Problems with licencing counselling

In response to Adam Osborne being struck off as a psychiatrist Amanda Williamson, a campaigner for better regulation in counselling, recently Tweeted:

It’s a point that deserves a much better response than I was able to squeeze into a tweet of my own, so here it is.

Not only do the General Medical Council (GMC) register physicians they also licence them as well.  Roughly speaking, being registered allows you to claim to be a physician and being licenced allows you to actually practice medicine. Doctors practicing in the UK are always registered and licenced.  However, if a doctor decided to stop practicing and work as a lecturer instead she could give up her licence whist keeping her registration; she would still appear on the GMC’s “List of Registered Medical Practitioners” but she wouldn’t be able to work as an NHS doctor or do things like write prescriptions and issue death certificates until she renewed her licence.

When Adam Osborne was struck off he automatically lost his licence to practice medicine.  He can no longer describe himself as a psychiatrist because he has been struck off the register, and he can no longer do the tasks that a working psychiatrist needs to do because he isn’t licenced.

It’s unusual for registration and licencing to be explicitly separated like this, more often register have a licencing element.  For example, on the Health and Care Professions Council’s (HCPC) register of podiatrists the members can be listed as being qualified to prescribe certain prescription only medicines; but it is important to note that most of the day-to-day activities of podiatrists are not licenced.  So whereas being struck off has made it impossible for Adam Osborne to act in the role of a psychiatrist, when Stephen Gardiner was struck off the HCPC’s register of podiatrists  he would have lost the privilege of administering prescription only medicine but that hasn’t stopped him from “resolving problematic ingrown toenails, biomechanics and solving our patients foot care issues” or from being “a Director and Head of Clinical Services at A Foot Above Limited”.

To create a situation where striking off counsellors stopped them practicing in the same way as striking off a psychiatrist does it would not be enough to simply set up a statutory register of counsellors.  You would have to go further and licence enough of the activities of counselling to make it impossible for an unlicensed/unregistered member of the public to legally carry out a role that mimicked counselling.

Imagine counselling was a licenced activity and Colin the counsellor and Kevin the key worker trained together on the same counselling course, after qualifying Colin found work as a counsellor but Kevin decided that career wasn’t for him so he quit his professional body and stayed in his job as a key worker instead.  As part of their jobs Colin and Kevin each have clients that they regularly meet in private.  What exactly is it that Colin is allowed to do but Kevin must refrain from doing because he isn’t licenced?

Psychiatry involves a lot of specialist activities that only people with specialist training should attempt, such as diagnosing a mental health condition and prescribing appropriate medication.  It is these specialist activities that are controlled by licensing, and it is the fact that these activities are essential to the practice of psychiatry that makes being struck off the GMC’s register an effective way of stopping someone from working in that role.

Counselling is based on an everyday activity, establishing and maintain a human relationship, which is carried out by a trained expert to make it into a specialist activity.  Psychiatrists are trained in the extraordinary skills needed to do extraordinary things, counsellors are trained to do ordinary things with extraordinary skill.  That is why licencing is an effective tool for policing psychiatry but it is inappropriate for policing counselling.

Fortunately licencing isn’t the only way of making registers effective tools for regulation.  If counselling registers were widely understood and respected then although a struck off counsellor would be able to legally offer his services it wouldn’t do him any good because his potential clients would know not to take him up on his offer (as I argue elsewhere).

One of the greatest strengths of counselling comes from the fact that it is a form of natural human relationships, the cost of this strength is that effective regulation of counselling has to operate at a cultural level.  There is no way of simply making all unethical counselling illegal, the only way of protecting the public from unethical practitioners is to make the reliable identification of ethical practitioners common knowledge, and we are a long way from that.

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