This document from HPC sets out a number of aims and issues relating to the proposed regulation by the state of talking therapies and recommends the establishment of a liaison group to tackle the specific tasks of regulation. Protection of the public is the main variable. It is immediately surprising that the document does not consider whether the training standards, complaints procedures and regulatory frameworks of the current counselling and psychotherapy organisations are adequate to protect the public or not. UKCP and BPC have worked for years to establish such frameworks, yet the document proceeds as if they did not exist. It must be a question, if protection of the public is the avowed aim, why no consideration is given to making the public more aware of the strict frameworks of these regulatory networks.

No psychotherapy group, to our knowledge, opposes regulation: what they do oppose is regulation by the state conducted within the framework of health care. Arguments for such regulation must first demonstrate what is genuinely lacking in current regulatory frameworks rather than set up arguments with straw men in order to push through legislation that will be damaging to patients, therapists and the field of psychotherapy itself.

We are also unaware of any psychotherapy group which opposes the idea of rigorous training standards and transparent complaints procedures. This is indeed the reason that such procedures are in place. But any credible regulatory framework must start from a study of the nature of psychotherapy itself, rather than using models that may be germane to other fields and then trying to adapt them to suit the talking therapies. This means a serious consideration of three main issues: the symptom, the concept of health and transference.

Psychoanalytic therapies, in contrast to many other forms of therapy, do not aim at the removal of symptoms, even if this is one possible effect of a treatment. Rather, the aim is to access what is being expressed through symptoms. In many cases, despite complaining of a symptom, careful work with the patient reveals that the symptom is a source of unconscious satisfaction for them. Hence it may not be in their interest to give it up. Beyond the patient's conscious complaint lie other unconscious factors which mean that the idea of 'the patient' is a divided one: split between what they might want consciously and what they might want unconsciously.

This clearly has implications for how health is conceived. Many psychotherapies are highly critical of how contemporary society 'sells' the idea of 'health', promising happiness and cures. These therapies are thus resolutely opposed to the very concept of 'health', and see their work as involving an exploration of each person's unique history. Nothing can be predicted in advance or promised to the patient. The therapist here does not know in advance what is best for the patient, although other forms of therapy today claim to know precisely this. They thus involve different ethical positions. Some therapies will offer to satisfy their patients: others make no such claim.

The third crucial issue is of transference. All psychoanalytically inspired psychotherapies recognise that therapy is based on a mobilisation of trains of thought and feelings - usually established in infancy and childhood - onto the clinician. Although different therapies have different views on how or whether transference should be interpreted, there is general agreement that the landscape of psychoanalytically inspired therapy is entirely dependent on the existence of transference. This means that the patient's relation with the therapist may involve thoughts and feelings which will very often be negative: the therapist may be seen as abusive, exploitative, unjust, etc. The whole range of negative human qualities may all become situated in the transferential space.

It is thus crucial that any considerations of the behaviour of the clinician take transference seriously: there is no neutral space outside transference within the therapy itself and there is a very great risk that regulatory bodies ill-equipped to grasp this will try to incarnate this supposedly neutral and objective standpoint from which transference can be evaluated. This is of course different from the clear cases of sexual or financial exploitation that are already codified against in the codes of ethics and practice of all psychotherapy trainings.

The above three issues are nowhere dealt with in the HPC literature to date despite their centrality to the whole question of potential regulation. There are also a number of other problems in the December document. In the section headed 'Maximising the success of the process to regulate an aspirant group', we read that "one measure of the success of the process to bring an aspirant group into statutory regulation is the percentage of individuals who either join the register when it opens, or are eligible to join the register once they have completed their programme of education and training". However, as we understand it, individuals who choose not to join the register will be prohibited by law from practising. Hence it is a circular argument to claim that the success of the legislation can be gauged by its uptake. This is rather like saying that the success of using red as the colour of traffic lights to indicate that vehicles should stop can be gauged by the number of vehicles that go through red lights. This will obviously be a minority.

We also note in the same section that although "there are many who will welcome the introduction of statutory regulation, there might be a small but vocal minority of individuals and organisations who may want to avoid statutory regulation for a variety of reasons". There follows a list of six reasons and one wonders from where the authors of the document have derived them. They emphasise non-constructive reasons rather than the ethical ones that have so far been the main focus of those opposed to the state-regulation model developed up until now. Regarding these issues, it is surely little more than rhetoric to qualify any voices of dissent in advance as 'a small but vocal minority' before the process has even started. The list of reasons that follow then suggest that this 'minority' would contain those who disagree because they are 'unable to meet competence standards', or 'ethical standards' or are 'reluctant to pay the registration fee' etc. Since these reasons are clearly poor ones they suggest that dissent is not grounded on serious objections but rather is simply an effort to safeguard incompetence or unethical practice or one's financial position. The idea here is that the basic problem involves suspect practitioners and that hence the field needs to be cleaned up. This view no doubt contrasts with one which examines the actual nature and practice of psychotherapy itself and then derives its arguments from that. Such a perspective would have the advantage of appealing less to gossip and contingency.

Regarding the issue itself of the suspect practitioner, it is a question why there is no consideration in this document, or indeed elsewhere in the HPC discussions, of the mostly forensic literature examining cases of those individuals who violate boundaries with patients. If this literature is actually examined, it becomes clear that the most dangerous practitioners are precisely those who are able to pass through bureaucratic hoops most successfully and display the competences required: in other words, those who know what is expected of them.

In the section 'Different kinds of education and training', we read that there are no compulsory requirements to undertake education and training and 'it is reasonable to assume that some practitioners undertake no training whatsoever'. While there may be a handful of examples of this, there is no evidence that those practising counselling and psychotherapy have avoided going through a training. There is the idea that those who are unable to meet training requirements will use titles that are not protected rather than seeing what really matters in this debate: the fact that there are many practitioners who see their practice as involving work that does not fall under the rubric of health care in any way and, furthermore, see their practice as specifically a challenge to health care ideology. This is also the reason why many patients will seek psychoanalytic as opposed to other forms of therapeutic work.

It is also stated that there is 'no definitive list of individuals and/or organisations providing education and training and education programmes, the standards used, quality control used or the types of qualifications awarded to those who successfully complete the programme'. In fact, there are certainly lists of individuals and organisations with clear indications of what their programmes consist of. These will not be uniform because the field itself is diverse and different programmes have different requirements. As long as the public are aware of which training or which orientation the therapist belongs to then these will be clarified. It is simply not possible to find a uniform quality control for a simple reason: many orientations argue that other orientations practise unethically. For example, some psychoanalytic practitioners might see cognitive behavioural therapy as a potentially unethical treatment. There is just no common measure between them. What matters is to make the public aware of the differences and the arguments for and against so they can make an informed decision.

In the next section, it is correctly pointed out that many practitioners and their clients will not allow their practice to fall under the rubric of 'health'. This questions the role of the HPC as a regulator. Given the diversity of the field and the profound differences in ethical and training requirements, it is indeed a question, as stated in the next paragraph, 'if statutory regulation is appropriate', albeit that HPC fails to make a proper distinction here between the real meaning of the term 'statutory regulation' and what they are really talking about, which is regulation by the state.

These considerations indicate that any viable regulatory framework should be based on a sensitivity to the actual content of psychotherapeutic practice, and it seems unlikely that HPC is able to meet this brief.

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