Should therapy be regulated?

Before I started training as a therapist/counsellor, I assumed that the therapy profession in the UK was regulated. Therapists often enter your life at turbulent times, usually holding a position of power in your dynamic - if only implicitly. I knew life coaching was a grey area, but therapy… you can do some serious damage if you don’t know what you’re doing. That’s why doctors and nurses are regulated, after all. 

It was when a friend of mine was harmed by a dodgy therapist last year that I looked into it and discovered something that unsettled me. Counselling and psychotherapy are unregulated in the UK!

This means that, unlike other healthcare professions, therapists in the UK don’t have to be registered with a regulator (like the General Medical Council, for example) in order to practise. Technically, anyone can call themselves a counsellor or psychotherapist without having any qualifications or experience.

Seems risky, right?

Whether therapists should be regulated in the UK has been the subject of ongoing debate since the 1970s. Statutory regulation would involve an independent body being set up to oversee the profession, uphold standards and investigate complaints. Being a statutory regulator means your processes are legally binding. This in turn means that, if someone is struck off your register for doing something dodgy, they can’t practise as that profession going forward and, ideally, cannot cause further harm. However, the UK government hasn’t deemed the risk posed by dodgy therapists severe enough to warrant setting up statutory regulation for the profession, given the eye-watering costs this would incur.

Where does that leave us?

Currently, therapists can voluntarily register with an accrediting body such as the British Association for Counselling and Psychotherapy (BACP). Training providers in the UK encourage membership with these bodies, who attempt to keep the profession credible by setting standards, providing CPD opportunities and investigating complaints against their members. A completely defanged version of a statutory regulator, they aren’t a legal body and their processes aren’t legally binding – you don’t have to register with them to call yourself a counsellor/psychotherapist, and the worst these bodies can do is cancel your membership if you’re found to be harming your clients. That doesn’t mean much – without a voluntary membership, you can carry on practising as a therapist anyway. There’s nothing to stop you. Hell, most therapy clients aren’t even aware of the existence of accrediting bodies anyway, and wouldn’t know to check your membership status before engaging your services.

So – should we regulate therapists?

The knee-jerk response is YES. Obviously yes, especially when I think of my friend who was harmed only recently.  But when I was asked to explore this question further as part of my job, what I found surprised me.

Regulation only goes so far to protect the public. You can protect the title of ‘counsellor’ or ‘psychotherapist’ by putting in law that you can’t use these titles without X qualifications and being registered with an accrediting body. But when you think about it, people can just use alternative titles like ‘hypnotherapist’ and ‘coach’ to evade being registered. It’s not exactly a watertight solution.

Interestingly, one accrediting body I spoke to said that the prevalence of therapists practising in the UK without any form of qualifications is relatively unheard of, despite the prevailing myths about it. What therapists are actually doing in their sessions is another matter.

To address that bit, you can try to regulate counselling and psychotherapy at a service level. But as so much of the work is done on an informal basis and in private practice, how would you go about enforcing standards and inspecting those services to make sure everyone is up to scratch? That involves setting up a huge body like the General Medical Council to do inspections and keep a weather eye on practitioners. The logistics (and cost to the taxpayer) would be enormous.

You also have to ask: would introducing statutory regulation to the extent of doctors and nurses change the therapy profession in the UK? Would formalising it in this way (likely charging fees for the privilege) lead to therapists – particularly informal volunteers - leaving the profession altogether, to the detriment of people seeking support? One accrediting body certainly seems to think so.

It's an interesting debate, and one I haven’t quite got to the bottom of. Perhaps for now the answer lies somewhere in between – that the government should raise awareness of these accrediting bodies and encourage the public to check a therapist’s credentials before engaging their services. Hopefully this is enough to hamper dodgy therapists and reduce risk of potential harm, for far less cost than introducing statutory regulation.

Sure, this idea puts the onus on us as individuals rather than the therapists. But it keeps bureaucracy (and costs) low for the therapy profession - in a time of economic turbulence and increased focus on mental health support, that may not be such a bad thing.

What do you think?

NB: Psychiatrist, psychologist, and arts/drama/music therapist are protected titles in the UK, while therapeutic counsellors and psychotherapists aren’t protected titles.