Tag Archives: professionalisation

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 –

  1. How will the framework affect clients or patients in being able finding the right kind of help to meet their needs?
  2. How will the framework affect employers in being able to establish which counsellors or psychotherapists to employ in their service?
  3. How will the framework affect trainees in their understanding of the pathways open to them for core training with adults? (sic)
  4. 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.

*


 

 

Advertisements

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

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

January 24th 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??

 

 

 

 

 

 

Regulation, professionalism and cultures of dominance

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

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

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


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

January 20, 2018

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

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

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

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

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

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

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

Promoting professionalism, reforming regulation

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

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

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

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

Some perspectives that may be relevant:

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

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

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

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

This is perhaps the most important issue of the consultation.

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

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

Three reasons for this:

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

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

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

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

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


Brief references

Books

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

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

Videos

The PsyCommons – Ordinary Wisdom and Shared Power

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

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

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