Ministers are facing calls for urgent regulation of psychotherapists and counselors to protect vulnerable people, as lawyers report a rise in lawsuits by patients for alleged harm caused during therapy.
Unlike most other healthcare roles, including doctors, midwives and osteopaths, “psychotherapist” and “counsellor” are not protected titles or statutorily regulated professions in the UK.
Experts told the Guardian that few people realize that anyone without a qualification can call themselves a therapist, and that they can continue to practice after an episode of misconduct.
There has been an increase in the number of people seeking help for mental illness in recent years, with services across England receive a record of 5 million referrals during 2023, 33% higher than in 2019.
While the vast majority of people find professional help beneficial and even life-saving, lawyers have reported a significant increase in the number of inquiries about alleged cases of malpractice and even abuse.
Although clinical psychologists are statutorily regulated, psychotherapists and counselors may voluntarily apply for accreditation with one of several bodies. These include the British Association for Counseling and Psychotherapy (BACP), which requires a minimum level of training with recognized courses, and operates a complaints process that is not legally binding.
Catriona Rubens, a solicitor at Leigh Day, said that since representing Ella Janneh – who in June successfully sued her sexual assault therapist in the first High Court case of its kind – she has been “inundated” with enquiries, with approaches quadrupling from people claiming to have been sexually, psychologically or emotionally abused.
“I’m sure that’s probably the tip of the iceberg,” she said. “One of the very difficult aspects of this type of abuse is that it takes place in such a position of trust, when you are already vulnerable.
“If you’re looking for therapeutic services, you’re probably talking about intimate, personal disclosures. If someone abuses that trust, it is difficult to challenge it and take further action. Women talk to me about how embarrassed and humiliated they feel, how under the control of the therapists they feel.”
She added that for most clients, their priority was to prevent other people from suffering the same harm, as even after a successful lawsuit, therapists were not prevented by law from continuing to practice.
Janneh was awarded damages of £217,000 in the High Court following a civil case against TV sex therapist Michael Lousada, whom she accused of raping her. She waived her right to anonymity so potential victims would know to avoid him.
Janneh and Rubens are now campaigning for the introduction of statutory regulation, and are organizing an event in December with MPs and experts with a view to presenting a draft text for possible new legislation to parliament.
“Ella and I feel very strongly that the state is failing to protect therapy patients and clients. Many would assume that psychotherapists, counselors and therapists must be registered and regulated by a professional standards body, but this is not the case,” said Rubens.
The BAKP has reported a 24% increase in complaints against its accredited therapists since 2020, although not all will lead to sanctions. Most complaints concerns competence, transgression of professional boundaries and presenting medical diagnoses, for example of autism or narcissism.
The BACP has long supported statutory regulation of the profession, but Lisa Morrison Coulthard, its director of professional standards, said its accreditation in the meantime offered some “confidence and reassurance” to the public.
The BACP is also working with NHS England and the Professional Standards Authority on a framework for registrations and accreditations for psychological professions for NHS practice, which is intended to provide greater clarity for the public.
David Greenwood, an attorney at Switalskis who specializes in therapy abuse, said his firm has seen cases more than double since the pandemic. Emma Crowther, a lawyer at Irwin Mitchell, said therapy abuse was a new area for her firm, with people now “more willing to come forward”.
Statutory regulation of psychotherapy has been debated on and off since the 1970s, and has been included in a white paper published by the previous Labor government in 2007.
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Rachael Maskell, a Labor MP and co-chair of the all-party parliamentary group on mental health, said she and other MPs would consider backing the government to review the statutory regulation of psychotherapy and counselling.
“These are unfinished business from a long time ago, so the government must be focused on finding a way through,” she said. “Regulation is very important, including the protection of title, not least when dealing with mental health professionals. There are many people called therapists and counsellors, without the voluntary regulation or powers, who are working, and therefore the best way to keep the public safe is to introduce regulation.”
Dan Poulter, a psychiatrist and former health minister, said therapists were out of step with “all other healthcare professionals”, which resembled a contractual arrangement rather than a patient-clinician relationship.
The fact that psychotherapists are dealing with people with complex histories of trauma, who may be suffering from post-traumatic stress disorder, or who are trying to remain abstinent after alcohol or drug abuse, “is a strong argument for saying they should be formally regulated,” he said.
“I have no doubt that the vast majority of people practice to a very high standard and have very valuable skills, but it is also the case that there are some rogue practitioners out there, and it is very difficult for the public to necessarily be able to easily distinguish between … someone who is well qualified and who is not,” he said.
Jonathan Coe, a specialist in professional regulation who was involved in the inquiry into a regulatory framework under the last Labor government, said the issue had been sidelined by the coalition government, for whom “it was not a priority”.
While many psychotherapists wanted to see regulation, others opposed it on the grounds that they wanted the “freedom to be in a dynamic relationship,” he said. Still, the British Psychological Society saw statutory regulation of some psychologist titles as a “sign of confidence in their profession”, he added.
Coe pointed to a recent example where a therapist was struck off a professional register, then set up a new website that made no mention of the misconduct allegations. “Nothing in the law prevents him from doing that,” he said. “How does it protect the public?”
A government spokesman said: “Anyone seeking therapy deserves to have confidence and trust in their healthcare professional, which is why we insist on using qualified practitioners who are accredited by the Professional Standards Authority for Health and Social Care [PSA]. To meet the standards for PSA accreditation, an organization must focus on public protection and robust processes for handling complaints against practitioners.”
