I can’t remember feeling as disappointed with BACP as I do at this moment. I have just finished reading Sally Aldridge’s response to the Alliance for Counselling and Psychotherapy’s statements of opposition to state regulation through the Health Professions Council (‘Making your mind up’, Therapy Today, May 2009). I feel very strongly that the fluidity that I actively seek and need to practise is about to be ‘straight-jacketed’. The repeated message of Sally Aldridge, that there is no evidence of state regulation being detrimental to counselling and psychotherapy, simply doesn’t stand up in the real world.

I work as a counsellor in a hospice. The hospice movement, like so many voluntary sector organisations, came into being to change and challenge the statutory sector’s ‘power over’ way of relating. Holistic care, not medical treatment, determined hospice ethos. However, in recent years the ever-increasing demands of the Health Care Commission, now the Quality Care Commission have placed a great strain on the maintenance of a hospice way of being. Ever demanding proof of so-called evidence based practice, audit, greater insistence on medicalisation, standardisation and increased bureaucracy have resulted in less time being available to devote to individuals in need. There is a greater usage of tick-box diagnoses, eg the Hospital Anxiety and Depression Scale (HADS) and the subsequent use of antidepressants, despite evidence that both CBT and person-centred counselling is more effective than medication in the treatment of depression.¹

The irony is that it is the hospice movement that has forged standards of care that are unequalled within the health service. Hospices have achieved this, not by standardised treatment modalities or by evidence based practice, rather, they have achieved exemplary care by way of paying acute, compassionate attention to the individuals they care for and by embracing practice based evidence. Practice based evidence means that practices are not nailed down, static or regimented, but rather they remain alive – alive to individual need and evolving relationships, calling on creativity as well as scrutiny. Unlike evidence based practice, practice based evidence has insured social and scientific progress.
Please don’t tell me that government regulations and guidelines don’t inhibit therapeutic practice when there is abundant evidence that they do just that. I experience this, not only in my current place of work, but also in past places of work, eg government guidelines through drug action teams have brought about huge limitations for therapeutic relationships in so called addiction counselling. NICE guidelines actually ensure that the public are disallowed evidence based practice because they ignore ‘gold standard’ evidence when it is presented to them.²

How can Sally Aldridge seriously argue that a UK model would somehow be superior by separating professional organisations from regulators, thus leaving BACP free ‘to support its members’? The last time I looked, the ‘C’ in BACP stood for ‘counselling’ not ‘counsellors’. BACP has never supported its membership above that of the ethics of the profession and this is precisely why I value my membership. Being a member of BACP has meant that public safety has been a constant priority as it is fused with the integrity of the profession. Furthermore, when BACP has imposed sanctions or withdrawn membership, it has published its findings and actions openly for the world to see. Is BACP now to change its ethical position?

I am of the view that what is best for counselling and psychotherapy is also best for counsellors, psychotherapists and the public. The campaign against state regulation is a campaign for what is best for therapeutic practice, which includes public safety. The environment in which we practise must be of paramount importance. I cannot understand how or why BACP adopts a position that ‘Government knows best’, despite a huge proportion of its membership ardently remonstrating otherwise. Pete Sanders has cited ‘disability’ as an excellent example of opting out of health care in order to establish a social model that enhances the interests of those affected by disability.3 Why is BACP not moving heaven and earth to bring about a similar position?

If regulation goes through in the proposed form, I am in little doubt that most therapists will find a way to continue to practise and stay true to their therapeutic orientations. I also feel fairly optimistic that in time we will find a way of disentangling ourselves from a healthcare model that is alien to most psychotherapeutic philosophies. However, what will be the cost of continuing our practice and why must we practise in such impoverished circumstances. In therapy we are engaged in the process of emancipation, we require freedom to practise, our purpose is to evolve according to our true natures. Our belief in human potential is such that we cannot sacrifice fundamental developmental drive. Therapy as we know it will survive, yet I wonder if this will be the case for BACP, after putting a significant proportion of its membership in an untenable position.

I feel in desperate need of support from the kind of courageous organisation that brought into being the Ethical Framework, that stood against the prevailing short-term, accountability-driven, paranoid culture of the day, an organisation that took the moral high ground. I have never before considered terminating my membership of BACP on ethical grounds. I am considering this now.

It seems imperative that as a profession we must take a stance outside of the healthcare profession. Then and only then will we be in a position to consider the matter of regulation. May therapists forbid that BACP sells us short.

Steve Cox
MBACP (Senior Accred)

1. King M. Randomised control trial of non-directive counselling, cognitive-behaviour therapy and usual general practitioner care in the management of depression as well as mixed anxiety and depression in primary care. Health Technology Assessment. 2000; 4(19).
2. Elliot E, Freire B. Person-centred & experiential therapies are highly effective: summary of the 2008 meta-analysis. Person-Centred Quarterly. November 2008: 1-3.
3. 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: a positive psychology of mental health. Ross-on Wye: PCCS Books. 2005:21-42.