The big issue: Mapping the future
Therapy Today, March 2021

Former BACP Registrar Sally Aldridge runs half-marathons – very successfully (do check out her handicap at www.runbritainrankings.com). It suggests a level of endurance and determination that fits well with someone who was BACP’s lead executive officer with responsibility for standards and regulation for some 15 years. First, as Head of Accreditation, she oversaw the formalisation of BACP’s accreditation process; subsequently, as Head of Regulatory Policy, she took the Association through the agonising bid for statutory regulation with the Health Professions Council (as it was then called), which was halted by the 2010 change in government and consequent change in policy. Finally, as Registrar, she oversaw the establishment of BACP’s voluntary regulation system under the Professional Standards Authority.

She also completed a PhD on the history of the counselling profession in 2010,1 and is thus something of an authority on the context out of which the current SCoPEd initiative has emerged. The arguments besetting the profession today are those she engaged with, many times, over those years, she says.

This article will attempt, very briefly, to set the current consultations around the SCoPEd framework in that historical, organisational context. I’ll be talking to past and present Chairs and officers from BACP, UKCP and BPC, the three professional bodies who share this history and initiated SCoPEd, to explore that history and how we have arrived here.

United we stand

Says Sally: ‘When you look back to the origins of BACP, when it emerged as BAC from the Standing Conference for the Advancement of Counselling (SCAC) in 1977, every single group in the UK whose work involved listening to people and who had some concern with the quality of help being offered was in there. Then it split because the status issue became important. The psychotherapists went off saying they were different from counsellors and formed what became UKCP, and then the analysts left the psychotherapists saying they were not getting the seniority they deserved and became BPC.

‘For me, there are four very fundamental splits in the profession: the status split, the theoretical orientation splits, which cross the status split, the voluntary/paid split and the split over whether counselling wants to be a professional occupation at all. BACP’s history is one of repeated attempts to create a mesh that would hold us all together, and inevitably it has ended up being shouted at by people on one or the other side,’ she says.

SCoPEd, for her, is another step in that one-forward, two-back, three-forward journey taken by counsellors towards acquiring professional status – the boundaries, ethics, standards and exclusions necessary if they are to be taken seriously as players in the mental health and wellbeing arena. Yet anything that smacks of exclusion is anathema to those who were drawn to the counselling profession because its fundamental values and principles eschew the hierarchies, power inequalities and exclusionary practices through which the medical and most other professions establish and maintain their status.

The title of Sally’s PhD thesis – ‘Counselling – an insecure profession’ – reflects that ambivalence. Gaining professional status means, essentially, hedging yourself around with exclusionary clauses. It means establishing what is unique about what you do, that it is safe and effective, and creating ‘occupational closure’ – setting boundaries so that no one else is able to claim that they can do what you do. Sally doesn’t subscribe to what she regards as a patriarchal model operated by ‘men in grey suits’. But, if counselling wants the status and recognition needed to survive in the modern world of the healthcare industry, it has to be able to present itself in a form and language that the other professions and the ‘men in grey suits’ can recognise and understand, she argues.

And, above all, it has to be able to present a united front – which repeatedly over the years, it has failed to do. ‘What’s significantly different now,’ Sally says, ‘is that the professional bodies are working together.’ Perhaps, she wonders, the profession has finally realised that it has to present a united front if it wants to avoid more debacles like IAPT and the NICE depression guidelines, where counselling and psychotherapy found themselves sidelined.

'BACP’s history is one of repeated attempts to create a mesh that would hold us all together'

Sally Aldridge

‘Mapping standards would, we hoped, build awareness in the public of the profession and drive up employment for our members’

Janet Weisz

Psychotherapist Janet Weisz was Chair of UKCP from 2012–16 and its interim Chief Executive Officer from 2016–17, so has been involved in this process of growing rapprochement for many years. ‘Historically, the relationship between the bodies has been fractious,’ she agrees. ‘The decision to collaborate came at a time when regulation of the profession was increasingly on the agenda. The increasing collaboration between the three organisations meant looking at ways to work together on public affairs, regulatory activity, therapy trainings and employment. SCoPEd became one of the projects designed to help. Mapping standards of training and competence across the three organisations would, we hoped, build awareness in the public of the profession and drive up employment for our members.’

Andrew Reeves (BACP Chair 2014–19) was Janet’s BACP contemporary, in both her capacities. He says: ‘The history of relationships between the professional bodies has been very brutal – lack of trust, fighting for your own position and jockeying to get the ear of the people with power. That we met at all is amazing; that we might get to a stage very quickly of agreeing a formal collaboration with the UKCP and BPC – and were able to do that respectfully, transparently and cordially – would, at one point, have been almost unimaginable. But there is a real sense of, “Now we can speak with a collaborative voice” – as a united profession, but with our own professional identities. And it’s because of that, I believe, that we are now being invited to sit around the tables with policy makers and ministers, because now we are representing 75,000 practitioners and not just our individual membership bases. And we’ve been told, explicitly, we are being invited to those meetings because we are speaking with one voice.’

Professional maturity

‘Where counselling and psychotherapy have always fallen down is that, for external bodies, and most notably civil servants and the Government ministers they serve, negotiating with the counselling and psychotherapy professions has been, in the words of one member of the HPC Council, like dealing with a bunch of ferrets in a sack,’ Sally says. Others speak more kindly of ‘herding cats’. Val Potter, who chaired BACP from 2002–05, remembers when the Northern Ireland Alliance Party MP Lord Alderdice was pursuing his ill-fated Private Members Bill that would have introduced a statutory Register for Psychotherapists – but not counsellors. He was a consultant psychiatrist and psychotherapist; he understood psychotherapy; he felt it would be better to start there and expand once the register was established. BAC, as it then was, promptly added the ‘P’ to its title, so it couldn’t be shut out of the discussions. Says Val: ‘There was a point when we were all together, and one of the civil servants said, “If I want to know what doctors think, I go to the BMA. And similarly with all the other health professions – they all have their representative professional body. But who do I talk to if I want to find out about counselling and psychotherapy?” And we each said, “Talk to us!” and we were all able to produce reasons why. But she wasn’t talking to all of us.’

‘There is a real sense of, “Now we can speak with a collaborative voice” – as a united profession, but with our own professional identities’

Andrew Reeves

‘What matters is that we achieve something that properly honours what we do’

Jan McGregor- Hepburn

Jan McGregor-Hepburn, past Registrar and current Chair of Professional Standards with BPC, and its representative on the SCoPEd working group, recalls similar occasions from the past: ‘I was at the New Savoy Conference in 2008 when Richard Layard and various Department of Health officials were there to explain IAPT to counsellors and psychotherapists, and the then Chair of NICE accused us of being children squabbling over the Christmas presents. And he wasn’t wrong. No one could agree how we would just work together, accept and celebrate our differences and hold onto what we have in common, so that we could speak with one voice where necessary.’

Tim Bond (BACP Chair 1994–96 and, more recently, author of the BACP Ethical Framework) has worked with other, non-psy professions and says the path to professional status has been painful for all of them, throughout their histories. Counselling is one of the youngest ‘kids on the block’ and still going through the growing pains of adolescence: ‘On balance, it’s better to make those sacrifices in order to have the benefits of a clearer structure that our clients will understand better and so too will policy makers, commissioners and funders. It suggests we have achieved sufficient maturity within the profession to be able to talk across our differences. Otherwise, we will look as though we are still in an adolescent phase and we are not yet ready to be full adults. Squabbling tribes of any type of profession are not very attractive to anyone except those involved in the battles.

‘The price of coming together can be painful because it is giving up a bit of individuality and distinctive contribution in order to have a more coherent collective structure and presence,’ he says. But it’s necessary and ultimately worth it. ‘Counselling needs to be in a position to compete for funding in a very competitive market – and one where, in this era of the pandemic, there is likely to be even less money available. It needs to be able to present what it can offer to meet current and emerging community need, and to do that with any likelihood of convincing those with the money and power, we have to have a more coherent presence as a profession, without sacrificing any more than necessary of the diversity within the profession.’

‘Squabbling tribes are not very attractive to anyone except those involved in the battles’

Tim Bond

‘If you can’t put your own house in order, why would anyone take you seriously?’

Nicola Barden

Or, as Nicola Barden (BACP Chair 2005–08) puts it: ‘If the main professional bodies can present a united approach, that is the strongest thing they can do. If you can’t put your own house in order, why would anyone take you seriously?’

What about the clients?

Andrew echoes the importance of this collaboration for the people who, he reminds us, matter most – the clients. ‘We have to get our act together so more people can access what we can offer. We have a pandemic raging and still we are battling about which model is better. The debates are important, but they are preventing us from moving on.’

Andrew’s point is that, while the profession argues about who is better qualified and able to do the work, Government ministers, policy makers and paymasters are looking elsewhere for people to take up those roles. Counselling needs to make sure it communicates what it can offer as a skilled, effective, community-based service so it can play its part in whatever structure the NHS mental health workforce takes to deal with the fallout in a post-pandemic era.

‘For me, personally, the work that the professional associations are now collaboratively trying to do isn’t about professional status for the sake of it. It’s about trying to secure in a meaningful way the longevity of our profession for our clients,’ he says.

Nicola echoes his sense of urgency – that there is a danger of losing sight of the purpose of counselling and its professional bodies, which is not self-preservation but to better serve those who need its help. Says Nicola: ‘From a client’s perspective, a framework like SCoPEd makes sense. Of course there should be differentiation between the various levels of competency. If you are a client you need to know what you are getting. It’s unclear at the moment and SCoPEd makes it clearer.’

Coherence

Tim sees SCoPEd as offering ‘a shared language and a shared structure within the profession and a means whereby people outside the profession – whether it’s potential clients or funders of services – are able to understand and have a language to describe what is the distinctive offer from talking therapies. If counsellors want to be employed in the NHS, voluntary sector, EAPs, colleges and schools, they have to make transparent what it is they do in the privacy of the therapeutic relationship,’ he says. ‘The Government faces many obstacles to developing coherent mental wellbeing and mental health services. Some of those relate to funding, and clearly COVID-19 is complicating the provision of public services because of its implications for tax revenue. But the other obstacle is person-power – finding people to fill the roles, people who can form the necessary workforce. I think having a much more coherent offering across the talking therapies increases the potential for a more coherent mental health service, which will be partly public funded but also, as now, partly private. But if it’s more integrated you can have a more coherent and attractive offering.’

Lynne Gabriel (BACP Chair 2008–11, and a member of the SCoPEd expert reference group) was Chair when IAPT was introduced, and the counselling and psychotherapy profession found itself fighting a losing battle with NICE about its depression guidelines and what it considered to be evidence-based psychological therapies. This resulted in the employment of psychology graduates and cognitive behavioural therapists in the new talking therapies service. Counsellors who had been employed by GPs to work in their surgeries lost their jobs in droves. ‘There are many other organisations and people looking to scoop up the opportunities if counselling and psychotherapy can’t get our act together,’ Lynne warns. ‘Roles are extending in so many different ways. If we can’t demonstrate some kind of framework for our training, I don’t know how we can be factored in and taken seriously by people responsible for work programmes across the different settings – workplaces, universities and colleges and schools as well as health.’

‘There are many others looking to scoop up the opportunities if we can’t get our act together’

Lynne Gabriel

‘We are being replaced by cheaper wellbeing workers. We need to define our place and communicate it’

Andrew Reeves

Mental health link workers, wellbeing workers, mental health first aid workers and others are already occupying roles for which counsellors are ideally qualified, and who don’t have counsellors’ in-depth foundational preparation. Says Andrew: ‘In universities and colleges, we are seeing counselling services being closed and counsellors put out of work because they are being replaced by cheaper wellbeing workers. We don’t have an exclusive right to be a player in the mental health arena. We need to find our place, define our place, refine our place, and communicate it. And I think SCoPEd is attempting to do that.’

Hierarchy

Professionalism may for some carry the taint of elitist, unaffordability and exclusion, says Nicola, but for her, ‘it’s a recognition of effort and place. It’s very helpful to be able to define your client base and the issues they bring. Then employers know that, to be able to deal with those issues within a professional framework, they need to employ this type of person with these qualifications, because they don’t want to put their patients at risk.’

However, this question of hierarchy – are psychotherapists more expert than counsellors and are psychoanalysts more expert than everyone? – has also dogged the counselling and psychotherapy profession throughout its relatively short life. Critics of the first iteration of SCoPEd were horrified that it seemed to be presenting counselling as least qualified and competent to work with complex issues, and psychoanalysts at the top of the hierarchy. This differentiation was, of course, why psychotherapists split from what was then BAC in 1989, and why the psychoanalysts left what was then the UK Standing Conference for Psychotherapy (which became the UKCP) in 1992, as mentioned earlier. Neither felt that their members’ levels of professionalism and qualifications were being adequately recognised and represented by their parent body.

Val was one of those who strongly objected to the hierarchy implicit in the first SCoPEd iteration, fearing it would restrict counsellors to low status roles. ‘I told BACP, “We fought for years to establish that these professions are different but equal and at a stroke that has been destroyed.” I think heading the columns A, B and C and sidestepping the issue of the titles has answered that for now, but the question will come up again – we can’t sidestep it forever.’ SCoPEd has to give due value to the different backgrounds, histories and underpinning principles, she says. It has to articulate a mutual respect.

‘Personally, I hoped that the SCoPEd project would bring clarity to the different types of trainings that are available and also parity of trainings and qualifications,’ says Janet.

‘We are all part of the talking therapies profession. The fundamental thing to me is that we respect each other’

Val Potter

‘It’s time to look outwards, beyond the individual therapist, to what we offer to our clients, the general public’

Hadyn Williams

Hadyn Williams, BACP CEO, is sympathetic to BACP members’ fears about hierarchy: ‘The struggle for status is a very human instinct,’ he says. ‘We are a comparatively young profession.’ Small wonder that, like any adolescent, the profession has jostled with its peers. But, he argues, this professional insecurity is no longer necessary: ‘We are mature now; we’re in a very different place. It’s time to look outwards, beyond the individual therapist, to what we do, what we offer to our clients, the general public. With SCoPEd, we are thinking inclusively, as a profession, about what our clients need and the skills sets and experience we bring that can deliver it.’

Current BACP Chair Natalie Bailey agrees: ‘SCoPEd to me demonstrates that we now have the maturity to hold up a mirror to ourselves, shine a light on what we do and subject ourselves to that level of objective scrutiny. We are a helping profession for people in need. I think sometimes we lose sight of that.’ SCoPEd aims simply to throw objective light on the various trainings. The columns in the second SCoPEd iteration are simply mapping in tabulated form the equivalences of the competences and academic levels that already exist.

Says Jan: ‘What matters is that we achieve something that properly honours what we do and gives people who need our help a choice. And that we make sure everybody within our profession is properly qualified to do what they do. Nobody who is properly trained and works professionally has anything to fear from SCoPEd.’

BACP has always prided itself on its inclusivity and egalitarianism. Sally points out that BACP was also the only one among the counselling and psychotherapy professional bodies to sign up to NVQs and ensure counselling stayed rooted firmly in further education. UKCP and BPC pitched their qualifications at university degree and postgraduate levels. But the further education route has ensured an access point for people of all academic abilities into the profession, and this is one of the reasons why SCoPEd is so important, says Andrew: ‘SCoPEd is an attempt to make sense of all the different routes people take to becoming a therapist. It is not an attempt to shut the doors on the level 4 counsellors. In fact, it is an attempt to safeguard that route. SCoPEd says, whether you come in at level 4, 5, 6 or 7, you have something to offer, you bring something valuable to the profession and, most importantly, to clients. My entry to the profession was a level 4 counselling training at the local college and I am immensely proud of that. It was a brilliant course. Of all my trainings since, it was one of the best I’ve done.’

However, says Lynne, the profession has to face facts: ‘I would be really sad if the SCoPEd columns led people who are trained to column A standards to feel they were less valuable than those in column C. But to say they are the same is a bit of whitewash, because psychoanalytic training and integrative humanistic training are very different, and not least because trainees on many of the BACP accredited courses only have to do 100 hours of practice, whereas trainees on other courses have to do 450 hours and a mental health component and that is a huge difference, which people somehow don’t see.’

Many experienced counsellors will, of course, have completed at least the 450 hours practice requirement that qualifies a psychotherapist and CPD to the equivalent of a degree-level training, only they will have done so cumulatively, over an extended period. But SCoPEd will chart those equivalences and allow practitioners to position themselves according to their training and experience.

Jobs and careers

And, says Tim, SCoPEd creates something that has previously been missing from the profession – a map for career progression. ‘It describes a ladder for people coming in from all the different sorts of life experiences that draw us into therapy – that drew me into counselling. It describes how people can incrementally extend their range, based firmly on their competence and experience as they acquire it and provides a way to articulate this. It’s not a way of stopping people doing things; it widens the pool and provides people with a variety of ways forward.’

‘We now have the maturity to hold up a mirror to ourselves, shine a light on what we do and subject ourselves to objective scrutiny’

Natalie Bailey

Natalie recalls the ‘pure chance’ that led her to choose a core training course that was the right one to qualify her to go where she wanted with her counselling career. ‘Ten years ago, I could have done with SCoPEd. I know colleagues and peers who made different decisions because they didn’t have that road map.’

And it’s not just the training, she points out; it’s also about jobs at the end of it. ‘When I go to round-table meetings with policy makers and ministers to promote what our profession can offer, and they are still not aware that we exist and what we can bring to the table, it’s frustrating, when we are facing massive numbers of people needing mental health care in the community, whether through COVID or just because there is that huge demand out there. We have this huge gap in provision in the mental health workforce that ministers are trying to fill and they’re doing it by creating new roles when we are here, trained and qualified already.’

Ten years ago, counsellors were debating whether they were a profession or a vocation, says Natalie: ‘We took that decision then. Now we need to pursue that route responsibly and effectively. I believe we owe it to all those joining the profession today who are looking for a career and a future ahead of them.’

Lynne similarly argues that it is long past time that the profession recognised the changing profile of its members and what brings them into training and the work. No longer is counselling primarily the preserve of women pursuing second careers or an unpaid vocation: ‘At York St John we are seeing more and more students and younger people in particular coming in because they see it as a profession, a career. For them, it’s a job and they want to be paid properly for that job and for their skills to be recognised and rewarded.’

Says Hadyn: ‘The three strands share a common outcome. Together we represent a range of sophisticated skills that need to be applied in the right place at the right time with the right client in order to deliver the right outcomes. But collectively we share the same outcome and our challenge is to articulate the skills that we represent, whether we are at the start of our journey or whether we acquire them through years of experience and different trainings that enable us to answer different kinds of needs.’

Val agrees: the profession should celebrate the differences within it. ‘At the Westminster Pastoral Foundation, where I was Co-Director, we did everything from counselling through to psychoanalytic psychotherapy, and that was a richness. We are all part of the talking therapies profession. The fundamental thing to me is that we respect each other.’

Seen through a historical lens, then, SCoPEd perhaps seems not so much an attack on counselling but a modest attempt to agree a framework for the whole of the talking therapies profession that makes sense to lay people, commissioners and policy makers. ‘Sally Aldridge always said you have to do what it takes to get a foot in the door in order to be allowed to sit at the table,’ says Lynne. Counselling has come a long way by persistently – sometimes literally – using that approach. SCoPEd can be the next step through the door.