Psychotherapists in turmoil over plans to start regulation

Government aim to protect clients from abuse will 'stifle creativity', say opponents

Their aim, as they put it, is to turn "neurotic misery" into ordinary human unhappiness. But now Britain's psychotherapists have heaped anguish on themselves with a damaging feud that has split their ranks.

The dispute has erupted over Government proposals for the regulation of the country's 50,000 therapists to protect their clients from abuse and exploitation. While some therapists accept the need for official monitoring of what they do, others are furious at what they see as a Government attempt to control how they talk to their patients.

Demand for "talking treatments" is booming as doctors and patients have recognised that they are more effective and safer as the first-line treatment for depression and anxiety in place of antidepressant drugs and tranquillisers. Fears of job losses and economic insecurity caused by the recession are driving increasing numbers to seek help.

Alan Johnson, the Health Secretary, announced last year that an extra 3,600 therapists would be trained to provide cognitive behaviour therapy – a technique for helping patients overcome negative thinking – on the NHS at a cost of £173m a year from 2010.

But every barrel contains bad apples. There is concern about therapists who abuse their position by, for example, having a sexual relationship with a client. Witness, a charity supporting those abused by health and social care workers, recorded 83 cases in 2005-06.

Under the proposals for the regulation of psychotherapists, published in February 2007, they would be required to register with the Health Professions Council, which regulates chiropodists and physiotherapists, and which has powers to investigate complaints and administer sanctions. Draft legislation to register psychologists was laid before Parliament last month. The plans are supported by the British Psychoanalytic Council which has condemned what it describes as "a strident campaign by a small group of therapists and counsellors against statutory regulation".

Peter Fonagy, professor of psychoanalysis at University College, London, said: "Most practitioners have come across individuals who have been inappropriately treated by fellow therapists. This kind of action must not be allowed to undermine public confidence in psychotherapy. Evidence shows increasingly clearly that therapy and counselling are among the most effective treatments for psychological disorder and are growing rapidly in popularity. We need a transparent and independent system which allows clients' voices to be heard if they feel their therapy has been inadequate or inappropriate."

Against this view, the Alliance for Counselling and Psychotherapy has attacked the Government's proposals as "singularly inappropriate" and claims they will "perpetrate net damage to the field". More than 2,000 therapists have signed a petition opposing the plans.

In a statement, the Alliance said regulation would "medicalise the field, rigidify training and inflate the cost of therapy, reducing access". Any attempt to make therapy conform to a "safety-first" culture would "degrade the quality of help offered".

Supporters of the Alliance include Professors Andrew Samuels of the University of Essex, Brian Thorne of the University of East Anglia and Haya Oakley, former honorary secretary of the UK Council for Psychotherapy.

In their statement, they say: "Many if not most practitioners see their work as more an art than a science. Any attempt to impose a quasi-objective framework of standards and competencies not only stifles creativity but also damages therapeutic work with the client. Applying a predetermined set of external principles means overriding the client's individuality. This is ethically unacceptable as well as therapeutically ineffective."

Psychotherapy has always been riven by schisms, since the split between Freud and Jung. An umbrella body, the UK Council of Psychotherapy, was established in 1982 to promote self-regulation but it has since splintered and is challenged by rival organisation the British Psychoanalytic Council.

Regulators have faced the daunting task of drawing up guidelines for therapy, to set a benchmark against which misconduct can be judged. The early efforts of a quango called Skills of Health, commissioned to make the first attempt, have not been encouraging. A draft of more than 450 rules produced last year included one requiring therapists to "identify the client's response to your use of silence", which is counter to the teachings of Freud and others. Another instructed therapists to seek "feedback" about the helpfulness or otherwise of an interpretation. One body, the Psychoanalytic Consortium, rejected that by declaring therapy was "not about making an evaluation of service, as in a pizza restaurant".

The regulators' difficulty is that they are attempting to police private conversations between two people which are freely entered into and which happen behind closed doors. Some professionals think they are foolish even to try.

The Health Professions Council said it was expected psychologists would be registered this summer and legislation to regulate psychotherapists would be introduced under a "further order".