competences – The Alliance for Counselling & Psychotherapy

Maps, Languages & Lost Continents: Person-Centred Therapy and the SCoPEd Project

Andy Rogers takes at look at the telling absence of the Person-Centred Approach in the development of the SCoPEd project.

There is so much to say about SCoPEd that it can be hard to know where to start. Fortunately, many elements of the project – the motivation, methodology, evidence-base, hierarchical structure, consultation process, conflicts of interest and so on – have been closely examined elsewhere, particularly on blogs and social media. So here I want to home in on a few core issues for person-centred practitioners.

Person-Centred Therapy (PCT) has been a major force in the UK therapy landscape since the 1980s. Leading practitioners were influential in the development of counselling services in education and contributed much to the growth of counselling training and professional organisations. The book Person-Centred Counselling in Action (Mearns & Thorne, 1988) is still a core text on many counselling courses and remains one of the UK’s best-selling counselling titles of all time.

Note that already I am referring to ‘counselling’ rather than ‘psychotherapy’. This is important for the SCoPEd project because its draft ‘competency framework’ explicitly differentiates ‘counsellors’ and ‘psychotherapists’, albeit with a third intermediate category labelled ‘advanced qualified/accredited/psychotherapeutic counsellor’. This differentiation, which the largest professional body involved, the British Association for Counselling & Psychotherapy (BACP), had argued previously there was no evidence for, has come in for much criticism; mostly – but not exclusively – from counsellors whose work has been downgraded, with newly qualified psychotherapists defined in the framework as more competent across a range of practice areas.

Inconvenient histories

Before I get side-tracked into the many overlapping issues here – not least around the organisational politics that feed this project – let’s just step back into the world of the person-centred therapist.

In PCT, there is not, and never has been, any meaningful differentiation between counselling and psychotherapy. A contemporary practitioner might be attuned to how others use these terms in a differentiating way and to the tendency for trainings with these labels to meet the differing requirements for professional organisations that cater mostly for either ‘counsellors’ or ‘psychotherapists’. They might also note wryly the way this division operates in the field of employment, with differences in pay, fees, context, status and so on. As Thorne (1999) writes, we need to ‘face the unpalatable truth that the business ethic is all-pervasive… In such a marketplace it is not politic to affirm that counselling and psychotherapy are indistinguishable’ (pp.229-230). Yet, in terms of the therapy itself, i.e. what happens between practitioner and client, there is no substantive case for differentiation within person-centred working.

In the academic literature, the tendency is to refer simply to ‘Person-Centred Therapy’ or to use the terms ‘counselling’ and ‘psychotherapy’ interchangeably. I was going to reference some texts here to illustrate the point but it makes more sense to throw out a challenge: find me a book or paper that articulates the difference between person-centred counselling and person-centred psychotherapy. If any exist, they will still be contradicted by almost all the other person-centred literature.

Much of the contemporary person-centred attitude to these terms has evolved from the position of the approach’s originator, Carl Rogers, who clearly viewed PCT as a form of psychotherapy (just browse his book titles), yet made no distinction between ‘psychotherapy’ and ‘counselling’. As far back as 1942, Rogers was using the terms interchangeably, writing that, ‘intensive and successful counseling [sic] is indistinguishable from intensive and successful psychotherapy’ (Rogers, 1942, p.4, my emphasis). Poignantly for the current debates, the general use of ‘counselling’ for the work of therapy also has its roots in Rogers’s life and work. As a clinical psychologist with no medical training, he made a tactical switch to ‘counselling’ in the mid-1950s in Chicago, when legally the practice of psychotherapy required medical qualifications.

Whatever the pragmatic motivations at the time, it is important to note that the person-centred approach was already becoming a direct challenge to the hegemony of the medical model (and would continue to be so, with increasing vigour and depth), so the switch also made sense politically and philosophically. Clearly, 1950s Chicago is a world away from the UK in 2019, but it is interesting how relevant this moment remains, how the terms continue to have a political potency: are contested, subject to claims of ownership and find themselves jostled into a status hierarchy that serves the interests of those who already have more power in the field by bolstering their portrayal of superior legitimacy, skill, depth or competence.

And there is another more recent historical nugget to unearth here too, which is that PCT’s association in the UK with ‘counselling’ rather than ‘psychotherapy’ could easily have gone the other way. In the early 1980s, as the United Kingdom Council for Psychotherapy (UKCP) developed in parallel with the BAC (then without the ‘P’ for psychotherapy), the person-centred approach had not yet established national organisational representation. So, as Mearns & Thorne (2000) write, there was,

‘no institutional process by which the approach could be involved with the developing professionalisation of psychotherapy/counselling. The result was that the work of engaging with professional organisations was left very much up to individuals, […] person-centred specialists [who] made the pragmatic choice of investing their time in BAC.’ (p.26)

Importantly, the decision not to go with UKCP was not made because PCT failed to qualify as ‘psychotherapy’. In fact, ‘it was only small matters of difference which inspired this choice’ (ibid.), mainly around personal therapy requirements and the approach’s potential positioning within UKCP’s humanistic section.

This alignment with BAC(P) would inevitably lead to an association with ‘counselling’ rather than with ‘psychotherapy’, so it is intriguing to wonder about how the field would have looked had PCT found its professional home within UKCP instead. Who knows how the approach – and indeed UKCP – would have evolved? But the SCoPEd project washes its hands of these inconvenient histories and their attendant complexity and illuminating angles.

Undoubtedly times have changed but PCT has never reneged on its philosophical, political and practical position in relation to ‘counselling’ and ‘psychotherapy’. As one of its leading thinkers in the UK has argued, the case for differentiation – inseparable as it is from professional politics – demands close scrutiny:

‘there is no essential difference between the activities currently labelled “counselling” and “psychotherapy”… [T]o suggest that there is is the result of any one or a permutation of the following: muddled thinking; a refusal to accept research evidence; a failure to listen to clients’ experiences; a lust for status; needless competitiveness; power mongering; a desire for financial gain; or some other unworthy motive prompted by professional protectionism.’ (Thorne, 1999, p.225)

Maps and missing territories

The fact that one of the most established therapeutic traditions in the UK has a lot to say on these matters – not only differentiation but manualisation and professionalisation generally – has been of such little interest to the SCoPEd project that there was no PCT representation on the teams tasked with developing the framework. Even the humanistic modalities more broadly were grossly underrepresented in the Expert Reference and Technical Groups, which were dominated by psychoanalytic practitioners. Statements from BACP following the outcry amongst members about this blatant bias have made small admissions that they got some of the language wrong and were endeavouring to recruit new people to better balance the team.

But how can this have been so overlooked at the outset? What does it say about a project which wants to ‘map’ the world of counselling and psychotherapy that it would erase a whole continent of thought and practice and then, when the inhabitants are outraged, desperately try to patch things up with reassurances that they are ‘listening’ and want to get it right?

What does it say about a project which wants to ‘map’ the world of counselling and psychotherapy that it would erase a whole continent of thought and practice?

Why has the person-centred approach been ignored in this way? Perhaps part of the answer lies somewhere in the SCoPEd organisations’ uncritical embrace of a ‘competency framework’ methodology derived from UCL’s manualisation of CBT for the IAPT project (IAPT, 2007; Roth & Pilling, 2008). While these frameworks might have some uses, it is difficult to understand the perception of the supremacy of this specific method for resolving difficulties in the field and promoting the profession, unless you actually want to bulldoze nuance and erase complexity in order to ‘clarify’ things. But BACP especially seems heavily invested in this approach, having already used it to create frameworks for a range of practice areas (including, it should be said, an IAPT-compliant, manualised version of PCT). Indeed, the organisation is so attached to the Roth & Pilling methodology that in a statement in Therapy Today, the Chief Professional Standards Officer and Chair of the SCoPEd Technical Group, Fiona Ballantine Dykes, claimed that the alternative to developing the SCoPEd framework is ‘doing nothing’ (Therapy Today, May 2019, p.51).

Given this single-minded, blinkered commitment to the competency framework process, it is hard not to conclude that person-centred perspectives – with their critical takes on both the manualisation of therapy and the associated alignment with healthcare values and medicalisation – are simply too awkward, too inconvenient, too damned political. As if a project like SCoPEd could not be political! As if, in its much-trumpeted spirit of collaboration between competing organisations, it could magically transcend all the history, politics, power struggles and diversity of thought and practice in order to objectively ‘map the competences’ of ‘counsellors’ and ‘psychotherapists’, without in the process distorting the field to shoehorn it into such a simplistic hierarchical structure.

I am not suggesting a deliberate conspiracy here, more that a number of professional interests converge around the adoption of these frameworks, whose politically expedient effect – in the apparent coherence of their efficiently organised categories and columns – is to eliminate awkward truths, not least in the profession’s sales pitch to governments and the NHS.

From this perspective, the SCoPEd project is so full of holes that, in one sense, it is hardly there at all. Part of me wonders whether, for all the fanfare and controversy, it will end up – like so many other documents – parked on our hard-drives or floating in the digital cloud, read more than once by almost no one outside of the organisational players, ignored by most of the public, of little interest to potential clients, perhaps skim-read by other stakeholders in the mental health field and then… what?

Well, it is how these things linger on the edges of awareness that says something about their potential power, about how – once installed – their unspoken values seep almost unnoticed into all sorts of areas of our lives as therapists (practice, training, supervision, organisational procedures, government policy). In person-centred terms, they begin to form a hard-to-grasp but nonetheless influential set of conditions of worth for therapeutic practice, which further externalise our professional loci of evaluation.

This is particularly problematic for PCT because, as I wrote in my own submission to the BACP consultation, the draft SCoPEd framework is alarmingly ignorant of person-centred working. Some of the exclusively ‘psychotherapist’ competences, for example, are almost the bread and butter of person-centred therapeutic relationships, which in the real world are often engaged with under the banner of ‘counselling’. Check out 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 I say in my response, for person-centred counsellors this would be a central principle of everything they do. Yet ‘qualified counsellors’ are deemed only to have the:

Ability to recognise and understand issues of power and how these may affect the therapeutic relationship.(3.5)

They are perceptive but passive witnesses to issues of power, which for me edges into an unethical disavowal of both the potential impact of their role and the asymmetry of the therapeutic encounter.

Read on and we find that only trained ‘psychotherapists’ have acquired the:

Ability to evidence reflexivity, self-awareness and the therapeutic use of self to work at depth in the therapeutic relationship and the therapeutic process.(5.1.c)

Which, again, is at the very heart of person-centred working (e.g. Mearns & Cooper, 2017). Yet ‘qualified counsellors’, we are led to believe, have only an:

Ability to demonstrate a commitment to personal development that includes self-awareness in relation to the client or patient to enhance therapeutic practice. (5.1)

Elsewhere, other competences make ‘psychotherapist’ the sole territory of those who lean heavily towards medical or psychoanalytic thinking, e.g. Ability to demonstrate the skills and critical awareness of unconscious process (3.10.b), which further alienates and excludes person-centred therapists.

Language barriers?

In response to the criticism attracted by the draft framework, BACP has suggested it will attempt to iron out some of these issues with language tweaks in future iterations, but such errors are extremely revealing of the way the unique theory and practice of PCT is invisible in the project, subsumed and submerged within generic statements around counselling practice while its more challenging perspectives have been redacted or just ignored into oblivion.

In any case, we should be wary of the reassurances from the SCoPEd teams that they just need to get the language right. For one thing, this smacks of PR rather than full engagement with the critiques (as in the infamous politician’s or corporate CEO’s defence, “I misspoke”). Furthermore, in this focus on language, BACP et al seem (wilfully?) to misunderstand the various challenges and objections, which are not only about words – as if swapping them with others would make it all better – but rather see language as the most obvious manifestation of deeper flaws in the project.

Something else I find troubling here is my own personal experience of having the same conversations with senior individuals at BACP about another competency framework, one drawn up for university and college counselling in 2016, which I had criticised as inappropriately redefining the sector as a branch of manualised healthcare (Rogers, 2019). In a face-to-face meeting and follow-up emails, it was acknowledged that BACP did not ‘get the language right’ and I was offered reassurances that this would be taken on board for future frameworks. Yet here we are again. I have no idea what the people I spoke with took away from our chat but somewhere in the subsequent organisational processes these reassurances evaporated into nothing and PCT once more finds itself ignored and excluded.

The person-centred approach, arguably, is not blameless in all this. Perhaps we have not been great at organising; perhaps we have felt so compelled to make concessions to the dominant narratives in ‘mental health’ and the therapy professions that we have our lost ourselves a little along the way, woozy with disorientation and gripped by a fear of judgement if we defy the trajectory of our own field. Nevertheless, the fact that a voice speaks with less assertiveness amid the noise of our culture’s deepening conversation with psychological distress is no excuse to ignore it, and it is troubling – and disturbingly ironic – when therapy organisations fall into this trap.

Perhaps my own tiny sketch of PCT’s political difficulties does it a disservice too. While I have drifted away from person-centred forums (journals, organisations, conferences etc.) over the years, social media – for all its flaws – has reminded me recently that there is a vibrant community of practitioners out there and PCT still has a unique and vital contribution to make to our field, to ‘mental health’ thinking generally and to our culture more widely. As ever, what the person-centred approach has to say is not always easy listening for those with professionalising aspirations and intentions, but surely it is our job as therapists to hear the things that others cannot bear, to listen to the most difficult truths, to welcome their complex, quietly spoken messages, to meet and fully engage with the challenges they present – why can’t our organisations do the same?

Tipping point

As I researched the background to PCT’s early alignment with counselling and BACP (as discussed above), I stumbled across another passage in the same book (Mearns & Thorne, 2000) that, although written in my early days as a person-centred therapist twenty years ago, rings as true now as it did then:

‘It would be a tragedy… if person-centred therapists lost heart at this stage when, precisely because of some of the unfortunate moves towards a sterile professionalism… there is a greater thirst than ever among therapists and would-be clients for an engagement with what is truly human’ (p.218).

Whatever happens as SCoPEd ploughs on, we urgently need to find our voices. There are shifts in the mental health sector across disciplines and hierarchies. The medicalisation of distress, the dominance of biomedical psychiatry/pharmacology, the related mechanisation of therapy as another manualised treatment for discrete psychological ‘disorders’ and its subsequent co-option by the State in health and welfare policy are all coming under increasing pressure from a range of critical standpoints.

We may be at a tipping point. The more people experience this rigidly medicalised ideology in practice, the more they become aware of a need for something else and actively begin to seek it out. With IAPT’s legitimacy crumbling (Jackson & Rizq, 2019), the promises of psychopharmacology unfulfilled and psychiatric diagnosis itself falling further into disrepute, it is starting to look as if Person-Centred Therapy was on the right side of history all along.

Our professional organisations might want to listen more closely to what we have to say; not to assist their PR blitz around contentious projects, but to reset the course of the professions in ways that more authentically respect and promote the core values and diverse perspectives found in our field’s rich ecology of practitioners.

Andy Rogers has been a BACP member and counselling service coordinator in further and higher education for 20 years. He also works in private practice in Basingstoke, Hampshire.

References

IAPT (2007) The competences required to deliver effective cognitive and behavioural therapy for people with depression and with anxiety disorders. https://www.ucl.ac.uk/drupal/site_pals/sites/pals/files/migrated-files/Backround_CBT_document_-_Clinicians_version.pdf (accessed 05 July 2019).

Jackson, C & Rizq, R (2019) The Industrialisation of Care: Counselling, Psychotherapy and the Impact of IAPT. Monmouth: PCCS Books.

Mearns, D & Cooper, M (2017) Working at Relational Depth in Counselling and Psychotherapy. 2^ndedition. London: Sage.

Mearns, D & Thorne, B (1988/2013) Person-Centred Counselling in Action. London: Sage.

Mearns, D & Thorne, B (2000) Person-Centred Therapy Today. London: Sage.

Rogers, A (2019) ‘Staying Afloat: Hope & Despair in the Age of IAPT’ (pp. 142-155) in Jackson, C & Rizq, R (2019) The Industrialisation of Care: Counselling, Psychotherapy and the Impact of IAPT. Monmouth: PCCS Books.

Rogers, C (1942) Counseling and Psychotherapy: Newer Concepts in Practice. Boston: Houghton Mifflin.

Roth, AD and Pilling, S (2008). ‘Using an evidence based methodology to identify the competences required to deliver effective cognitive and behavioural therapy for depression and anxiety disorders.’ Behavioural and Cognitive Psychotherapy, 36, pp. 129-147.

Thorne, B (1999) ‘Psychotherapy and counselling are indistinguishable’ (pp. 225-232) in Feltham, C. (1999) Controversies in Psychotherapy and Counselling. London: Sage.

Joint letter to BACP, UKCP and BPC on the SCoPEd consultation results

In response to the SCoPEd initial consultation results, a joint letter to BACP, UKCP and BPC has been signed by the Alliance for Counselling and Psychotherapy, the National Counselling Society, Psychotherapists and Counsellors for Social Responsibility, the Psychotherapy and Counselling Union and the College of Psychoanalysts.

Dear Chairs and Chief Executives of BACP, UKCP and BPC,

The Alliance for Counselling and Psychotherapy, the National Counselling Society, Psychotherapists and Counsellors for Social Responsibility, the Psychotherapy and Counselling Union and the College of Psychoanalysts have noted your claims hailing the results of the recent consultation.

We have analysed the available statistics, and, on behalf of our combined memberships of well over 2,000 practitioners, nearly all of whom register with yourselves, respectfully beg to differ.

The results are hardly a ringing endorsement of the SCoPEd project (dramatically so, as far as BACP is concerned).

The return rates are assuredly below acceptable minima for the adoption of such wholesale change in any profession. We calculate that there is an overall return rate of the survey of around 13 per cent (7,087 respondents out of 53,500 members) – or about one in eight.

BACP’s return rate appears to be 13 per cent (5,878 respondents out of 44,000 members. (If the smaller register were used then the return rate will have been higher.)

BPC’s return rate appears to be 15 per cent (230 respondents out of 1,500 members).

And UKCP’s return rate appears to be 12 per cent (979 respondents out of 8,000 members).

Our organisations consider that it would be foolhardy to attempt to make such fundamental changes to the structure of our professions on the basis of the level of response garnered up to now. Don’t forget, it is you yourselves who have asserted that the changes will be fundamental, not only your critics. We will continue proactively to oppose any such developments.

Nor do the more detailed statistics offer you anything like the succour that you have claimed. Drilling down, we find that:

60 per cent of respondents did not believe SCoPEd would improve things for clients.

46 per cent did not believe it would help recruitment.

39 per cent did not believe it would make things clearer for trainees.

46 per cent did not believe it would help professional organisations to promote therapy.

Given that the leaderships of the three organisations so strongly supported the direction of travel of the project, these figures should make for depressing reading for you.

And among BACP members, the positive responses were even lower. Only 36 per cent of BACP respondents to the survey believe SCoPEd will make things easier for clients trying to find the right help (Question 1a). This is just 2,131 members, which is about 5 per cent of BACP’s total membership.

For comparison and to get these returns into some kind of proportion, this is 1,000 less than those, mainly but not all BACP members, who signed the petition to scrap the project.

It also contrasts fairly dramatically with the 57 per cent of BPC and 56 per cent of UKCP respondents who believe the framework would be positive for clients – an intriguing difference that is reflected throughout all the results, as laid out here.

On the question of how useful SCoPEd will be for employers (Q1b), 50 per cent of BACP respondents answered that it will be easier to establish who to employ, whereas 78 per cent of BPC and 71 per cent of UKCP respondents agreed.

On the effect on clarity for students choosing training pathways (Q1c), 57 per cent of BACP respondents were positive, compared with 84 per cent of BPC and 78 per cent of UKCP. Similarly, 50 per cent of BACP members answering the survey believed SCoPEd would make promotion of members’ skills by professional organisations easier (Q1d), whereas 75 per cent (BPC) and 73 per cent (UKCP) felt the same.

What are we to make of this? Is it surprising that organisations representing those identifying more often as ‘psychotherapists’ (and in BPC’s case, exclusively psychoanalytic psychotherapists), rather than ‘counsellors’, would favour a framework that places psychoanalytic psychotherapy at the top of a hierarchy of practice? We also note with as little cynicism as we can manage the close ties these organisations have with training programmes that would profit from such an assertion or reassertion of superiority.

Despite the deeply problematic nature of the consultation methodology, as shown in this article, and the lack of any real endorsement of the project in the results – not to mention the widespread dissatisfaction with the framework (particularly amongst ‘counsellors’ and especially the under-represented person-centred/experiential/existential/humanistic communities), as well as the substantive critiques of the political agendas and claimed ‘evidence base’ of the project – despite all this, BACP, BPC and UKCP assert nonetheless that, ‘we have an early indication that we should progress this work’.

Surely, if anything, a dispassionate viewpoint would be that there is an ‘early indication’ that the entire project is deeply flawed, and is pursuing a path that a substantial portion of the field finds at best misguided, and at worst a complete betrayal of their practices. In what sense, then, can this work be said to be happening ‘alongside our memberships’?

To progress the SCoPEd framework anywhere near ethically, it would mean reappraising every single aspect of it: its motivations and intentions, its assumptions, its methodology, its form, the composition of its ‘expert reference group’, the ‘independent’ chair, the disputed ‘evidence base’, the nature of further consultations, and so on.

Is there any will at all to do this within BACP, BPC and UKCP? The leaderships of your organisations may ‘acknowledge’ the ‘strength of feeling’ in the debates around ScoPEd, but how can they possibly continue with the project in this form, knowing the numerous substantive critiques of the project and its current functioning?

Perhaps the 3,000 consultation comments, as yet not analysed by the ‘independent research company’, hold some of the answers. Is it possible that all of these comments and all other relevant data beyond what you have released thus could be published on one of your websites? We are serious about this and consider it to be normal good practice for a consultation. Not to do so, or to refuse to release the comments, will leave you open to allegations of cooking the books.

In the meantime, the organisations sending this letter would welcome open dialogue, above all in a public format, with BACP, BPC and UKCP about the future of the therapy field.

Collegial greetings from,

The Alliance for Counselling and Psychotherapy

Psychotherapists and Counsellors for Social Responsibility

The Psychotherapy and Counselling Union

The College of Psychoanalysts

The National Counselling Society

19 March 2019: post amended to add the National Counselling Society to the letter signatories.

SCoPEd Consultation: Methodologically Challenged

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Richard House Ph.D., former Senior Lecturer in Psychotherapy, Counselling and Psychology at the University of Roehampton, subjects the SCoPEd framework consultation exercise to critical analysis.

Introduction and Context

In this commentary I wish to deconstruct, and subject to critical analysis, the apparent methodology used by the psy sponsor organisations in their recent SCoPEd consultation process. In precipitating a process that could end up having major implications for the practice of many thousands of psy practitioners, organisations surely have a grave responsibility to ensure that, as far as possible, any research that is carried out is methodologically robust, and transparently fair and unbiased. In the case of the SCoPEd consultation, I will show below that this is, alas, very far from being the case – which, in turn, places substantial doubt on the reliability of the initial findings as recently announced.

A Fair Consultation?

The first observation to make about the consultation process is that the most important question of all wasn’t even posed – i.e. “Do you think that it is necessary and appropriate for the psy organisations to develop an explicit written framework for competent practice in the therapy field?”.

Rather, the need for a competency framework is merely asserted and assumed by “organisational fiat”, as a background given; and only then do respondents answer the questions posed, having already tacitly and implicitly agreed to the need for such a framework by the way the consultation has positioned them, and by the very act of them completing the consultation.

It should by no means be tacitly or casually assumed that everyone who completed the consultation necessarily agrees that such a framework is necessary; yet there is no mechanism within the consultation as implemented to discover this vital information. One has to ask whether this was an oversight, or a quite deliberate “positioning” by those conducting the process.

So one has to ask, further, why were members not asked, first and foremost, to give their view on whether a generic framework is necessary and appropriate? Although of course this has to be speculative, it might conceivably be because by doing this, it would then have been far more difficult to position members into accepting the principle of a framework per se without any debate. And as mentioned above, the very “democratic” act of completing the consultation can easily be read as giving tacit legitimacy to that which, at the outset, should have been open to discussion and possible refutation, rather than merely assumed as an uncontested datum.

Thus, a fair and proportionate consultation that was genuinely aiming to find out members’ views – as opposed to one merely seeking rubber-stamping legitimation for a pre-decided view – would have sent all potential respondents both the proposed framework and a document of equal length critiquing the need for a proposed framework. This would then have left members free to make up their own minds, “un-nudged”, with an accompanying, genuinely open-ended set of consultation questions.

As it is, a methodological “coach-and-horses” can be driven through this whole process, as anyone with any expertise in research methodology will know. (I can just imagine what a group of sharp, methodology-savvy Roehampton PsychD research students would have made of this! – and it wouldn’t have been pretty…)

It’s therefore extremely disappointing to this commentator, at least, that this consultation wasn’t far better informed methodologically. Moreover, this in turn is, at the very least, consistent with the suspicions of organisations like the Alliance for Counselling and Psychotherapy that this is yet another choreographed, top-down power move by our field’s psy organisations, still intent on importing the dead hand of state regulation into our work.

An “Independent” Research Company?

We read in the rubric from the organisational sponsors of “[t]he consultation exercise, which was run by an independent research company on behalf of BACP, the British Psychoanalytic Council (BPC) and the UK Council for Psychotherapy (UKCP), … [and that] … More than 3,000 members and stakeholders submitted a comment as part of the consultation process. These are currently being analysed by the independent research company for the key themes, which will be published in the summer.” (my emphasis)

The phrase “was run by” needs to be carefully interrogated and unpacked. It is indeed potentially reassuring to be told that the research company “running” the consultation process was “independent”; but such cosy reassurance is of no substance unless respondents are told in detail what the term “running” actually means in practice. For example, to have any methodological confidence in the consultation’s reported findings, the public needs to know what written remit the “independent research company” was given by the sponsoring organisations prior to the consultation exercise. This is critical, because it needs to be totally transparent to what extent the research company is, indeed, genuinely “independent” – e.g. merely in the sense that they carried out the data-collecting exercise, or in the sense that they themselves decided on the questions to be asked in it, and how those questions were framed.

Moreover, regarding the analysis of the comments received, we also need to know what, if any, guidance was given to the “independent” company by the sponsoring organisations, in terms of how the company analyses and presents the qualitative findings. If this information is not completely transparent, respondents will have no way of knowing whether the presentation of the results is a fair and representative depiction of the actual feedback which respondents gave in their thousands.

The Questions Themselves

Regarding the actual questions posed in the consultation procedure: first, respondents were asked, “Q1a – How will the framework affect clients or patients being able to find the right kind of help to meet their needs?” (my italics).

First, note that the tell-tale word “will” is used here, rather than “would”. If this were a genuinely open-minded consultation that hadn’t already pre-decided the desired outcome, the word “will” would most certainly not have been used in this question. Rather, the hypothetical “would” should and would have been used.

This is by no means a minor, semantics-oriented issue – for the way these questions are worded will have a major impact in creating the background “mood-music” to ease the driving through of any required institutional agenda. Those composing the wording of these survey questions will have been well aware of this (and if the sponsoring organisations weren’t, for any reason, then any reputable “research company” worth its salt certainly would have been).

In my view, and strictly speaking, respondents who were expecting a fair and open consultation which was not already positioning them by the way the questions were posed should have refused to answer this question. A much fairer and objective wording for this question would have been something like the following:

“Q1a – Would a framework like the one suggested have any impact, negative or positive, on clients/patients being able to find the right kind of help to meet their needs; and if so, how?”.

The key point here is that such a question might well have yielded significantly different results from the question that was actually posed (on which, see below).

Indeed, all four consultation questions commit this elementary methodological error in using the weasel word “will”. So, in relation to question 1b, a fair, more objective wording would have been as follows:

“Q1b – Would a framework like the one suggested have any effect, negative or positive, on employers being able to establish which counsellors and psychotherapists to employ in their service; and if so, how?”

And for question 1c:

“Q1c – Would a framework like the one suggested have any effect, negative or positive, on trainees in their understanding of the pathways open to them for core training with adults; and if so, what and how?”

And finally for 1d:

“Q1d – Would a framework like the one suggested have any effect on professional bodies being able to promote the skills and services of their members; and if so, how?”

If the employed research company wished to test the reliability of the first reported consultation results, they could quite easily carry out a much smaller survey of practitioners who did not complete the first survey, using these alternatively worded questions. The results of such a survey would then provide clear evidence on the extent to which the original survey results are reliable and representative, or otherwise. Without doing such a follow-up, the reliability of the original survey results must remain in question.

Finally, regarding the raw presented statistical results, it’s clear that even when we ignore the multiple biasing effects of the way in which the whole consultation process was conducted (referred to in detail above), around 25 per cent of respondents – a considerable minority – were not happy with the proposed framework. If I were one of the psy organisations wishing to see this framework implemented, I certainly wouldn’t be feeling at all triumphant about these initial results.

In Conclusion

I have raised a number of core methodological issues in this commentary, and I ask the sponsoring organisations to reply to the concerns I have raised here in adequate detail.

If there is no full response, the silence will be deafening, and the many thousands of concerned practitioners will no doubt reach their own conclusions.

Dr Richard House, C.Psychol., AFBPsS, Cert.Couns.

Former Senior Lecturer in Psychotherapy, Counselling and Psychology, University of Roehampton; former PsychD research supervisor; former counsellor and psychotherapist in General Practice (1990–2007); author of Therapy Beyond Modernity (2003) and co-editor (with Del Loewenthal) of Against and For CBT (2008).

richardahouse@hotmail.com

SCoPEd: Butchering Psychopractice

Denis Postle (ARCA; Independent Practitioners Network) interrogates the power relations of the SCoPEd project.

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SCoPEd seems to be yet another instance of ethical sleep on the part of its authors, BPC, UKCP and BACP, institutions that aspire to the high ground of human sensibility and civic accountability. One of the long-standing deficiencies of the psy trainings that they validate, and thus the crust of institutions that represent them, notably for 1:1 work, is the lack of explicit attention to the ubiquity of power-relations. If this were not so, how else can the current SCoPEd initiative – and its likely tame acceptance by the psy demographic it refers to – be understood?

The shenanigans of UK therapy training schools’ efforts to secure their economic status via state regulation, has a long history. Isn’t SCoPEd, a remarkable pro-active coming together of entities previously laden with toxic animosity, yet another precursor for state regulation? Or as time may tell, a defensive response to whispers from government that it is minded to take the psy world in-house?

Let’s back off from this to a reprise of what, to a long-term watcher of power relations in the psy demographic, appears to be a continuing ethical contradiction. This can be outlined as follows: the overwhelming source of complaints from clients (leaving aside mistakes) is the result of practitioner behaviour that drifts from facilitation to coercion, manipulation, exploitation or bullying, i.e. dominance behaviours. But if we look at the organisations whose work has given us the SCoPEd taxonomy, they are top-down structures in which dominance behaviour has for decades been intrinsic to their ethos and operation.

People who have trained since say, 2010, may not be aware of this but it was blatantly evident in the previous decades in conflicts over market share, modal validity/invalidity, and here it is again in SCoPEd. Yet another definition of what psychopractice is, yet another taxonomy, with no sense – as I pointed out in 2007 – that such taxonomies are forms of violence and lead to taxidermy of the organism they engage with. What were then relatively open, rich multitude of modes of therapeutic relations are now in SCoPEd reduced to three levels of competency, free of any sense of the coercive forcing of the ecologies of psy practice that this entails.

“overwhelmingly likely to distort or corrupt the wildernesses of nuance in client practitioner relations”

As too often with such intentionally seductive interventions by power-brokers, the context is hidden. Why might this be so? What benefits are intended to accrue for clients and practitioners from SCoPEd? The context that is obscured seems potentially to come in two parts: preparations as I have mentioned, to embrace/field state regulation of the psy demographic; and secondly to provide succour for training schools that not only have the UKCP, BPC, BACP etc. on their backs but also the commodification of their courses via universities selling authority/validation/status. Universities that increasingly are being run as businesses, with ‘products’ and ‘services’.

In this relegation of context to invisibility, the SCoPEd initiative is also a notable example of what I have come to understand as a ‘trance-induction’. Trance induction captures attention via cogent images, sounds, phrases and naming which make the background context go missing. Current examples include ‘take back control’, ‘project fear’, ‘Make America Great Again’. Trance inductions are ubiquitous and through their temporary exclusion of the street, the venue, or the rest of the audience, in cinema, theatre, sport and literature, they can be beneficially entrancing. However when ‘trance inductions’ such as SCoPEd become embedded in our psy culture as agents of dominance, or claims of entitlement, they seem overwhelmingly likely to distort or corrupt the wildernesses of nuance in client practitioner relations.

The claim implicit in the SCoPEd initiative is that it is ‘evidence-based’, currently a very potent trance induction that typically excludes the context of how the evidence for their taxonomy was derived, how the choices were made. SCoPEd doesn’t appear to have been generated via research with people, more likely it has emerged from research on people (or even research without people); the point being that the ownership of the research rests with the researchers, which as in SCoPEd, emerges yet again as institutions presenting entrancing power-over assertions of psychopractice entitlement.

That said, the psy ecology has many inter-related strands, embracing cooperation, challenge and support – some form of civic accountability is essential. SCoPEd demonstrates only too clearly that if its layers of competencies are intended to enhance client safety – i.e. freedom from coercion, exploitation and abuse (why else would the initiative be undertaken) – the way they celebrate top-down power relations in both form and intention means they unawarely subscribe to its opposite, an ethos of entitlement, that is likely to result in client harm. This may support the economic dynamics of training institutions and their validity networking, but it is hard to see how it would be other than harmful to clients.

Against SCoPEd: actions and materials

The consultation for the draft SCoPEd competence framework for counselling and psychotherapy closed on Friday 22 February 2019. If you are concerned about SCoPEd or you just want to understand more about the project, here’s a summary of some of the materials and activities that have emerged in response, which hopefully will help you to join the debate.

1) Read and comment on the Alliance’s blogs, which have been viewed and shared hundreds of times each:

Joint letter to BACP, UKCP & BPC from the Alliance, PCSR, PCU, the College of Psychoanalysts and the National Counselling Society. 17 Mar 2019.

The SCoPEd Consultation: Methodologically Challenged. Dr Richard House subjects the consultation survey to critical analysis. 12 Mar 2019

SCoPEd: Buthering Psychopractice. Denis Postle interrogates the power relations in the SCoPEd project. 23 Feb 2019.

A damaging business paradigm – latest SCoPEd response by Keith Barber. 20 Feb 2019.

SCoPEd: new consultation responses Arthur Musgrave (BACP Senior Accredited counsellor and supervisor) and Joe Suart (UKCP Registered psychoanalytic psychotherapist) share their SCoPEd consultation responses. 15 Feb 2019.

The Questionable Evidence Base of SCoPEd. David Murphy, Associate Professor at the University of Nottingham, interrogates the claim that the SCoPEd framework is ‘evidence-based’. 31 Jan 2019.

SCoPEd Denial, Distortion & Deception. Andy Rogers – BACP member and counselling service coordinator in further and higher education for two decades – responds to BACP’s consultation survey. 30Jan 2019.

‘Psychoanalytic Coup’ – Andrew Samuels on the SCoPEd competence framework. 30 Jan 2019.

Regulation, Professionalism & Cultures of Dominance, by Denis Postle. 25 Jan 2018.

2) Read the Alliance’s newsletter, which has been sent to over 500 addresses.

3) Watch the Online Events live webinar event We’ve Been SCoPEd!, featuring David Murphy, Andrew Samuels, & Clare Slaney. This was oversubscribed and can still be seen on Facebook, where it has had almost 5000 views.

4) Follow and join the debate on Twitter with #SCoPEd

5) BACP members might like to sign the petition for BACP to scrap the SCoPEd project. 2500 members have already signed.

6) Read the National Counselling Society’s letter challenging BACP’s apparent u-turn on the counselling/psychotherapy differentiation.

7) Read PCSR’s excellent 10-point statement on SCoPEd.

~~Last, it is important that as many people as possible fill in the BACP, UKCP and BPC’s consultation survey by end of Friday 22nd February 2019.~~

The consultation is now closed but if you are a BACP, UKCP or BPC member, please do still contact your organisation to express your views on SCoPEd.

You can see the draft SCoPEd framework here and the equally controversial Methodology document here.

Thank you.

From the Alliance for Counselling & Psychotherapy

Contact info@allianceforcandp.org

Blog amended 25/02/2019 following closure of the consultation survey, and will be updated as and when new materials emerge.

A damaging business paradigm: latest SCoPEd response

The sixth in our series of responses to the BACP/BPC/UKCP SCoPEd project, following responses from Andrew Samuels, Andy Rogers, David Murphy, Arthur Musgrave and Joe Suart. Here, Keith Barber (UKCP registered psychotherapist) critiques the consultation process, differentiation, methodology and the framework itself.

Consultation Process

The clear implication of the introductory remarks to these questions is that SCoPEd is a ‘done deal’ and will be rolled out regardless of the content of consultation responses. If so, this whole exercise is therefore meaningless PR. It does UKCP no credit, as a professional body, to associate itself with such a flawed process.

The questions and multiple-choice answers are worded in such a way that it is almost necessary to be deliberately perverse if respondents wish to answer in a way that does not support this framework. Again, the consultation process itself is fundamentally flawed.

I do not believe that the outcome of such a flawed process will command respect in the Profession(s) nor the assent of practitioners.

Differentiation

The question of differentiation between Counsellors and Psychotherapists has been a vexed one for many years. In spite of repeated attempts to discern such a differentiation, none has been identified that might command sufficient support among practitioners or the public to be accepted. I can see nothing to suggest this exercise has succeeded where its predecessors have failed.

“the vast majority of therapeutic practice takes place in this overlap, in which counsellors and psychotherapists are equally competent”

Let me be clear: I believe it is possible to differentiate between some activities that are truly counselling and some that are truly psychotherapy. However, my experience shows there is a huge overlap between them – the overlap covers ground far more extensive than the both differentiated areas put together – and the vast majority of therapeutic practice takes place in this overlap, in which counsellors and psychotherapists are equally competent to practice. I am quite certain that a considerable majority of counsellors are either trained in or acquire skills sufficient to practice in the area known as psychotherapy (and those who can’t have the skills to refer as appropriate), while it is nonsensical to suggest that psychotherapists cannot function in the area of counselling. The framework does not, it seems to me, acknowledge the practical implications of this reality.

Any attempt to differentiate the titles will force those seeking our help to choose, right at the start, what kind of work they seek, regardless of their actual need. Given the stigma that still attaches to mental and psychological distress, this is likely to lead to people in need of psychotherapy choosing, rather, to enter counselling. If the (entirely artificial, in most cases) differentiation is in any way enforced, they are unlikely to find the help they seek.

Moreover, most clients bring a huge and complex range of experiences that will require an equally large range of responses from a practitioner. In that case they will find that significant areas they seek to work on are characterised as needing an entirely different kind of help (another practitioner entirely, at additional expense – even assuming the issues around working with two therapeutic practitioners simultaneously can be negotiated). I quite fail to see how this may be considered to help or protect the public and would welcome enlightenment – if such exists!

The Framework

“cursory inspection of Appendix viii of the Methodology document reveals that the Chair is both a member of the British Psychoanalytic Council and closely associated with Roth & Pilling, therefore hardly independent”

Selection of the Roth & Pilling methodology must be considered controversial, at best, in view if its focus on manualised treatments. It is impossible for an informed member of the Profession(s) to be unaware of the vigorous debates and deep unease at such ‘treatments’; the way research is used to (supposedly) support such ‘treatments’ is likewise strongly contested and there is as yet no sign of consensus in the field. It is claimed that the SCoPEd methodology is evidence-based (another area of continuing controversy), yet it is acknowledged that this has had to be adapted “…due to a paucity of empirical research into differentiated competencies.” In other words, we read that the study was set up with the deliberate intention of establishing differentiated competencies and that the evidence was selected with a view to achieving this result.

Given these manifold defects, I am minded to say that the Framework is not worth the paper it is printed on. It is incomprehensible to me that such a document could be presented for approval with a view to adoption by our profession(s), and incredible that a learned professional body should allow itself to be associated with it.

I learn from a variety of other sources that the composition of the Expert Reference Group is heavily weighted towards psychoanalytic modalities; cursory inspection of Appendix viii of the Methodology document reveals that the Chair is both a member of the British Psychoanalytic Council and closely associated with Roth & Pilling, therefore hardly independent. Again, we see defects that negate the credibility of the Framework.

Given the prevalence of psychoanalytic thinking on the ERG, it is most striking that the Framework does not see fit to prescribe competences for psychoanalysts. I wonder if they are considered, in some way, to be above such reductive and limiting descriptions? But why should that be so? Or is the answer, perhaps, to be found in my previous paragraph?

“hierarchical structures, universal application of economically-driven models of outcome evaluation and a strict regulatory model”

More generally, it seems to me that the endless initiatives to systematise the field with standards identified as ‘competences’ indicates an attempt to fit the therapeutic field into what we may describe as the ‘business’ paradigm. Here I follow Kuhn (1962/1970), who showed that the paradigm we are committed to dictates and limits even the questions we can ask, let alone the ways they can be answered. The business paradigm privileges hierarchical structures, universal application of economically-driven models of outcome evaluation and a strict regulatory model that facilitates command and control of virtually every aspect of a field of work. It may (the jury is still out) provide economic benefits, but there is no evidence whatsoever that it is good for the psychological health fo the human beings that inhabit it.

This would not be so bad if the competency-based approach was effective. But my experience in a previous career is that it is, in general, of little utility but comes at the cost of a huge bureaucratic overhead that quickly damages the organisation’s ability to perform its most basic tasks. Again, the approach of this Framework is unlikely to gain the assent of most practitioners in our field and, given the increasingly-recognised association between psychological distress and (business-inspired) austerity and insecure work, gives every indication of being rather part of the problem than of the solution.

Conclusion

This Framework is not a response to any currently known need. It is misconceived, insufficiently evidenced and reaches an inappropriate predetermined conclusion. It will do nothing to help or protect the public but – like the proposals for statutory regulation in 2009 – will do enormous damage to the work of counsellors and psychotherapists, if it does not entirely destroy therapy as we know it. The SCoPEd process should be terminated and the resources our profession commands be redirected to meeting the needs of people in distress in the UK.

Reference

Kuhn, T. S, 1962/1970: The Structure of Scientific Revolutions; University of Chicago Press

SCoPEd: new consultation responses

Two therapists – one a BACP Senior Accredited counsellor and supervisor, the other a UKCP Registered psychoanalytic psychotherapist – share their SCoPEd consultation responses with the Alliance.

Arthur Musgrave, BACP Senior Accredited Counsellor and Supervisor.

The consultation questions

This consultation exercise seeks answers to four questions –

How will the framework affect clients or patients in being able finding the right kind of help to meet their needs?
How will the framework affect employers in being able to establish which counsellors or psychotherapists to employ in their service?
How will the framework affect trainees in their understanding of the pathways open to them for core training with adults? (sic)
How will the framework affect professional bodies being able to promote the skills and services of their members?

Summary

This draft framework promises to provide clarity but fails to deliver. Take, for example, the employment of counsellors and psychotherapists – there is already a well-established and much more satisfactory way of establishing whom to employ and that is through the use of a well thought out person specification and a good selection process. It is hard to see that whatever is finally ratified will add much to this.

Nor does the draft framework offer clarity to other stakeholders who would much prefer that other, more fundamental issues were resolved The key components of training and practice that lead to a good outcome remain as obscure as ever. To what extent, for instance, is there any correlation with the length of training a counsellor or psychotherapist has undergone? Or with hours of personal therapy? Or with hours of supervised practice? Do trainee psychotherapists in practice receive more supervision than trainee counsellors? And, if they do, does that mean their clients/patients are necessarily more satisfied?

Without satisfactory answers to questions of this nature campaigns promoting the skills and services of counsellors and psychotherapists will have limited value. And neither potential clients/patients nor anyone wanting to decide what qualification to pursue will be much the wiser.

“further layers of complexity and obfuscation”

But a document of this kind does more than fail to provide clarity – it actually adds further layers of complexity and obfuscation. The answer to each of the consultation questions must therefore be that the draft framework will make clarity harder to achieve.

Much is being claimed for this exercise, but at root it is an attempt at tidying up discrepancies in documentation held by each of the three sponsoring bodies in order for these bodies to agree between themselves what they regard as the distinguishing characteristics of a ‘qualified counsellor’, an ‘advanced qualified counsellor’ and a ‘psychotherapist’.

Stripped bare of any significant benefit for others, what becomes starkly apparent is that the three sponsoring bodies are set up to be the main beneficiaries. As a result of reaching a shared consensus about common standards for practice and education, they will be better placed to press for control over the entire field of counselling and psychotherapy.

There a serious danger here that once competencies are laid down in this fashion, a common curriculum will be prescribed and good practice will then be judged primarily in terms of adherence to what is taught on training courses. This would undoubtedly have a devastatingly inhibiting effect on creativity and the development of good practice.

Specific concerns: (1) Language

The language is opaque. The competency statements are peppered with words such as ‘suitable’, ‘appropriate’ and ‘relevant’. This language requires a further gloss from those within the profession and defeats the stated purpose of offering clarity to outsiders such as members of the public and potential trainees.

Even when qualifiers of this kind aren’t used the competency statements necessarily lack precision so that, for instance, it is unclear to what extent practitioners of all kinds have “the ability to reflect on their own cultural background and history and have the capacity to work in an authentically non discriminatory manner” (Theme 4.8). It is equally unclear what constitutes sufficient “knowledge and ability” to be able to work within professional and ethical frameworks (Theme 1.1).Two decades and more ago I was involved in helping to draft standards for National Vocational Qualifications and, time and again, found that the language in competency statements was imprecise. At each iteration of the drafting process we were reassured that this would not be a problem since the assessor would be selected by the candidate and would be someone from within the field. In the case of the SCoPEd Framework such an interpreter will clearly not always be to hand.

At other places in the draft framework rather nebulous concepts are deployed in order to distinguish the work of an ‘advanced counsellor’ from that of a ‘psychotherapist’ – for example a ‘psychotherapist’ is able to “negotiate issues of power” whereas an ‘advanced counsellor’ is only able to “address issues of power”. What is the distinction here – that psychotherapists are expected to be in dialogue whereas advanced counsellors are limited to making a speech?

There is great scope for misunderstanding when imprecise language is deployed and this can have serious consequences. In following a case before a Health and Care Professions Council disciplinary panel I had the experience of seeing how problematic matters can become when definitions established in one context are interpreted by others whose professional expertise lies elsewhere. In the case in point a narrow definition of confidentiality based on the notion of consent for medical treatment was utilised to rule that conventional understandings about confidentiality in a group supervision setting were unethical as, somewhat inevitably, personal information about group members was disclosed to other trainees in the group.

Specific concerns: (2) Skills must be tested in context

A serious and even more fundamental problem lies in the fact that skills cannot be adequately tested in isolation from one another as they are in the draft framework. Let me give an example as to why not. I was once approached for help by a student on a counselling diploma course counsellor who had failed her viva apparently because she hadn’t demonstrated basic counselling skills. She brought a tape with them of the session she’d presented at the viva.

When I listened to it in was clear that, at one point when she said something like, “So what you’re saying is A and B”, the client replied, “No I’m not! What I’m saying X and Y!!!”Although the student got things very ‘wrong’ her client was able, as a result and for the first time, to state his viewpoint forcefully and congruently. The trainee then gave her whole attention not to the ‘mistake’ but to what her client had to say. This exchange proved to be the turning point in their work together – which, of course, was why the student had selected it for the viva.

Overtly, then, there was direct evidence of this trainee’s inability to meet Theme 3.8 (i.e. the examiners had detected a failure to sustain the therapeutic relationship) to the point where the existing relationship had been disrupted. However there was other, more subtle evidence, that the student had been able to deal with this rupture in a wholly positive fashion, thereby not simply responding successfully to a difficulty in the relationship (Theme 3.10) but also demonstrating both an ability to work therapeutically with ruptures and difficulties (Theme 3.10 b) and an ability to work proactively to minimise further damage.

Paradoxically, then, this trainee counsellor, in failing her viva, demonstrated that she was able to do something over and above what this draft framework claims only a trained and qualified psychotherapist is capable of doing.

Specific concerns: (3) A flawed threefold separation of roles

The distinction in the draft framework between ‘qualified counsellor’ and ‘advanced qualified counsellor’ doesn’t really work. It is better understood if it is viewed not as a difference in training but as a difference in experience, e.g. in the use of supervision (Themes 1.6 and 1.6a); team working (Themes 1.10, 1.10a and 1.10b); working online (Themes 2.10 and 2.10a); critical reflection on the client/patient’s process within the therapeutic relationship (Themes 3.8 and 3.8a); ability to find ways of making progress in the face of difficulties (Themes 3.12 and 3.12a); and so on.

The ‘advanced qualified counsellor’ reads more as someone who has assimilated what they gained from their training in the light of some years of practice. The threefold division between ‘qualified counsellor’, ‘advanced qualified counsellor’ and ‘psychotherapist’ is therefore fundamentally flawed as like is not being compared with like.

“There is a fundamental problem that training and experience cannot easily be separated when talking about competence”

There is a further fundamental problem in that training and experience cannot easily be separated when talking about competence. Someone whose initial training was as a counsellor can, for instance, obtain further training and experience that gives them the ability to “understand medical diagnosis of mental disorders and the impact of psychotropic medication during assessment and throughout therapy” (Theme 2.4b). Previous attempts to define competency have sometimes floundered on an artificial attempt to determine that labels are acquired only at the point of qualification, a view that can be hard for commissioners of services, employers and members of the public to appreciate when what they are primarily concerned with is practical applications, not demarcation disputes.

Even more problematic is the point that what distinguishes ‘psychotherapist’ from others is largely to do with matters that aren’t essential to what therapy is and that are perhaps better viewed as distinct areas of expertise.

A surprising number of extraneous activities are captured within the rather eccentric definition of psychotherapy used in this framework including being able “to take an active role within the professional community locally and nationally” (Theme 1.10c); being able to “resolve contradictions between ethical requirements and work requirements” (Theme 1.6b) as if psychotherapists are automatically capable of resolving these matters whereas others are necessarily either incapable of dealing with issues of role clarity or only manage to navigate their way pragmatically through intractable situations and irreconcilable expectations; being able “to assess and formulate when working with chronic and enduring mental health conditions”(Theme 2.1b); being able to being able “to critically appraise the history of psychological ideas”(Theme 4.2b) as opposed to simply being able “to critically appraise a range of theories underpinning the practice of counselling and psychotherapy” (Theme 4.2a); being able to utilise audit and evaluation tools/methodologies “to contribute to improving the process and outcomes of therapy” (Theme 4.9b) as opposed merely monitoring and maintaining standards within practice settings (Theme 4.9a); and being able to undertake substantial research projects (Theme 4.10).

A number of somewhat grandiose claims are made for both ‘advanced counsellors’ and ‘psychotherapists’. Apparently they are able to critically challenge their own values and beliefs, whereas mere qualified counsellors aren’t able to do this (Theme 5.3a). They are also able it seems, and again in contradistinction to qualified counsellors, to critically appraise published research on counselling and psychotherapy and integrate relevant research findings into practice (Theme 4.10a).

But to what extent do ‘advanced counsellors’ and ‘psychotherapists’ do either of these in practice? And to what extent do they differ in these respects from qualified counsellors? It is often forgotten that access to published research is limited for those in private practice who do not hold an academic post.

Some of these grandiose capabilities are in the purlieu of psychotherapists alone. They can apparently even “resolve contradictions between different codes of practice and conduct” (Theme 1.6b). They apparently also have a unique ability “to integrate relevant theory and research in the areas of diversity and equality into clinical practice” (Theme 4.8c).

Finally, over and above this substantial list of supposed distinguishing characteristics, one of the most immediately striking aspects of the draft framework is how many gaps it contains. In only a third of the listed competency themes has the draft framework so far been able to distinguish a ‘psychotherapist’ from a ‘qualified counsellor’.

Joe Suart, UKCP registered psychoanalytic psychotherapist, working and living in Cornwall.

There is a problem with the Roth/Pilling methodology [used to draft the SCoPEd framework], as pointed out in 2008 when Skills for Health were trying to develop National Occupational Standards for the profession. These problems have not been addressed and so have not gone away. The Council for Psychoanalysis and Jungian Ananlysis (CPJA) sent to Skills for Health its response in April 2009, in which it stated:

“Following continuous discussion and debate throughout this process, within the CPJA and with our colleagues in other professional organisations representing psychoanalytic and psychodynamic psychotherapy in the UK, the CPJA has concluded that it cannot support either the process or the outcomes of the Skills for Health consultation. The CPJA will be recommending to the UKCP as a whole that it withdraw its participation and support from the project in favour of its own more appropriately-derived statements of occupational standards for psychoanalytic/psychodynamic and other modalities of psychotherapy”

While the current attempt to standardise Professional/National Occupation Standards is not the same process, its reliance on the Roth/Pilling methodology (which was produced initially specifically for Cognitive Behavioural Therapy practice and then applied to other modalities) repeats the problem that was endemic to the previous attempt.

The SCoPEd Consultation claims to be evidence based, and yet there is no evidence that it’s methodological basis of matching perceived competencies of the therapist to improved life experience of the patient actually works. The collection of descriptions of activities of the therapist, presented under the term competencies are themselves not based in evidence gathering but in the opinion of practitioners and trainers concerning what it is they think should be the case.

The model of gathering empirical data is not well suited to the confidential conversation of two people in camera. At best it can only be done by reportage, usually only done by the therapist. This is an argument that is well known and leads to a well-worn criticism of the process of the ‘talking cure’, however the attempt to get round this problem by defining competencies in the manner done fails. Rather, in attempting to do so, it presents an image of a reality that has been distorted by the wishes and intentions of the presenters. As workers in the field of Freud’s legacy, this is not something that should be ignored or brushed over.

“there are many different and conflicting psychotherapeutic views, some of which would support the competencies and their implications, and some of which would be vehemently opposed to them”

Even within the framework itself, in its own terms, there are problems. The use of the three terms, ‘Counsellor’ ‘Advanced Counsellor’ and ‘Psychotherapist’ is confusing at the outset. It would have been better to use non-specific terms to denote different levels of sophistication and complexity, such as level 1, level 2, level 3. For the use of these terms that imply a reflection on current qualifications and associated capacities appears to mirror and reinforce a hierarchy of professional status that many would say is already in place.

There is then the additional problem that this implied hierarchy of professional status and capacity is one that is intended to become enshrined in nationally recognised standards which training bodies will be obliged to adhere to, and which, when the next attempt to statutorily regulate the profession occurs, will become enshrined in law. When that happens it will become an offence to practice unless you fit yourself into these frameworks.

The success of this attempt to standardise the activities and responsibilities of counsellors/psychotherapists whilst being carried out in the noble desire to protect patients, will have the effect of both reducing patient care and therapists’ ability to respond to the specific and individual needs of the patient. Many of the competencies as set out in the document are written as if they are neutral and non-controversial in their import. This is not the case as there are many different and conflicting psychotherapeutic views, some of which would support the competencies and their implications, and some of which would be vehemently opposed to them.

For example, there are assumptions which would be vigorously challenged when the competencies use terms like ‘conscious’ and ‘unconscious’, ‘inner world’ and ‘outer world’, ‘transference’ and ‘countertransference’. The nature of the complexities and even existence of some of these apparently neutral terms, let alone how the mechanisms, phenomena and experiences that these terms are meant to refer to have been the subject of debate and even controversy for decades. The validity of this history of debate and disagreement is given no recognition by the consultation.

The consequence of this standardisation attempt being successful will be to reduce the options of talking therapy work available to the public, and risk making it an offence for them to be provided with options that are not in agreement with it. This point has been made with full description and elaboration in the Maresfield Report.

The questionable evidence base of SCoPEd

David Murphy, Associate Professor at the University of Nottingham, interrogates the claim that the SCoPEd framework is ‘evidence-based’.

A cornerstone of the SCoPEd approach to generating their competences is to arrive at their findings having drawn from an ‘evidence base’. This is apparent in two separate claims made in the opening two paragraphs. Here the SCoPEd projects’ members say, “The aim of the SCoPEd project is to agree a shared, evidence-based generic competence framework to inform the training requirements, competences and practice standards for counsellors and psychotherapists working with adults.” And they go on in the next paragraph to say that, “The draft framework has utilised an evidence-based process of mapping existing competence frameworks, professional standards and practice standards to identify areas of overlap and areas of difference between counselling and psychotherapy.”

In this blog, the first of two tackling the issue of an ‘evidence-base’, I shall point to the fact that any reference to the use of evidence is questionable and more likely not, and therefore lacks integrity. First, let’s look at one of these statements again in more detail, “The aim of the SCoPEd project is to agree a shared, evidence-based generic competence framework to inform the training requirements, competences and practice standards for counsellors and psychotherapists working with adults”. Here the aim clearly suggests that the differentiated competences between the role of counsellor and psychotherapist will be grounded in evidence. But what do the SCoPEd team mean by evidence? And what might be an example of ‘evidence based competence’ that could be differentiable and identify clear evidence for a difference between the activities carried out under these two adjectival titles?

To first address the issue what evidence is being used, it seems that the list of sources used to arrive at the differentiated competence framework have been taken from existing lists of competences used, or even sponsored, by the same institutions that are trying to the find the evidence for the claimed differences between these titles. One of the issues with this process is that the documents tend to identify something that isn’t real. They are a fiction in regards to what people actually ‘do’. This is a well-known problem with the development of competences designed for a ‘labour market’ and they fail to adequately identify both the specifics and idiosyncrasies of actual praxis. What would be better, and would provide real evidence, is to look closely at what people actually ‘do’ in their work under these different titles.

Doing this would, I am sure, show something quite different from what is presented in the framework and might even show some new or unexpected findings. But the chance of discovering something new through this process has been closed off right from the outset because the aim is really not as it appears on the surface. The idea that counsellors are not doing the same work as psychotherapists flies in the face of all the evidence one can find from spending even just a little time listening to counsellors talking about their work. The chance to find this out has been forgone because a decision was made, at the outset, to look for the evidence in the data that already tells the SCoPEd team what they wanted to know.

‘But what does the actual evidence say?’

Let us look at just one example of a differentiation offered in the SCoPEd report. That is, Competency 3.10 under Theme 3 – Relationship, and refers specifically to the idea of ‘alliance ruptures and repairs’ (competence 3.10, 3.10b, 3.10c). In the SCoPEd document it is suggested that where there is a lack of ‘empirical evidence’, ‘grey literature’ has been used. It is difficult to know what evidence or grey literature has been used for the differentiation of this particular competence; not least because the research on therapeutic alliance, including the more specific topic of alliance rupture and repair, is one the largest bodies of empirical research in the entire psychotherapy process-outcome literature. Yet there is no citation to the empirical evidence that has been consulted. However, as this area of the psychotherapy literature is so extensive we probably should assume that the SCoPEd team will have consulted a recent meta-analysis of alliance rupture repair and outcome studies.

Looking at the differentiated competences (3.10, 3.10b, 3.10c) it seems that the SCoPEd project claim that psychotherapists are more skilled in dealing with alliance ruptures and repairs than are counsellors. But what does the actual evidence say about such a claim? Well let’s take a quick look. In a recent meta-analysis published in the American Psychological Association journal Psychotherapy (not a lightweight publication by any means) the very issue of alliance rupture and repair was considered as was its association to the improvement or progress that clients might make. Let me just say that whether or not one is against or for the quantitative paradigm, given that SCoPEd is an advocate for evidence it is probably worth noting the findings of this type of research because that is the premise on which it claims to be able to differentiate competence.

Esteemed alliance researchers Eubanks, Muran and Safran (2018) examined the association between alliance rupture repair and outcome in 11 studies involving 1,314 clients. Overall the effect size for rupture resolution and positive outcome was pretty impressive (d = .62 for those interested). Clearly good news for those theoretical approaches that regard the alliance as an integral feature of their practice (mainly psychodynamic but also CBT and some integrative therapies). A number of the studies included in this meta-analysis included ‘trainee therapists’ (so not even ‘qualified’ counsellors). The researchers tested the data to see if there were differences between the trainees and qualified/experienced therapists in this association between repairing ruptures and outcome. This was a test of moderation to see if this can account for the variance in the effects. The findings showed those studies that included primarily trainees do not differ significantly from those studies of more experienced qualified therapists in showing an association between rupture repair and outcome. This finding cannot provide evidence for supporting the claim that the more qualified/experienced a therapist is the more likely they will show an association between rupture repair and outcome.

‘the competences drawn up by SCoPEd have been deduced rather than induced from the close observations and recording of what therapists actually do’

So, the evidence from this most recent, up-to-date, and rigorous meta-analysis is overwhelmingly in favour of there being no difference between experienced/more trained therapists and the unqualified/trainee therapists in the associations they show between alliance rupture repair and outcome. But wait, the psychotherapists will say, obviously we refute this claim. Psychotherapists will work with ‘more complex and more distressed clients’ so there would be a difference if you looked at that, wouldn’t there? Well it seems the answer to that might also be available in the ‘evidence’ provided by this cutting edge meta-analysis. The evidence is as follows. Eubanks, Muran and Safran (2018) addressed the issue that more complex client work (such as that with clients given a diagnosis of a personality disorder) might mean that there would be less chance of a positive association between rupture repair and outcome. Again this was not found to alter the effects, meaning that whether or not a study included a majority of clients with a diagnosed personality disorder or not, the association between rupture repair and outcome did not differ significantly from those studies where this was not the case. So the ‘evidence’ suggests that even if psychotherapists claim to work with more distressed cases it seems this cannot be used as evidence to suggest they require more skills in working with alliance ruptures.

But wait, surely psychotherapists would be ‘trained specifically to deal with ruptures and repair’ and that is why their training is at a higher level. So now the question is what effects does having specific training in managing alliance ruptures have on the association of alliance rupture repair with outcome? Well, the same researchers completed a second meta-analysis comprising six separate studies and 276 therapists that had undergone such specific training. The findings again point to some interesting ‘evidence’. Once more, status as a trainee or qualified therapist undergoing this specific rupture repair training did not moderate the association between rupture repairs and outcome, suggesting that the finding is not affected by level of qualification. However, interestingly those training in CBT had a much stronger association between rupture repair and outcome than did the psychodynamically oriented rupture repair training. In fact, for psychodynamically trained therapists, the association was in a negative direction – suggesting the less effective they were in rupture repair, the better were client outcomes!

So what are we to make of this? Well it seems that if we are to look at the empirical evidence, that drawn from the very latest and most up-to-date evidence from meta-analysis, it appears to be suggesting that there’s little difference in association of outcome and rupture repairs in terms of the level of training a therapist has had. Of course, if we look to the ‘grey literature’ it is highly likely that we will find such differences; not least because those differences are simply statements of intent and not reality of practice. The issue here is that the competences drawn up by SCoPEd have been deduced rather than induced from the close observations and recording of what therapists, regardless of their level of qualification, actually ‘do’.

But let’s be honest, the ‘aim’ of SCoPEd is, at best, to determine what the differences are between ‘counselling’ and ‘psychotherapy’ in order to protect the various financial interests of those involved in the accrediting the training of counsellors and psychotherapists. At worst the aim is about laying the groundwork for the next attempt at protecting these titles under statute by pursuing the Statutory Regulation of counselling and psychotherapy. Referring to an ‘evidence-base’ is merely an attempt to give this project legitimacy in the eyes of the membership, who are kept in the dark about the real agendas playing out. This is an attempt to try and convince the members of BACP, UKCP and BCP – run down into the ground by the lack of employment opportunities after training – that they will be better off having these titles first differentiated and then protected. But in truth this will do nothing to protect or enhance the employment opportunities for the tens of thousands of under-employed counsellors/psychotherapists already trained and looking for work, and will do nothing to protect the public from rogue practitioners.

Reference

Eubanks, C. F., Muran, J. C., & Safran, S. D. (2018). Alliance rupture repair: A meta-analysis. Psychotherapy, 55, 508-519.

SCoPEd: Denial, Distortion & Deception

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.

andyrogerscounselling.com

@AndyCounsellor

‘Psychoanalytic coup’ – Andrew Samuels on the SCoPEd Competence Framework

Sent to the Chairs and CEOs of BACP, UKCP and BPC

January 24^th 2019

From Professor Andrew Samuels

You have every right to ignore this.

I was in the room as chair of UKCP when the HPC Professional Liaison group in 2010 were told by Prof Peter Fonagy that counselling was inferior to psychotherapy. BACP (Sally Aldridge) were apoplectic. But now, when I look at the lists of competences, I feel sure that many counsellors meet those ascribed to psychotherapy. I’ve trained some of them.

(Incidentally, didn’t the abject failure of the Skills for Health competency based project stick in anyone’s memories?)

Moreover, the interests of Jungian analysis, body psychotherapy, arts psychotherapies and transpersonal psychotherapy have been downplayed. I am not sure how a humanistic and integrative psychotherapist might react, to be honest. Not well, I surmise.

What has happened is that psychoanalysis and psychoanalytic psychotherapy have pulled off a major coup. Their values and approaches have triumphed. I am sure that this will be widely recognised by anyone who reads the documents. It reflects the dynamism and skill of their top people, in my view, so hats off to them in a way!

I have returned the survey to BPC and UKCP. In the free section, I have expressed astonishment that the discredited work done by Roth and Pilling in different contexts has been utilised in this one. Those academics are gung-ho for NICE, IAPT and statutory regulation. They are not friends of the work that we do.

The whole thing strikes me as an example of fiddling while Rome burns. Actually, it is worse than that. We’ve spent decades making sure that, for example, job adverts ask for BACP or UKCP or BPC membership where once the BPS held sway. I’ve been proud to be a part of that. We even managed to reduce the stress on modality in most adverts, except those where the consultant doctors were psychoanalysts. We have begun to get the Professional Standards Authority on the map.

Now three utterly bizarre neologisms are being put forward. And this is going to make getting jobs easier? Or help applicants? ‘Qualified counsellor’, ‘advanced qualified counsellor’, ‘psychotherapist’.

Even if the old terms are restored once the survey has run its course, the discrepant crunch between the two indicative languages will be so confusing.

And what is the point of saying that these terms are ‘loosely described’? They are not loosely described at all; they are clearly differentiated (albeit on shaky grounds) and formed into a tendentious hierarchy.

Sorry for the passionate way in which I write. I am hoping that there will be massive opposition to these proposals but am realistic: the supine memberships mostly won’t bother about it at all – a few will support, a few will oppose, and we shall lumber on, promoting the demise of depth, relational work – what I still call (semi-seriously) ‘real psychotherapy’.

Finally, I will comment on page 72 of the main document where the membership of your Expert Reference Group is given. There are 12 in total, 7 of which are psychoanalytic, 2 integrative (unspecified combination), 1 hypno-psychotherapy, 1 pluralistic (unspecified combination) and 1 humanistic-integrative. Add in the chair and information analyst and I believe it comes to 8 psychoanalytic and 6 others (of which only two are explicitly humanistic in orientation).

How is this a balanced group of experts??

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