Psychoanalysts threaten legal action against health regulator

October 26, 2009
EXCLUSIVE
By Adam James

......

Psychoanalysts who fear they will be banned by planned new regulation rules have threatened legal action against the UK health professions regulator.

Lawyers for six organisations representing around 1,500 Freudian psychoanalysts have written to the Health Professions Council (HPC) stating they will order a judicial review over the council’s “unlawful” failure to assess whether statutory regulation is necessary for psychoanalysts.

Psychoanalysis was devised by Sigmund Freud in the early 1900s, and psychoanalysts are among the estimated 60,000 psychotherapists and counsellors that the government plans to regulate by national standards.

The aim is to protect the public from abusive therapists and create an independent complaints procedure. At present anyone – even if they have no qualifications - can advertise themselves as a psychotherapist or counsellor.

But London solicitors, Bindmans, has written to the HPC accusing it of an “ongoing” failure in its legal duty to assess the best form of regulation for Freudian and other psychodynamic psychotherapists, and which body should administer such regulation.

"The HPC has attempted to leap over several stages in the statutory process. This is not lawful,” wrote Bindmans in its letter to the HPC.

The letter warns of a judicial review “if the HPC does not remedy these serious deficiencies.”

But HPC spokesperson Ebony Gayle said it denies the allegations and “will vigorously defend its position.”

Psychoanalysts argue there is no evidence that statutory registration prevents abusive therapists.

"There is no solid research that conclusively demonstrates there’s a degree of malpractice by counsellors and psychotherapists that would warrant heavy-handed regulation by the HPC,” said Professor Andrew Samuels of the Alliance of Counselling and Psychotherapy against State Regulation.

"Nor is there either research or argument to show that such regulation lessens abuse. Doctors, for example, have been so regulated for many years, but shocking cases still occur regularly,” he said.

Psychoanalysts also fear skill “competencies” drafted by the HPC that all psychotherapists must meet will precipitate the end of British psychoanalysis.

The competencies are overly-medicalised and mechanistic, say psychoanalysts who argue analysis is often as much art as science.

"If you read the list of things we are supposed to be doing I will not be able to practice,” said Darian Leader, a founder the Centre for Freudian Analysis and Research. “Psychoanalysis will effectively be banned.”

Ten psychoanalyst organisations have also published a hard-hitting 37-page report detailing their opposition to statutory regulation.

Called the Maresfield Report, it accuses the HPC of being overly-bureaucratic and slow in its handling of complaints by patients of other health professionals. It also accuses the HPC of “conspiring to lie” and "fabricating” documents over how it has failed to consult psychoanalysts.

Psychoanalysts say that the 7,000-member United Kingdom Council for Psychotherapy (UKCP), for example, handles complaints more sensitively and with a better response rate than the HPC. Whereas HPC finds no case to answer in over 70% of complaints, UKCP finds no case to answer in 10%, states the report.

Psychoanalysts, who accept some form of regulation is needed, advocate a “disclosure” system whereby therapists would be required to provide details of their qualifications to the public and to a central register. Failure to do so would be a criminal offence. Therapists who sexually abuse patients can be prosecuted under criminal law, they argue.

More than 2,700 people have signed an online petition against HPC-registration of psychotherapists. Signatories include Princess Diana’s therapist Susie Orbach and novelist Will Self.

"The new regulations - which include 451 rules for the analytic session - would effectively make it impossible to practice psychoanalysis and many other forms of therapy in the way they have been practiced for the last hundred years,” states the petition.

The British Association for Counselling and Psychotherapy (BACP), the leading body for counsellors and psychotherapists with 32,000 members, is critical of the psychoanalysts’ position.

"The public expects regulation. If you tell any member of the public in the street that psychotherapy and counselling is not under statutory regulation, they will say that it is wrong.” said BACP’s spokesperson Phillip Hodson.

"They [some psychoanalysts] want to be their own sole regulator – the judge and jury on their own form of psychoanalysis. That’s not acceptable.”

Ms Gayle said: “We refute the suggestion that the HPC has failed to undertake a proper assessment of the regulatory needs of this field and any suggestion that the consultation process has been narrow, biased or dishonest.”

She denied psychoanalysts would be banned. “I would not say they would be banned. But [if not registered by the HPC] they will not be able to use the protected title of psychotherapist,” she said.

"When we set standards, we consult widely with stakeholders to ensure that the standards are set at an appropriate level for safe and effective practice and do not act as an unfair barrier to innovation or diversity."

The HPC already regulates 14 professions, such as chiropodists and paramedics.

Read for yourself:
The Maresfield Report
Health Professions Council's plans to regulate psychotherapists and counsellors
Alliance for Counselling and Psychotherapy Against State Regulation

See also:
Sept 3, 2008: Psychotherapists and counsellors should refuse registration - state control will fail to protect the public from abuse and will threaten psychoanalysis, argues Ian Parker

.....

Agenda fighting

From: Jennifer Maidman, Member of the British Association for Counselling and Psychotherapy, London.
Date: October 30, 2009

There are so many unackowledged agendas in this debate, which seems to be more about this that or the other organization gaining advantage, rather than empowering clients. (Note: not "protecting" them. Language of liberation rather than language of control).

The HPC refutes the allegation that it has failed to consult appropriately on the regulation of Counselling and Psychotherapy. Yet the facts appear to tell a different story: entire sections of the profession are now considering legal action against HPC.

The largest organization in the field, the British Association for Counselling and Psychotherapy which has some 32,000 members, has rejected many of the proposals and is particularly critical of the "medical model" on which the HPC operates.

Surely it is self evident that the consulation thus far must have been at best less than adequate, at worst a box-ticking exercise. Nobody wants an unsupervised free for all. On the contrary reputable therapists are already subject to rigorous voluntary codes of ethics and complaints procedures. If statutory regulation is to go ahead it must be through a process and a model which can command widespread support. The HPC seems not to be that process.

Statutory Practitioner Disclosure could work. It would be less bureaucratic and centralized, encourage genuine diversity, and also be more client friendly. Why it has not been seriously considered by government is a mystery.

......

Voluntary regulation is a sham

From: Abused client, name witheld, UK
Date: November 2, 2009

Voluntary regulation is a sham - the professional bodies protect their members and reputations above all.

Ms Maidman, what on earth does this mean: "(Note: not "protecting" them. Language of liberation rather than language of control)"? I'm afraid this is just semantics - the public need protection from charlatans and malpractice. Counselling is potentially devastating if a practitioner gets it wrong either through incompetence or malice. There needs to be a transparent and independent complaint handling process to root out the dishonest parasites that take advantage of vulnerable people.

How much effort did this HPC consultation make to learn of actual clients' views? How many of the questions sought people's understanding of the protection already in place for the the talking therapies? How many questions asked people what they would like to see put in place? If the HPC aren't performing they need to up their game.

For Prof Samuels to argue: "Nor is there either research or argument to show that such regulation lessens abuse. Doctors, for example, have been so regulated for many years, but shocking cases still occur regularly,” is just shameful. One reason is that doctors are protected by the professional code of keeping schtum on malpractice and the old boys network of the BMA. Or does Mr Samuels think that the public would like an unregulated GP sector too? Perhaps it could become like the talking therapies?: See here and here

Ms Gayle says: "When we set standards, we consult widely with stakeholders to ensure that the standards are set at an appropriate level for safe and effective practice and do not act as an unfair barrier to innovation or diversity." So how many members of the public were consulted MsGayle? And how many practitioners?

......

Politics not protection

From: Kay Coombes, speech and language therapist, ARCOS, Malvern, Worcestershire
Date: November 23, 2009

Regulation as operated by the HPC is not based on evidence.
In my experence HPC Fitness to Practise procedures are not even carried out in acordance with HPC documentation and there is no investigation into the wellbeing of patients.

The HPC is about health politics, not public or patient protection.

......

Clients more likely to abused by registered, high-status professionals

From: Jennifer Maidman, Member of the British Association for Counselling and Psychotherapy, London.
Date: November 26, 2009

Thank you to the anonymous client who posted here. I agree with most of what you said. To be clear, though I am a qualified counsellor it is not my main occupation and I have no professional or financial interest here, one way or another.

One of the reasons I have been vocal about the issue of regulation is that I too have been an abused client. Only recently did I train as a counsellor. Perhaps part of the reason was so that I might make my voice heard in exactly this debate. Before training, I had experience in many different types of therapy as I tried to work through my own personal issues. Going into therapy places a person in a very vulnerable position. I suspect some therapists may underestimate this, and I personally think any counsellor or psychotherapist needs to have considerable experience in the clients chair. The fact that some may lack this is cause for concern. It is quite possible to reach the higher echelons of psychiatry for instance having had none, no sense at all of how it feels to be in the hot seat, and little insight as to how to manage the kinds of personal and boundary issues which can surface in the intimacy of a therapeutic relationship.

People without personal experience of it, do not realize how suggestible one can be as a client, how open to both subtle and overt forms of abuse.My previous posting may seem like just semantics, yes, perhaps that's a fair criticism; but I do believe, from bitter experience, that it is exactly the kind of implicit "for your own good" attitude embodied in these convenient assumptions of 'public protection' which can contribute to a context in which abuse may more easily take place.

One of the top researchers in this area, Ken Pope, has found that far from being the stereotypical 'rogue therapist', (he says this is a bogey-man invented by an embarrased profession), clients are if anything more likely to be abused by high status individuals. A prominent case in the UK involved two psychiatrists repeatedly abusing female clients, despite being highly qualified members of the Royal College of Psychiatrists.

I'm sure you are right that HPC needs to up its game, whatever happens. The problem as I see it is that the 'consultation' has been nothing of the sort. As you point out, where is the client voice? Why is this webpage one of the few places where we are having this conversation? How come thousands of practitioners are up in arms? Surely they are not all abusers? It suits certain factions who see HPC regulation as a way to consolidate their professional power to portray all dissenters in a negative light. But power and its misuse is the problem, not the solution. Having experienced it first hand, I make no excuses for abusive or damaging therapy. It can be so deeply destabalizing and damaging and my heart goes out to anyone else who has been through it. There's actually a real lack of public understanding in this area. There are also, as you point out, serious conflicts of interest regarding regulation by what are effectively trade unions for therapists.

There are no easy answers here. But the kind of one-size-fits all approach taken so far, I honestly think it may make matters worse through the kind of unintended consequences we've already seen in other areas such as social work and education. Many of those calling for tighter regulation have the right intention, but I respectfully suggest that we need to think through carefully how we do this if we are not to make things worse.

Add your comments
What do you think? Email your comments on the above
article to the editor using the form below. Selected comments will be displayed.

© 2001-7  Psychminded Limited. All rights reserved