Statutory Regulation of Counselling and Psychotherapy

fannymagee

Interesting article on regulation- BRING IT ON!! :-)

http://www.irishtimes.com/news/politics/oireachtas/varadkar-says-strange-people-advertising-as-psychotherapists-1.2180034

JuliusCaesar

AUSTRALIA
And here's a quote from Australia about why they didn't bring in statutory regulation (p. 16 of the report):

The training of counsellors and psychotherapists differs from that of psychologists, social workers, psychiatrists and doctors in that it contains a much greater emphasis on interpersonal communication, experiential learning and development of relational and psychotherapeutic skills. This approach is affirmed by a considerable body of research demonstrating that the strength of the therapeutic relationship accounts for 30-40% of those factors predicting a successful therapeutic quality of life, outcome (Hubble, Duncan, & Miller, 1999).

While counselling and psychotherapy overlap considerably, there are some distinctive differences. As identified through a consensus process and adopted by the PACFA Council of 41 associations, the focus of counselling is more likely to be on specific problems or changes in life adjustment, while psychotherapists are more likely to work intensively with deeper issues and/or more deeply disturbed clients who are seen more frequently and over a longer period of time (PACFA 2006a). However, psychotherapy and counselling are widely understood to fall on a continuum rather than being two discrete professions (HPRAC, 2006; PACFA, 2006a).

It is recognised that a wide range of professions may use a variety of counselling skills as part of their practice, and that the term counselling is part of everyday language with different meaning in different contexts. An effective regulatory model needs to define more clearly its meaning in the professional context and determine the standards for an acceptable knowledge base, training, experience and skills, for practice as a counsellor or psychotherapist. This will allow the profession to present a credible identity and standard of practice to both the public and other professionals, and a mechanism through which professionals are held accountable.

UNITED KINGDOM
The UK has also gone on the Voluntary Regulation route.

Here's an interesting article from the UK, which is against Statutory Regulation - worth reading, even (and maybe even especially) if you are in favour of it.


AUSTRIA
Info from here:

After intensive and controversial discussions both among public at large and the
psychotherapy associations, the Law on Psychotherapy was finally passed of in July
1990. This Law, which requires a 7-year training and enables psychotherapy practised as
a profession in its own right, had far-reaching consequences for the development of
psychotherapy in Austria. In 1991 the General Social Security Law was changed to
include the provision that every Austrian citizen who is in need of psychotherapeutic
treatment for an illness must be provided with such treatment as a part of public health
service. Since then work is ongoing to ensure that this Law is actually put into practice,
and today in all 9 Federal provinces insurance companies have made possible to obtain
psychotherapy within public health service (which was before normal for other forms of
medical treatment). Today around 5500 trained psychotherapists in Austria are active in
the health care service and the social services.

So one of the consequences of the new Law was an exponential growth of the
expenditure by Health and Social Insurance for Psychotherapy (source: Hauptverband der
österreichischen Sozialversicherungträger, 28th May, 2002, cited by Pritz (16)) (Table 1).
The whole psychotherapy market (private and public together) in 2002 in Austria had a
volume of approximately 200 millions Euros per year.

Table 1. Exponential growth of the expenditure by Health and Social Insurance for
Psychotherapy in period 1992-2000 in Austria.
Year Millions Euros
1992 3.20

2000 16.13

...psychotherapy training is regulated by a law. All education and training
institutes and facilities require an accreditation from the Health Ministry for which a
Psychotherapy Board is responsible. This Board, made up of representatives of all
psychotherapy approaches, university professors and other representatives of
psychotherapy, consists almost entirely of psychotherapists, and its members number
approximately 60 persons. It is the Board's task to examine the applications for training
accreditation, which is granted only after a rigorous examination of scientific qualifications
and abilities of the trainers.

IRELAND
CORU is the Statutory Regulation body for Health and Social Care professions in Ireland (includes psychologists). Counselling and psychotherapy is not on their list.




I look forward to an interesting discussion! :-)



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fannymagee

I would love to see psychotherapy regulated, which is hopefully what Varadkar is proposing!

I think it would be very messy to include counselling in any regulation, given that it's such a broad umbrella term- a structured conversation between two untrained lay people could technically be called counselling, and I don't necessarily think that's a bad thing. Professional counsellors could still be accredited by the existing bodies, IACP etc, but I think the title 'psychotherapist' should be protected, with a minimum training requirement similar to what other countries have done. That's my two cents on it anyway!

There is already a move towards bringing psychotherapy training programmes in line with the Austrian model, and accreditation with ECP & IAHIP now requires a minimum of 4 years post-grad, supervised clinical training. But until there's regulation, the onus is still on the client to investigate the credentials of their therapist.

hotspur

fannymagee wrote: »

I think it would be very messy to include counselling in any regulation, given that it's such a broad umbrella term.

And psychotherapy isn't? Lying on a couch with a Freudian-Lacanian psychoanalytic psychotherapist bears no relation to what happens in humanistic psychotherapy, which bears little relation to what will happen in CBT etc.

I believe the whole issue of separating counselling and psychotherapy is being driven by a competitive desire relating to professional domain. Hardly a new phenomenon within health professions, but disappointing that therapists in this country should be engaging in it.

I don't believe that the distinction can be justified on any grounds. What differs is models of therapy. If you do a 4 year Master's in humanistic and integrative therapy you will be studying the same things as someone doing a 4 year Bachelor's in humanistic and integrative therapy, and in the practice of therapy you will be doing the same thing. But some want to say that the former are psychotherapists and the latter are only counsellors.

People who do 4 year postgraduate courses in therapy almost never have undergraduate qualifications in psychotherapy. And plenty of people who do undergraduate courses in therapy have previous undergraduate qualifications, such as in psychology. The postgraduate aspect of it makes little sense when it is not truly a progression from what one studied at undergraduate.

I find it very difficult to accept that there are genuinely therapists out there who truly believe that there are therapists who work with long standing issues and those who don't. What do they imagine happens? A client comes into a counsellor suffering with depression, underlying social anxiety problems for 20 years, lack of mindfulness, and constricted experiencing and expression of emotions, and the therapist says let's talk about the depression you have had recently and then leaves the other stuff alone because they have the wrong letter in their qualification?

If it goes through how do the psychotherapists plan to market the difference in the things they can work with? Across their 450 modalities which bear little relation to one another, but are definitely different to all the different types of therapy a counsellor can provide? It's nonsense.

If you want to set the educational bar for becoming a therapist higher, then fine. But don't attempt to create a ridiculous, theoretically and evidentially groundless and unjustified distinction between you and your colleagues which places half of them below you in a lesser category.

Economically times are hard for the therapy profession. Client numbers are down, and willing to commit to shorter durations, courses and thus therapy graduates are still going up and up, fees are often going down. It's scary, especially so for those not in salaried jobs. But creating professional elitism as a solution is not an answer worthy of those of us who are in this for vocational purposes.

We are in this because we care, because we want to help our fellow people. Mutual respect and co-operation should be our guiding principles here. Instead of activating our competitive motivational system which narrows attention, makes us competitive by highlighting difference, and is driven by fear and contraction, we should orientate our attention towards that which is common, and activate our co-operative social motivational system characterised by openness, generosity, compassion, and expansion rooted in our shared humanity.

Personal development should not end with the personal.

fannymagee

Wow, was that all directed at me?! I have no interest in telling therapists what they can and can't work with. I believe that's for the client and therapist to decide, and I believe clients deserve the widest possible scope of options. Whatever works for the client is fine by me.

WRT psychotherapy: Yes I would like to see the the educational requirements regulated. NOT the presenting issues- I don't know how you could think that's even possible to regulate what goes on in the therapy room. A 4 Year post-grad Masters from an accredited University combined with clinical placement under supervision and a minimum requirement for personal therapy is a solid training in my book. I don't see the problem with differentiating that from someone who calls themselves a Child Psychotherapist after buying a €50 Groupon 'diploma'. I'm not saying it's going to stop it from happening, but it would make it illegal.

It's not going to happen today or tomorrow, so don't go losing any sleep over it

JuliusCaesar

This is interesting. At least we have to discover the commonalities of what actually works. Dismantling studies are really important.

The problem with regulation, as I see it, is that very few therapy approaches can say that they have an evidence base - that they are based on solid evidence. CBT can, but that's because it derives from the psychology - learning principles - behaviourism experimental history. (The cognitive bit less so.) But the real problem is that new therapies are springing up daily. There is money to be made out of it!

I have a great idea walking home one day; I call it the JC method of dealing with mental health issues. So I try it out with patients, and it seems to work. I set up the JC institute for DWMHI. I charge a fee for training. I have a further think about it, and decide the training done so far is only Level 1 training. So now you'll need Level 2 to practice. Three years later, I introduce Level 3 training.

But loads of other people have been doing the same thing and we've all been members of the ISSLHIP - the International Society of Seemed Like a Huge Insight Psychotherapy. Now we have the authority of being oh at least several years old, so we must be good.

So can the JCDWMHI method be included or excluded from the Statutory Regulation?

fannymagee

JuliusCaesar wrote: »

This is interesting. At least we have to discover the commonalities of what actually works. Dismantling studies are really important.

The problem with regulation, as I see it, is that very few therapy approaches can say that they have an evidence base - that they are based on solid evidence. CBT can, but that's because it derives from the psychology - learning principles - behaviourism experimental history. (The cognitive bit less so.) But the real problem is that new therapies are springing up daily. There is money to be made out of it!

I have a great idea walking home one day; I call it the JC method of dealing with mental health issues. So I try it out with patients, and it seems to work. I set up the JC institute for DWMHI. I charge a fee for training. I have a further think about it, and decide the training done so far is only Level 1 training. So now you'll need Level 2 to practice. Three years later, I introduce Level 3 training.

But loads of other people have been doing the same thing and we've all been members of the ISSLHIP - the International Society of Seemed Like a Huge Insight Psychotherapy. Now we have the authority of being oh at least several years old, so we must be good.

So can the JCDWMHI method be included or excluded from the Statutory Regulation?

Has the JCDWHMI training met the Fannymagee Criteria above?

If yes, it can be included :-)

hotspur

fannymagee wrote: »

Wow, was that all directed at me?!

Eh, none of it was, it was about the official position being adopted by the bodies in the ICP that counselling and psychotherapy are different and that this should be reflected in legally preventing half the therapists from calling themselves psychotherapists.

I am in favour of regulation. Forget the straw man of the chancer who has done a few weekends of some nonsense course. They want to prevent people who have trained in therapy for 4 years, accredited by a university, during which they had clinical supervised placements and required personal therapy, then completed 450 hours of supervised post graduation hours from calling themselves psychotherapists.

fannymagee wrote: »

I don't know how you could think that's even possible to regulate what goes on in the therapy room.

Read my post again.

JuliusCaesar wrote: »

The problem with regulation, as I see it, is that very few therapy approaches can say that they have an evidence base - that they are based on solid evidence. CBT can, but that's because it derives from the psychology - learning principles - behaviourism experimental history. (The cognitive bit less so.) But the real problem is that new therapies are springing up daily. There is money to be made out of it!

I couldn't begin to count the number of studies of non-cbt therapies I've read that have found their approach to be efficacious for specific issues.

Given the issue at hand I have to say that some within the CBT camp have been among the least generous in respect of tribalism and looking down their noses at other therapies over the years. Evidence-based therapy is aspirational is nature. It shouldn't be used as a weapon to try to dominate.

But this does point to the ridiculousness of proposing a hierarchy of counselling and psychotherapy. If you are a counsellor who heads up to Queens and does their diploma in CBT you would be a poor relation to the psychotherapist who has done their 4 year Master's with a heavy emphasis in psychosynthesis, or solely Freud / Lacan. That is, it would bear no relation to what the therapist actually does.

So you would have situations such as A (psychotherapist) and B (psychotherapist) > C (counsellor), where A and B have zero overlap in what they do, but C might do the exact same thing as A does. This is not a sensible or rational basis for creating such discriminating categories in law.

JuliusCaesar

I'm not saying that therapies other than CBT don't work, or don't have value, it's just that they don't have the massive research input that CBT has. Of course I disagree that the heavily controlled RCTs (usually implemented by post-grad psychology students with a few days/weeks training in implementing CBT) reflect life in routine practice - but at least CBT does have this weight of 45+ years of research. Other therapies were slower to implement outcome research. But outcome research, research into effectiveness is REALLY important.

and anyway, the amount and diversity of therapies that come under the CBT umbrella is getting wider and wider - from Schema Therapy to Behavioural Analysis - that it may soon break under the strain. But they do all tend to do the studies!

It'll be interesting to see how it all pans out.



I agree, there is no real dividing line between psychotherapy and counselling.



But back to the Statutory Regulation: the article against it was at least interesting? It seems to have been taken up here in Ireland as the saviour of the profession/s, with no dissenting voices (that I'm aware of - but then I'm not a member of any of the major counselling organisations).



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