Statutory regulation of psychotherapy and counselling is back on the political agenda, now reincarnated as a means to ban treatments which claim to be able to change a person’s same sex preference, often referred to as “gay conversion” or “reparative therapy”. The Labour MP for Swansea West, Geraint Davies, has introduced The Counsellors and Psychotherapists (Regulation) Bill into the House of Commons. The bill proposes that psychotherapists and counsellors be registered by the Health and Care Professions Council (HCPC). The HCPC would publish a code of ethics that “must include a prohibition on gay to straight conversion therapy”, and abiding by the code would be a condition of a therapist’s registration1. While this Private Members’ Bill stands no chance of becoming law, it has attracted a fair amount of publicity, some cross party political support, and been welcomed by LGBT activists.
Regulating therapy and outlawing gay conversion work are both sound ideas. Given the rapid expansion in the numbers of psychotherapists and counsellors being trained in the UK, it is time for both the profession and politicians to consider strengthening regulation to maintain standards and protect clients. Gay conversion “therapy”, many of whose promoters appear to be Christian fundamentalists, is just the sort of unethical and dangerous practice that regulation would root out. So Mr Davies deserves some credit. But pushing regulation onto the majority of ethical therapists to shut down the unethical few is misguided. Not only does it discredit therapy in general, but it also gets the regulation debate off on the wrong foot.
MPs and therapists have been here before, and not that long ago. In 2009, the Labour government put forward plans for the Health Professions Council (HPC), predecessor to the HCPC, to regulate the profession. These were abandoned by the Coalition in 2011, partly on the grounds of cost, but also as a consequence of resistance from therapists. The HPC, being a government body that regulated medical practitioners, would have replaced oversight by professional associations, such as the British Association for Counselling & Psychotherapy (BACP), with direct regulation by medically focused civil servants. Many therapists felt, with some justification, that the HPC lacked understanding of the variety of approaches and methods used by therapists and that it was not best placed to judge competence. For many practitioners, therapy is a personal craft learned over many years, rather than a medical science that anyone can practice effectively if they have the requisite training. Rather than ensuring ethical professionals using widely differing approaches were included, HPC regulation seemed more about keeping out the rogue few.
By recommending regulation by the HCPC, Mr Davies’ bill serves up the same fare the profession was offered in 2009. Spicing it up by challenging a particular therapeutic abuse will not make it any more palatable. His proposals once again put one aspect of regulation, protection of the public, ahead of other positive objectives of regulation – maintaining a register of qualified professionals, fostering good practice and promoting high standards of training. To frame regulation in terms of protection implies that therapists who seek to abuse their power or practice unethical modalities are rather more common than they are.
Failure to address such concerns and obtain buy-in from the profession doomed the 2009 plans before the economic crisis ruled the whole thing out on cost grounds. The Coalition’s solution has been “assured voluntary regulation”. The Professional Standards Authority for Health and Social Care (PSA), which oversees professional bodies such as the General Medical Council, and is answerable to Parliament, has taken on oversight of professional therapy bodies like the BACP. This arms length system has gone some way to assuring quality and standards, as the PSA can conduct audits and scrutinise decisions of the bodies it oversees. However, it still leaves therapists policing one another. Complaint processes remain protracted, complex and stressful for all parties, and it has been argued that the profession is unduly lenient in dealing with therapists who are found to have broken the rules. Unlike doctors, therapists who act unethically or unprofessionally can still, even if expelled, continue to practice, often by simply leaving a particular professional body. “Psychotherapist” and “counsellor” are not “protected titles”, as proposed in 2009. Under the current system anyone can claim to be a professional therapist, even if they are trying to convert the gay into the straight.
This sizeable loophole notwithstanding, the present structure has actually done a reasonable job of highlighting the abuse of gay conversion therapy and rooting it out. Thanks to the efforts of campaigning journalists, notably Patrick Strudwick2 of The Guardian and Channel 4’s Dr. Christian Jessen3, the very few therapists and organisations that practice or advocate conversion therapy have been exposed and expelled from their professional bodies. The BACP and other professional organisations have made their rejection of this abusive practice clear. While nothing can stop faith-based groups, such as Core Issues Trust4, continuing to advocate gay conversion, any potential client with access to the internet has the opportunity to learn that this practice has no place in ethical mental health work in the UK.
However, the UK today is a place where every professional, authority figure is distrusted. Whether you are an MP or a psychotherapist, the public feels the need to be on its guard lest you abuse the trust placed in you. As psychotherapy counselling courses proliferate to the point of being advertised on TV and radio, there are compelling reasons for stronger and if necessary statutory regulation. But the debate about what structures are appropriate needs to start from an assumption that the majority of professionals are honest and genuinely wish to do the best for their clients.
Mr Davies and others may have re-opened the debate, but it is up to the profession to put it on the right track. Rather than starting from the need to root out a particular abuse, the discussion should focus on fostering good practice and maintaining and improving training requirements and standards. The best means of ensuring that clients with alternative sexualities are protected from abusive therapy is to ensure that all therapists learn about the breadth of human sexual preferences in training. There should be greater emphasis on introducing evidence based practice, for example, by ensuring that therapists have easy-to-use evaluation tools that help them identify when they get it right and when they get it wrong in client work. Supervision regimes, which have a tendency to focus on the impact of work on the therapist, need to be adapted to help practitioners learn from evidence of how effectively they work with clients. Finally, there is a case for amalgamating the professional associations to which therapists belong. Accreditation by a variety of different bodies, be it the BACP, BABCP or UKCP, that duplicate the functions of registration and setting standards, is certainly not cost effective and may no longer be credible. Creating a single professional body would simplify for clients the process of assessing, choosing and, if necessary, complaining about a therapist.
The Counsellors and Psychotherapists (Regulation) Bill has highlighted the need to keep the conversion whackos out of the profession, and Mr Davies should be applauded for making a strong statement. But his Bill is a poor place from which to re-open the debate on the regulation of psychotherapy and counselling. When that debate is joined it needs to focus on the best the profession can do, not the worst.
- “Conversion therapy: she tried to make me ‘pray away the gay’”, Patrick Strudwick, The Guardian, 27 May 2011. http://www.theguardian.com/world/2011/may/27/gay-conversion-therapy-patrick-strudwick