The discussion in this article is fascinating for an American mental health professional. We have had some level of licensing and regulation by government for most of the century here in mental health. However, as appears to the case in the U.K. we do not have much regulation over "alternative" health care providers, e.g. homeopaths and the like. What's interesting is that despite all or our regulation here, we still chastise ourselves for not consistently utilizing evidence-based practice or not sufficiently worshiping at the altar of empirically validated treatments. Meaning, despite having formal regulatory mechanisms mental health as a field still feels there are too many charlatans among us, particular the psychology end of mental health practice. I'm aware of a great deal of research in the U.K. that would suggest a critical mass of psychotherapists there are equally concerned as to whether they are using proven practices or not. However, when a field is essentially unregulated those conscientious masses of scientifically-oriented practitioners are often drowned out I imagine by the even larger throngs of practitioners who need only their gut and a glint in their eye to determine what a client with a mental or behavioral problem needs. It is this dynamic tension between objectively defined practices and experientially derived practices that seems omnipresent throughout health care providers, but is acutely problematic in the mental health professions.
In the "Counseling" field in the U.S., a mentality that favors subjectivity and experience over research and science is certainly an ongoing phenomenon. While social workers, psychologists and psychiatrists have consistently merged with allied health care professions in terms of their accountability, and adoption of the standards within the market place of health care, counseling, i.e. mental health counseling, as a field has clung to its roots in humanistic psychology. This branch of psychology values subjectivity and lived experience over objectively identified standards or evidence. In my view counseling has done so for two reasons, 1) as matter of intellectual or theoretical integrity - it's what we believe about human beings, and 2) as a means of acting out a deep-seated professional insecurity vis-a-vis the other mental health professions (particularly social work and psychology). So when I read this piece on the move to regulate psychotherapy in the U.K. these same tensions are palpable there.
These tensions exists for very legitimate reasons. First, there is the desire to keep therapy work authentic and free of constraints. The more the government or science intrudes on the individual therapist's style of relating to and collaborating with a patient, the less effective therapy can be. But...alongside that concern is the fear that regulation will require the therapist to substantiate precisely how they make decisions in treating a patient or on what basis the choose one approach over another with each client. As in the U.S. they will face difficulty in balancing the right of the public to fully informed consent when receiving a health care treatment against the legitimate need for a provider to work in a style and manner that is psychologically and interpersonally authentic.
In the end there are two "outs" from the dilemma regulation of therapy poses. First, therapists in the U.K. as many in the states have done, can practice in a manner that they can argue their work is not a "health care" service. In the states this seems to be happening with "life coaching" and other such non-clinical/non-medicalized descriptions of services that mental health professionals or simply untrained lay people are increasingly providing. Doing so avoids legal regulation, at least in the near-term. The alternative route to coping with regulation is to "identify with the aggressor" so to speak, i.e. agree fully to the terms of government (or in the U.S. managed care insurance companies) imposes upon psychotherapy practice. This could mean more didactic and educational services delivered through manuals and workbooks (I almost passed out from boredom writing that last phrase). I think this is, unfortunately, where many agencies have gone in the U.S. over the last two decades to cope with managed care at least. The fact of the matter is that licensure laws and government regulation of psychotherapy has little real impact on the day to day practitioner in the U.S. Given our market driven health care system, insurance companies have a larger impact; and much of their effort is simply to limit or titrate care, not impose some scientific standard on practitioners or a standard that involves careful concern for the public good. The impact of licensure here is mainly that one must attend continuing education. Recent research has shown that con-ed for mental health folks has serious problems in terms of quality in the states. I'm hard pressed to claim that licensure making me attend CEUs makes me a better therapist. In the U.K. government regulation likely poses a more real day-to-day hassle for practitioners, due to the socialized health care system. In the U.K. licensure may mean some sort of actual peer review of your professional practice on a regular basis. That would be interesting; there is no such parallel to that in the states. I plan to see where this heads in the U.K. the process should be interesting to watch.
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