State regulation of counselling and psychotherapy - for or against?

The British government is preparing to regulate the activity of counsellors and psychotherapists through the Health Professions Council. This process is being marketed by the HPC as protection of the public, but really what it amounts to is protection of the rules that define what counselling and psychotherapy should look like. And the HPC version of these rules will ensure that therapy provision in the NHS will be cut down and turned into a cynical attempt to cheer people up and get them to accept their lot. Bureaucratic micro-management of each aspect of the ‘profession’ is here designed to mesh counselling and psychotherapy into a slimmed-down NHS and to reduce treatment to short-term interventions that will get people off benefit and back to work.

This new HPC regulation is closely connected with the ‘Improving Access to Psychological Therapies’ programme which its architect Lord Layard explicitly sold to the government as a cheap way of fiddling unemployment figures. The deal here is that money pumped into training up therapy ‘assistants’ would enable them to give a quick dose of cognitive behavioural therapy to the long-term unemployed on incapacity benefit, and the money would be recouped after only six months if it got them off the register. So the stakes are high here for the left, and have run-on implications for the defence of the NHS as well the marking out of a new ‘expertise’ in managing social relationships.

We need to set this process of professionalization and state regulation in a broader context of the way expertise over mental health care becomes privatised and controlled under capitalism. Historically women played a crucial part in care for others, including around what we now call ‘mental health’, and their own practice was excluded with the formation of professional medicine. Witch trials were an early part of this process of marginalising women in medicine. Now, when many counsellors and psychotherapists are women – especially in the lower-status and more informal volunteer sectors – this professionalization will side-line traditional stereotypically-feminine activity of care and social support. Health regulation will reduce therapy to procedures, techniques and targets to roll through as many people as quickly as possible, and so a crucial aspect of that work – time and space to speak and be taken seriously by another person – will be crushed out. You can guess already where women will figure, as the assistants in organisations and regulatory bodies run by men and, most important, running to an agenda that values stereotypically-masculine prediction and control of how we think and behave.

This HPC regulation will bring alienation – and this includes our struggle against the conditions that cause it – into the domain of the state. Counselling and psychotherapy training organisations will be monitored to ensure, for example, competency in the English language and even immigration status.

The attempt to regulate counselling and psychotherapy follows the regulation and ‘protection’ of titles of different kinds of psychologists in July this year, and the HPC realised that ‘psychologist’ is such a widespread term that it would be impossible to control who can and who cannot use it. Instead, different specific kinds of psychologist – clinical, educational and so on – will have their titles ‘protected’. Now as the HPC moves on to therapy regulation, the definitions are becoming more telling. A recent meeting the ‘Professional Liaison Group’ set up by the HPC to bring together the great and good in the therapy world settled on definitions of therapy as ‘treatment of the disordered mind’ and counselling as concerned with ‘mental health well-being’. The bureaucratic medical language used here to describe personal anguish and protest at life under capitalism says it all.

There is a crucial class aspect to this monitoring of therapy which is revealed in that distinction between different treatments. Humanistic and alternative and complementary counselling is at the bottom of the pecking order, with ‘psychodynamic’ approaches having just a little more status. Then psychotherapists have a little more power, especially if they are psychodynamic or ‘psychoanalytic’, and the top of heap is mainstream psychoanalysis. You can guess what the difference is between how much it costs to train in each of these modalities, and how much you will pay if you go privately. It is no surprise, perhaps, that some have been hoping that their family and professional links with the medical profession and the House of Lords will make ‘psychoanalysis’ as such exempt from any regulation. At the very least, they would like psychoanalysis defined in such a way as to keep out the rabble. Now, with the HPC Professional Liaison Group controlled by psychoanalysts and those in awe of them, there is an attempt to divide and rule those who would like to be seen as health professionals, and class hierarchies will be fixed in place along the way if they succeed.

A number of different coordinating groups and campaigns have been formed to counter HPC regulation, but these campaigns have so far often been caught in the agenda set by capitalism and its state apparatus. As the noose tightens round their necks, they tighten it themselves all the more when they rail against the attack on their professional integrity and complain that the cheaply-trained and poorly-paid ‘assistants’ are not expert enough. Many of the counselling and psychotherapy training organisations would like to be treated like the British Medical Association rather than as any kind of trade union. These campaigns have tended to be divided on petty sectarian lines, with one layer of the profession fighting its corner and set against the others. Last year a more open Alliance for Counselling and Psychotherapy Against State Regulation was formed, but has yet to tackle the class nature of these issues, let alone an alliance with trades unions in the NHS.

NHS counsellors and psychotherapists have already endured a much more invasive regulation of their practice as internal privatisation and sub-contracting of services takes pace, and many of them are already broken into the kind of systems the HPC now want to extend to private practice. The worst of NHS models of management will be rolled out for all, and this will then make it all the more difficult to challenge, wherever it is implemented.

State regulation is a class issue, it will hit women hard and it will increase the surveillance and control of minority communities. A fight-back now needs to explicitly link with NHS workers fighting cuts in services, fighting for good quality provision open to all. Specific demands need to be developed that challenge the version of counselling and psychotherapy as health care ‘professions’ enforced by the HPC.

The only open consultation meeting arranged by the HPC took place in Manchester in March, and now local activists in the Alliance against State Regulation have organised a public recall meeting co-sponsored by different groups including Stockport Women’s Centre on 3 October at Friends Meeting House. This will be a test not only of the resolve of counsellors and psychotherapists to work together but also to work with other public sector workers who are fighting ‘regulation’ which is but a short-cut to cutting and distorting public, private and voluntary mental health services.

(Details of the meeting from Ian Parker I.A.Parker@mmu.ac.uk)

In this article, Ian Parker puts his personal view, against regulation: Socialist Resistance does not have a position on the issue.