Three of the large therapy organisations – the British Association for Counselling & Psychotherapy (BACP), the British Psychoanalytic Council (BPC) and the United Kingdom Council for Psychotherapy (UKCP), collaborating under the banner of the SCoPEd (Scope of Practice & Education) project – recently published a draft ‘competence framework’, which attempts to differentiate counselling and psychotherapy.
Andy Rogers (BACP member and counselling service coordinator in further and higher education for two decades) submitted the following response to BACP’s consultation survey.
It is astonishing that the SCoPEd project claims this document will improve clarity for clients, employers, trainers and other stakeholders. I can only assume the competence framework exists for other political purposes, because there is certainly no clarity here, which might be forgivable if the document was at least more truthful.
But, as one of a number examples of the confused (unintentional?) deceptions in this framework, it is completely erroneous to identify 3.5.c (Ability to negotiate issues of power and authority experienced in the inner and outer world of the client or patient as part of the therapeutic process) as a ‘psychotherapist’ competency (one therefore presumably not held by mere ‘counsellors’), when for any person-centred counsellor worth their salt, this would be a central principle of everything they do! The same could be said of another ‘psychotherapist’ competency, 5.1.c. (Ability to evidence reflexivity, self-awareness and the therapeutic use of self to work at depth in the therapeutic relationship and the therapeutic process).
These examples demonstrate how formal differentiation between the adopted titles often means the imposition of something (i.e. simplistic, hierarchical separation and compartmentalisation) that isn’t actually there in practice among the human beings entering into therapy as practitioners and clients. In reality, there is much fluidity and complexity, which the framework attempts to iron out by positioning psychotherapists as doing the really deep stuff, counsellors as merely dabbling, and then a mysterious in-between group that does more than the basic counsellors but isn’t quite at the psychotherapist level.
“it is not the practitioner’s title that determines what happens in the therapy relationship.”
As most of us know, these levels – assumed in the document to be clear-cut enough to be separated into columns and boxes – are manufactured. At best they are only partially truthful, some of the time, in some situations, for some individuals. They certainly do not accurately represent the field, within which many practitioners who identify as counsellors will see their day-to-day work in the ‘psychotherapist’ column; while there will be plenty of ‘psychotherapists’ who have not yet developed the depth of practice (if we describe it that way) of some ‘counsellors’. After all, it is not the practitioner’s title that determines what happens in the therapy relationship.
That we end up working under one label and not the other is subject to all sorts of choices, influences, values, historical precedents and contextual factors, and often says little to nothing about what the experience of therapy will be like for clients, which could be vastly different between any two ‘psychotherapists’ or any two ‘counsellors’. For a whole swathe of the field, such as the humanistic section – and particularly in person-centred therapy – there is no distinction at all made between ‘counselling’ and ‘psychotherapy’ in terms of the actual work (which this framework purports to articulate); the different titles merely refer to the traditions and histories of various training programmes, professional organisations/groupings and work contexts (and the job titles therein).
“When did therapists become so uncritically disengaged from the roles of history and power in the narratives we hold about ourselves?”
The therapy field is a diverse and complex ecology, which, rather than celebrate, the framework appears to want to eliminate by reasserting hierarchies that are well past their use-by date. A historical aside here is that counselling as an alternative word for psychotherapy has roots in Carl Rogers’ mid-twentieth century tactical switch from the latter to the former at the University of Chicago, which was necessitated by a law that ‘psychotherapy’ could only be practiced by medical professionals. From the very beginning of ‘counselling’, then, the different words were not functional descriptors of differing activities, roles or levels of ‘competence’, depth, ability, skill or experience but were value-laden, politically charged and subject to the operation of power and professional (self-)interest. This is no less true today, but the SCoPEd project is in complete denial about it. When did therapists become so uncritically disengaged from the roles of history and power in the narratives we hold about ourselves?!
It’s notable in sections of the framework that ‘psychotherapist’ is apparently equated with greater alignment with psychoanalytic theory. Is the field not done yet with this power struggle, with the idea that psychoanalytic theory sits at the top of a hierarchy? The ‘note on terminology’ almost acknowledges this tension but concludes, absurdly, “Where terminology has been used that could be interpreted as being modality-specific, this is not the intention.” Oh, that’s okay then – it’s the thought that counts, eh? Being ‘expert’ therapists, I thought the Expert Reference Group (ERG) might have a bit more to say about the importance of language and the power that runs through it, looking beyond stated intentions towards the deeper meanings and influences when we choose one way of saying something over another (especially in a potentially influential document such as this). No?
I was also wondering how this apparent pro-psychoanalytic bias – with its implicit discrediting and delegitimising of humanistic/existential/person-centred counselling/psychotherapy (and their associated values, not least around language) – came about. Then I noticed the ERG was made up of 12 practitioners, 7 of whom were identified as psychoanalytic, whereas only 1 was clearly identified as humanistic (and even then, only as part of an ‘integrative’ model) (see pp.72-73 of the SCoPEd Methodology document). How can the framework produce an accurate picture of the field, when the ERG does not represent the diversity within it?
But the whole project is also skewed by other assumptions and value systems around therapy, which are perhaps even more important for the future of our professions. The Roth/Pilling UCL methodology used here was developed originally by manualised CBT proponents for the CBT competence framework, which was commissioned by the Department of Health as part of IAPT’s development. As this history suggests, breaking down the relational art of therapeutic work into lists of discrete ‘competences’ is not a neutral or objective activity (however ‘evidence-based’ it disingenuously claims to be); it is a technocratic pursuit that clearly derives from the NHS-appeasing assumption that therapy can be manualised into specific skills that, if applied in accordance with the manual, provide ‘effective’ ‘treatment’ for specific ‘disorders’. In other words, the project inevitably – via its very form – aligns therapy with an instrumental and medicalised healthcare model, again potentially delegitimising approaches that see therapy as, say, a meaning-making dialogical encounter or principled way of being.
That none of these biases or agendas, and the political expediency from which they spring, are acknowledged in the framework, highlights its failure to take a therapeutically informed, self-reflective, critical thinking approach to its own motivations, intentions, guiding principles, methodology or articulation. Presumably none of this matters much if your goal is to air-brush the imperfect, fallible, human complexity of relational therapeutic work, in order to prepare for the distribution of power that statutory regulation would involve for the organisations that have composed this empty but highly potent document.