Last week, the tenth and final meeting of the HPC professional liaison group on counsellors and psychotherapists took place before a packed public gallery of observers.
Since the meeting in December last year, the counsellor and psychotherapy members of the group have held meetings to undertake further reviews of the draft standards of proficiency.
There were three substantive items on the agenda – consideration of a new draft set of standards for psychotherapists working with children and young people, the draft standards of education and training, and the revised draft standards of proficiency for counsellors and psychotherapists, aligned with the new version of the generic standards of proficiency.
The Group had already made an in principle decision that the profession specific standards of proficiency should be drafted for counsellors at Level 5 and Level 7, and Level 7 for psychotherapists, effectively creating two level of entry points for counsellors, and one for psychotherapists. This meeting provided an opportunity for the whole group to review these draft standards with a view to making recommendations to the HPC Council in due course.
As ever there was a wide ranging discussion on almost all of these issues, and at several points the group felt it was important to take an indicative vote amongst those from the counselling and psychotherapy professions around the table. The outcome of this voting was as follows
• There was agreement (one abstention) that the first entry point for counsellors should be set at Level 5.
• There was agreement (one abstention) that there should be different entry points for counsellors – one at Level 5 and the other at level 7
These outcomes represent significant progress in the work to describe different levels of practise.
On the other two substantive points, - creating a separate set of standards of proficiency for child psychotherapists and holding two separate sets of standards of proficiency for counsellors and psychotherapists at Level 7 - the group did not reach a consensus. . These matters were therefore referred to the HPC Council for further deliberation.
There were passionate views round the table, not least over the importance of the language of the standards, and a clear feeling that there were differences in identity, philosophy and semantics between counsellors and psychotherapists. There were also differences in practise, which some felt could be more clearly articulated in the draft standards at Level 7. However, the opposite view was that that differentiation at entry level 7 was not supported by evidence from the field – there were currently counsellors and psychotherapists who use the title interchangeably, applying theory and practise from both fields, depending on the context.
The disparity continues to centre around describing differentiation – and specifically how and what differentiates a counsellor and a psychotherapist trained to Level 7 when they qualify from a training programme. For me, the debate is a philosophical and ideological one – tied up closely with identity. I did not hear anyone say that there was no difference between the two – only disparate views on how and what distinguishes them at the point of entry to practise.
Since the outset of the work of the PLG, references have been made to the ‘building blocks’ of regulation – standards, levels of entry to the Register and the structure of the Register being examples of these. It struck me after the meeting that the standards could also be described using the analogy of a climbing wall. The standards are something like the footholds and hand-grips on a climbing wall. If the wall is ‘professional practise’, and the climbers are practitioners – there are an almost unlimited number of ways that the wall can be climbed. For counsellors and psychotherapists, we may not yet have agreement on where the foothold and hand grips should be placed on the wall, but we are significantly closer now than we were a year ago.
This debate will therefore continue well beyond the ending of the PLG. I very much believe that this further work will bring us to a pragmatic solution that is acceptable to the majority. Members of the PLG have been tenacious in their commitment to this work, and have created new milestones, new agreements, new clarity. Without clear standards, there can be no robust regulation. On behalf of the Council, I would like to thank them for their personal investment and considered contribution to this important work.
Anna van der Gaag
Chair
HPC
Showing posts with label counsellors. Show all posts
Showing posts with label counsellors. Show all posts
09 February 2011
26 October 2010
A meeting of minds
On the 7th October, HPC held an information event for counsellors and psychotherapists in Glasgow. It was well attended. We began with a presentation on the purpose of regulation, and moved on to an update of the work of the Professional Liaison Group for psychotherapists and counsellors and a description of the HPC’s Fitness to Practise process. This was followed by an hour long Question and answer session with a panel. Brain McGee, Chief Executive of COSCA (Counselling in Scotland) and member of the HPC’s PLG, joined us on the panel.
The audience raised a wide range of issues about the proposals for statutory regulation. First, there were concerns about the potential financial impact of regulation on voluntary sector organisations and their volunteers. In Scotland there is a strong and well established infrastructure of volunteers who provide counselling services, perhaps more so than in other parts of the UK, and the issue of funding the fee could become a breaking point. There was discussion around whether the Scottish government could or would offer a subsidy, given the widespread use of volunteer counselling services in Scotland.
Some representatives from the voluntary sector organisations also asked about the timescale for the implementation of statutory regulation, and expressed frustration at the continuing delay. As well as the desire to fully address the complexity of some of the issues about regulating psychotherapists and counsellors the uncertainly around the current governments position in this regard was also noted by the audience.
There was discussion about some of the unresolved issues still being considered by the PLG, such as the criteria for selecting voluntary registers for transfer, differentiation between counselling and psychotherapy, and what individuals would call themselves post regulation. There was some feeling expressed that the result of the consultation exercise showing that 78% of individuals did not favour differentiation should be taken as a clear sign of the views of counsellors and psychotherapists. However, the HPC noted that these figures might not convey the full picture as a number of the current voluntary registers had asked individuals to respond directly to them and had collated views.
There was a discussion around the relationship between professional bodies and the regulator – with concerns expressed that regulation would diminish the role of the professional bodies. Clearly, HPC could not replace the services and support offered by these bodies. The panel responded by referring to previous experiences from other professions where the role of the professional body as the body focused on promotion of the standards and the reputation of the profession was enhanced once the disciplinary function was transferred.
Fitness to practise processes were also raised, in particular concerns about how the HPC supported those individuals for whom there was no case to answer. What was the duty of care to them? Kelly Johnson, Director of Fitness to Practise described the processes that had been put in place to support individuals and outlined the work being done exploring the role of mediation in a regulatory context. She acknowledged again the significant stress arising from any scrutiny of an individual’s practise.
I personally was heartened to hear that at least one individual who had attended one of our previous stakeholder events held in Manchester in 2009, said she felt this event showed that the HPC was listening to the views of practitioners and was more constructive in the dialogue. There has been the need for some culture shifts/changes in approach for us as an organisation in thinking about the regulation of psychotherapists and counsellors. I hope that such listening will continue on both sides.. The whole event did feel like a conversation that was illuminating for both listeners and speakers, and I was pleased to be part of it.
Anna van der Gaag
Chair HPC
The audience raised a wide range of issues about the proposals for statutory regulation. First, there were concerns about the potential financial impact of regulation on voluntary sector organisations and their volunteers. In Scotland there is a strong and well established infrastructure of volunteers who provide counselling services, perhaps more so than in other parts of the UK, and the issue of funding the fee could become a breaking point. There was discussion around whether the Scottish government could or would offer a subsidy, given the widespread use of volunteer counselling services in Scotland.
Some representatives from the voluntary sector organisations also asked about the timescale for the implementation of statutory regulation, and expressed frustration at the continuing delay. As well as the desire to fully address the complexity of some of the issues about regulating psychotherapists and counsellors the uncertainly around the current governments position in this regard was also noted by the audience.
There was discussion about some of the unresolved issues still being considered by the PLG, such as the criteria for selecting voluntary registers for transfer, differentiation between counselling and psychotherapy, and what individuals would call themselves post regulation. There was some feeling expressed that the result of the consultation exercise showing that 78% of individuals did not favour differentiation should be taken as a clear sign of the views of counsellors and psychotherapists. However, the HPC noted that these figures might not convey the full picture as a number of the current voluntary registers had asked individuals to respond directly to them and had collated views.
There was a discussion around the relationship between professional bodies and the regulator – with concerns expressed that regulation would diminish the role of the professional bodies. Clearly, HPC could not replace the services and support offered by these bodies. The panel responded by referring to previous experiences from other professions where the role of the professional body as the body focused on promotion of the standards and the reputation of the profession was enhanced once the disciplinary function was transferred.
Fitness to practise processes were also raised, in particular concerns about how the HPC supported those individuals for whom there was no case to answer. What was the duty of care to them? Kelly Johnson, Director of Fitness to Practise described the processes that had been put in place to support individuals and outlined the work being done exploring the role of mediation in a regulatory context. She acknowledged again the significant stress arising from any scrutiny of an individual’s practise.
I personally was heartened to hear that at least one individual who had attended one of our previous stakeholder events held in Manchester in 2009, said she felt this event showed that the HPC was listening to the views of practitioners and was more constructive in the dialogue. There has been the need for some culture shifts/changes in approach for us as an organisation in thinking about the regulation of psychotherapists and counsellors. I hope that such listening will continue on both sides.. The whole event did feel like a conversation that was illuminating for both listeners and speakers, and I was pleased to be part of it.
Anna van der Gaag
Chair HPC
18 May 2010
Counsellors and psychotherapists working group meets again
Anna van der Gaag, Chair of HPC writes:
On the 12 May 2010, the sixth meeting of the HPC’s working group (called the professional liaison group) on counsellors and psychotherapists took place in London. The purpose of the meeting was to review progress and to discuss the plan of activities over the coming months.
There was a consensus round the table that progress had been made over the past year. Areas where further work was necessary were now more clearly in focus. The HPC’s initiatives on reviewing the generic standards of proficiency, and the Council’s recognition that the generic standards needed to become more over arching and less orientated towards the language of ‘health’ were seen as a key to accommodating counsellors and psychotherapists within the existing structures. There was also an acknowledgement that HPC’s ongoing engagement with the professional associations was important to making progress on all the outstanding issues – differentiation between counsellors and psychotherapists, child and adult work, as well as consensus building on the standards of proficiency and the standards on education and training. Third, members of the group spent time discussing the wider debates taking place about regulation, and the need for ongoing engagement with those who currently oppose regulation. There was an acknowledgement of the range of reasons behind opposition to HPC as a regulator. Several members felt it would be helpful to know more of the detail behind the proposals for the alternative form of regulation being proposed.
The planned activities over the coming months will centre around the PLG’s further engagement with a range of stakeholders as well as further deliberations by the group on the outstanding issues outlined above. There was agreement that the group wished to invite service users to present their perspectives on these issues, as their voice had been under represented. Careful consideration would need to be given to how best to hear more from users on their experiences of counselling and psychotherapy and views on regulation. Other suggestions included employers and those with expertise in working with children, some additional perspectives on regulation of the profession across the world, and possibly additional input from educationalists when giving further consideration to standards from education and training.
The work of the PLG in gathering more expertise and hearing from a wider range of stakeholders will run in parallel with four public meetings across the UK. These public meetings will provide opportunities for further dialogue with the profession. Each meeting will include presentations from HPC on its work, a question and answer session and workshops.
My own observation was that there were several threads running through today’s discussions – one was the ongoing need for the PLG members and the HPC to engage with the profession. The second was the centrality of the relational element in counselling and psychotherapy – which was common across all modalities - and should be clearly recognised and articulated in the current debate. The meeting was, as ever, populated by a wide ranging and constructive dialogue and a desire to make further progress towards statutory regulation.
Anna van der Gaag
Chair
HPC
On the 12 May 2010, the sixth meeting of the HPC’s working group (called the professional liaison group) on counsellors and psychotherapists took place in London. The purpose of the meeting was to review progress and to discuss the plan of activities over the coming months.
There was a consensus round the table that progress had been made over the past year. Areas where further work was necessary were now more clearly in focus. The HPC’s initiatives on reviewing the generic standards of proficiency, and the Council’s recognition that the generic standards needed to become more over arching and less orientated towards the language of ‘health’ were seen as a key to accommodating counsellors and psychotherapists within the existing structures. There was also an acknowledgement that HPC’s ongoing engagement with the professional associations was important to making progress on all the outstanding issues – differentiation between counsellors and psychotherapists, child and adult work, as well as consensus building on the standards of proficiency and the standards on education and training. Third, members of the group spent time discussing the wider debates taking place about regulation, and the need for ongoing engagement with those who currently oppose regulation. There was an acknowledgement of the range of reasons behind opposition to HPC as a regulator. Several members felt it would be helpful to know more of the detail behind the proposals for the alternative form of regulation being proposed.
The planned activities over the coming months will centre around the PLG’s further engagement with a range of stakeholders as well as further deliberations by the group on the outstanding issues outlined above. There was agreement that the group wished to invite service users to present their perspectives on these issues, as their voice had been under represented. Careful consideration would need to be given to how best to hear more from users on their experiences of counselling and psychotherapy and views on regulation. Other suggestions included employers and those with expertise in working with children, some additional perspectives on regulation of the profession across the world, and possibly additional input from educationalists when giving further consideration to standards from education and training.
The work of the PLG in gathering more expertise and hearing from a wider range of stakeholders will run in parallel with four public meetings across the UK. These public meetings will provide opportunities for further dialogue with the profession. Each meeting will include presentations from HPC on its work, a question and answer session and workshops.
My own observation was that there were several threads running through today’s discussions – one was the ongoing need for the PLG members and the HPC to engage with the profession. The second was the centrality of the relational element in counselling and psychotherapy – which was common across all modalities - and should be clearly recognised and articulated in the current debate. The meeting was, as ever, populated by a wide ranging and constructive dialogue and a desire to make further progress towards statutory regulation.
Anna van der Gaag
Chair
HPC
30 April 2010
The proposed regulation of counsellors and psychotherapists: reflections from the Chair
Anna van der Gaag, Chair of HPC writes:
In recent months I have benefited greatly from conversations with members of the profession, who have discussed the government’s proposals for statutory regulation. Several have asked me to write a brief statement, which may help to explain some facts to those unfamiliar with the HPC and in particular, to describe our underlying principles as well as practices.
When was the HPC set up?
The HPC was established in 2001, as the UK wide statutory regulator for 12 professions working in NHS, education and social care settings as well as private practitioners. From the start, it was given a remit to advise the government on the statutory regulation of additional professions and by 2010, it had assumed responsibility for regulating three further professions, including psychologists.
How do professions become regulated by HPC?
There are two ways in which a profession can be recommended for regulation by the HPC.
Firstly, the HPC itself has the legal power to make recommendations to the Secretary of State for Health and to Scottish Ministers on the regulation of a profession. To help us in exercising this power we have a ‘new professions process’ through which professional bodies representing professions seeking regulation can apply and demonstrate that they meet 10 criteria for regulation. To date we have received unsolicited applications via this route from 11 professions, including dance movement therapists, and have made recommendations for their regulation to government.
Secondly, the government can make a decision to regulate a profession itself, normally via a White Paper. In 2007, this was the route chosen by the government for the regulation of several professions, including psychologists, counsellors and psychotherapists. Direct reference is made to the government’s desire to regulate these professions in the White Paper entitled ‘Trust Assurance and Safety – The Regulation of Health Professionals in the 21st Century’ .
What do we do?
The four key functions of a statutory professional regulator are to
• Set and monitor standards for the professions regulated by them, including standards on continuing professional development
• Keep a register of those who meet the standards
• Monitor and approve education programmes
• Run a fitness to practise process
Underlying principles
There are several key principles underpinning our work. First, many of our standards are ‘generic’, that is they are designed to apply to all the professions that we regulate. This recognises the similarities between many professions, and allows for greater consistency and clarity from the public’s perspective. Second, our legislation is compliant with Human Rights principles and law, and is designed to protect the public and not to ‘punish’ practitioners. This compliance underpins all our processes – from the way in which standards are agreed and set, to the organisation, language and delivery of fitness to practise processes. For example, there is no reference in the fitness to practise process to ‘punishment’ or ‘guilt’ ‘ ‘defendant’ or ‘charges.’ The emphasis is on establishing whether the person’s ‘fitness to practise’ is ‘impaired’ and whether public protection is ‘required’ in relation to that individual.
How does the Fitness to Practise process work?
Anyone can make an allegation against any practitioner on our register. We decide whether the allegation meets our standard of acceptance for an allegation and if it does, we start a process to assess whether or not the practitioner does, or does not meet our standards. We do recognise that any examination of a professional’s work is going to be stressful and will have an impact on all those involved.
The process involves a number of stages, and we make sure that we communicate with the individuals concerned so that they know what is happening at each stage. It may involve a full public hearing at which all sides have an opportunity to have their views heard by a panel. There are certain circumstances in which hearings are heard or part heard in private, for example, when panels are required to consider details of a professional’s physical or mental health, or where the identity of witnesses need to be protected. However we adhere to the ‘open justice principle’ used throughout the United Kingdom, which means that in general our hearings are held in public.
The panels are made up of professional and lay people. They will always include a person who is from the same profession as the practitioner, and where appropriate there will be experts from the field who are invited to give their views at the hearing. The HPC has well over 400 Partners, many drawn from the professions themselves, who undertake the work of inspecting education programmes, assessing applications to join the register, as well as sitting as panel members at fitness to practise hearings. There are also many ‘lay’ Partners, who come from a wide variety of public service and independent sector backgrounds, and are all given training in HPC’s principles and processes. If we were to regulate counsellors and psychotherapists, we would recruit new Partners from the various counselling and psychotherapy modalities and disciplines to undertake this work.
Onora O’Neill, in her book ‘A Question of Trust’, talks about the importance of having ‘individuals with knowledge’ responsible for making judgements. HPC is wholly committed to ensuring that this is the case in all its day to day decisions – whether about education standards or ethical standards or standards of competence or – ‘proficiency’ as it is called in law – for a particular profession.
Where panels identify that a registrant’s fitness to practise is impaired, they must determine what degree of public protection (if any) is required. Panels should approach this in a proportionate manner and as so far as possible, registrants should be allowed to remain in practice subject to any necessary restrictions if that is consistent with public protection.
HPC’s approach to justice, para 9.0, 2010.
When determining what action to take, the panel have a range of sanctions which it can apply to practitioners, including placing conditions on practise, or requiring a period of supervised practise, or suspending the person from work until such time as they are ready to return to work.
The approach to justice at HPC is, in this sense, restorative, not retributive in nature (see illustration below showing the justice continuum). The panels of the HPC are not there to punish individuals, although a small minority of individuals (currently 0.03%) are taken of the register and are not able to continue practising. These individuals have in most instances been identified as posing a serious risk to the public by an independent panel with representation from the profession itself.
We know from independent sources (Borys and Pope, 1989, Pope, 1991, Sarkar, 2004) that there is evidence that a minority of practitioners do present a risk to the public but it is only a tiny minority.
Recognising what is different about counsellors and psychotherapists
Many psychotherapists and counsellors have discussed with me the complex nature of their work with individuals. Depending on their ideology and discipline, they explain this in different language, but one of the common themes that comes across is that therapy can be a risky business – and we know that some argue that any kind of ‘talking’ therapy is inherently risky. People who come for therapy can be ‘damaged’ by events and circumstances, vulnerable, abused, and angry as well as searching for greater levels of insight and understanding. The risk therefore of misinterpretation, retaliation, or disappointment is often high, and the therapist enters into therapy with a degree of awareness that the client may, or may not derive benefit, and may or may not find the experience of therapy to be a positive one. Indeed, many will undergo therapy which becomes difficult, painful, confusing and challenging, though in the majority of cases the outcome will leave the person feeling that therapy has been a rewarding and strengthening experience.
If one introduced a system of statutory regulation into this therapeutic environment, then the concern is that there will be therapists who are ‘blamed’ by their clients for disappointment or disorder in their lives which may have nothing to do with the therapist’s behaviour or competence. It is the relational element in counselling and psychotherapy, common across all modalities and central to the therapeutic process itself, that gives rise to great complexity and therefore greater potential for misrepresentation.
HPC is aware that theses are some of the concerns amongst practitioners. However, I believe that the system of regulation delivered by HPC is able to accommodate this, whilst still offering the level of public re-assurance and protection. I believe this for a number of reasons:
Firstly, our fitness to practise process is about deciding whether a professional remains fit to practise. Sometimes a client might be unhappy about their therapy or their therapist, for example, they are unhappy because they didn’t find their therapy helped them. We have to consider the complaints we receive individually but we only need to take action where a practitioner’s fitness to practise might be impaired and where we might need to take action to protect other members of the public.
The HPC cannot address all complaints, and nor does it wish to. It is concerned only with investigating impairment in practise which has consequences for public protection. For example, the fitness to practise of a therapist who borrows money from their client or who engages in sexual activity with a client during therapy sessions is very likely to be impaired.
In these examples most members of the public and indeed fellow therapists would reasonably conclude that this was unacceptable behaviour. These are the kinds of issues of impairment that have consequences for public protection.
Secondly, we have experience in regulating arts psychotherapists, a group of therapists with whom there is certainly some commonality with counsellors and psychotherapists. From this experience we know that the number of allegations against these professions has been very small. For example, between 2005 and 2007, there were four allegations against arts therapists. The assertion that the HPC is receiving many dozens of complaints against talking therapists is unfounded.
Lastly, the standards we use are ‘enabling’ standards, not prescriptive standards. We do not and would not prescribe what should happen during each therapy session, for example, and we recognise that professionals on our register might meet our standards in a variety of different ways, depending upon, for example, their professional background, their personal preference, and the needs of individual clients.
In a recent article published in the spring edition of ‘New Associations’, Val Huet, group psychotherapist and Chief Executive of the British Association of Art Therapists, told New Associations, the new publication from the British Psychoanalytic Council ,
‘Nobody from HPC is going to stand at your elbow and say you must do this or that. Their concern is public protection.”
Furthermore we are in the process of reviewing our standards to make them more overarching and to remove the language of health and disease which has caused concern.
HPC’s plans for Mediation research
There are some disputes between therapist and client that may be more amenable to different means of resolution, such as mediation. Such alternatives will be more appropriate in some circumstances than others, and will depend upon factors such as the nature and severity of the allegation and whether or not both parties agree to such an approach. They can reduce the impact of the experience of bringing an allegation for both parties and provide a way of resolving conflict. We are looking at how and when such approaches are applied in other fields of work, and will then make a decision as to whether or how they might be piloted by HPC. We will be working closely with the professions on this, and there will be further updates on the progress of this work later in the year.
References
Department of Health (2007)
Trust Assurance and Safety – The Regulation of Health Professionals in the 21st Century’ .
HPC Fitness to Practise Annual Report 2009
www.hpc-uk.org/publications
HPC’s Approach to Justice and Impairment
Council papers, March 25 2010, Enclosure 9.
New Associations – News analysis and opinion from the psychoanalytic community. ‘Forging as modern profession’, Spring Issue 2010, p6-7.
O’neill, O. (2002) A Question of Trust. Reith Lectures 2002
In recent months I have benefited greatly from conversations with members of the profession, who have discussed the government’s proposals for statutory regulation. Several have asked me to write a brief statement, which may help to explain some facts to those unfamiliar with the HPC and in particular, to describe our underlying principles as well as practices.
When was the HPC set up?
The HPC was established in 2001, as the UK wide statutory regulator for 12 professions working in NHS, education and social care settings as well as private practitioners. From the start, it was given a remit to advise the government on the statutory regulation of additional professions and by 2010, it had assumed responsibility for regulating three further professions, including psychologists.
How do professions become regulated by HPC?
There are two ways in which a profession can be recommended for regulation by the HPC.
Firstly, the HPC itself has the legal power to make recommendations to the Secretary of State for Health and to Scottish Ministers on the regulation of a profession. To help us in exercising this power we have a ‘new professions process’ through which professional bodies representing professions seeking regulation can apply and demonstrate that they meet 10 criteria for regulation. To date we have received unsolicited applications via this route from 11 professions, including dance movement therapists, and have made recommendations for their regulation to government.
Secondly, the government can make a decision to regulate a profession itself, normally via a White Paper. In 2007, this was the route chosen by the government for the regulation of several professions, including psychologists, counsellors and psychotherapists. Direct reference is made to the government’s desire to regulate these professions in the White Paper entitled ‘Trust Assurance and Safety – The Regulation of Health Professionals in the 21st Century’ .
What do we do?
The four key functions of a statutory professional regulator are to
• Set and monitor standards for the professions regulated by them, including standards on continuing professional development
• Keep a register of those who meet the standards
• Monitor and approve education programmes
• Run a fitness to practise process
Underlying principles
There are several key principles underpinning our work. First, many of our standards are ‘generic’, that is they are designed to apply to all the professions that we regulate. This recognises the similarities between many professions, and allows for greater consistency and clarity from the public’s perspective. Second, our legislation is compliant with Human Rights principles and law, and is designed to protect the public and not to ‘punish’ practitioners. This compliance underpins all our processes – from the way in which standards are agreed and set, to the organisation, language and delivery of fitness to practise processes. For example, there is no reference in the fitness to practise process to ‘punishment’ or ‘guilt’ ‘ ‘defendant’ or ‘charges.’ The emphasis is on establishing whether the person’s ‘fitness to practise’ is ‘impaired’ and whether public protection is ‘required’ in relation to that individual.
How does the Fitness to Practise process work?
Anyone can make an allegation against any practitioner on our register. We decide whether the allegation meets our standard of acceptance for an allegation and if it does, we start a process to assess whether or not the practitioner does, or does not meet our standards. We do recognise that any examination of a professional’s work is going to be stressful and will have an impact on all those involved.
The process involves a number of stages, and we make sure that we communicate with the individuals concerned so that they know what is happening at each stage. It may involve a full public hearing at which all sides have an opportunity to have their views heard by a panel. There are certain circumstances in which hearings are heard or part heard in private, for example, when panels are required to consider details of a professional’s physical or mental health, or where the identity of witnesses need to be protected. However we adhere to the ‘open justice principle’ used throughout the United Kingdom, which means that in general our hearings are held in public.
The panels are made up of professional and lay people. They will always include a person who is from the same profession as the practitioner, and where appropriate there will be experts from the field who are invited to give their views at the hearing. The HPC has well over 400 Partners, many drawn from the professions themselves, who undertake the work of inspecting education programmes, assessing applications to join the register, as well as sitting as panel members at fitness to practise hearings. There are also many ‘lay’ Partners, who come from a wide variety of public service and independent sector backgrounds, and are all given training in HPC’s principles and processes. If we were to regulate counsellors and psychotherapists, we would recruit new Partners from the various counselling and psychotherapy modalities and disciplines to undertake this work.
Onora O’Neill, in her book ‘A Question of Trust’, talks about the importance of having ‘individuals with knowledge’ responsible for making judgements. HPC is wholly committed to ensuring that this is the case in all its day to day decisions – whether about education standards or ethical standards or standards of competence or – ‘proficiency’ as it is called in law – for a particular profession.
Where panels identify that a registrant’s fitness to practise is impaired, they must determine what degree of public protection (if any) is required. Panels should approach this in a proportionate manner and as so far as possible, registrants should be allowed to remain in practice subject to any necessary restrictions if that is consistent with public protection.
HPC’s approach to justice, para 9.0, 2010.
When determining what action to take, the panel have a range of sanctions which it can apply to practitioners, including placing conditions on practise, or requiring a period of supervised practise, or suspending the person from work until such time as they are ready to return to work.
The approach to justice at HPC is, in this sense, restorative, not retributive in nature (see illustration below showing the justice continuum). The panels of the HPC are not there to punish individuals, although a small minority of individuals (currently 0.03%) are taken of the register and are not able to continue practising. These individuals have in most instances been identified as posing a serious risk to the public by an independent panel with representation from the profession itself.
We know from independent sources (Borys and Pope, 1989, Pope, 1991, Sarkar, 2004) that there is evidence that a minority of practitioners do present a risk to the public but it is only a tiny minority.
Recognising what is different about counsellors and psychotherapists
Many psychotherapists and counsellors have discussed with me the complex nature of their work with individuals. Depending on their ideology and discipline, they explain this in different language, but one of the common themes that comes across is that therapy can be a risky business – and we know that some argue that any kind of ‘talking’ therapy is inherently risky. People who come for therapy can be ‘damaged’ by events and circumstances, vulnerable, abused, and angry as well as searching for greater levels of insight and understanding. The risk therefore of misinterpretation, retaliation, or disappointment is often high, and the therapist enters into therapy with a degree of awareness that the client may, or may not derive benefit, and may or may not find the experience of therapy to be a positive one. Indeed, many will undergo therapy which becomes difficult, painful, confusing and challenging, though in the majority of cases the outcome will leave the person feeling that therapy has been a rewarding and strengthening experience.
If one introduced a system of statutory regulation into this therapeutic environment, then the concern is that there will be therapists who are ‘blamed’ by their clients for disappointment or disorder in their lives which may have nothing to do with the therapist’s behaviour or competence. It is the relational element in counselling and psychotherapy, common across all modalities and central to the therapeutic process itself, that gives rise to great complexity and therefore greater potential for misrepresentation.
HPC is aware that theses are some of the concerns amongst practitioners. However, I believe that the system of regulation delivered by HPC is able to accommodate this, whilst still offering the level of public re-assurance and protection. I believe this for a number of reasons:
Firstly, our fitness to practise process is about deciding whether a professional remains fit to practise. Sometimes a client might be unhappy about their therapy or their therapist, for example, they are unhappy because they didn’t find their therapy helped them. We have to consider the complaints we receive individually but we only need to take action where a practitioner’s fitness to practise might be impaired and where we might need to take action to protect other members of the public.
The HPC cannot address all complaints, and nor does it wish to. It is concerned only with investigating impairment in practise which has consequences for public protection. For example, the fitness to practise of a therapist who borrows money from their client or who engages in sexual activity with a client during therapy sessions is very likely to be impaired.
In these examples most members of the public and indeed fellow therapists would reasonably conclude that this was unacceptable behaviour. These are the kinds of issues of impairment that have consequences for public protection.
Secondly, we have experience in regulating arts psychotherapists, a group of therapists with whom there is certainly some commonality with counsellors and psychotherapists. From this experience we know that the number of allegations against these professions has been very small. For example, between 2005 and 2007, there were four allegations against arts therapists. The assertion that the HPC is receiving many dozens of complaints against talking therapists is unfounded.
Lastly, the standards we use are ‘enabling’ standards, not prescriptive standards. We do not and would not prescribe what should happen during each therapy session, for example, and we recognise that professionals on our register might meet our standards in a variety of different ways, depending upon, for example, their professional background, their personal preference, and the needs of individual clients.
In a recent article published in the spring edition of ‘New Associations’, Val Huet, group psychotherapist and Chief Executive of the British Association of Art Therapists, told New Associations, the new publication from the British Psychoanalytic Council ,
‘Nobody from HPC is going to stand at your elbow and say you must do this or that. Their concern is public protection.”
Furthermore we are in the process of reviewing our standards to make them more overarching and to remove the language of health and disease which has caused concern.
HPC’s plans for Mediation research
There are some disputes between therapist and client that may be more amenable to different means of resolution, such as mediation. Such alternatives will be more appropriate in some circumstances than others, and will depend upon factors such as the nature and severity of the allegation and whether or not both parties agree to such an approach. They can reduce the impact of the experience of bringing an allegation for both parties and provide a way of resolving conflict. We are looking at how and when such approaches are applied in other fields of work, and will then make a decision as to whether or how they might be piloted by HPC. We will be working closely with the professions on this, and there will be further updates on the progress of this work later in the year.
References
Department of Health (2007)
Trust Assurance and Safety – The Regulation of Health Professionals in the 21st Century’ .
HPC Fitness to Practise Annual Report 2009
www.hpc-uk.org/publications
HPC’s Approach to Justice and Impairment
Council papers, March 25 2010, Enclosure 9.
New Associations – News analysis and opinion from the psychoanalytic community. ‘Forging as modern profession’, Spring Issue 2010, p6-7.
O’neill, O. (2002) A Question of Trust. Reith Lectures 2002
26 January 2010
Confer Conference State Regulation: The Issues
23 January 2010, Conway Hall, London
This conference provided an opportunity for members of the counselling and psychotherapy professions to ‘clarify the facts about statutory regulation, explore concerns and to put questions to a panel’. It was well organised and well attended by some 250 delegates from a wide range of modalities and backgrounds. The panel consisted of Lynn Gabriel, Chair BACP, Andrew Samuels, Chair UKCP, Marc, Seale, Chief Executive, HPC, Julian Lusada, Chair BCP, Darian Leader, Alliance for Counselling and Psychotherapy Against State Regulation, Michael Fischer, psychotherapist and researcher from Kings College and Di Waller, HPC Council Member and Chair of the HPC PLG.
During the morning the panel offered their views on some pre-set questions followed by a general question and answer session, and in the afternoon participants took part on café style conversations followed by feedback.
Michael Fischer described his observations of a small sample of doctors and their fear of the growing ‘blame culture’ in society. Julian Lusada spoke about the need for regulatory processes which were ‘sensitive and thoughtful’, but offered protection to both patients and therapists. Lynn Gabriel reiterated the need for counsellors and psychotherapists to be of equal value in whatever system emerged, and the need to address the mis-perceptions which existed about the HPC. Andrew Samuels proposed that there would be ‘independent statutory regulation’ in some form in the future.
My observation was that there was more agreement than disagreement on the need for some form of regulation beyond the status quo. Various options were presented and discussed – HPC regulation, regulation by a new independent regulator, ‘alternative professional accountability’ as well as reference to profession led forms of regulation elsewhere in the world. There was also agreement than whatever form regulation in the future might take, it must, in the words of Darian Leader, ‘respect the diversity which exists within the field’.
It came as no surprise that the panel expressed very different views on almost all topics. However, I was struck by the amount of misunderstanding there was amongst some members of the panel on, for example, the continuing misperception of the universal use of the medical model by HPC regulated professionals, the suggested lack of a contribution from the counselling and psychotherapy professions to the drafting of the current version of the Standards of Proficiency, the mistaken assertion that ‘user groups’ were denied access to the PLG, and the somewhat confused and therefore confusing discussions about the application of the criteria used by the HPC for assessing readiness or otherwise of a profession for regulation.
Despite this, several clear and constructive themes emerged from the panel and from the delegates. First, there was a call for more dialogue, more discussion between the HPC and members of the profession in order to achieve a regulatory process that was ‘fit for purpose’. Second, there was a call for re-assurance that HPC were listening and would address ongoing concerns from the professions. During the feedback sessions in the afternoon, the word ‘trust’ recurred more often than any other. Trust was acknowledged as fundamental to progress. Third, there were calls for the professional bodies to work together and agree more on a way forward.
I found the café conversations particularly helpful. There were discussions about the impact of statutory regulation on the ‘relational space’ in therapy, and the importance of preserving its unique contribution to society. There were also concerns about clients who might have become obsessed with litigation during or before therapy, others who might use litigation as a means to play out other more unconscious and unresolved conflict in their lives. Regulation needed to address these complex areas. On the other side there was acknowledgement that the professions had not to date made much progress themselves with regulation and that perhaps an independent body might actually provide the impetus for positive change. Overwhelmingly however I felt the discussions highlighted to me the mis-understanding and lack of accurate information about HPC regulation and the desire for further discussion and dissemination of facts. If we are to achieve this, we must pursue the facts and work harder to build trust on all sides.
I would like to thank the organisers of the conference for offering this opportunity for dialogue and debate. We look forward to continuing the dialogue at other meetings in the future.
Anna van der Gaag
Chair HPC
This conference provided an opportunity for members of the counselling and psychotherapy professions to ‘clarify the facts about statutory regulation, explore concerns and to put questions to a panel’. It was well organised and well attended by some 250 delegates from a wide range of modalities and backgrounds. The panel consisted of Lynn Gabriel, Chair BACP, Andrew Samuels, Chair UKCP, Marc, Seale, Chief Executive, HPC, Julian Lusada, Chair BCP, Darian Leader, Alliance for Counselling and Psychotherapy Against State Regulation, Michael Fischer, psychotherapist and researcher from Kings College and Di Waller, HPC Council Member and Chair of the HPC PLG.
During the morning the panel offered their views on some pre-set questions followed by a general question and answer session, and in the afternoon participants took part on café style conversations followed by feedback.
Michael Fischer described his observations of a small sample of doctors and their fear of the growing ‘blame culture’ in society. Julian Lusada spoke about the need for regulatory processes which were ‘sensitive and thoughtful’, but offered protection to both patients and therapists. Lynn Gabriel reiterated the need for counsellors and psychotherapists to be of equal value in whatever system emerged, and the need to address the mis-perceptions which existed about the HPC. Andrew Samuels proposed that there would be ‘independent statutory regulation’ in some form in the future.
My observation was that there was more agreement than disagreement on the need for some form of regulation beyond the status quo. Various options were presented and discussed – HPC regulation, regulation by a new independent regulator, ‘alternative professional accountability’ as well as reference to profession led forms of regulation elsewhere in the world. There was also agreement than whatever form regulation in the future might take, it must, in the words of Darian Leader, ‘respect the diversity which exists within the field’.
It came as no surprise that the panel expressed very different views on almost all topics. However, I was struck by the amount of misunderstanding there was amongst some members of the panel on, for example, the continuing misperception of the universal use of the medical model by HPC regulated professionals, the suggested lack of a contribution from the counselling and psychotherapy professions to the drafting of the current version of the Standards of Proficiency, the mistaken assertion that ‘user groups’ were denied access to the PLG, and the somewhat confused and therefore confusing discussions about the application of the criteria used by the HPC for assessing readiness or otherwise of a profession for regulation.
Despite this, several clear and constructive themes emerged from the panel and from the delegates. First, there was a call for more dialogue, more discussion between the HPC and members of the profession in order to achieve a regulatory process that was ‘fit for purpose’. Second, there was a call for re-assurance that HPC were listening and would address ongoing concerns from the professions. During the feedback sessions in the afternoon, the word ‘trust’ recurred more often than any other. Trust was acknowledged as fundamental to progress. Third, there were calls for the professional bodies to work together and agree more on a way forward.
I found the café conversations particularly helpful. There were discussions about the impact of statutory regulation on the ‘relational space’ in therapy, and the importance of preserving its unique contribution to society. There were also concerns about clients who might have become obsessed with litigation during or before therapy, others who might use litigation as a means to play out other more unconscious and unresolved conflict in their lives. Regulation needed to address these complex areas. On the other side there was acknowledgement that the professions had not to date made much progress themselves with regulation and that perhaps an independent body might actually provide the impetus for positive change. Overwhelmingly however I felt the discussions highlighted to me the mis-understanding and lack of accurate information about HPC regulation and the desire for further discussion and dissemination of facts. If we are to achieve this, we must pursue the facts and work harder to build trust on all sides.
I would like to thank the organisers of the conference for offering this opportunity for dialogue and debate. We look forward to continuing the dialogue at other meetings in the future.
Anna van der Gaag
Chair HPC
11 December 2009
Conclusions on the proposed statutory regulation of psychotherapists and counsellors
As followers will be aware the HPC Council met on 10 December 2009 to review the responses to the consultation on the recommendations of the Psychotherapists and Counsellors Professional Liaison Group. The Council concluded that there are no specific issues that would prevent psychotherapists and counsellors from coming into the system of independent statutory regulation operated by the HPC. The Council is confident that it can accommodate the regulatory needs of these practitioners.
Having reviewed the responses to the consultation, the HPC has concluded that if the decision is taken to proceed with statutory regulation of psychotherapists and counsellors, then:
• one additional Part of the Register should be established for “Psychotherapists and Counsellors” and these titles should be protected;
• modalities should not be reflected in the structure of the Register;
• the HPC should adopt the approach to dual registration;
• the inclusion of names in the HPC register from other eligible registers should be performed by means of a three-stage process; and
• the ‘grandparenting’ period for those professions should be three years.
In addition, the HPC has concluded that any further consideration of draft standards of proficiency for psychotherapists and counsellors should be deferred until the Council has concluded the current review of its existing generic standards.
Government stated in the 2007 White Paper ‘Trust Assurance and Safety – The Regulation of Health Professionals in the 21st Century’ that it intends to introduce statutory regulation for psychotherapists and counsellors. Hence the HPC was not asked by Government to look at whether the profession should be statutorily regulated, but instead at how they should be regulated.
The HPC set up a working group of stakeholders, known as a Professional Liaison Group or ‘PLG’ to consider and make recommendations to the Council about how psychotherapists and counsellors might be regulated, in light of the conclusions made in the White Paper. The HPC held a public consultation on the PLG recommendations which ran for three months in 2009 and as previously mentioned the consultation received more than 1,000 responses.
The Council approached the task by considering four regulatory ‘building blocks’ and looked at: how the Register could be structured; which professional titles should be protected; what standards of proficiency (SOPs) would be appropriate; and what standards of education and training (SETs) would be appropriate.
This work was intended to be a feasibility study rather than to produce final drafts of either SOPs or SETs. Further work and consultation on those standards will need to be conducted after government has finalised any regulatory proposals in the form of a Section 60 Order.
I do believe the purpose of statutory regulation is to protect the public. Statutory regulation will protect members of the public by setting standards, protecting commonly recognised professional titles and providing a way in which complaints can be dealt with fairly and appropriately.
At the moment, a psychotherapist or counsellor who is removed from the membership of their professional body for any reason can simply continue in practice without there being any legal means for preventing potential harm to members of the public. The protection of titles mean that someone who is ‘struck off’ the Register is unable to continue using the title related to their profession and could be prosecuted if they do so.
Safeguarding professional titles is an important way in which statutory regulation protects members of the public, improving upon a voluntary system in which such titles can continue to be used without any means of redress.
The HPC remains confident that, as a multi-professional regulator and given its experience and approach to regulation, it is well placed to regulate psychotherapists and counsellors should it be instructed to do so. The HPC has a strong track record in bringing new professions into regulation and currently regulates arts therapists, including arts psychotherapists. It also recently took on practitioner psychologists and has successfully integrated them onto the Register.
The HPC agrees with Government that the regulation of psychotherapists and counsellors is important for the protection of the public. However, the final decision about the statutory regulation is one for Government.
Anna van der Gaag
Chair of HPC Council
Having reviewed the responses to the consultation, the HPC has concluded that if the decision is taken to proceed with statutory regulation of psychotherapists and counsellors, then:
• one additional Part of the Register should be established for “Psychotherapists and Counsellors” and these titles should be protected;
• modalities should not be reflected in the structure of the Register;
• the HPC should adopt the approach to dual registration;
• the inclusion of names in the HPC register from other eligible registers should be performed by means of a three-stage process; and
• the ‘grandparenting’ period for those professions should be three years.
In addition, the HPC has concluded that any further consideration of draft standards of proficiency for psychotherapists and counsellors should be deferred until the Council has concluded the current review of its existing generic standards.
Government stated in the 2007 White Paper ‘Trust Assurance and Safety – The Regulation of Health Professionals in the 21st Century’ that it intends to introduce statutory regulation for psychotherapists and counsellors. Hence the HPC was not asked by Government to look at whether the profession should be statutorily regulated, but instead at how they should be regulated.
The HPC set up a working group of stakeholders, known as a Professional Liaison Group or ‘PLG’ to consider and make recommendations to the Council about how psychotherapists and counsellors might be regulated, in light of the conclusions made in the White Paper. The HPC held a public consultation on the PLG recommendations which ran for three months in 2009 and as previously mentioned the consultation received more than 1,000 responses.
The Council approached the task by considering four regulatory ‘building blocks’ and looked at: how the Register could be structured; which professional titles should be protected; what standards of proficiency (SOPs) would be appropriate; and what standards of education and training (SETs) would be appropriate.
This work was intended to be a feasibility study rather than to produce final drafts of either SOPs or SETs. Further work and consultation on those standards will need to be conducted after government has finalised any regulatory proposals in the form of a Section 60 Order.
I do believe the purpose of statutory regulation is to protect the public. Statutory regulation will protect members of the public by setting standards, protecting commonly recognised professional titles and providing a way in which complaints can be dealt with fairly and appropriately.
At the moment, a psychotherapist or counsellor who is removed from the membership of their professional body for any reason can simply continue in practice without there being any legal means for preventing potential harm to members of the public. The protection of titles mean that someone who is ‘struck off’ the Register is unable to continue using the title related to their profession and could be prosecuted if they do so.
Safeguarding professional titles is an important way in which statutory regulation protects members of the public, improving upon a voluntary system in which such titles can continue to be used without any means of redress.
The HPC remains confident that, as a multi-professional regulator and given its experience and approach to regulation, it is well placed to regulate psychotherapists and counsellors should it be instructed to do so. The HPC has a strong track record in bringing new professions into regulation and currently regulates arts therapists, including arts psychotherapists. It also recently took on practitioner psychologists and has successfully integrated them onto the Register.
The HPC agrees with Government that the regulation of psychotherapists and counsellors is important for the protection of the public. However, the final decision about the statutory regulation is one for Government.
Anna van der Gaag
Chair of HPC Council
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