Please note that from 5 December 2009 UKCP's chair is Andrew Samuels
Chair's Bulletin
13 October 2009
Holding and negotiating the boundaries
UKCP is the only organisation in the UK which faces the challenges unique to multimodal psychotherapy in the 21st century. We have the multidisciplinary experience of setting standards, and of promoting the profession and safe practice for practitioners and the public, encompassing the philosophy of psychotherapy.
The challenge of being a psychotherapist in today's world parallels the tension between the individual and social conflicts in government, finances and services. For both client and professional, the external world impinges on the inner world. Can we hold the boundary, symbolised by the safety of the consulting room, where the two are brought together as a synthesis of the whole? We have worked hard to make changes to UKCP to make it fit for purpose to address these issues.
Fundamental questions
Since its formation, UKCP has tried to answer many questions. Are we a profession? Where and what are our roots? Can we describe what we do in our work? How should we be regulated? We now face a further challenge: the government is now a major purveyor of psychological services. We have struggled to achieve recognition; now we are in a pivotal position facing our future where that very recognition could destroy the fundamental ethos of psychotherapy. It has often been said that psychotherapy is a cottage industry in a professional world. This may be a fair statement, trying to move it to a level of recognition by the public carries a risk. We have now reached the point where the art of psychotherapy is being lost to commercialisation which drives the science of psychotherapy in some professional organisations and academic institutions. There are bodies led by the government and given millions in research monies that are distorting the professional values by emphasising efficiency at all costs and it can feel like their ultimate goal is merging the psychological, social welfare and criminal justice systems. Views of healthcare become reductionist and fashion driven, which further divides the art and science of the talking therapies.
As we come to the point of fundamental change, it is easy to forget the history of UKCP and its place in the development of the psychotherapy profession. We are faced with a so called happiness agenda that reduces well being and the mental health agenda to a formulaic response to human distress. Bob Hinshelwood states that 'happiness is not the value of psychotherapy' (The Values of Psychotherapy by J Holmes and R Lindly, Karnac Books, 1989). Our values are in the human relationship. Is it any wonder that we have conflicts with initiatives that promote happiness as the necessary outcome of any psychological work?
The roots of regulation
The roots of psychotherapy as a regulated profession can be traced back to the Foster Report of 1971: 'Psychotherapy (in the general sense of the treatment for a fee or reward of illnesses, complaints, or problems, by psychological means) should be organised as a restricted profession open only to those who undergo an appropriate training and are willing to adhere to a ... proper code of ethics ... the necessary legislation should be ... presented to parliament as soon as possible.' Imagine how much simpler it would have been had legislation been passed then. We would have avoided the current complexities such as Skills for Health, Improving Access to Psychological Therapies (IAPT), the Care Quality Commission and the Health Professions Council (HPC).
By the mid-1970s the establishment of a psychotherapy profession looked on course. The Department of Health and Social Security (DHSS) commissioned the Sieghart Report (1978), which recommended the statutory regulation of psychotherapists. Unfortunately, rivalry between the emerging psychotherapy professional organisations and the established health professions scuppered the process. Between 1971 and 1981 many independent psychotherapy training organisations were formed, while older established psychotherapy professional organisations looked on with suspicion. This brought about two sets of status wars: those between the established professions (psychiatry, psychology, nursing, social work, etc) and the psychotherapists, and those between the psychotherapy organisations themselves. However, in 2001, the government made it clear that it would move towards treating psychotherapy, for all its schisms, rivalries and acronyms, as a profession that needed to be regulated.
Change and reform
In 2004, UKCP and BACP were commissioned to write a report for the Department of Health (DH) on the work carried out by psychotherapists and counsellors. The project was woefully underfunded and the report was not well received by the DH. A project to look at whether psychotherapy and counselling should be regulated by the HPC was also commissioned. In 2005, the DH reframed the original proposal to commission the UKCP/BACP to identify the extent of the profession and its systems as a much smaller project, and commissioned a map of existing training and qualifications, an outline of standards, sample codes of conduct, ethics and performance, and a toolkit covering competences and processes. At the same time, UKCP received a DH grant to look at organisational reform. Along with this was the idea that UKCP would cease to exist in its current form and become a small umbrella body with sections becoming member institutes - individual organisations with their own legal status that would subscribe to UKCP for services. There was a hope that the British Psychoanalytic Council, BACP and others would become institutional members of the UKCP. This idea in itself was unrealistic and allowed the government to use the historical conflicts of the psychological therapy organisations to take greater control of the formulation of regulation. This became the rational for creating the Skills for Health work.
Attempts to create a Psychological Professions Council governed by the professions from collaboration between the UKCP, BACP, BPC, BPS and BABCP were savagely rejected by the government in 2006. This group continues to include this in our strategy moving toward regulation.
Gordian knot
We tried to work through that Gordian knot but could not find the energy or focus to make it a reality. With a change in the Board of Trustees there came a slightly reduced vision: that of transforming UKCP sections into colleges. The inclusion of other professional bodies was lost, but the road to independent colleges was kept as a cornerstone of the drive for organisational change. With the confirmation of HPC as the regulator, the creation of IAPT and difficulty with the Skills for Health initiative, it was clear that UKCP was doing what it had done in the past, splitting itself into small parts and making itself ineffective.
A leap of faith
UKCP took a leap of faith and refocused the direction of organisational change to one that could meet the challenges of the future. Two key drivers for reorganisation were the separation of trustees from the executive and the shift towards becoming a membership organisation. This could be achieved with a change from a federated structure of member organisations to a wider membership that included individuals as members. As the statutory regulatory process is imposed UKCP will lose value as a (voluntary) regulator. We have to engage individuals and organisations as members by defining standards that are more relevant to psychotherapy than those specified by the regulator, and we need to provide services to our members. As an ageing profession we need the vitality of a wider group of people evolved in holding the ethos of the organisation.
Valuing volunteers
UKCP exists on a huge volunteer effort that we have to recognise, value, accommodate and manage. This effort ensures that UKCP truly represents the values of the profession and that business needs are not the primary driver of strategy. Our volunteers are often overworked and get burnt out. The interface between volunteers and professional staff has to be well managed.
The new constitutional documents put before the EGM are a system which will facilitate collaborative interaction and energising tensions of the independent, yet mutually interdependent, parts of UKCP: colleges, faculties, organisational members, individual members, staff, volunteers, committees, elected officers, appointed officers, management and managed, unified and diverse. Such a system can give all constituents a sense of place and ownership. We need to be a professional organisation that uses business methods to further our vision and goals. Under no circumstances must we fall into the trap of using business drivers to determine the nature of psychotherapy.
Anticipating change
UKCP must evolve as the profession develops. Some of the current changes are driven by external factors that have overtaken us. We must become a more cohesive organisation able to anticipate change. The vision we have for organisational change will take three to five years to realise and will be adjusted to meet emerging realities as we develop. However, we must shift our focus to membership, individual and organisational, in advance of the changes brought by statutory regulation. While setting higher standards and providing member services, in the future we may need to define a model for direct service provision by setting up centres of excellence to sustain our future.
This gives you a sense of our history: where we have come from and where we are headed. There is a continual fight to keep the ethos and philosophy of psychotherapy strong in the world. I started by saying that being a psychotherapist in today's world is a challenge that parallels the tensions between the individual and the social. Psychotherapy must be seen as a strong, influential profession that has something to say on existence, how we are governed and the social issues that surround us. The UKCP has been seen as occupying an ivory tower of psychotherapy. We must become more accessible, more visible.
As you read this, I will be coming to the end of my UKCP offices. It has been both a joy and pain to have been so close to the workings of a chaotic and inspirational organisation. For me, perhaps my success is that I leave more questions unanswered than I found.
One last thank you to the staff members both present and past, registrants and members who have allowed me to do this work, for their criticism and support.
If you would like to see this material come to life, please join us in 'Resolution, revolution or reversal? A conversation with UKCP Chairs past and present' on 7 November 2009. For more information about this event, please contact Jessica Davenport at .
Defining Psychotherapy and Counselling
We struggle to define ourselves in relation to the psychological work we do in the world. Currently, there is discussion about the difference between psychotherapy and counselling. Anyone who looks at it from that narrow perspective will be creating a problem that doesn't reflect the reality of the work or the world.
Those of us who work in the world of 'talking therapies' must recognise that we all share the same tools and objects, and broadly the same desired outcomes. There is a danger that those who would control the work we do may exploit the problems we have in defining the boundaries in our work. This has been true in the attempts to create hierarchies between psychiatry, psychology, psychotherapy, counselling mental health worker, social workers and psychological workers. It is in not in the public's interest to do engage in this tribalism. We must find ways of informing the public including government, service users, carers, employers of the way all of us use tools and overlap. That must not take away from recognition that the titles we use are something we have earned not something bestowed or self selected.
We are concerned with the way pathology has been used to differentiate titles and look forward to finding a more meaningful solution. Please let us have your comments on the following statement:
Difference between psychotherapy and counselling
Psychotherapy focuses on the use of the dynamics of the relationship between practitioner and client (patient) as a 'tool' of the therapy whereas counselling relies on the relationship to the world and the 'working alliance' to focus on a system for change. The psychotherapist and the client (patient) work together to remodel the internal world to affect the external world and the counsellor works on the external world to affect the internal world. Both may use the same language but the attitude of the practitioner reflects the mode of operating and how the tools are used. This is developed during the training which evolves a state of mind that is congruent with the understandings used in the practice of the profession. This could be said to go to the root of the conundrum.
If you would like to comment on this statement, please email Jessica Davenport at
UKCP chair James Antrican
Chair's Bulletin archive
17 February 2009
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