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TX: 15.01.04 – SHOULD PSYCHOTHERAPISTS FACE TIGHTER REGULATION?

PRESENTER: JOHN WAITE

THE ATTACHED TRANSCRIPT WAS TYPED FROM A RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT. BECAUSE OF THE RISK OF MISHEARING AND THE DIFFICULTY IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE BBC CANNOT VOUCH FOR ITS COMPLETE ACCURACY.

WAITE
Psychotherapy has become increasingly popular in recent years - it's good to talk - as the old ad goes and more and more of us want to talk through our problems and share our secrets with a sympathetic stranger, you can even do it online these days. And yes you don't need training or qualifications to set up as a psychotherapist - if you've a couch or just a computer you or I could do it tomorrow. Because unlike most other healthcare professionals psychotherapists are not regulated by law, even though the obvious potential for abuse, incompetence, financial exploitation, taking sexual advantage is enormous. There are lots of good therapists, of course, who are safe, well trained and helpful but how does the public know which is which? And then there's the question of what exactly is psychotherapy - something on which its own exponents can't seem to agree. Is it psychoanalysis, is it counselling?

Well 10 years ago when the profession set up its own regulatory body, the UK Council for Psychotherapy, the idea was to publish a register of accredited members that would pave the way for a statutory registration scheme. But almost immediately there was a split when leading organisations in the psychoanalytic section set up a rival group called the British Confederation of Psychotherapists. And those divisions show no sign of abating with a recent row over who can call themselves child psychotherapists, which resulted in the Association for Child Psychotherapists withdrawing from the UK Council for Psychotherapy. Well James Pollard is chair of the UK Council, James the Association of Child Psychotherapists has pulled out of your organisation, the NHS funded Tavistock Clinic is now considering whether it'll follow suit - what is going on?

POLLARD
Well what we have been trying to do in the UKCP and have made a lot of progress with is developing methods of setting training standards and standards of conduct for psychotherapy which stand independently of particular philosophies and particular clinical approaches. This has caused quite a lot of difficulties with the traditional psychoanalytic groups which is what led to the original departure of the British Confederation of Psychotherapy. And in a sense the departure of the Association of Child Psychotherapists is a delayed fall out of the same difficulty.

WAITE
But while are all these disagreements and divisions continue the public remain unprotected.

POLLARD
Well this is absolutely true and we're very concerned about that. And we have created processes where we consider these difficulties very carefully - we have a registration board, we had an extended consultation process. It is a great regret to me that the Association of Child Psychotherapists did not accept the outcome of that process but that is where we stand, there is no statutory backing for this and if a group is - takes such exception to a decision, it leaves, that we can stop them.

WAITE
But at the moment is it the case that even therapists who've been found guilty of serious misconduct by their own organisations, whatever they are, they are free to continue to practice?

POLLARD
Absolutely, there is no legal impediment to them doing that, they're simply not registered by a reputable organisation.

WAITE
Well what we can do about all of this we'll discuss in a moment but James Pollard please stay with us for that. But with an estimated 50,000 therapists to choose from how do you go about finding one you can trust to help you with your innermost problems and what happens if your psychotherapy goes wrong? Well Jo Sandford Smith has been investigating the relationship between therapist and client and started by visiting counsellor and psychotherapist Jo Ellen Grzyb.

GRZYB
Right why don't you take a seat?

SANDFORD SMITH
I see this is your therapy couch is it?

GRZYB
Well no actually it's just my sofa in my home. I would even invite you to take the chair opposite the couch.

SANDFORD SMITH
That's even less intimidating isn't it. So Jo Ellen you see clients here in your home.

GRZYB
Yes I do. It is very cosy and it gives us a chance to meet each other as mutual human beings rather than the quite formal setting of client and therapist. And that's the way I practise, not every therapist practises that way.

SANDFORD SMITH
You describe yourself as a counsellor and a psychotherapist. Many people aren't sure if there's a difference between those two terms.

GRZYB
It's a very, very interesting question. When I first joined my membership organisation it was called the British Association for Counselling and there were many, many debates in its magazines about our we counsellors, are we psychotherapists? And then they changed their name to the British Association for Counselling and Psychotherapy. So magically suddenly we're all psychotherapists. This is my definition: for me counselling is very situational - a bereavement, a break up of a relationship, being made redundant - it's usually short term and it focuses on the issue at hand. Psychotherapy is a lot more like archaeology - I'm looking at the causes and the roots for what's known in the jargon as psychopathology - the behaviours that you keep repeating over and over and over again that actually get in the way.

SANDFORD SMITH
With so many professional bodies and different styles of therapy on offer finding a therapist can be a daunting process. Many of Jo Ellen's first time clients know next to nothing about what to expect from therapy, so part of herrole is demystifying the whole process.

GRZYB
I'm not comparing myself to a car mechanic but you bring your car in, you want to sort of know that they aren't going to make a botch of it and they might ask more questions of something like that than coming here with someone who's working with their vulnerability. And so even if you don't know anything to be able to come in and say I don't know anything, what is therapy going to be like, how long is it going to last, what do you do? And instead they often just come and say - okay I'm here, let's start.

SANDS
Well I went in, sat down, my analyst didn't say very much so you always feel a bit awkward at the beginning wondering how to start. It felt quite odd in a way, I mean it wasn't a particularly natural or spontaneous encounter.

SANDFORD SMITH
Anna Sands recalls her first session with the psychoanalyst she started seeing because she was having problems with her marriage. He was recommended by a friend and was well qualified.

SANDS
I think I thought you were supposed to find it difficult and have awkward silences and so on. I remember - I remember once he said to me - I wonder what that tells us about your innerreality? Which is a bit of a tough question to answer off the top of your head.

SANDFORD SMITH
At her analyst's suggestion Anna upped her visits from once to twice a week, even though she wasn't sure whether the sessions were really helping she found it hard to stop going.

SANDS
I think there's this idea that therapy should make you feel worse and that the worse you feel the more important it is to stay and work through those feelings, so it's a kind of catch 22. And you get kind of drawn in, it's actually quite difficult to just stop and I think I felt that if I stopped it would be sort of cowardly, that I wasn't prepared to see it through.

SANDFORD SMITH
But six months into her psychoanalysis Anna found she was unable to cope with normal life, a decline she puts down to the therapy she was receiving.

SANDS
I had what I can only describe as a kind of breakdown, it was a very weird experience. A friend said to me that it sounded a bit like a bad LSD trip. My husband did all the cooking, friends looked after the children, I think I stayed in bed for a couple of days - I can't remember very clearly now. I didn't feel as if I was really in the world, I felt as if I was floating about somewhere and I was very, very frightened because I thought I'd gone mad. And my children were quite young at the time and I was desperately worried because I kept thinking I'll end up in a psychiatric unit and who's going to look after the children and my husband won't remember to wash my son's rugby shirt on a Wednesday and all the things that mothers do.

SANDFORD SMITH
It's taken Anna years to understand why her therapy went wrong and she's written a book about her experience called Falling for Therapy. She didn't want to make a formal complaint against her analyst, she just wanted to have a normal conversation with him and some recognition that things had gone wrong on both sides.

SANDS
I mean my analyst hadn't done anything unethical, he hadn't breached his organisation's ethical code, I mean I'd had a very damaging breakdown but he hadn't, in theory, done anything unprofessional. So there was effectively no accountability and there was, as they put it, no case to answer.

GRZYB
It's never going to be a completely equal relationship, it can't be. I'm the professional, someone is paying for my services. There are times when a client wants me to give them the answer, absolutely wants me to tell them what to do and I won't do it and it's one of the dangers that therapists can become very powerful in a client's life and abuse that power. And there's lots of stories of sexual abuse, emotional abuse, almost intellectual abuse, so that therapists themselves have to be in very good supervision and be willing to take whatever is going on inside them to their supervisor. I mean I fell in love with a client once, he never knew - this was years ago - but it was shocking to me because that had never happened before. The first thing I did was book another session with my therapist and really look at what was going on in my own life that that was happening in the session. And so it was that scrupulous honesty and that keeps that power balance more in check.

SANDFORD SMITH
Anna feels there are many lessons to be learnt from her experience but isn't sure that tighterregulation would prevent people from falling foul of therapy when what's really needed is a change in attitude.

SANDS
Being less arrogant, less insular and I think also to acknowledge how very damaging therapy can be, it's a very high risk endeavour and the damaging effects perhaps are not dealt with very well in the profession and perhaps not even sufficiently well understood. I think maybe therapists need to be a bit more grown up about the whole thing and a bit more genuinely professional in the sense of really caring about the client.

WAITE
Anna Sands ending that report from Jo Sandford Smith. Jonathan Coe is director of POPAN - the Prevention of Professional Abuse Network, he joins us now. We heard Anna's criticism there, Jonathan, that there needs to be more openness and honesty within the profession about the potentially damaging effects of therapy - how much do we know about the extent of problems caused by that practice?

COE
I think there's a difference between straightforward bad practice and the nature of therapy itself. Now there's some evidence to suggest that for some people therapy is very beneficial and for others it can be damaging. There is a whole range of different kinds of therapies - you're talking about the talking treatments as a whole, so you have psychoanalysis, psychotherapy, counselling and so on and so forth. And there's a big debate going on about how effective they all are.

WAITE
But I mean what is wrong in your view with the system at the moment?

COE
Currently we don't just have the United Kingdom Council for Psychotherapy we also have the Psychoanalysts, who you mentioned earlier, and we also have the British Association for Counselling and Psychotherapy. Now there are too many bodies trying to assume the role of both professional association and of regulator and that's a recipe for disaster for the general public. What needs to happen is that there needs to be a single route for complaint and a single regulatory authority.

WAITE
Well one section of the profession - psychologists - they will soon be regulated, they voted in favour of regulation by the Health Protection Council which is the statutory body for people like physiotherapists and speech therapists, is that in your view Jonathan the best route for everyone else?

COE
POPAN wants to see regulation come through on to the statute books for all the talking treatments, whether that is through the route of the Health Professions Council or through otherroutes is somewhat immaterial, the fact is that there needs to be properregulation and accountability and decisions need to be made within this profession which hasn't just been discussing this for the last 10 years but at least since the 1930s, the profession as a whole goes back over a hundred years and we still have this appalling situation that we're in today.

WAITE
Well James Pollard is with us. There again James your house seems divided against itself, I mean the HPC - the Health Protection Council - already regulates art therapists but you wouldn't let them join your organisation, the UKCP, so I mean does the HPC - the Health Protection Council - have the confidence of your profession, would you members vote for it?

POLLARD
I think whatever system of regulation we have it's going to have recognise that there are different schools. The complaint we heard in your film, in yourreport, is a familiar complaint about traditional psychoanalysis. There are many other schools, each has their own difficulties and their own strengths, what I think we're going to have to do is develop a structure that accepts that and sets standards for all of them. Now we are looking at the Health Professions Council, the Health Professions Council is a relatively recently created organisation, one of the strengths of it is it does deal with in fact a very broad range of health professions and not just psychotherapy and related professions, that may actually be a strength because it would bring some more legal approach, some neutrality into it and that may help.

WAITE
Okay well the Government has told us this morning that it wants psychotherapists to be regulated by the HPC in due course but Denis Postle joins us now from ourBrussels studio, and Denis is a member of the Independent Practitioners Network, he's a psychotherapist, a counsellor and a coach. And Denis you feel strongly that regulation wouldn't protect the public, why not?

POSTLE
Well because I think it's an urban myth that clients need protection in the way that has been described. I mean there are certainly vulnerable people who need to be - need a helping hand. But what's missing from the debate - and there has been a very considerable long debate with a huge amount of dissent from the current proposals and recent and past proposals - is that the UKCP is essentially a trade association, it's an organisation which primarily looks after the interests - contrary to what it might argue publicly - of its training organisation, of its training members.

WAITE
So are you just saying anyone should be allowed to call themselves a psychotherapist and leave it at that?

POSTLE
Well you see I think there is no evidence - there is a great deal of evidence to say that the current form of regulation - after all Anna Sands therapist was accredited, was fully and highly qualified, they would no doubt argue - I think there's a considerable amount of evidence to say - quite a lot of research which says that a modest level of training, a certain amount of skill and the capacity to get into very good rapport with people is as effective as a highly qualified academically checked etc. …

WAITE
Without regulation, Denis Postle, I mean how would you police and how would you punish malpractice?

POSTLE
Well you see the Independent Practitioners Network, of which I'm a part, has been researching and developing what we would perhaps regard as exemplary ways of being accountable, the issue is to be accountable to clients. And it's feasible to be accountable to clients in a way that does not produce rejects, it does not produce - if you have a tight enough and close enough level of disclosure between people working in a say a practitioner group, which is certainly the one that I belong to, then the chances that somebody will go off the rails is negligible …

WAITE
Well let me put that point …

POSTLE
… it's not the case in the UKCP and even less so in the psychoanalytic tradition.

WAITE
Let me put that point to James Pollard. Without regulation - and that is not imminent as we've agreed - how do you prevent those kind of damaging experiences that we heard about in ourreport, do we just leave it to professionals getting together and monitoring each other?

POLLARD
Well I think the UKCP is already having a significant impact on this problem, for all the difficulties we're talking about today. Firstly, it is setting standards and I think that has moved the whole debate and the whole sensibility about what being a psychotherapist involves, it has moved that on hugely in a very short space of time. It has done a great deal towards public education, so although there's more to do there is this debate going on and people are beginning to understand what the problems are. And we are having a system now for dealing with complaints, it's not good enough in certain respects but that's not an argument for throwing it away, it's an argument for improving it.

WAITE
Jonathan Coe …

POSTLE
If I can just come in there. I just want to say that it would be much more - from a client - potential client's point of view - the essential ingredient that there is nothing like enough financed or nothing like enough in the foreground is education. The rather excellent story that we heard earlier of what to expect from therapy, what the limitations are, what can be wonderful and what can be difficult and were this to be the focus, it seems to me, the clients' interest would be much better served than the whole performance that those of us who have been watching this for 10 years see in - it's a kind of elbow work - turf wars is what's going on in the psychotherapy …

WAITE
Okay, well James Pollard is nodding there at this mention of education. But Jonathan Coe is it all down to better educating the public do you think, to solve all the problems?

COE
I mean I would agree with Denis that there's a definite need to improve public education and provide information about what to expect when you go into therapy. But Denis's argument really ignores completely the admittedly smaller group of psychotherapists and counsellors who deliberately and maliciously sexually exploit their clients. Now there's a guy who was struck off two years ago by his own professional association who is still offering services now. Now that's a completely unacceptable situation and at the very least statutory regulation would absolutely prevent a person like that continuing to work.

WAITE
And better education couldn't do much about that when you've got a rogue on the loose. Well psychotherapy is becoming even more available these days with increasing numbers of therapists offering their services online. But how much emotional support and guidance can you get from an e-mail? Tom Parker has been finding out.

HODSON
If we just type in counselling and search we've got 6,110,000 and we've got various links with counselling training, superb online counselling, let's talk counselling. Let's try this one. We've got to a Dr so and so, who is a consultant childhood clinical and counselling psychologist. I'm quite impressed with the site because she says what sort of psychotherapy, what do people talk about in psychotherapy, each of us is unique so that no two people experience the same difficulty in the same way, people present with stress, anxiety, panic attacks, redundancy issues and so on. She is candid about cost, she says it's £65 a session payable by cheque or credit card.

PARKER
If I pay £65 for my one hour what do I get for that?

HODSON
You will either get an online instant message dialogue being typed by client and therapist at either end of the terminals or if both sides have got web cameras you can see face to face.

PARKER
If I come across something like this, it's got all these things that it spells out and it says I'm registered with this association, how do I know that that's actually correct and true - this is the internet after all?

HODSON
You get in touch with accreditation at the British Association for Counselling and Psychotherapy and they will tell you whether it is or not.

PARKER
Or any other accreditation body?

HODSON
Any other accreditation body, ring them up and check it out.

PARKER
There seem to be a lot of the student online counselling services available.

HODSON
Well most students are computer literate, they don't always wrestle terrible well with an appointment system, it's also above all highly beneficial for the group of people who are the invisible population in accessing counselling and psychotherapy services generally and that's young single men.

PARKER
There do seem to be quite a few therapists offering services anywhere from Russia to America to China.

HODSON
When you go beyond your own shores you're in much greater uncertainty and the more we do this the more I'm persuaded that one should stick to where we are at home, where it's much easier to check things out. So it'll always be difficult to find reliably what you want and what I would like to encourage the public to do is to be very questioning, critical and to a degree open-minded to sceptical to start with, don't rashly assume you're in safe hands because somebody says you are.

WAITE
Phillip Hodson from what Denis Postle would presumably call another trade body - the British Association for Counselling and Psychotherapy. Well Sue Wright is from the UK's largest online psychology service - www.psychologyonline.co.uk she joins us now. Isn't there an even greater danger online, Sue Wright, that the public is dealing with someone who is unregulated and unqualified?

WRIGHT
Yes, good morning. I think that is very true. I mean you have access to - the internet has access to the whole world basically and as someone was saying earlier you don't know what the qualifications of the person you're talking to are, you could be in touch with Linda from Idaho who has a very distressful life and thinks that she can empathise with you online and this is not good enough. And as people have been saying it's very, very important that you actually consider the qualifications of your therapist or your psychologist. At Psychology Online we only have psychologists and UKCP accredited psychotherapists.

WAITE
And is it really possible to provide a solution to a condition like depression in a chatroom environment?

WRIGHT
Yes I think it is a very useful way to deal with something for that for some people. We find online that people are able to disclose very quickly and you're able to get to the focus of their complaint quite quickly and quite efficiently.

WAITE
But aren't you missing out on what's important in therapy, many would say, the emotion, the eye contact, the body language, the human in other words?

WRIGHT
Yes, I mean many people do say that and of course we're not attempting in any way to replace face-to-face therapy but what we can offer online is something that is very focused - you don't have the eye contact, you don't have the body language indeed - but what you do have is a facility where someone can actually open their hearts to you and it has been said that - indeed Freud himself put his patients away out of sight so that he couldn't see the eye contact, the body language and would get a more open exchange.

WAITE
James Pollard a final question to you. There are ever more psychotherapists, all the time, now we've got them online, when are they all going to be regulated and regularised?

POLLARD
Well barring intervention by the Government we are going to have to continue to work to build bridges, to make agreements - I'm aware of the other organisations of course that Jonathan referred to and we're trying to work closely with them and bring a body together to get an agreement about this so we can move forward.

WAITE
But when?

POLLARD
I would hope that we would make progress and that within the next 10 years there will be a statutory regulator in place.

WAITE
James Pollard, Jonathan Coe, Denis Postle and Sue Wright thank you all very much indeed.

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