Report on Health Professions Council

Meeting of Counselling and Psychotherapy Professional Liaison Group, 4th December 2008.

The PLG group is made up of the following members:

Sally Aldridge - British Association for Counselling and Psychotherapy
Fiona Ballantine Dykes - Counselling and Psychotherapy Central Awarding Body
Jonathan Coe - We Need To Talk
Mick Cooper - University of Strathclyde
Peter Fonagy - Skills for Health
Julian Lousada - British Psychoanalytic Council
Brian Magee - Counselling and Psychotherapy in Scotland
Linda Matthews - British Association for Behavioural and Cognitive Psychotherapies
Rose Mary Owen - Relate Institute
Jean McMinn - Queen's University Belfast
Kathi Murphy - United Kingdom Council for Psychotherapy
Mary Clark-Glass - Lay member of the HPC Council
Jeff Lucas - Lay member of the HPC Council
Graham Smith - Physiotherapist member of the HPC Council
Eileen Thornton - Alternate Physiotherapist member of the HPC Council
Annie Turner - Occupational therapist member of the HPC Council
Diane Waller - Arts therapist member of the HPC Council and Chair of the PLG

The meeting was well attended by observers. It was open by Anna van der Gaag, President of HPC Council, who made an enthusiastic case for HPC being the best regulator for counselling and psychotherapy. It was then handed over to Diane Waller, who clearly struggled to sustain her function to continue enthusing members about regulation through HPC.

A presentation followed by Niall McDermott, Head of Policy & Standards from the Dept of Health. He informed the group that once its work is done he and his team of lawyers will move to translate it into law. He pressed that, in order to make legislation 'possible and quick', policy will needs to be 'clear and tight'. He confirmed that the legislative process would take approximately two years, so, likely, regulation would not happen until 2011. A question was raised about the relationship between HPC and SfH, and an assurance was given that there are no formal links between the two, and HPC processes are completely independent. Nevertheless, the point was also made that it is appropriate for the two agencies to inform each other's work. A question was raised about consultation processes with the DH. NM replied that, once the work of the group has been submitted, representations could be made to the DH to raise whatever objections. However, he also stressed that the process would need to go ahead regardless of unresolved disagreements. Ultimately, disagreements would need to be submitted to Parliament, which would have the final saying. A debate followed about the HPC's own processes. Several PLG members insisted that all processes should be made transparent, and agreement was reached that HPC, DH and Parliamentary processes would be made available through the HPC's website.

There was then a presentation by Michael Guthrie, HPC Head of Policy and Standards. This was as hollow as could be expected. A slide highlighted the fundamental principles of HPC: openness, transparency, inclusiveness, diversity, public protection, professional and lay input throughout all processes... Safeguarding the Ethics of clinical practice - small detail - was not among these principles. MG predicted that there will be times when PLG members may disagree with each other. He announced that at such times they would be expected to move on in 'pragmatic ways', and stressed several times that members would be asked to make 'very pragmatic decisions'. He professed his commitment to ongoing consultation with people and organisations that had been 'unsuccessful' in joining the group, and said that he would seek contributions from them at the reference meetings, scheduled to take place over two separate days. He added that once the PLG work is completed it will be submitted to Council and other stakeholders for further consultation. If necessary, the PLG would then reconvene to undertake further work in view of their feedback.

After this, the meeting moved to consider the responses to the HPC document 'Calls for ideas'. Attempts were made by some HPC members to progress the meeting, ignoring the strong voice of opposition to regulation through HPC. These attempts quickly came to grief, so much so that the rest of the meeting was dominated by considerations and discussions about this. Early interventions by HPC members misrepresented the nature of this dissent, presenting it as being opposition to statutory regulation and regulation in general. Thankfully, Kathi Murphy (UKCP) took up the position of representing the voice of opposition, which she maintained throughout the meeting. She clarified that many practitioners are not against statutory regulation, but are very concerned about regulation by the State. She developed the arguments in relation to this eloquently, and also raised the expressed concern about psychotherapy being subsumed to the medical model. Several attempts were made by some HPC members to quickly dismiss Kathi's points with banal and patronising arguments. Some told the group that they understood and sympathised with these concerns, but that they were based on myth rather than reality. They too had been anxious about regulation, but things had turned out well after all. They too had worried about being subsumed to the medical model, but had found that HPC does not at all impose this model on their professions. And the medical language of HPC could be reviewed - for example, patients could be called clients. On this point, Kathi responded that the language of HPC and the language of psychotherapy are fundamentally different. She emphasised that the difference is philosophical in nature, that the difference could not be resolved by simply changing some linguistic terms, and that psychotherapy articulates itself not in one language but in many different languages. Mick Cooper asked how non-health modalities may fit into the discourse of HPC. Other PLG members raised the issue of the heavy promotion of CBT, insisting that the work of the group should counteract this bias. The point was also made that the work of the group should not be NHS focused.

After lunch, Fonagy, who had sat silently throughout the first part of the meeting, was asked to give a presentation about the work of SfH. The presentation was delivered in the language of management, with frequent use of terms like 'quality assurance', 'occupational standards', and so on. He explained that it has been necessary to develop NOS because there is no clarity as to what constitutes each modality. He said that in no way the NOS developed by SfH form the boundaries of the registration process, and HPC members/lay people also stressed the importance to defend the independence of HPC from SfH. He informed the meeting that the SfH's work on NOS had been guided by available evidence. A question was asked about how these standards would relate to counselling, and he said that he was unable to give a clear anwer to this. Kathi Murphy asked how the PLG group could be informed about expressed opposition to the work of SfH — how may the group be enabled to 'consider the whole picture'. The question was not picked up, and some HPC members quickly tried to divert the discussion. Pretty soon Kathi brought the focus back onto the questions raise by the opposition, saying that the group would need to have difficult debates about very complex issues and adding that UKCP members wanted these issues properly addressed by the PLG. For example, she asked, what constitutes evidence?

A HPC member/lay member made the point that this is the first time that a professional body is forced to register trough HPC. All other professions apply to be registered. There was an acknowledgement that this would present particular challenges to HPC. Another HPC member/lay member said that the group should ensure that the process meets the HPC's criteria. The HPC President replied that this was not necessary, since the Government's mandate for the regulation of counselling and psychotherapy had superseded the need to do so. However, other HPC members/lay members thought that the process should be followed regardless.

The meeting had by now become visibly tense. A HPC member/lay member said that the group should get on with the work, or else Government would have to do it instead. Fonagy endorsed this 'whole heartedly', telling the group that it should not waste time considering arguments that were not related to the protection of the public. The issue of medical model, he said, should not be an issue for the PLG, since both medics and non-medics are equally capable of malpractice and abuse. Kathi Murphy replied that the public protection is important to the vast majority of practitioners and she has never met anyone who is against this principle. However, she said, the principle may be understood very differently by different people. Again, A HPC member/lay member stressed the importance to engage with the opposition and try to understand their arguments. For example, he asked, what did people mean that 'regulation would lower standards'? 'People arguing non-compliance make ropes for their own necks', he said, 'but we do have a responsibility towards our community'. Other members agreed that the group should engage with the opposition, and asked how this could be done given that there was no representation from opposing groups on the PLG.

Although time had been allocated until 3:30, the meeting was suddenly brought to a closure at 1:30.

Simona Revelli

5th December 2008

Click here to return to Latest News