The Guardian view on regulating psychotherapy: people need help finding safe help | Editorial
HEvery year, thousands of people in Britain seek help from counselors and psychotherapists. But the case earlier this year of Ella Janneh, who was awarded £217,000 in damages after suing a sex therapist for personal injury and negligence, has reignited calls for legal settlement.
This was considered by the last Labor government, is supported by a number of MPs and will certainly be 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. This could, among other things, allow people found guilty of professional misconduct to be suspended. Ms. Janneh is rightly horrified by the prospect that the man who abused her, Michael Lousada, could do the same to someone else. Currently, there is no law stopping anyone from working as a therapist or counselor without qualifications – even if they have faced sanctions before.
Art, drama and music therapists are already protected titles; This also applies to various categories of psychologists. Psychiatrists are medical doctors and are regulated as such.
No one knows exactly how many people see (or have seen) a counselor or psychotherapist. These are often private arrangements that do not belong in official datasets. The last one census for England and Wales it has been identified 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 counseling, as well as the variety of techniques and philosophies used, make mandatory registration a complex issue. Careful coordination with stakeholders would be required to address these complications. Some worry that their field, which is dominated by sole proprietors rather than large corporations, is not suited to the kind of regulation designed for medical environments. Professional associations such as the BACP are also cautious.
Some believe that the existing system of voluntary registration through professional associations is strict enough. They point out that a minority of doctors and nurses are abandoning patients, despite being regulated. And while an increase in complaints appears to strengthen the case for regulation, this pattern is broader. NHS England has seen a rate of 42% increase in written complaints – from 162,019 in 2012-2013 to 229,458 in 2022-2023. Because the general title of therapist cannot be protected, loopholes will always remain.
But while regulation should not be seen as a silver bullet and health ministers arguably have more pressing priorities, private provision must be made as clear and safe as possible. This is even more true at a time when the NHS mental health system is chronically overburdened.
There are strong arguments for making child psychotherapist a protected title, based on the specific vulnerabilities of children and the specialist training required. In terms of the broader category of psychotherapists, professional organizations have already done some work to more clearly define the distinctions from counselors. Over time, protected titles for both, along with greater public understanding of what their work consists of, are certainly worth considering. For the time being, the public health roles of the new NHS integrated care systems should include clear information and signage, with the aim of raising public awareness of how to seek this kind of help.