Alliance Meets the Shadow Minister for Mental Health

Report of the meeting between Luciana Berger, the Shadow Minister for Mental Health, and representatives of the Alliance for Counselling and Psychotherapy, 8th December 2015

Andrew Samuels, Jay Watts and Jeremy Weinstein met with Shadow Minister for Mental Health Luciana Berger MP on behalf of the Alliance for Counselling and Psychotherapy. This is the second time we have met with Luciana, and we congratulated her on her appointment and work in mental health. We then raised four areas of discussion.

IAPT

We asked if Labour would consider an urgent review of the Improving Access for Psychological Therapies (IAPT) scheme. We discussed the need for increased service user choice, given its effect on engagement and recovery. We proceeded to raise concerns about the planned roll-out of IAPT-SMI (IAPT for those with psychosis and so-called Personality Disorders), fearing that it will take precious resources away from already decimated secondary mental health services. Psychosis services in the NHS and voluntary sector already struggle to get financing to offer the long term services needed for those with the most chaotic lives; moulding services into an IAPT outcome-obsessed shape will work against these clients who demand heavy investment of time and patience. This is because winning an Any Qualified Provider (AQP) contract demands showing quick, efficient treatment with good outcomes creating a desire to cherry pick cases which look good on paper. This would leave those most in need of society’s help without services.

Lastly, we provided a rereading of the figures on IAPT, showing the hundreds of thousands who are referred but who never experience a reliable recovery. We emphasised how being referred is not a neutral act, but brings a disappointment if no help is then available. Most importantly, we emphasised that IAPT has had an effect on the widespread closure of other services – especially for long-term psychotherapy – with organisations like MIND working increasingly from an IAPT model, leaving those with the most distress alone. Luciana shared her concerns about the effects of IAPT on wider mental health provision, and mentioned her recent visits to innovative crisis and day centres in precarious financial straits. She noted that she had asked a Parliamentary Question on the numbers who get referred but never actually receive a therapy, and registered our demand for an urgent review of IAPT.

Alternative Sources of Funding for Talking Therapies

We spoke to Luciana about the erosion of long-term and in-depth counselling and psychotherapy of a relational nature, both in the NHS and voluntary services, giving examples of innovative service provision which we can ill afford to lose. Of particular note, we emphasised that a two-tier system is emerging whereby the poor and disenfranchised have access to a very brief, highly manualized form of treatment (at best) – whilst the middle-classes who have resources continue to access and benefit from traditional counselling and psychotherapy. We were glad to note that Luciana agreed this is highly problematic, socially divisive and against Labour Party principles. The Alliance suggested various ways of tackling the problem with minimal cost including the provision of a small budget to inject into existing and new services for counselling and psychotherapy.

Social Work Action Network Mental Health Charter

We presented the Charter, explaining its identification of key problems such as the crisis facing service users, the role of the market, and the preoccupation with negative risk. We told Luciana about the support the Charter has received from a number of campaigning organisations such as Disabled People Against the Cuts (DPAC) and other service user led organisations, as well as practitioners involved in the Critical Mental Nursing Health Nurses Network and Psychologists against Austerity and, of course, the Alliance. Most importantly, we emphasised the positive steps of redress suggested in the Charter, including a renewed emphasis on User-run services, and the importance of hope. We hoped that the Charter’s vision might be incorporated into Labour policy on mental health.

A National Debate on Mental Health

The Alliance argued that the UK desperately needs Labour to initiate a new debate on the causes of ‘mental health’ and ‘mental illness’ based on the considerable evidence that there is no biogenetic cause of mental distress. There is a need to challenge all that might be depicted as ‘the medical model’. We argued that evidence shows us that human suffering is shaped by the society we live within, impacted by factors such as austerity measures, the breakdown of community and increased individualization at the expense of social cohesion. Luciana agreed that there is a fundamental problem with the language around ‘mental health’ and ‘mental illness’ and herself used the example of changes in the language in which suicide is discussed.

The Alliance suggested categories such as ‘anxiety’ and ‘depression’ are deeply problematic, and presented evidence that the public prefers stigma-busting campaigns based on psychosocial understandings of distress as opposed to illness models. We suggested that reshaping the narrative to include the importance of community, helping one another, listening and a relational  understanding of the self and soul fits with core Labour values.

We then all discussed how innovative projects based on community models of mental suffering could not only save money, but inspire different ways of viewing the self away from the national purse. Luciana informed us of details of the Opposition Debate on Mental Heath the following day. She stated that she appreciated our time and input, and welcomed on-going contact between the Alliance and the Shadow Ministry.


Report by Professor Andrew Samuels, Dr Jay Watts and Jeremy Weinstein (on behalf of the Alliance for Counselling and Psychotherapy)

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Soundings #2: Nobody heard him, the dead man, but still, he lay moaning…

Friday June 26, 2015 

There is a meeting today at 1.30pm at the Streatham Memorial Gardens. I shall be there early. The meeting will gather together a group of people, perhaps 100, maybe more judging from the Facebook page, who will then march up the road, not far, to the Streatham Job Centre. It is a mark of our varying dissatisfactions with the Government’s idea to put CBT therapists in Job Centres in a supposed attempt to get people ‘off the dole and back to work’.  

What a beautiful day for a protest, the roses are blooming and the birds are singing. I barely have time to look at the statue with its inscription To Our Glorious Dead and the list of names inscribed below – it’s 1.15pm and already there are 12 people standing in the shade of the trees, and two are holding up a banner which the other ten are photographing. The gist of the banner is this: ‘CBT practitioners: are you a professional or a collaborator?’ 

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I set to work introducing myself and asking people why they have bothered to come today. 

“It’s a human right to be able to refuse medical treatment. To not be made to be part of an experiment. It’s written in the UN Declaration of Human Rights.”  

“I’m just gutted. Council Houses, Brixton Arches, rent increases, everything.” 

“I want to support people facing cuts to their allowances. I have friends with distress who are scared by the way things work.” 

“It seems a really bad idea to combine a disciplinary system with social care.” 

The next person turns out to be a national spokesperson for the Green Party:

“the Government is crossing a line – it’s written in their Manifesto, their intention is clear. Don’t believe them when they say there’s no coercion, it’s written in their Manifesto.” 

And others:

“Its an inappropriate setting – it is not a place to speak freely, which it should be for any therapy”. 

 “It’s wrong to make a mental health service part of a sanction system.” 

“To cut public spending, they are hitting the most vulnerable.” 

“It’s clearly wrong.” 

“Mental Health isn’t something you can flick a switch and fix”.

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“The problem, in my opinion, is that we live in a system which makes us ill – unemployment, poverty. Actually I’m doing therapy, CBT, over there [points just over the main road which is throbbing with traffic fighting its way into the narrowing Streatham High Road]. The services become part of the problem. They mean well, the people who work there, but it’s done in a way that, well you are made to feel uncooperative if you turn it down. And the political, social situation is not up for discussion – these are the things we really need to talk about if we are going to get better.”  

“The problem with CBT is that it makes you the problem, and tries to change your attitude.” 

“Debt. Struggling with debt leads to suicide.” 

“I’m horrified, instead of funding mental health services in clinical settings, I had to wait six months for CBT – why not fund it more in places where people actually go to talk about their health?” 

“My girlfriend is terrified, and has taken on the language of officialdom. She says that she is a ‘shirker’! She is terrified of psychiatrists, of the ways of the medical system. She feels like a terrible burden on everybody. She has been invited to go to job centres, I go with her, but she panics in waiting rooms, and she panics when she sees the security guards – it freaks her out. She was on DLA, and they said ‘would you like to work?’, and she said ‘Yes, I would like to work!’ and they said ‘we will help you to go to work’. So we went there together, I held her hand, she wanted to work, but her expectations were really unrealistic.” 

“Its funny, they speak of parity don’t they, of parity between mental health and physical health. So, if you break your leg and can’t work, will they send you to the job centre to fix it?” 

“It’s about dignity. My partner has worked, she has paid her National Insurance, she has contributed, but now she has taken on their vocabulary, she calls herself a burden…” 

“Treatment should be voluntary. If the Job Centre should suggest that people go to the Doctor, well, are they qualified to tell people to go to the doctor? If I was working in a Job Centre I would be very uncomfortable raising it with people, because you have to be very diplomatic when you suggest to someone that they might need counselling. Even when your friend says so, you might feel offended! I mean, you have a personal relation with your job centre advisor when you are unemployed, you don’t want them prying into your personal life, do you? You have to be careful if you speak to someone about their mental health, it could be negligent to raise the question, it is a bit like the oppression we associate with Russia. When I was unemployed you had to sit in an open plan office every day for two weeks, and look for work. There were people who lectured you about looking for work. There were a lot of vulnerable there then. Imagine if you had to raise the question of mental health with someone who is clearly in distress and struggling. It could be negligent, are the people in the job centre qualified?” 

“How dare they take food away from someone, it’s against Human Rights.” 

“It is a symptom of our civilisation’s discontent, and therefore, worth punctuating. It might not be necessary, never mind possible, to remove it.” 

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By this time there were about 60 people gathered in the Memorial Gardens, some holding placards and banners and others taking photos. I asked one man what he planned to do with his photos. It turned out he was a freelance photographer commissioned by the South London Press to cover the demo.  

Two women picked up the sticks to the Alliance for Counselling and Psychotherapy banner. They were sisters, and they had another sister with a learning difficulty. They told me that they were ‘watching’ and ‘listening’ to what was happening in the country with the politics, and she said, we have noticed that ‘they go for the weakest first’.  

Now we start slowly to muster together and walk across the road. A bloke rolled down his lorry’s window and shouted, “Get outta the fucking road, go get a fucking job”.  

While we edge ourselves in amongst the traffic and saunter up the main lanes of the road, I recognise someone who used to run a psychotherapy service in one of the big London hospitals. “I used to be head of psychotherapy” he said, “and I would have been raising hell against a move like this made by the management”. Who’s the head of therapy now? I asked. “A CBT guy”, he replied with a rye smile. And is he raising hell against this new policy? A derisive laugh was all that I could hear of the reply amongst the roar of the traffic and the shouts of the London drivers, who only wanted to move fast and not think about us.  


The paradox had not escaped her, so how had it escaped our civil servants and government ministers?


Someone next to me said that she was concerned about therapy being put next to the Job Centre function because “it puts fear into people’s minds,” then added, “which is not desirable.”

“It is the very thing isn’t it, fear,” she went on. “This is what CBT people try to resolve, isn’t it? Yet the people who might need it most would be the ones most vulnerable to exactly this kind of fear.” The paradox had not escaped her, so how had it escaped our civil servants and government ministers, one wonders?  

People with a microphone are raising our spirits with their strong voices. There is a discreet police presence up the hill, and down the hill, and the security guards in the building are checking people’s ‘tickets’ before letting any one in. Too late! An advance guard has snuck into the building and is creeping up the stairs as we listen to the man with the mic doing his best to rouse the rabble. A few people take it in turns to move the crowd through the mic, and then a cheer goes up, and everyone moves to the other side of the street and looks up at the top floor of the building. A large red banner is unfurling in the wind with the words ‘Back To Work Therapy Is No Therapy At All’. It is now 2.30pm. 

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Someone with the microphone is haranguing Ian Duncan Smith and talking about the suicides of people who have lost their benefit, and I remember Stevie Smith’s (no relation) wonderful poem ‘Not Waving, but Drowning’: Nobody heard him, the dead man, but still he lay moaning

Nobody heard him? We can hear him because he is not yet fully dead, only half dead, still moaning. Threatened and pushed out of the symbolic order, off the benefits, deprived of a means to live with his dignity, turned into an object, treated as any old piece of rubbish, but not yet dead. Not yet.  

In April 1953 Stevie Smith wrote her poem Not Waving but Drowning. On 1 July 1953 she self-harmed in the office and her doctor decreed that she is not emotionally stable enough to go back to work. She was retired with a small pension, and dedicated her life to writing and looking after her ailing aunt. In 1957, the publication of her collection under the heading Not Waving but Drowning established her firmly as a major poet worldwide and opens a new life for her of poetry readings and broadcasts. She soon becomes a cult poet and is sought after by the likes of John Betjeman, Philip Larkin and Sylvia Plath.  

Should we, perhaps, rather put poetry into Job Centres, and save the CBT for somewhere more fitting?


Nobody heard him, the dead man, 

But still he lay moaning: 

I was much further out than you thought 

And not waving but drowning. 

 

Poor chap, he always loved larking 

And now he’s dead 

It must have been too cold for him his heart gave way, 

They said. 

 

Oh, no no no, it was too cold always 

(Still the dead one lay moaning) 

I was much too far out all my life 

And not waving but drowning.

 

Stevie Smith

Alliance Newsletter – June 2015

Dear colleagues,

We have decided to circulate a brief newsletter following-up on the issues raised in our recent Open Letter to the Guardian, which has been shared over 6500 times, along with other related developments in the psy field.

• Psychological therapy located in Jobcentres

Following our Guardian letter, a group of therapist, psychologist, disability and social security benefits campaigners met in May to discuss working together to protest at the prospect of coercive therapy and mental health treatment being located in Jobcentres.

The meeting supported the Mental Health Resistance Network’s open letter on the issue, as well as the protest at Streatham Jobcentre Plus on Friday 26th June. Please take a look at the Open Letter and circulate it among interested colleagues. Join us on the 26th if you can. Also see the MHRN Facebook page for newsreel coverage of campaigning around DWP policies and mental health.

There has been considerable media and professional response to the growing thrust by the Government to link social security benefits, mental health and IAPT style psychological therapies within the toxic context of Jobcentres, WCA’s and benefits sanctions. See, for example, this excellent piece by Lynne Friedli and Robert Stearn. Professional bodies are beginning to publicly address the ethical issues raised by “get to work” therapy – e.g. BACP, BPS.

The Alliance is building a resource and news update section on its website on this issue, and will circulate links when it is available. Meanwhile, please contact us with any developments, ideas and relevant resources from your networks: info@allianceforcandp.org

March Against Austerity

The Alliance is joining the People’s Assembly march against austerity in London this Saturday – 20th June – under its new banner. Join us at 12 noon outside Jo Malone, 24 Royal Exchange Building, at Bank.

Big Issue(s) Conference organised by Psychotherapy and Counselling for Social Responsibility – 26th September

This PCSR conference is intended as an opportunity for practitioners to express their concerns about the current direction of counselling and psychotherapy, and discuss plans for action. Take a look at the programme for the conference and its booking form here.

Best wishes,

The Alliance

Nailed: Tory lie on suicide rates and austerity

Dear friends and colleagues,

The question of mental health under the previous government’s austerity policies has taken a vital new twist. Please find a new press open letter touching on this in Monday’s Guardian, here:

http://www.theguardian.com/politics/2015/may/03/us-and-british-health-specialists-support-the-nhs

In the accompanying newspaper report, we read that,

…A [Conservative] party source added: “Every suicide is a tragedy, but the latest available data shows that the rate is now the same as in 2003 and has been relatively stable during successive governments in the intervening period.”

The following rebuttal appears in today’s “i” newspaper (not available online):

SUICIDAL POLICY

Having announced their £12 billion of welfare cuts nearly two years ago, any responsible government would have long since devised clear plans for implementing them (6 May). The Conservatives are also being equally disingenuous about the impact of their austerity policies on Britain’s suicide rate, having recently publicly denied that there has been any spike in the data. This denial flies in the face of all the empirical evidence. Extensive international epidemiological evidence shows a clear and consistent causal link between austerity policies and suicide rates. With the Conservatives returned to office and these cuts imposed, Britain’s suicide rate would soar to previously unheard-of levels.

Dr Richard House – Chartered Psychologist, Stroud; Alliance for Counselling and Psychotherapy

Could you please circulate this far and wide to all your contacts ASAP, and ask them all to do the same… That way, we can maximise the extent to which voters know about this scandalous issue before voting today.

Thanks once again for your much-valued support of our initiatives on this crucial issue.

STOP PRESS: Important news re: deaths linked to ESA. Please share:

http://www.disabilitynewsservice.com/election-2015-greens-demand-ids-apology-for-misleading-voters-on-benefit-deaths/

http://www.disabilitynewsservice.com/dwp-told-to-publish-esa-deaths-report-after-two-year-delay/

‘Like an Open Sky’ documentary

Like an Open Sky – a beautiful documentary by Marian Otero – is a fantastic testimony to children struggling with mental and social difficulties, and the adults who try to understand them.


film

Film maker Mariana Otero wanted to make a documentary about madness, and spent a long time visiting institutions looking for a place to film in. She wanted to find an institution which treated children as subjects, not as objects. Eventually she found one – Le Courtil, on the border of France and Belgium. The film focuses on a small group in one part of the institute. However, the institution is in fact very much larger – it was set up 30 years ago, and has enjoyed a steady growth and welcomes many children who come to it, even, from France. This makes the institution rather popular with the Belgium government, as they see that their investment in the work acts as an ‘export’!

The director spent about a year at the institution before she even strapped on her camera, and you can see how this has helped both staff and children to be at ease in front of the camera. It is clear that some of the children really welcome her and make use of her as part of their experience at the institution. In fact, this becomes the subject of one of the staff meetings that we watch, which discusses the way that one of the children (Alyson) makes use of the gaze of the camera to ‘not fall down in front of’.

Mariana follows the children into the music workshops, the ‘pretend’ workshop, she watches as they cook in the kitchen, or dig and plant in the garden, she accompanies them on a trip to the shops, and into the intimacy of their rooms, and she also follows the staff into their staff rooms and meetings and listens to them animatedly discussing their work via their theoretical ideas. On a night shift, the film-maker asks a worker to explain the difference between neurosis and psychosis, and as the mini-lecture unfolds, you hear him explain the way that the staff work and why they are careful not to make demands on these children.

The film is by turns funny, touching, fascinating and inspiring.

You can read more about the film here, buy a DVD here, read the book of interviews arising from the making of the film here, and watch the trailer here. Details of a community cinema screening on 14 March  in London SE27 are here and on Facebook here.

PCSR & Alliance September Conference Announcement

THE  BIG  ISSUE(S) – Addressing the Crisis in Psychotherapy and Counselling


An invitation from Psychotherapists and Counsellors for Social Responsibility and the Alliance for Counselling and Psychotherapy to a day conference at Resource for London, Holloway Road, London N7.

Saturday 26th September 2015 – 10am to 5pm. Donation: £10 in advance, £20 on the door.

This event is intended as an opportunity for practitioners to express their concerns about the current direction of counselling and psychotherapy, and to discuss plans for action. If you care about the future of counselling and psychotherapy, please come!

More details and booking form here

BACP’s Ethical Framework Revisions – The Emergence of State-Endorsed Therapy?

I want to talk about what is happening within the British Association for Counselling and Psychotherapy (BACP). I want to put it to you that what is going on there represents a shift towards “state endorsed therapy”.

I use the phrase “state endorsed” to draw attention to the fact that these proposals are designed not by government, or by one of its arm’s length agencies, but by one of our own professional associations. I want to make a separation between this and “state approved therapy”, a term that has been applied to the delivery of therapy under the banner of IAPT (Improving Access to Psychological Therapies). There the format and structure are, to all intents and purposes, laid down by the state itself.

BACP is in transition. In February 2013 its register of counsellors and psychotherapists was endorsed by the Professional Standards Authority for Health and Social Care. In December 2013 the BACP Board of Governors decided to align its membership structure to the BACP Register. By April 2016 all members will either be registered or en route to becoming so. In April 2014 BACP began a consultation with its members on professional ethics. This consultation closed on 28th November and its revised Ethical Framework will come into force in January 2016.

Until this summer BACP had not undertaken a thorough review of its ethics since the late 1990s. In April, May and July this year it ran three 2½ hour webinar seminars on Saturday mornings.

To give you an idea of what this involved, on each of these Saturday mornings there were two half hour presentations by Professor Tim Bond, Emeritus Professor of Professional Ethics (University of Bristol). There were questions from the live audience and there were panel discussions before and after each presentation. The presentations themselves were accompanied by a split screen PowerPoint display so you could read as well as listen to what was going on.

The impetus for changing the Ethical Framework comes from a variety of sources. There have been those developments in theory, in research and in the law that one might expect – and there has also been a quantum leap in computerisation. The most important changes though are connected to the abuse of trust. There have been a whole string of celebrities who have been exposed – Jimmy Savile, Rolf Harris and the rest; there’s been the Winterbourne View care home scandal where residents were physically abused by staff; and there’s the Mid Staffordshire hospitals scandal where perhaps 300 or more people died unnecessarily.

Most importantly there have been the two Francis Reports. One published in 2010 was some 2,000 pages long and dealt with what went wrong in Mid Staffordshire. The other, published in 2013, is half that length and is about how to prevent it happening again.

Robert Francis QC wanted a change of culture in the NHS, but his proposals have been taken up not just by Government but by local authorities, trades unions and professional associations. His reports are changing the whole landscape of health and social care.

In brief Francis is demanding that, when things go wrong, managers must be much more active in setting about remedying matters. They can no longer receive a complaint, set up an enquiry and then sit back and wait for it to report. The impact of the Francis Reports was most apparent in the second of these webinar seminars which proposed major changes to line management and supervision – and these changes need to be understood in the context of two notions which had been previously floated in the webinar presentations: (a) that therapy can be conceptualised as a product, and (b) that supervision can be thought of as part of a quality assurance system.

Not surprisingly, I was more than a little taken aback when I heard these comments.

To the specific proposals and their implications –

  • All clients to be informed by their therapist of the name of their supervisor.
  • The jobs of both therapist and supervisor to be defined as operating in the “best interests” of the client.
  • Supervisors to be required to keep records to show that they have acted in this way.
  • These records to demonstrate that each client of each of supervisee has been spoken about at each supervision session and that the supervisor has, in each case, acted in the client’s best interests.

The focus in this webinar seminar was squarely on the position of those in employment in the health and social care sector. The argument was that, as austerity bites and managers, like everyone else, are expected to do more with less and to new “post-Francis” standards, the position of employed supervisors will be in danger of being marginalised unless supervision can be demonstrated to have a direct impact on client outcomes.

But for me, as a self-employed supervisor working from home, the nightmare scenario was that, if my name is given to all my supervisees’ clients, because of the ease with which contact details can be identified via the internet, I will have to be prepared for the possibility of dissatisfied “customers” contacting me at any time of the day or night demanding that I intervene on their behalf to remedy whatever they happen to be concerned about. The pressure to “do something” will be inescapable and I am almost certainly going to get caught up in enacting something that properly belongs within the therapy itself.

But the situation is worse than this. If BACP is to lay down that there is to be a this direct link between supervision and client outcome and I’m required to keep records on all the supervision I do, I need to be mindful that anything I write may be trawled over by a lawyer in order to detect whether a case can be made Musgraveout that, at some point, I have failed to act in the “best interests” of his or her client.

What’s the likely outcome? Three things, I think –

In the first place there’s the danger of supervisors slipping into defensive practice. Secondly, the knock on consequence is that a surface level understanding of reflective practice will be further entrenched – instead of a reflective attitude lying at the heart of good supervision it becomes a kind of “add on”. Another way of putting this is to say that something will be taken away from the quality of attention I believe a supervisor needs to cultivate, who then acts a role model for each supervisee. Let me give some examples. For Freud the ideal state of mind for a therapist is one in which attention is “evenly hovering” or “evenly suspended”. Drawing on a very different body of theory, Carl Rogers identified six necessary and sufficient conditions for therapeutic change. In both cases there’s a focus that requires full attention – and, if this focus is absent or diluted, something is lost in the quality and depth of the work.


under the rubric of revising its ethics, BACP is apparently willing to accommodate its definition of good practice in counselling and psychotherapy to a shift in government policy


Taken altogether, then, what we have here is an impoverishment of supervision and therefore a constraint on supervisees’ learning about good practice. This is bound to lead, I would argue, to a narrower understanding of what in depth therapy is.

Moreover, in these webinar seminars BACP drew explicitly on an understanding of therapy that highlights its role in the alleviation of distress without any acknowledgement that any such understanding needs to be embedded within a contextual understanding concerned with meaning‑making. This is contrary to the research evidence, as Bruce Wampold showed in the meta-analysis he undertook for his book ‘The Great Psychotherapy Debate’, where he carefully examines the results of thousands of outcome studies.

What puzzled me deeply about these proposals for change is that they appeared to run counter to BACP’s traditional stance, which is to position itself as a broad church and so maximise its chances of dominating the field. So, I suppose, it’s not surprising that, when BACP circulated a revised draft early last month it had made changes.

The emphasis on supervisors keeping records of each supervision session was limited to a general obligation to keep records appropriate to the service being provided. And the duty to tell each client the name of your supervisor has been dropped completely.

But what, you may say, are we to make of all this? Should we be pleased that BACP is responsive to feedback? Or should we be alarmed at the extent to which, under the rubric of revising its ethics, BACP is apparently willing to accommodate its definition of good practice in counselling and psychotherapy to a shift in government policy?

At a BACP meeting I attended in September it was claimed that the original proposals were simply possibilities that were being floated rather than serious options. Shades here of Nigel Farage’s recent backtracking from a firm commitment to privatise the NHS (“We never really meant it anyway”, “It was just an idea we were floating”). But I think what we can say is that, in the course of these webinar seminars, we got some insight into what BACP would be willing to countenance.

So what is there in the latest draft of BACP’s Ethical Framework that still gives rise to concern? And to what extent is it still legitimate to be worried about a movement towards “state endorsed therapy”?

I think there is a good deal to be concerned about, but first we need to look more closely at the wider context and the kind of organisation that BACP is in the process of becoming. BACP’s mission includes wanting to be the leading body for counselling and psychotherapy in the UK. BACP was originally founded in 1977 as an educational charity open to anyone with an interest in counselling. Charitable status confers a patina of respectability and, under English law, all BACP’s activities must be charitable and wholly in the public interest so that any personal benefit accruing to members has to be “incidental”.

Yet at the same time BACP operates a trade association – in other words, it is a group, one of whose primary purposes is to attempt to influence public policy in a direction favourable to its members.

BACP’s membership has expanded rapidly in recent years. When I joined in 1992 it had 6,000 odd members. It now claims it has over 41,000. I think it’s pretty self-evident that people join BACP because they think it is an important step in advancing their careers. Is that, then, an “incidental” benefit? So how can BACP continue to be a charity? I have to hold my hands up here and admit I am completely bemused by what looks to me, a mere cottage industrialist, to be a mismatch between the theory and practice of how charity law works. But what do I know? Eton school, after all, remains a charity.

BACP’s Register is endorsed by the Professional Standards Authority for Health and Social Care. By endorsing Registers such as BACP’s the PSA has said it hopes to establish a gold standard for voluntary regulation in the area of health and social care – and thus obviate the need for statutory regulation. BACP has decided to align its membership structure to the BACP Register. By April 2016 its membership will consist of registered therapists or those on their way to becoming so.

This series of steps links membership of BACP back to the state and, I suggest, leaves individual BACP members more anxious than ever that they will need to comply with any requirements laid down by the organisation if their careers are to thrive.

One thing I think we can say is that, whereas in the past statements about ethics issued by BACP could be viewed as the distillation of a consensus about good practice that was derived from the field, matters are now more complex. In the October 2014 draft of its Ethical Framework, BACP is in some respects more prescriptive. Sometimes the requirement is straightforwardly normative – for instance, formally reviewing knowledge and skills in supervision – but elsewhere standardisation is embedded in the very fabric of the document. The argument seems to be that introducing standardised practices is a good thing because it makes matters more explicit and a greater degree of explicitness is the route to establishing greater trust between therapist and client. This is evident in the overarching structure of the commitment to clients, which frames everything that follows –

  • We recognise that our clients must be able to trust their practitioners with their well-being and sensitive personal information. Therefore we have agreed…that we will…

The detail then follows – for instance in paragraph 26 in the section on ‘Good Practice’ there are the new requirements about written contracts between therapist and client. In this way the building of trust is reduced to a standardised procedure.

The relationship between line managers and clinical supervisors is also specified in terms of procedures that have to be adhered to and reviews that have to be undertaken at least once a year in particular ways – again a standardised procedure. Here are some examples:

  • Where supervision is taking place alongside line management we will consider how responsibility for the different supervision tasks is distributed and will review how the allocation of these tasks is allocated at least once annually.
  • We will review the application of this Ethical Framework to the services being provided at least once annually.
  • We will clarify who holds specific responsibilities to our clients between the practitioner, supervisor and any line managers and review how well these responsibilities are working in practice. This review will take place in supervision as required and at least once annually.

Members are even required to be activists outside the therapy room:

  • We recommend supervision to anyone providing therapeutically‑based services, regularly giving or receiving emotionally challenging communications or engaging in relationally complex or challenging roles.
  • We will challenge colleagues or others involved in delivering related services whose views appear to be discriminatory

In other words – it’s not all bad!


BACP is abdicating its responsibility to assert what it believes is distinct about good practice in counselling and psychotherapy


Elsewhere in this document BACP is deliberately using vaguer language. Some of this is both badly phrased and, I want to say, provocative – for example, “we have agreed…that we will demonstrate accountability and candour by being accountable to you for the …effectiveness of services provided”

What on earth does this mean? Statements of this kind could prove a hostage to fortune, for instance when working with people who adopt a wholly passive attitude to therapy and expect their therapist to fix their problems for them without ever themselves really engaging in the therapeutic endeavour. I don’t think it would be hard for such an individual to use this paragraph in order to make a complaint.

BACP has been here before. In the mid 1990s the BBC’s Watchdog programme took what was then just the BAC (the British Association for Counselling) to task for not taking effective action against the comedian Bernard Manning who had joined BAC and then fixed a brass plaque to his wall announcing that he was a counsellor. BAC claimed this attack was unfair as they had no power to stop him and make him take it down – all they could do was expel him from membership. After that BAC redoubled its effort to gain statutory powers.

In offering to be accountable in this way is BACP setting things up for another media furore that will allow them to press Government for more powers? I wonder.

But there’s another even more significant matter, which is that BACP has deliberately put at the core of the 2014 Ethical Framework the notion that therapists will work in clients’ “best interests”.

Who defines “best interests” and from whose point of view? This is a notoriously slippery concept in law and here, I would argue, BACP is quite deliberately leaving it to the courts to decide what good practice is, I would say in line with what good practice is in the health and social care sector – as opposed to asserting what is special and different about therapy.

A statement asserting what is different about the professions of counselling and psychotherapy is something the courts could have reference to if they needed to consider whether therapists, and especially those in private practice, have different obligations in law from those in the state sector – they certainly do under the Children Act and for good reasons.

Here BACP is emphasising the similarity between therapy and health and social care rather than highlighting the difference –

  • Commitment  We recognise that our clients must be able to trust their practitioner with their well-being and sensitive information. Therefore, we have agreed as members or registrants of BACP that we will…. Put our clients first by making you our first and most important concern during our work together
  • Putting clients first  4. We will make each client’s well-being and best interests our priority whilst working together.
  • Working to professional standards  12. We will collaborate with colleagues to serve the best interests of clients.

In short, is BACP in this draft of its Ethical Framework, abdicating its responsibility to assert what it believes is distinct about good practice in counselling and psychotherapy in favour of inviting the courts to determine how counselling and psychotherapy sit within the overall thrust of state health and social care policy?

Looking into what’s going on in this kind of detail reveals the underlying thrust of the present revision of BACP’s Ethical Framework. If you want further evidence, look no further than the new title – ‘BACP Ethical Framework for the Counselling Professions’.

So there we have it – an organisation, whose mission includes being the lead body for counselling and psychotherapy, is subsuming both coaching and psychotherapy under such a heading – and is thereby marginalising both psychotherapy and in depth counselling whilst, at the same time, privileging a narrow definition of counselling that is actively not supported by the research evidence. Not only that, BACP is preparing to redefine coaching, psychotherapy and counselling as subsets of health and social care. And, whilst claiming that this is a review of ethics, BACP is overtly (as was quite clear in the webinar seminars) redrafting those ethics in order to seek to protect members’ jobs – and, I would argue, promote itself and curry favour with Government.


By Arthur Musgrave. This blog was originally a conference presentation for the Universities Psychotherapy & Counselling Association (UPCA), November 2014. For Arthur’s detailed account of the BACP consultation process, see: https://arthurmusgrave.wordpress.com/2014/11/12/the-british-association-for-counsellings-2014-consultation-on-ethics/

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