Hundreds of thousands of people each year in the UK seek help from counsellors 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 statutory regulation.
This was considered by the last Labour government, is backed by a number of MPs, and is certain to be on the agenda of the all-party parliamentary group on mental health. What campaigners want is for “psychotherapist” and “counsellor” to become legally protected titles. Among other things, this would enable people found guilty of professional misconduct to be struck off. Ms Janneh is rightly appalled by the prospect that the man who abused her, Michael Lousada, could do the same thing to someone else. Currently, there is no law to stop anyone from setting themselves up in business as a therapist or counsellor without qualifications – even if they have faced sanctions before.
Art, drama and music therapists are already protected titles; so are several categories of psychologists. Psychiatrists are doctors and regulated as such.
No one knows exactly how many people see – or have seen – a counsellor or psychotherapist. Often, these are private arrangements that do not belong in official datasets. The last census for England and Wales found that there are 55,000 counsellors, psychotherapists and cognitive behaviour therapists in England and Wales; the British Association for Counselling and Psychotherapy (BACP) has 71,000 members.
The overlap between psychotherapy and counselling, as well as the variety of techniques and philosophies used, makes compulsory registration a complex issue. It would require careful coordination with stakeholders to address these complications. Some are fearful that their field, which is dominated by sole traders rather than big businesses, is unsuited to a type of regulation designed for medical settings. Professional associations such as the BACP are also cautious.
Some believe the existing system of voluntary registration via professional associations is rigorous enough. They point out that a minority of doctors and nurses fail patients despite being regulated. And while an increase in complaints might seem to strengthen the case for regulation, this pattern is wider. NHS England has seen a 42% rise in written complaints – from 162,019 in 2012-13 to 229,458 in 2022-23. Since the general title of therapist cannot be protected, there will always be loopholes.
But while regulation should not be viewed as a panacea, and health ministers arguably have more urgent priorities, private provision must be made as clear and safe as possible. This is all the more true at a time when NHS mental health services are chronically overstretched.
There is a strong case for making child psychotherapist a protected title on grounds of children’s particular vulnerabilities, and the specialist training required. On the broader category of psychotherapist, professional bodies have done some work already to more clearly demarcate the differences with counsellors. Over time, protected titles for both, along with increased public understanding of what their work consists of, is certainly worth considering. For now, the public health duties of the NHS’s new integrated care systems ought to include clear information and signposting, with a view to raising public awareness of how to go about seeking this kind of help.
