Hcountless thousands of people every year in the UK seek help from counselors and psychotherapists. But the case earlier this year of Ella Jannehwho was awarded £217,000 in damages after suing a sex therapist for personal injury and negligence, resumed calls for statutory regulation.
It was considered by the last Labor government, is backed by a number of MPsand is definitely on the agenda of the All Party Parliamentary Group on Mental Health. What campaigners want is for “psychotherapist” and “counselor” to become legally protected titles. Among other things, this will enable people found guilty of professional misconduct to be struck off. Ms Janneh is rightly upset at the prospect that the man who abused her, Michael Lousada, could do the same thing to someone else. Currently, there is no law stopping anyone from establishing themselves as a therapist or counselor without qualifications – even if they have previously faced sanctions.
Art, drama and music therapists are already protected titles; so are various categories of psychologists. Psychiatrists are doctors and are regulated as such.
No one knows exactly how many people see – or have seen – a counselor or psychotherapist. Often these are private arrangements that do not belong in official data sets. The last census for England and Wales found that there are 55,000 counsellors, psychotherapists and cognitive behavioral therapists in England and Wales; the British Association for Counseling and Psychotherapy (BACP) has 71,000 members.
The overlap between psychotherapy and counselling, as well as the variety of techniques and philosophies used, make compulsory registration a complex issue. Addressing these complications will require careful coordination with stakeholders. Some fear that their field, which is dominated by sole traders rather than large businesses, is not suited to a type of regulation designed for medical institutions. Professional associations such as the BAKP are also cautious.
Some believe the existing system of voluntary registration via professional associations is strict enough. They point out that a minority of doctors and nurses are failing patients despite being regulated. And while an increase in complaints seems to strengthen the case for regulation, this pattern is wider. NHS England saw a 42% increase in written complaints – from 162,019 in 2012-13 to 229,458 in 2022-23. Since the general title of therapist cannot be protected, there will always be loopholes.
But while regulation should not be seen as a panacea, and health ministers probably have more pressing priorities, private provision needs to be made as clear and safe as possible. This is all the more true at a time when NHS mental health services are chronically overstretched.
There is a strong argument for making child psychotherapist a protected title based on children’s particular vulnerabilities, and the specialist training required. On the broader category of psychotherapists, professional bodies have already done work to more clearly delineate the differences with counsellors. Over time, protected titles for both, along with a greater public understanding of what their work consists of, are certainly worth considering. For now, the public health duties of the NHS’s new integrated care systems should include clear information and directions, with a view to increasing public awareness of how to proceed looking for this kind of help.
