Jonathan Coe is absolutely right that state regulation of counselling and psychotherapy will not end sexual and other forms of misconduct. The long-recognised need for more training and information in these areas of practice may lead the HPC to fund such activities, and Witness would be very well placed to accept this work. However, the rest of his article seemed to me to be a largely uncritical eulogy to the HPC, and I felt a need for a more reflective discussion of these matters, a discussion that resonates with what practitioners already know (and, inevitably, struggle with) concerning ethics and discipline.

There is an unwritten and extremely offensive assumption running through Coe’s piece that anyone who does not root for the HPC is thereby ‘soft’ on issues of sexual and other forms of misconduct. Is Coe saying that people in counselling and psychotherapy do not know how appallingly damaging sexual and other misconduct is for clients? We all condemn sexual activity between practitioners and clients, not to mention deploring financial exploitation and misrepresentation of qualifications, to name but a few offences. More sophisticated accounts recognise that some therapists unwittingly abuse the autonomy of their clients by being over helpful, maybe a little too identified with the figure and role of the good mother, and end up by more or less telling the client what to do in their life.¹ 

Those of us with experience of ethics know what is needed in our systems, aside from the possibility of striking someone off or withdrawing recognition from them, is the chance for conciliation and mediation leading, sometimes, to restitution of fees and the recognition by the practitioner that her or his ways of working must change. Though some dispute the practice of rehabilitative therapy and/or supervision, I personally believe that these are desirable courses of action.

Virtually none of the above will be available under what the HPC is likely to propose as regards ethics. Instead, we will be subject to a legalistic, adversarial, bureaucratic and public procedure, completely at odds with what is needed. It is true that in those ethics cases where conciliation fails, you have to allow for a quasi-judicial process, but current best practice in counselling and psychotherapy is to hold off on this until other courses of action have been exhausted. Naturally, if the client wants to move immediately to a formal hearing with representation and so forth, their wishes should be (and are) accepted. And we should never forget that very serious offences might be better taken to the public arena of a law court at an early stage or whenever the complainant wishes. 

What I am suggesting is that the current systems of ethics and discipline that the range of professional organisations in our field presently offers are good enough. Making the changes that HPC registration will bring will cause more harm than good. Some ethics codes are not, as yet, fit for purpose, notably because they do not make sufficient provision for external members of panels. If the panel is all members of the organisation, there is a risk of bias either in favour of or against the therapist. However, most organisations with this problem know about it by now and are moving to fix it.

The ‘anyone can call themselves a therapist’ argument is not going to change with the HPC. Get kicked off the counselling register, and you can call yourself a coach or, as Marc Seale, Chief Executive of HPC, proposed to a group of us who went to see him, a ‘soulwright’, just as in the Royal Navy (he said) they call dentists ‘toothwrights’. Nevertheless, despite Seale’s flippancy, we should all work together, whether we support the HPC or not, to make it absolutely clear that the days of the self-appointed therapist are over and we should do our best to catch and denounce anyone trying this on. 

The Pope paper that Coe depends on is extraordinarily flawed as many academics have commented. Space permits me to do no more than note that this short paper refers to psychologists, often in educational contexts, and the cases reported are cases the respondents have heard about over their entire careers – these are not a snapshot of the respondent’s view of the system at the time of reporting.

I want to end with two general points, one of which is deeper and more reflective, and the other more pragmatic and political. On the deeper level, we need to continue to explore why sexual and other misconduct happens even when everyone is against it.

We have some debates still to have – for example, about the probity of sexual relations when therapy has genuinely stopped and appropriate advice and counselling sought by the parties wishing to get together on another basis. The Pope paper ‘found’ that 80 per cent of post-therapy sexual relationships harmed the client. Where do people stand on this? Where do Witness and the HPC stand? Finally, I am very worried that, if and when HPC comes on stream, the climate is going to become much more litigious. Armed with the hard and fast verdicts from the tribunals of the HPC, complainants will turn to the courts. What if an unholy alliance of solicitors working on a no-win-no-fee basis, expert witnesses, and complainants’ organisations were then to come into being, boosted by the advent of the HPC? This would have little to do with the mental health or wellbeing of anyone involved; it would be about money, power and influence. We need to be extremely vigilant about this kind of thing. Quis custodiet ipsos custodes? as Juvenal put it. Who will police the police? Who will guard the guards? Who will watch the watchers? 

1. See Samuels A. From sexual misconduct to social justice. Psychoanalytic Dialogues. 1996; 6:3.