Digesting psychotherapy

Last updated:

12 November 2012

old warning about statutory regulation

latest news

16 February 2011: The HPC route to regulation will be halted, according to the white paper Enabling Excellence: Autonomy and Accountability for Health and Social Care Staff just published. It appears that the government has decided that "assured voluntary regulation" overseen by the Council for Healthcare Regulatory Excellence (CHRE) is the most appropriate way forward.

06 January 2011: Our new performance analysis of the Health Professions Council (HPC) is now available.

10 December 2010: A Judicial Review permission hearing found against the HPC. The HPC’s plans for the statutory regulation of psychotherapy and counselling will now be taken to a full Judicial Review. In the judge's view, the review was "important" and "clearly arguable", and he also criticised the misleading nature of HPC statements to both Government and stakeholders. Practitioner groups had been led to believe the HPC were considering and would be reporting to the Department of Health (DH) on whether it should be the regulator in circumstances where this was apparently never planned or done. With such profound implications, it appears that the DH is already exploring alternative models of regulation and practitioner accountability. The result of the permission hearing seriously undermines the credibility of HPC's claim to be the right regulator for the field, given its admission to the court it has in fact done no research to support making such a claim.

UK government plans defy research evidence and may cause more harm than good

In the United Kingdom the government is pressing on with its plan to introduce statutory regulation to psychotherapy and counselling in the United Kingdom through the Health Professions Council (HPC). Despite bullish statements from government ministers, Department of Health (DH) and HPC officials, there are serious and well-founded concerns that the proposed form of regulation will not effectively achieve its advertised aim of protecting the public from harm. Indeed, there are precedents elsewhere to suggest that fostering clients' dependency on state-endorsed but specious credentials to choose a practitioner may actually increase the risk to the public and erode the integrity of the profession generally. As well as restricting the choice of therapists and therapies, it is very likely that simplistic and clumsy regulation would increase the cost of services and discriminate against the poor and minorities becoming clients or indeed therapists themselves. For example, the voluntary counselling sector already appears to be significantly constricted by the portent of statutory regulation.

The fundamental flaws in the regulatory approach taken by the government include:

  1. The level of danger in psychotherapy and counselling has not been scientifically assessed, especially relative to other activities for which no demand for regulation exists. The DH has failed to provide statistically significant or even substantive evidence concerning the prevalence and severity of harm caused to clients by psychotherapists and counsellors. This official DH reply to a Freedom of Information request shows the paltry and unscientific standard of evidence being applied:
    "[T]he Department does have correspondence concerning individual cases where harm allegedly occurred. However, as they are not claims the Department investigated directly, they would not fall into the category of 'evidence'. Further, the Department does not have permission from the authors to disclose their personal details. The Department has, however, listened to organisations such as POPAN (the Prevention of Professional Abuse Network) [now WITNESS] and has seen their data concerning the number of calls, cases advocated and supported. Departmental officials have talked to organisations that have been prepared to share their information about complaints and have also looked at independent research conducted into the area. By these means, the Department has been convinced that there is a case on abuse to answer."
  2. The DH does not have evidence that the HPC regulatory route is the most likely to improve public safety while having the least restrictive impact on services and practitioners. Other regulatory routes have not been objectively considered (see resources below).
  3. Psychotherapy and counselling are being treated naively as "health professions", despite the overwhelming research evidence (Wampold, 2001; Bohart & Tallman, 1999; Mowbray, 1995) that psychotherapy is fundamentally a different activity from medicine and allied professions.
  4. The HPC's assumptions about what constitutes "professional standards" defy longstanding research evidence (for example, Beutler, 1994 & 1997; Berman & Norton, 1985) which shows that a therapist's qualifications, training, experience, and participation in personal therapy are not significantly linked to competence. Outcome in psychotherapy is much more dependent on the personal qualities of the practitioner. The HPC also seems content to allow psychotherapists and counsellors to be differentiated by imposing spurious criteria.
  5. Each profession regulated by the HPC is supposed to satisfy a "body of knowledge" criterion: "[E]ach profession that the Council regulates has its own distinct body of knowledge and applications will not be successful if the Council considers that the applicant occupation has not provided sufficient evidence to demonstrate that it, too, has a distinct body of knowledge." Such a distinct body of knowledge for psychotherapy and counselling has never been identified by research. Worse still, the HPC's Director of Policy & Standards has admitted in public that psychotherapy and counselling have not even been assessed against the new professions admissions criteria intended "as the primary means by which it [HPC] will decide whether to recommend an occupation for regulation". The HPC has acted on a political decision by the government, conveniently bypassing its own procedures and any evidence base.
  6. The conduct of the bodies concerned has left much to be desired, with science, openness and genuine consultation being subordinated to the government's dogma that the HPC route to regulation must be followed. While some of the large trade associations with their huge vested business interests have indeed been wooed by the DH and HPC (for example, having been invited to serve on the HPC's Professional Liaison Group), other lesser organisations and individuals have been forced at times to submit Freedom of Information requests to extract even basic information (see resources below). Such lack of transparency and sincere public accountability is unacceptable in our democracy.

Even supposing that the case for statutory regulation could be properly substantiated by research evidence, sounder and more effective ways of achieving public protection are discussed in the comprehensive works of Hogan (1979-1999) and Mowbray (1995). Any form of regulation must sensibly incorporate our current best evidence from research into psychotherapy and counselling. The knowledge base in these fields is now substantial and for several years the National Health Service has proclaimed evidence-based practice to be a central tenet of its work. However, the current HPC approach to regulation has almost entirely eschewed this knowledge.

The formal consultation on the recommendations of the Psychotherapists and Counsellors Professional Liaison Group (PLG) about potential statutory regulation closed on 16 October 2009. The HPC published its conclusions on 10 December 2009, and despite over 1000 responses to the "consultation" (mostly exceedingly critical), the HPC's Chief Executive breezed: "Based on the work undertaken to date, the HPC is confident that its systems can accommodate the regulatory needs of psychotherapists and counsellors."

If you are also concerned about these developments, either as a potential therapy client or as a practitioner, please support the Alliance for Counselling and Psychotherapy, write to your MP (and/or MSP in Scotland) and request information from the DH. You can also check your MP's or MSP's details and voting record at TheyWorkForYou.

Even if you support statutory regulation in principle, please scrutinize the HPC approach carefully and make any representations as soon as possible.

does the HPC protect the public effectively and efficiently?

For the period 2009-2010:

  • The HPC’s operating expenditure was £15m, of which payroll costs amounted to £5.24m (34.9%), and legal expenses we estimate to £2.93m (19.5%, based on previous years).
  • The HPC employed 133 full time equivalent staff, costing £4m in wages and salaries, representing an average salary of £30,142. The Chief Executive/Registrar’s salary and pension cost £168,503, with his salary just above that of the current Prime Minister.
  • The budget to consider allegations about the fitness to practise of registrants was £6m (40% of the operating expenditure).
  • Of the 772 total allegations made against registrants, 237 (30.7%) came from the public, compared with 254 (32.9%) from employers and 108 (14.0%) from the HPC itself.
  • 499 allegations (64.6%) of the total were considered, taking an average of 7 months before a case was heard by an Investigating Panel.
  • 130 (54.9%) of the allegations from the public were heard, and only 29 (22.3%) of these allegations were found to have a case to answer.
  • Each allegation with a case to answer which came from the public represented an HPC expenditure of £517k.

Sources: HPC Annual report and accounts 2009-2010, HPC Fitness to practice annual report 2010
Analysis prepared for on 6 Jan 2011
© Copyright waived, in the public interest, if document reproduced in its entirety

Download current analysis in PDF format, 25 kB
Download 2008 analysis in PDF format, 40 kB


© 2005-2011 Copyright waived in the interests of public information; please copy freely