and Ronald Reagan, under the sway of ideologues like Hayek and Friedman. Atomising communities, destroying social housing, breaking the trade unions, deskilling labour, generating massive inequalities of wealth and income, increasing poverty, undermining social welfare provision, consistently cutting the mental health budget, creating a precariat of low pay, part-time, zero hour employment; overseeing a staggering increase in household debt, manufacturing a global financial crisis, following it up with austerity policies aimed at the least well-off, waging imperialist wars in the Middle East – all of this has no bearing on the mental health of the nation. It is NOT true that it is our society that’s sick.

In fact, third, psychological pain and distress is located in the individual. A good proportion of it is probably genetic and/or the embedded dysfunctionality of troubled families. A lot of it is negative thinking, laced with self-pity and dependence on a welfare culture. People need to strive more, skive less. With a judiciously administered balance of encouragement, nudge, threat, bribery and coercion most people will recover their capacity to join in our happy society.

Finally, we need to trust our psy experts up there on the podium, give them more money and more power. Let them get to work on this contagious epidemic of loneliness, depression, fear and anxiety. Trust the technologies of diagnosis, treatment and cure that are so successfully defining and dealing with the epidemic, offering each suffering individual recovery into happiness, optimism and the chance of being part of our hard-working family. Stop putting money into the welfare state, stop putting money into old fashioned care and treatment. Focus on building the innovative, practical recovery strategies that are quick, easy and cheap.

I suppose when we come down to it, talking with people is not very easy, and not very conclusive. All too often it turns out that, like you, people are really very complex and confusing human beings. Before long, talking with people at any depth over a decent period of time undoes your sense that you may know something more about being a successful person than they do. In fact, talking to people soon leads you to realise that you don’t really know very much at all, once you’ve been taken outside your comfort zone. Soon you are flying by the seat of your pants in that intersubjective realm that is so human and yet so disturbing. Most of us, quite rightly, get busy trying to establish anchors, to impose narratives of meanings that are familiar enough to our poor old egos and their ‘entitlements’.

Otherwise, this is exactly how the contagion gets going. Whose pain, love, fear and loss am I feeling? Yours or mine? When we begin to experience our differences, who is right, who is wrong? Why is it so bloody hard to be me and let you be you? What am I frightened of? Like the testimonials to lived experience in the zine, people move us and not necessarily into worlds we want to visit.

This is not the kind of experience that facilitates handy diagnosis, treatment regimes and evidence-based efficacy.

In an age when a tide of depression and anxiety is overwhelming us, when the loud and increasingly disingenuous promises of more resources for mental health services are outdone only by the savagery of regular service cuts, and when the rhetoric of a revolutionary expansion of psychological therapies is being swamped by mushrooming waiting lists, shorter courses of treatment and undertrained and underpaid workers – surely the very last thing we need are the voices of service users and survivors muddying the waters.

If we are not very careful, the conclusion that neoliberal society itself is a mental health disability afflicting all our citizens will be difficult to disguise.

Paul Atkinson

Andrew Samuels on Jobcentre Therapy and the Psy-Organisations

Letter submitted to Therapy Today (the BACP journal) but not published.


I’d like to respond to Catherine Jackson’s interesting article Colocation or collusion? How ethical are the Government’s proposals for closer working between IAPT services and Jobcentre Plus?’ (Therapy Today, April 2016, pp.8-9).

Catherine’s title suggests that the issue is generating heat and, at the end of this letter, I make a suggestion for a dialogical, relational next step.

What Catherine wrote illustrates the usual dilemma that the large professional organisations find themselves in with regard to Government policies – in this case, the many linkages between employment on the one hand and psychological therapies on the other. If bodies such as BACP, UKCP, BPC, BPS and BABCP are too robust in their criticism of Government policies, they will be labelled as ‘the awkward squad’ and ‘the usual suspects’. Doors in Whitehall close, requests for meetings go unanswered or evaded. That doesn’t serve the interests of the members. But what if they are too compliant, too accepting and even collusive with Government policy? What if the Big Five (as I call them) have inadvertently fallen into a role as being one of passing on reassurance to their memberships about the reassurance they themselves have received from the Department of Work and Pensions? That isn’t what members expect either.

I suspect that getting this particular balance right matters a lot to BACP members – it certainly did at the UKCP when I was Chair and the conundrum continues to be frequently discussed there. It is a really difficult balance to achieve. Be that as it may, Catherine’s article describes a significant new development in the field, in which 17 separate organisations have united to make the claim that the Big Five professional bodies referred to may need to do more to bring to the attention of their members what the overall thrust is of the linkages being made at many levels between employment and ‘mental health’. These 17 organisations include service user/survivor groups working alongside organised groups of professional counsellors, psychotherapists, psychologists, social workers, mental health nurses and academics. In all my 44 years as a therapist involved with public issues, I cannot remember anything like this happening before. It’s really important that BACP, in particular, with its deserved reputation for being the most outward-oriented of all the big professional bodies, clocks the significance of what has happened; I hope that the recognition of the importance of user-professional co-operation is not being too slow to arise. (See Note 1, below, for a roll call of the organisations concerned; the names tell their own story.)

In the public correspondence between the Big Five and the 17 organisations challenging them, there seems to be one point of agreement – at least in the abstract, at the level of principle. This is that therapy which has employment as a specific goal stated in advance is questionable from clinical and ethical standpoints. This is what the memberships of the Big Five believe, I think, and hence it is what they expect their leaderships to support.

But there is an increasing amount of ‘therapy-for-work’ being offered in Britain today and the Big Five know about it. Not least, their websites carry adverts whose job descriptions make it clear that the client’s employment is to be the clinical goal of the therapist that will be appointed. To be clear: the main issue here is not that our organisations carry the adverts. The thing is, now it has been pointed out, it is a little problematic to go on saying that this is not happening on the ground. The evidence is very close to hand. Or, to give a further and more general example, the New Savoy Conference, of which four of the Big Five are members, has been explicit that the stated clinical goal of psychological therapy should be employment. IAPTs, too, follow the same line, as Catherine mentions.

Counsellors and psychotherapists, who bring psychological perspectives to bar on public affairs, will understand that the proposals to locate ‘therapy’ in job centres will have (and has already had) a profound emotional impact. Counsellors and psychotherapists all know that the line between ‘suggestion’ and ‘compulsion’ is a very difficult one to demarcate. Vulnerable people can and often do say ‘No’ to what they believe will damage them, no matter how well intended. But, as therapists, shouldn’t we be concerned at what a false compliance does to the emotional state of an individual going through a difficult time?

Returning to the suggestion I flagged up in my opening paragraph, how about BACP convening a Stakeholders’ Meeting at which these matters can be more deeply explored. The Big Five plus the 17 smaller organisations would be at the core of such a gathering. Whether the Department of Work and Pensions would attend is something to discuss.

Andrew Samuels

Professor of Analytical Psychology, University of Essex; former Chair, United Kingdom Council for Psychotherapy


Note 1

The organisations referred to are: Mental Wealth Foundation, Mental Health Resistance Network, Disabled People Against Cuts, Recovery in the Bin, Boycott Workfare, The Survivors Trust, Alliance for Counselling and Psychotherapy,  College of Psychoanalysts, Psychotherapists and Counsellors for Social Responsibility, Psychologists Against Austerity, Free Psychotherapy Network,  Psychotherapists and Counsellors Union, Critical Mental Health Nurses’ Network, Social Work Action Network (Mental Health Charter), National Unemployed Workers Combine, Merseyside County Association of Trades Union Councils, Scottish Unemployed Workers’ Network, National Health Action Party

Jobcentre Therapy: MWF exchange letters with the big Psy-Organisations

Following the Mental Wealth Foundation’s (MWF) letter to the five large psy-professions organisations, challenging their statement on jobcentre therapy and psycho-coercion, the organisations responded (see that response at the end of this blog).

The MWF replied on 12 April 2016, raising further issues and proposing a meeting for further dialogue. At the time of writing, this and other requests to meet face-to-face have gone unacknowledged.  Please read on for the full MWF reply…


From:

Mental Wealth Foundation

Mental Health Resistance Network; Disabled People Against Cuts; Recovery in the Bin; Boycott Workfare; The Survivors Trust; Alliance for Counselling and Psychotherapy; College of Psychoanalysts; Psychotherapists and Counsellors for Social Responsibility; Psychologists Against Austerity; Free Psychotherapy Network; Psychotherapists and Counsellors Union; Critical Mental Health Nurses’ Network; Social Work Action Network (Mental Health Charter); National Unemployed Workers Combine; Merseyside County Association of Trades Union Councils; Scottish Unemployed Workers’ Network; National Health Action Party

To:

British Association for Behavioural and Cognitive Psychotherapies; British Association for Counselling and Psychotherapy; British Psychoanalytic Council; British Psychological Society; United Kingdom Council for Psychotherapy

Professional bodies scrutinise Government therapists in job centres plans

Thank you for your response of 24 March 2016. We would like to reiterate our invitation to a dialogue around these issues. We are a unique alliance of 17 diverse organisations, representing clients, therapists, campaigners and academics with a unique breadth and depth of perspective. We would very much like to share this wealth of experience and expertise with you; and to understand your position better. We think your members would expect you to meet with us, given the very diverse range of organisations that have united in order to communicate with you.

We appreciate your assurances that you oppose as unethical any coercion or sanctioning connected with psychological therapy’s contribution to the government’s workfare programmes. We also welcome your statement that “[you] do not believe the role of therapists should be to get people back to work”, and that the therapeutic value of employment is conditional both on individual circumstance and the nature of any particular employment and its environment.

At the same time, we are aware that as members of the New Savoy Partnership four of your organisations have welcomed recent workfare proposals, have initiated collaboration between DoH and DWP on Health and Work pilots, and have invited Lord Freud as Minister of Welfare Reform to open a number of your recent annual conferences. Your ‘Joint Pledge on Welfare’  states:

“We welcome the opportunity the Work Programme provides to support more people with mental health conditions into appropriate and sustainable employment.  Specifically, we will develop our expertise to help people with mental health conditions find, enter and remain in employment.” (emphasis added)

We cannot see how your position differs in any significant aspect from that of the DWP and you seem to have allowed yourselves to be drawn into becoming active partners in the government’s workfare policies. We believe – and we know many of your members agree – that the “psy” professions are being let down by our professional bodies going along with government aims and schemes, instead of using their professional knowledge together with service user experience to influence the proper provision of therapeutic services in more appropriate settings, for the benefit of clients and the profession. Clearly your views do in fact differ significantly from ours. Isn’t this something better explored at a meeting?

Over recent months, dozens of adverts for DWP financed mental health advisor and employment coach posts have invited applications from people accredited by you, including as we have already pointed out, those in Therapy Today. These job descriptions are explicit that the role is to get people off benefits and into work. Our concern remains that no action has been taken to inform or protect your members or their clients about involvement in work of this nature which breaches ethical practice.

The top-down nature of policymaking causes alienation and distrust of government workfare policies with a reliance on expert think-tank research, “evidence-based” reports, and a reluctance to engage in any real collaboration with either service users or practitioners.   We are offering you an opportunity to do something different. We believe it is within your role and responsibility, as national professional bodies representing psychological therapies, counselling and psychotherapy in the UK, to hold open an independent arena of public debate on issues of national policy.

We believe your collusion with the government is now threatening to undermine the ethical integrity of the “psy” professions among service user/survivors and professionals. A year ago, our joint letter to the Guardian signed by 440 psychologists, psychotherapists and counsellors raised the alarm about the probability of mandatory psychological therapy coming into being through the co-location of IAPT workers in Job Centres. A year on, the development of Health and Work projects under the DWP’s workfare banner is promoting more, not less fear, demoralisation, and distrust among the members of the organisations the MWF umbrella represents.

As survivors and witnesses of the impact of these developments, we are compelled to act against welfare to work policies and associated government-sanctioned psychological coercion which harms service users and professionals alike. You didn’t reply to our call to cease engagement with the Government Joint Work and Health Unit, and to hold a national event where all stakeholders views can be heard. We would like our campaign to include open debate with the professional bodies whose interests must surely include upholding the ethical values of psychological practice, for the sake of all.

We look forward to your response to our offer.

 


Appendix

Letter from psy-organisations to MWF, dated 24th March 2016:

Dear members of the Mental Wealth Foundation,

Thank you for your letter,

It might be useful if we started by clarifying a number of points that we have made repeatedly to the Department for Work and Pensions. We do not believe that anyone should be coerced into therapy and would denounce any coercion or sanctioning in relation to ‘job centre therapy’. As a result of ethical concerns raised last summer around coercion and sanctioning in relation to ‘job centre therapy’ we, as professional psychological therapy organisations, immediately contacted the Department for Work and Pensions. We were also acutely aware of, and remain acutely aware of, the wider context of sanctions and cuts.

Work is not always good for people’s mental health and wellbeing and we too recognize that poor quality, stressful and insecure employment can be detrimental and profoundly damaging. We also do not believe that employment should be viewed as a universally beneficial health outcome. At the same time, however, good employment can help people, by adding security and purpose to people’s lives, thus enhancing their mental well being. There should indeed not be a ‘one size fits all’ approach and we do not support a policy of work as cure.

We share the view that clients should have their current needs, perspective and autonomy respected but we also make it clear that we do not believe the role of therapists should be to get people back to work. Instead, we believe that the role of the therapist should always be to work with clients to help them resolve their mental health issues. We also do not believe people should receive psychological therapy in an environment where they feel uncomfortable and we do not believe client’s privacy should be compromised.

It is nevertheless important to recognise that access to psychological therapy remains restricted and people are suffering needlessly because of this. It is also the case that rates of mental health problems among people who are unemployed remain unacceptably high. There are likely to be a multitude of reasons for this, from loss of sense of purpose, to the stresses of the sanctions regime – and we wish to see all of these factors tackled. Improving voluntary access to psychological therapy for jobcentre clients is therefore a policy which deserves proper consideration and as organisations which represent psychological therapists, we recognise that the provision of appropriate, voluntary, therapy can play a role in alleviating distress.

The DWP has repeatedly told us that there will be no coercion involved or sanctioning of clients who do not wish to enter psychological therapy. It has also said that clients will have
a choice of where they can access their therapy. We have also secured a promise of a thorough evaluation of their planned small-scale co-location feasibility trial, which should provide a clear indication of whether people’s health and wellbeing is genuinely being improved in both the short and the long term. We suggest it is prudent to review these evaluations before prejudging a project that could provide genuine help to jobcentre clients who experience issues with their mental health.

We also note that your letter conflates different projects. Our organisations are concerned with the provision of therapy to jobcentre clients. We are mindful that other projects have
been initiated in regard to the co-location of work coaches in GPs surgeries, and that other organisations have engaged in scrutiny of these projects. We do not believe we are the most appropriate organisations to comment on those proposals, given they do not involve therapeutic coaches or psychological therapy – which is why our joint response made no mention of those plans.

We would also ask you to note that any past job adverts for positions outside of our organisations should in no way be regarded as the official opinion of any of our organisations individually or collectively.

Yours sincerely,

The British Association for Behavioural and Cognitive Psychotherapies
The British Association for Counselling and Psychotherapy
The British Psychoanalytic Council
The British Psychological Society
The UK Council for Psychotherapy

The Alliance for Counselling & Psychotherapy

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