Is psychotherapy a suitable case for statutory treatment? This book responds with a resounding No!

A thorough investigation of the case for a 'protected' profession reveals a tale of flimsy historical underpinnings, professional and political shenanigans and vested interests.

In this careful appraisal, Richard Mowbray explains why a conventional licensing system would be inappropriate, ineffective and actually harmful to the public interest. Licensing would also marginalize the human potential movement or submerge its message beneath the dominant world-view of remedial treatment.

This resourceful guide provides detailed information on the whole tangled question of registration and offers a solid basis for rational debate. International comparisons and examples from already established professions give additional perspective to this key issue.

Constructive proposals are offered for viable, practical and holistic alternatives to conventional licensing, along with clear recommendations for conserving the vitality of the human potential movement.

This book is essential reading for anyone concerned about the future of psychotherapy, counselling or personal growth, and anyone interested in the impact of licensing systems on our society in general.

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Juliet Lamont from Gestalt South West Newsletter No21

As one of a growing number of people with grave reservations about the registration system for psychotherapists in the U.K., I have been waiting for a well-thought out, coherent attempt to lay out the arguments for the independent therapists' cause. My colleagues and I continue to express our doubts about the justification for setting up such a system, with all its attendant emphasis on academic standards, protection of titles and extension of training programmes.,

Richard Mowbray's book does the job of examining and evaluating our concerns. And it does it very well. This is not a whinge from the fringe, but the clear, well researched response that is needed to counter the United Kingdom Council for Psychotherapy's push towards statutory registration, which, if it comes, will have enormous implications for us a[

Mowbray argues that individuals and organisations are joining the registration road-show out of fear; fear of exclusion from the right to practise, to offer training or to refer. But, says Mowbray, no-one is actually demanding that we take these steps except ourselves. He lays out the history of the drive towards registration from the Rugby Conference in 1982 to the establishment of the U.K.C.P, and shows how the pressure has come from the profession, not from the bogeymen of 'government' or 'European legislation'. He points out that U.K.C.R is essentially a group of training organisations and accreditation bodies, understandably eager to ensure their status and to stake a claim to professionalism. Individual practitioners and clients have no representation How then can it avoid being self-serving?

I depart somewhat from Mowbray when it comes to his attribution of motive. He tends to concentrate on the financial rewards which would flow from the effective creation of a closed shop. l believe that by taking such an attacking stance, he is in danger of widening the rift. A polarity is created whereby we, the non-registered, humanistic, independent practitioners occupy the moral high ground,, while those who seek influence in the registration 'process are concerned with cornering a potentially lucrative market from both training and client fees This, view describes a situation which exists, but it is not universally the case, and perhaps emphasising it hampers communication. It is also disingenuous of us to try to appear unsullied by the need to make a living, as if we weren't also dependent on a client group seeking our services.

I think this is my only quibble about the book, and it is more than balanced by his detailed questioning of the issues. For instance - is it the name 'psychotherapist that will be registered, or the practise of psychotherapy? How can it be appropriate for the training organisations to be in control of the establishment of training standards? Does registration protect and empower the client, or does it rather ensure that choice is restricted? If this is the case, then the client is unprotected in a system that only appears to be disinterested.

So, what is the focus of our fear and is it justified? The problem is that its effects are real. Psychotherapists often feel vulnerable, particularly when under attack in the media for perceived deficiencies in our practice. One way to protect that vulnerability is to earn credentials which confirm our proficiency, and then to buy an insurance policy, just to be on the safe side.

I recommend this book to anyone who is concerned with the future of our profession, because I believe we must keep the debate as open and broadly-based as possible. If we believe in the need for candour and self-examination as a basis for personal growth, then surely we must attempt it ourselves. Mowbray is offering us a clear exposition of the argument for further questioning of our motives. If we are choosing the path of registration as an answer to our uncertainties, then we should be stopping and examining those uncertainties, not pushing ourselves towards premature resolution.

Richard Mowbray, author of a new book, The Case against psychotherapy Registration, looks at the implications for counsellors, arguing that diversity, not uniformity, is healthier for the profession in the Iong term

During the 1990s, the practice ofpsychotherapy and counselling has attracted a great deal of adverse publicity.

Tales of sexual exploitation, false memory implantation or other dubious activities have become so common in the media that one could be forgiven for thinking that these are very hazardous activities indeed, perhaps carrying risks comparable to those that have so often accompanied drug-based approaches to personal problems, whether professionally or privately prescribed.

Alongside this clamour, calls for statutory regulation to curb the menace posed by unqualified psychotherapists andsuchlike practitioners have become more strident. An 'inevitable' advance towards statutory control has been widely touted and in the face of this prospect, a climate of compliance and passivity, if not sup-port, prevails amongst practitioners.

UKCP, the UK Council for Psychotherapy, has been a vigorous proponent of the notion that psychotherapy should be a post-graduate statutory profession. Digby Tantam, current Chair of UKCP, has commented that statutory registration is "one of UKCP's most cherished aims, conceived at a time when no one else thought that registration was required".

Now, however, UKCP has been joined in this enthusiasm by other groups, not least the British Association for Counselling (BAC) and the Confederation of Scottish CounsellingAgencies (COSCA), who are pursuing a UK register of counsellors.

Can counselling really be differentiated from psychotherapy in a way that is sufficiently clear and acceptable to hold up in a court of law? This is one of the questions that counsellors should be asking themselves in the face of UKCP's avowed aspiration to achieve statutory regulation of psychotherapy.

The BAC has previously taken the view that it is not really possible to make a generally accepted distinction between counselling and psychotherapy (BAC 1992). Likewise, as the President of the European Association of Counselling has pointed out, counselling and psychotherapy are not differentiated in many European countries (Collis, 1994).

Nonetheless, in Britain, the Lead Body for Advice, Guidance, Counselling and Psychotherapy has undertaken a mapping exercise of counselling (including, apparently, at BAC's request, a mapping of "therapeutic counselling") and is now attempting to draw up a "functional map" of the psychotherapy "domain

Perhaps only the statutory control of titles will be sought by those promoting registration. However, as Daniel Hogan (1979) has shown, in North America, where licensing this type of occcupation has been allowed, the tendency has been for laws that restrict the use of a particular title to eventually become extended to cover function and practice as well.

Moreover, where one occupational group has sought or achieved legal privilege, other occupational groups in overlapping spheres of activity have attempted to protect their interests by seeking similar legal privileges, thereby setting in motion a legislative scramble.

Digby Tantam has expressed the view that rather than try to "outgun" these other would-be registers, the UKCP should accept the role of a contributor to a registering authority drawn from all such organisations. This is a personal opinion not necessarily shared by all in UKCP.

However, whether construed in the form of separate registers for counsellors, psychotherapists, psychologists or so on, or as a combined authority, there is a remarkable lack of evidence to support the contention that statutory registration of any hue would actually deliver the benefits claimed by its proponents.

Arguments for statutory registration are usually couched in terms of protection of the public but we have little reason to be confident that this would actually happen.

I have been a practitioner in the Human Potential Movement since 1979. Preoccupied as I was in the 1980s with the demands of a busy practice, I remained heedless of the aspirations to a legal monopoly on title usage or practice that were being spawned at the annual meetings of the "Rugby Psychotherapy Conference" at that time.

Believing, as I did, that the sort of work I practised would not be regulated by some crude statutory approach, I did not believe that anyone would be absurd enough to try. However, by the end of the 1980s, a time marked by economic recession and widespread fears of forthcoming European regulatory requirements, UKSCP as it then was, had arrived with "full-frontal" statutory ambitions.

I realised that my previous stance had been politically naive and in conjunction with my partner Juliana Brown, began to formulate a response. In 1990, we wrote an article about the subject in Self and Society. Following that, I set about looking into the matter in more depth and it became apparent that the risk of legislation was in the medium or longer term rather than an immediate prospect.

Moreover, the more I discovered about the issue, the wider its ramifications and the deeper its significance appeared to be. Consequently the project grew into a full-size book.

In the course of writing it, it became clear to me that there is nothing inevitable about counselling and psychotherapy becoming subject to statutory control as this so often maintained.

Neither the UK government nor the European Community/Union institutions have expressed any intentions of initiating legislative changes. Nearly all the pressure for this has come from the practitioners themselves, particularly trainers, or from occupations with an overlapping sphere of interest, aided and abetted by media "horror" stories.

The introduction of a statutory registration in the UK would in my view have a significant detrimental impact on the working environment for psychotherapists, counsellors and for practitioners in the human potential field.

In a climate of fear and false rumours, where what registration advocates wish to be the case has become confused with what is the case, the establishment of what is merely a voluntary register by UKCP has already had a deadening effect on practice, training and innovation. It is important to note that the practice of psychotherapy and other forms of related work is not totally unregulated in the UK. Under common law, there exists a right to offer such services for payment and to call yourself a counsellor, psychotherapist, or whatever. However, this right is subject to the same laws (of contract, trade description, etc) that regulate the provision of any other service. Britain provides a uniquely open milieu which is, in my opinion, more conducive to the healthy development of personal growth work, counselling and psychotherapy than the restrictive situation which the "therapy bureaucracies" would like to impose.

The legal framework for practice is not in need of remedial treatment and moreover provides an important example for other countries already saddled with inappropriate legislation. If legislative restrictions are to be introduced here, the onus should be upon those who favour this change to prove the necessity for it and to substantiate their position that they would be beneficial.

I believe that the case for statutory registration does not stand up to scrutiny. As I try to show in the book, while it may at first sight seem to be a sensible idea, there is evidence to indicate that at the very least it will be ineffective and in all probability, it would do more harm than good.

As I quote in my book from a paper by Jeffrey Pfeffe? in Social Problems:"It must be concluded that the outcomes of regulation and licensing are frequently not in the interests of the consumers or the general public. It is difficult to find a single empirical study of regulatory effects that does not arrive at essentially this condusion."

For example, the notion that disciplinary action against wayward registrants will afford effective protection for the public is not borne out by the evidence. Even the UKCP Chair admits that "Removing some, but not too many, names (from our register) will be what convinces people, unfortunately".

Practitioner image and status are the prime beneficiaries of the process rather than substantial consumer protection.

A question of ethical action on the collective, political level is involved in all of this. Unless the statutory control being sought can be justified on the grounds of public benefit - and my contention is that it cannot - its pursuit by practitioners collectively is an action with regard to the public as a whole which lacks the moral integrity that most of them would aspire to in their dealings with clients individually and which statutory controls are supposed to secure.

In the light of the arguments and evidence that I present in my book, the onus is clearly upon those who seek these changes to prove that they would be of net public benefit, if such action is to be ethically sound.

As Beverly Alberding and colleagues (1993) have said: "We hope that counselors want to make responsible, not harmful, choices and that counselors are not willing to accept professionally beneficial consequences at the expense of the public we profess to serve."

Furthermore, ensuring that consumers are aware of the full consequences of registration would seem to be consistent with counselling philosophy and an appropriate obligation for counselling organisations.

Although The Case Against Psycho-therapy Registration gives due attention to UKCP and its schemes, the arguments presented are in the most cases equally relevant to registration schemes in this area generally, whether in Britain or overseas. What appears to be on offer is a sort of bogus insurance policy representing a collusion with regressive urges for risk-free existence where responsiblity for key life decisions is lifted from the individual by benevolent experts.

Moreover this is a curious policy where the risks are low, the premiums are high, the settling of any claim unlikely and where taking out the policy actually increases the risk!

As Juliana Brown puts it, as in an organic garden, it is perhaps better to put up with a few pests than resort to chemicals and pesticides with the prospect of developing longerm negative side-effects, not least that of reducing the fertility of the soil.

It is better to put energy into encouraging the health of the garden as a whole. A flourishing garden can cope with its pests. Furthermore, as with the global ecosystem, species diversity provides a greater prospect of longtem health than a monocrop.

Proposals for psychotherapy regulation also bring into sharp focus the relationship between the human potential movement and the worlds of psychotherapy and counselling.

A major concern of my book is to present a case for the maintenance of a clear boundary and appropriate terminological differentiation between human potential practice, psychotherapy and counselling with a view to the conservation of a broadly-based and thriving human potential movement.

The issues addressed in the book go beyond those of a parochial professional squabble. They concern the interface between the spheres of the personal and the socio-political. Insofar as some of the activities involved are intended as systems for personal growth and transformation, the role of the state in relation to these bears comparison with issues of artistic, religious and educational freedom.

British Association for Counselling Code of Ethics and Practice for Counsellors 1992

Collis, Whiz. European Conference: A Peaceful Revolution for Health Care in Europe AHPP report 1994

Hogan, Daniel B. The Regulation of Psychotherapists Cambridge, Massachusetts: Ballinger, 1979

Pfeffer,Jeffery:Administrative Regulation and Licensing: Social Problem or Solution? Social Problems Vol.21, 1974

Tantam, Digby. UKCPNewsletter, March 1995

Counselling News September 1995 page 9