Tag Archives: AVR

Regulation, professionalism and cultures of dominance

The government has published a consultation document, Promoting Professionalism, Reforming Regulation. Although the paper does not mention counselling and psychotherapy directly, it does ask questions of, and propose changes to, the current system under which registers of counsellors and psychotherapists are accredited by the Professional Standards Authority (PSA).

In 2011, the Alliance cautiously welcomed the PSA system as an alternative to an earlier proposal to regulate counsellors and psychotherapists under the Health & Care Professions Council (HCPC), a plan we – and thousands of other practitioners – strongly opposed.

As we start to make sense of the current discussions, in which some in our field are already pushing again for state regulation while seeking to further align therapeutic practice with healthcare, we share as food for thought one submission to the consultation from long-term regulation-watcher and Alliance participant, Denis Postle.


Promoting Professionalism, Reforming Regulation: Consultation Submission from Denis Postle, ARCA

January 20, 2018

“How could the dominance cultures of the professional psychological organisations, however well intentioned, make reliable, just adjudications of the dominance misbehaviour of alleged errant members?”

I have been a practitioner of group facilitation, personal development training and therapy in the Humanistic Psychology and Human Potential traditions since 1985. In 1995 I was a founder participant of the Independent Practitioners Network (IPN) and for me this continues to be a dynamic way of sustaining practitioner civic accountability. This is not an Independent Practitioners Network response.

Over the last 20 years I have taken a detailed and sustained interest in the ongoing processes of regulation of the psychological therapies, publishing a considerable  amount of material on the internet via eipnosis: a journal for the Independent Practitioners Network  and two books, plus participation in several others.

As I will outline below, the more I saw of mainstream counselling and psychotherapy institutions in this time, the less I was inclined to be associated with them; this perspective is thus of an outlier. IPN emerged as a response to what was perceived as inadequate forms of civic accountability in the psychological therapies.

2.2  ………As the HCPC has traditionally been the regulatory body to assume regulatory oversight of new groups, it could be seen to have a vested interest in expanding its registrant base. We therefore believe that the PSA, working with relevant stakeholders, would be better placed to provide advice on the regulation of professions

During the abortive process of taking counselling and psychotherapy into regulation by the HCPC, then just HPC, I had extensive contact with its chief executive, Marc Seale, and attended and reported on a substantial number of events and meetings there. I became convinced that, then or now, for the HCPC to regulate psychotherapy and counselling would be as inappropriate as putting the Royal Ballet under the control of the Sandhurst military academy. The HCPC knew how to ‘grasp’ but had no capacity for ‘holding’ the nuances of the practice of counselling and psychotherapy. Happily the HCPC’s coercive, prescriptive approach to this task failed and should not be revived.

I attended many of the early foundation meetings of the PSA and its cultural grasp of regulatory tasks was notable for its more participative, cooperative stance.  I regard it as a least worst option.

Promoting professionalism, reforming regulation

The text of the departmental statement under this headline, as so often, appears to make a presumption that psychotherapy and counselling are some subsidiary of medicine, i.e. they consist of ‘assessment’, followed by ‘diagnosis’ and ‘treatment’ of ‘patients’. This hegemony of the medical paradigm and the assumption that how medicine is regulated can transfer to the psychological professions continues to defy constant challenge from critical practitioners. It is perhaps a key vehicle through which harm to people in need continues to be enacted.

There may be a small place in the diverse cornucopia of the psychological therapies for biomedical treatment using zero responsibility elixirs but the overwhelming basis of psychological work is relationship. This means that there is an intrinsic element of risk, and insofar as  regulation has sought to make this disappear, it has tended to make professional practice defensive. How can this be in the public interest?

Risk can and should be minimised, to do this successfully would seem to  mean there was comprehensive evidence of the actual amount of harm that was prevalent in the psychological therapies. I and colleagues I have consulted are not aware of any such evidence.

Witnessing the regulatory shenanigans over the last 20 years in the UK convinced me that ‘Professionalism’ in the psychological therapies is comprehensively compromised in ways that this consultation seems unaware of.

Some perspectives that may be relevant:

The psychological therapies can be seen as an extractive industry. Practitioners work with clients, they accumulate in professional journals the insights that emerge; there is parallel input to trainings, supervision and professional conferences, where the extracted knowledge is refined  and fed back into practice. This tends to be a self-referential elite activity, the psychological knowledge does not diffuse significantly into society. One result of this elite grasp of work with the human condition amplified by the pathologising of instances of common human distress, has been the generation of stigma. As a result, and especially in the current climate of economic ‘austerity’, access to professional psychological knowledge typically requires a crisis.

For the industrialised psychological therapies, regulation has multiple benefits. It supports the creation of professional walled gardens of therapeutic practice membership of which is restricted in ways that generate unnecessary scarcity. The walled gardens are also professionally and economically in competition with each other and have often seemed more concerned with status and protection of the profession than of enriching and empowering the population at large.

Due perhaps to the medical paradigm that shaped early development but also because of an overly self-referential professional culture, access to these professional walled-gardens tends to be excessively expensive, unduly lengthy and with inappropriately complex academic content. Where is the evidence that, apart from the economic benefits to universities and training institutes, and enhanced professional status, a Masters or a PhD is a requisite education path for sitting alongside people who are struggling with human condition difficulties?

2.9  ……….In addition, the Law Commissions recommended that regulatory bodies be given powers to operate a form of negative register through the use of prohibition orders for those groups not subject to statutory regulation. Such a scheme allows individuals to be barred from practising a specified profession or from carrying out specific activities and would set the standards required of a certain occupation. Where these standards were not met in a way that places the public at risk of harm, the relevant regulatory body would issue a prohibition order that would prevent or restrict an individual from carrying out a certain role or providing certain services.

This is perhaps the most important issue of the consultation.

I see no problem with a person convicted by a court of abuse or fraud being included on a public register of such offenders. The key to this is ‘convicted by a court’.

Inclusion on such a list of people found guilty of abuse by the professional bodies that are presently under the wing of the PSA would be unacceptable.

Three reasons for this:

1. In my experience of the behaviour of some people in the psychological professions, there will likely be a witchhunt of practitioners like myself who are on, or just outside, the margins of the regulation regime. Or for instance, who belong as I do, to civic accountability bodies that are too small for the PSA’s attention.

2. My study of the UK psychological professional bodies, including the HCPC, constantly demonstrated a profound paradox. The bodies claim to be protecting the public from abuse. But what is the origin of abuse? It is the enactment of some form of physical, emotional or cognitive dominance behaviour, i.e. some form of coercion, bullying or sexual abuse, due, leaving aside mistakes, to an unworked thread of belief or behaviour in the practitioner that licences them to enact some form of domination.

Why does this matter? It matters because with no exception that I know of, the professional psychological bodies associated with the PSA are all structured as traditional top down dominance cultures in which executives make decisions on behalf of members.

How could such dominance cultures, however well intentioned, make reliable, just adjudications of the dominance misbehaviour of alleged errant members? Especially if they are licensed to enact extreme dominance behaviour such as legally enforceable negative prohibition orders.

3. A negative prohibition order is way too close to potential abrogation of human rights, i.e. the human right to have a conversation with a consenting Other, paid or unpaid. In the hundreds of modes of approach to working with the wildernesses of the human condition, there will always be people and institutions who find some other approaches to be anathema or alien, and worthy of being dismissed as charlatanism. If they are introduced at all, negative prohibition orders should only apply to convictions by the courts.


Brief references

Books

Postle, D. (2007) Regulating the Psychological Therapies: From Taxonomy to Taxidermy. Ross-on-Wye: PCCS Books.

Postle, D. (2012) Therapy Futures: Obstacles and Opportunities. Lulu.com

Videos

The PsyCommons – Ordinary Wisdom and Shared Power

Around 75% of the UK population have no need of ‘mental health’ services. What is it they know and do that keeps them psysavvy? The psyCommons examines the ordinary wisdom and shared power hidden from us by the mental illness industries and the medicalization of ordinary human distress.

The psyCommons and its Enclosures: Professionalized Wisdom and the Abuse of Power

The second in a series of videos about the psyCommons looks at how the basic human capacity to resolve and survive the ordinary difficulties of daily life through family, friends and local communities, is undermined by the psychological professions, along with their pharma allies.

 

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Statement on Regulation

REGULATION OF COUNSELLING AND PSYCHOTHERAPY

STATEMENT FROM THE ALLIANCE FOR COUNSELLING AND PSYCHOTHERAPY, MAY 2014

Some years ago, the Alliance played a prominent role in the campaign against the statutory regulation of counselling and psychotherapy (SR). In reviewing the success of this campaign, it seems clear that it was not due solely to a change of Government in 2010. Petitions signed by several thousand practitioners against the plan to regulate the professions via the Health Professions Council (HPC, now HCPC) were remarkable, given the reticence usually shown by therapists in the political realm. Permission to proceed with a Judicial Review of HPC’s conduct was also highly significant. In general, the Alliance considers that, in the words of a Coalition health minister, ‘[we] won the argument’.

We are aware that SR is once again being discussed in some political and professional circles. We have studied Geraint Davies MP’s early day motion and Patrick Strudwick’s articles, and noted some pressure and mobilisation from the same groups of counsellors and psychotherapists who were previously supportive of SR under the HPC.

To us, it is, at the very least, foolhardy to consider rejecting the current Accredited Voluntary Register (AVR) scheme run by the Professional Standards Authority (PSA) which is not even a year old. AVR is a progressive institutional innovation that addresses the vast majority of the defects that existed with the old, traditional voluntary registers. It should be given the opportunity to prove itself by allowing it to continue for at least five years.

The Alliance continues to welcome this scheme which, on balance, we see as substantially superior to the proposals for SR under the HPC. In our view, the PSA scheme has already improved matters. For example, although the old voluntary registering organisations were already operating under ethical codes that made the offer of reparative therapy a matter of serious professional misconduct, it was the PSA’s committed anti-discriminatory policy that underlay the decision by the Association of Christian Counsellors (ACC) to follow suit. Until their accreditation by PSA required a rethink, this organisation was one of the main sources of providers of reparative therapy.

The PSA also deserves much credit for the United Kingdom for Psychotherapy’s (UKCP) adoption of a mandatory Central Code of Conduct, a long overdue reform.


“It is simply not the case that counsellors and psychotherapists are untrained and unaccountable”


The Alliance would like to see the PSA doing more to promote counselling and psychotherapy, including drawing the attention of the public to the existence of its accredited registers. It is simply not the case that, as some supporters of the early day motion state, counsellors and psychotherapists are untrained and unaccountable. Our understanding is that the PSA promised such a promotion during early discussions with the former voluntary registering bodies, so is therefore now obliged to conduct an appropriate campaign.

We hope that the PSA might now engage more with its accredited bodies with regard to how serious sanctions, such as striking off, can be better and more widely communicated to the public.

The PSA has, so far, remained silent on the matter of SR. We realise that it may be politically difficult for the PSA to speak in defence and justification of its own existence but now seems a good time to start such a process. Many of the proposals to reintroduce the failed project of SR seem strikingly ignorant of the nature and even the fact of the AVR scheme. In the face of this, we would like to see the PSA issue a statement on the progress of the AVR scheme so far.


“a damaging and misleading idealisation of statutory regulation is taking place”


The Alliance believes that a damaging and misleading idealisation of statutory regulation is taking place. Unless there is a change in primary legislation, we will continue to see people struck off by statutory registers rebranding themselves and continuing to practice as before. It is highly misleading to claim that evasion of sanction is only a problem for accredited voluntary regulators as has been claimed.

We are perplexed at the linkage of the quite legitimate concern over reparative therapy with SR. We speculate that those who want to see statutory regulation are using current repulsion at general homophobia to further their own political agenda. In reality, most reparative therapy was and is offered by people with a religious orientation whose practice is not going to be affected by any kind of regulation of counselling and psychotherapy.

The Alliance also believes that, whilst prejudice can never be eliminated entirely, the situation in our professions has changed substantially since one small-scale research project of 2009 discovered the extent of reparative therapy being offered.

A key factor in the successful campaign against SR was the development of a convincing argument that statutory regulation of counselling and psychotherapy as ‘health professions’ was and is inappropriate for this field. The medical model of clear-cut diagnosis and treatment does not apply. In particular, an adversarial and generic system of complaints, founded on tendentious principles, and with no systematic inclusion of alternative dispute resolution (ADR – conciliation and mediation) will never be fit for purpose.

We should not forget that, when the HPC’s process was halted, there was no agreement over such central issues as the difference (or not) between psychotherapy and counselling, or whether (or not) work with children required different trainings.

The Alliance for Counselling and Psychotherapy will, of course, fight against any new plans for statutory regulation. But the previous experience was so divisive that we sincerely hope that those who are looking to reintroduce the project will read this statement, reconsider their position and engage with us and the majority in our field in making the still-evolving AVR system work as effectively as possible – in the interests of clients and patients, the professions, and society as a whole.

The above statement has been sent to a number of key figures in the debate, including politicians, journalists, regulatory bodies and therapy organisations.