The Professionals
This blog is part of a larger report commissioned by CTUK looking at the financial landscape for counsellors and psychotherapists - to download the full report click here.
The Scope of Practice and Education for the counselling and psychotherapy professions (SCoPEd) is a proposed competency framework for setting standards for counsellors and psychotherapists to practice in the UK. This was adopted by three of the largest psychodynamic professional bodies – principally driven by the BACP, UKCP and BPC - although smaller professional bodies are currently participating in sector wide discussions about SCoPEd. Part of the regulation of therapists is to arbitrate on the ‘quality’ of training and clinical experience required to practice.
Although the concerns about the impact of SCoPEd are mixed and often under-represented as 17% of respondents did not feel they knew enough about it to really answer this question and 17% did not feel it would affect them. That in itself is an indicator of how important the work of CTUK in raising awareness about SCoPEd is, to make sure that the interests of all counsellors and psychotherapists are genuinely represented within this consultation period.
For those respondents who had a view on SCoPEd 47% felt that their employability would be lower. This is a staggering scenario that is presented here where the minority who are informed about SCoPED believe it will have a catastrophic affect on their income. Further, 40% anticipate a decline in diversity within a sector already with low representation which should raise alarm bells about the prospect of a genuine agreement to SCoPEd and the consequences of implementation.
Importantly even amongst the 64% of respondents registered with the BACP who are relatively protected from the negative impact of SCoPEd there is widespread recognition that the consequences of this system will be to create a hierarchy of practitioners favouring psychotherapy and leading to a downgraded system of counselling.
SCoPEd is creating artificial competition between counsellors and psychotherapists, the purpose of which is to embed the need for more training and more expensive training. As a consequence, instead of protecting the thousands of highly qualified counsellors and psychotherapists from the sector wide downgrading of clinical services and jobs, the strategy seems to be one of ring-fencing the status of psychotherapists and protecting those trainings accredited by the professional bodies.
Although this system of professional membership is voluntary, SCoPEd nudges the sector towards a de facto monopolization of what remains of the psychotherapeutic sector within the three largest professional bodies leaving the widespread downgrading and ‘Uberization’ of mental health services unchallenged.
As the CTUK’s campaign to debate the future of SCoPEd highlights, the SCoPEd proposal was passed on the basis of a membership consultation within just three professional bodies engaging 13-15% of their memberships. Unsurprisingly now that the implications of this policy are becoming clear, the workforce has engaged critically with SCoPEd.
The major professional and training bodies have acted as a conservative force in their role of maintaining the current system of training and professional registration within the sector. There continues to be an over-supply of psychological and psychotherapeutic training, and the number of people being trained in long-term mental health qualifications has no apparent relationship to the availability of paid employment. Within mental health services approximately 45 per cent of workers will come from a mental health nursing background, but many will also have undertaken Continuing Professional Development and further training, often in counselling and psychodynamic trainings. The vast majority of psychotherapeutic trainings are self-funded, as, increasingly, are clinical psychology trainings. Despite the decline in decent jobs, the training industry continues to be robust, and it is increasingly directed towards attracting international students, and promoting a model of post-qualification working life in private practice.
The work of the child psychotherapists offers one exception to this professional landscape: some years ago they managed to secure NHS recognition and funding for their training. Although the number of trainees in the UK remains small, most trainees go into CAMHS, although some will now find work in schools. Currently, clinical roles in CAMHS are likely to be held by trained child psychotherapists, but as the funding stream is cut it is likely that these roles will be downgraded, as in adult services.
The gap between institutional training and support and the real needs of graduates in securing full-time and paid employment remains large. Universities providing clinical training have not explicitly addressed the decline in employability in the mental health sector; while the independent training bodies have not addressed the decline in UK students who can afford lengthy trainings involving years of unwaged work (apart from in the marketing of courses to international students or offering specialist and CPD courses). Moreover, critical debates about the downgrading of work and the lack of paid work are not encouraged within these institutions, for fear of raising systemic and potentially unsolvable problems within the training model.
The professional and training bodies continue to offer the same model of professional training and development that has essentially been in place for the last thirty years. The issue of the costs of training, and the levels of honorary work involved in completing training and professional registration, is, however, the subject of an emerging internal debate, and some bodies, such as the UKCP and CTUK are attempting to develop policies around unwaged work. However, there is no radical agenda for change in response to the widespread downgrading of mental health jobs within the professional institutions.
Professional bodies attempt to contain debates within professional silos, and are reluctant to take a broader perspective on jobs in the mental health sector as a whole. Students consistently demand greater preparation for waged work and support in finding clients in private practice from these bodies, but, as with other insecure sectors - such as the creative industries - the realities of working life are not fully addressed at an institutional level. The realities of securing paid employment with potential for progression and setting up in private practice - the main alternative to waged work - are only superficially addressed during training. This helps to obscure the financial reality that, for newly qualified counsellors and psychotherapists, self-employment offers a bleak prospect for earning a living wage.
This absence of action on the part of the psychological and psychotherapeutic professional bodies is related to the internal tension between their roles: they function both as regulators and gatekeepers of mental health work and as membership organisations to defend members’ interests. None so far has taken a lead in coordinating the many organisations involved in representing mental health workers to establish a platform to negotiate wages and working conditions more broadly across the sector. Further, they have not attempted to challenge the IAPT model, but instead the BACP has attempted to dominate the promised growth in NHS jobs in response to the pandemic. Within most of these organisations there exist outspoken individuals and networks that make important challenges to their institutions; and there is a growing acceptance by members that the protection of their professions will involve opening up to difficult debates about money and jobs.
To read the original CTUK report on SCoPEd click here.
To read the 2021 CTUK report click here.