‘More than the practice of therapy... a practice of freedom in being with other persons.’¹

I think I may be suffering from an undiscovered disorder. I have begun to develop certain symptoms, feelings of intense frustration, astonishment, disbelief, being suddenly rendered speechless, and my heart sinking in my chest. Let’s call it incomprehensible speechless disorder (ISD). I have diagnosed in myself an agitated form, characterised by indulging in a great deal of reading and thinking, engaging in intense debate with peers and colleagues and a compulsion to keep writing letters to people. I jest, of course, but it is also a very serious matter. I find myself in a process of anticipatory grief for the end of an era of relative enlightenment.

It occurs to me that any rational argument against the centralised regulation of counsellors and psychotherapists under the Health Professions Council (HPC) cannot be heard, or at least be responded to, in any meaningful way by BACP.2 Steve Cox3 highlights very well the huge importance of local knowledge and practice-based evidence and he speaks for me, but I would like to offer a personal story to see if any further light might be cast into these currently dark and murky waters before we descend into another Dark Age.

Why I am opposed to state regulation
So this is my story of why I am opposed to the state regulation of counsellors and psychotherapists. Twenty-one years ago I joined an association of people committed to sharing and developing practice, learning from one another and raising standards. Over the years, I have been hugely supported in my practice by my membership of this association, first BAC, now BACP, and one of its fantastic divisions AUCC (which still retains the character of an association: member-participant led with continual open and accessible lines of communication, mostly focused on practice). My membership has provided guidance, opportunities to take time out to reflect and learn with peers, and processes to articulate and examine practice. Sadly, over recent years, I have watched a process of metamorphosis in BACP. The association I joined has become a different animal, more reptile than mammal, and so, increasingly alien to me.

In the early 1990s I had already spent a few years working as a voluntary counsellor and had undertaken many hours of in-house training and supervision and some formal training. Wanting to better understand the extremes of mental distress and to learn more about how to help people heal or manage their lives better, I decided to train as a mental health nurse. Joining a regulated profession and working alongside other regulated professions (medics and social workers), I naturally assumed that this would mean high standards of care and treatment, knowledgeable, skilful and ethical professionals and, most importantly, the best interests of patients at the heart of practice. For me, of course, should I join their ranks, this would also mean increased knowledge and skills, economic benefit and status.

What I discovered, both in school and on the wards where I undertook my placements, was a restrictive and stifling hierarchical structure with patients well and truly located at the bottom. I came up against a culture based on mistrust, fear and compliance, coercion and control, distant from and indifferent to patients, an unquestioning complacency with the way things were, and very little that resembled warmth or human kindness. The focus, and therefore the majority of time, was spent on established ward routine and the completing of paperwork that demonstrated policies and procedures were being followed (even if they weren’t). Being with and talking to patients was discouraged and frowned upon.

The task given to me as a student was to observe and follow such practices without question. There was a huge gap between the theorised learning objectives designed to ensure I reached the required occupational standards for the profession and the practice on the ground. To my horror, meeting these objectives mostly turned out to be a paper exercise; sometimes staff didn’t understand the objectives or openly declared that they thought they were a waste of time and sometimes they would make something up in a conspiratorial way so ‘we could get them ticked off’. There was little room to acquire and practise skill in anything other than maintaining appearances. I experienced overwhelming pressure to comply. The fact that many had lost sight of the best interests of the patients could not be spoken. It seemed to me that there was too much at stake for all concerned; society could not be wrong. If patients didn’t perform well the sick role cast for them, they were punished. I sensed that if they weren’t kept in line, the whole charade would be in jeopardy. These were the professional walls within which patients were prevented from being seen and heard as resourceful people worthy of respect and collaboration.

In the community, where practitioners had more autonomy, things were a little better but the system still set severe limits on what could be offered and delivered therapeutically. I was deeply shocked that I had entered into a world in which to care deeply about someone was perceived as a sign of weakness.

Learning from history
History is not short of important lessons for us about what the institutionalisation and professionalisation of human services does to people, workers as much as the recipients, and I believe these problems are terribly confounded when the state gets over-involved. In the literature, I found the critiques and concerns I was witnessing and duly raised them in school and referenced them in my written work. But in practice they were never given airtime or taken seriously. I wouldn’t wish to give the impression that the individuals involved did not care. There were many concerned and dedicated nurse tutors and practitioners, but they had no real power and could exercise little influence over the system.

When the day came for me to take a moral stand against such practices and refuse to continue towards registration as a mental health nurse it was painfully revealed to me how much of a non-person one becomes in such a world. Without a word, after nearly three years, I was duly dispatched without interest to follow the next protocol, to have myself ‘terminated’. After a few minutes, having signed the ‘termination of studies’ form, I found myself in the car park. Initially dazed, I walked free, out into the sunshine on a cold February day, as if I had just been let out of prison; jobless and penniless but nonetheless free. As far as the professional institution of nursing was concerned I became a wastage statistic, nothing more. 

Fortunately for me I didn’t feel wasted. I hadn’t wasted the last three years; they became and have remained a hugely important part of my counsellor training. I have, of course, never been allowed to use the protected title RMN (Registered Mental Nurse). I have been denied access to work in numerous settings, and forfeited both the real and perceived privileges and benefits of climbing the professional ladder and reaching the top. Fortunately for me at that time in history there was an alternative path – counselling, an activity offered and embarked upon by many, but not a regulated profession. I was now certain that this was the path I wished to take and it was here I found a freedom to practise with integrity and personal responsibility, freedom to care. Later, as a counsellor trainer and supervisor, I was to meet dozens more disillusioned and dissatisfied souls exiting the regulated professions as they arrived on counselling courses seeking the same freedom.

A grey future
Now 15 years later the world I so conscientiously rejected is about to catch up with me. Enter state regulation of counselling and psychotherapy. A post-regulatory ‘landscape’ has already been envisioned and so already exists in the minds of us all. In fact it has been a gradual process, creeping up on us for some time; professional bodies beginning to look to their own survival rather than service, a jostling for position and territory amongst people already in positions of power and influence, and the subsequent securing of public funds for the promulgation of a narrow form of psychological therapy under IAPT. Finally BACP has lost its way, lost sight of its original purpose. I see a grey landscape drowning in bureaucracy and laden with vested interests.

I firmly believe that the strength of existing ethical frameworks in counselling and psychotherapy is that they are voluntary; people on their own initiative choose to abide by a set of values and uphold certain standards and continually re-work them in the light of client needs, rather than being required to by law. As I imagine most counsellors and psychotherapists would know, such a difference has a profound impact on the way people feel, think and behave. It is vitally important for people to be free to choose, and that they should be encouraged to do so rather than blindly follow the rules. The first communicates trust and invites the exercise of personal responsibility; the second communicates a lack of trust and encourages, paradoxically, both compliance and non-cooperation. Both carry the same capacity for corruption and duplicity from those who are not capable of right thought and action, but the second also risks alienating good will and inhibiting creative and humane practice. The second is also open to greater contamination through the introduction of an economic bargain; a person both earns and buys an entry ticket to join a protected and privileged group through which they receive exclusive access to certain status and employment, and in exchange are henceforth required to relinquish any personal concern or morality that might conflict with the survival of the said group.

Have we left it too late?
I would also maintain that the success and strength of the counselling movement in the UK has been its non-professional (not to be confused with unprofessional) status and its non-medical approach to human distress and the problems of living. It has developed and flourished enormously over the years in local communities, in the voluntary sector, in education and finally, in finding its way into primary care, filling some of the pitiful gaps left by our existing state regulated social care and mental health professions. In most settings counselling has been largely free and easily accessible. Maybe counsellors should not have trodden on healthcare ground in the first place; was this the mistake we made?

Perhaps seeing the writing on the wall, Pete Sanders4 has long been urging person-centred therapists to disassociate themselves from the medicalisation of human distress and all of its apparatus. Have we left it too late? In future counselling is in grave danger of being dominated by a medicalised view of the person and through increased delivery in healthcare settings will be severely restricted by the restraints of the public purse. Now its success is about to be its downfall; regulation will only serve to wrestle power out of the hands of the local community and from those who would sit alongside each other as equals, without separation into polarised groups; the sick and the well, the normal and the disordered, the expert and the patient. This is the ground from which counselling sprang. To imagine this very human activity could become illegal without the dubious sanction of the state appals me.

So as one of the signatories to the letter ‘Regulation: refusing to participate’⁵ I would like to make my position clear. I have no interest in engaging in any illegal activity or any legal one which would require me to care more about appearances than truth.

So, what of John McLeod’s⁶ radical vision for counselling and his ‘call to action’? Or is it a call to stand in line and take your medicine? I can see the sense in what he suggests about separating counselling from psychotherapy in order to prevent us all from being dragged into the mire of a medicalised world. If regulation does come to pass I doubt this will be enough to protect counselling and psychotherapy from the professionalised degeneration I have described above. It also fails to grasp the real issues behind the attempt of some to claim the higher ground through the formal separation of counselling and psychotherapy through regulation. Already the self-interests of the new professionals are revealing themselves; as BACP⁷ has now grasped, a hierarchy of power, status and economic reward is about to be established. Let’s all think about where our clients might be placed in this system.  The mighty wheels are turning and there will be no brakes to apply. I know of no de-regulation of a profession in modern history, even when it becomes apparent to all that change has not brought progress. Let us be under no illusion, things will not stay the same.

It seems then I do not have a disorder after all. I am in mourning. I mourn for the end of an era and deeply so for I care passionately about the freedom to practice which I and others have appreciated for many years. For me it is a sign of a civilised society when this freedom is allowed and respected. And yet, when the mourning is over, I think there will still be reason to be hopeful and not dispirited. Counselling emerged to respond to a human need that no hierarchical institutionalised profession could hope to touch. If counselling is to be swallowed up and taken apart by this same beast, something else will be born and might provide us all with a cause to celebrate.

© Barbara Shannon 2009

Barbara Shannon is a counsellor at Loughborough University, supervisor on a diploma course in FE and has a small private supervision practice. She is MBACP accredited and committed to person-centred practice. Email b.shannon@lboro.ac.uk

1. Witty M. Barbara Brodley: an appreciation. PCQ. Ross-on-Wye: BAPCA; May 2009.
2. Gabriel L. Letters. Therapy Today. Lutterworth: BACP. 2009; 20(6).
3. Cox S. Letters. Therapy Today. Lutterworth: BACP. 2009; 20(6).
4.  Sanders P. Principled and strategic opposition to the medicalisation of distress and all of its apparatus. In Joseph S, Worsley R (eds) Person-centred psychopathology. Ross-on-Wye: PCCS Books; 2005.
5. Letters. Therapy Today. Lutterworth: BACP; 2009; 20(6).
6. McLeod J. Counselling: a radical vision for the future. Therapy Today. Lutterworth: BACP. 2009; 20(6).
7. Gabriel L. Letter to BACP membership. Lutterworth: BACP; July 2009.