Psychotherapy (Registration) (Hansard, 15 April 1981)

§ Mr. Graham Bright (Luton, East)

I beg to move, That leave be given to bring in a Bill to create a Council for Psychotherapy, with power to maintain a register of practitioners and to enforce a code of ethics. I have always believed that one of the major responsibilities of the House is to ensure that the highest professional standards are set and maintained in the treatment of the sick. Over the years, we have taken the necessary steps to maintain public confidence in the integrity of our medical and ancillary professions. The high regard in which our doctors, dentists and nurses are held and the trust which the people of Britain rightly place in them is proof of how successful we have been. The combination of legislation and regulation of the professions by bodies such as the General Medical Council is a guarantee that standards will be maintained and the public fully protected.

Unfortunately, there is one area—the practice of psychotherapy and its allied disciplines—in which the public have little or no effective protection. There is no legislation whatsoever to determine who may call himself a psychotherapist or psycho-analyst and who may offer treatment to members of the public. It is a profession that can be entered by the simple expedient of placing an advertisement in a newspaper or telephone directory. Indeed, there is no obligation on anyone practising psychotherapy to have received proper training, to possess academic or medical qualifications or to be a member of an appropriate professional body. In such a situation, abuses are inevitable.

A constituent of mine who sought help from a psychotherapist was enticed into a sexual relationship that led to the breakdown of two marriages. I am sure that similar tragedies have come to the attention of other right hon. and hon. Members. The only protection available to members of the public is through civil action in the courts, where proof that positive harm has been done to a patient has to be established. The fact that this is an extremely costly and lengthy process deters many victims of malpractice from taking that course. But even when civil action has been successfully taken by a patient there is nothing to prevent the practitioner responsible from continuing to treat other patients. It is this serious gap in the law protecting the public that I now seek the leave of the House to close by means of my proposed Bill.

The need for legislation was pointed out by Sir John Foster as long ago as 1971 in his report on the cult of scientology. It was his recommendation that inspired the appointment by the professional bodies concerned of the working party chaired by Mr. Paul Sieghart, which considered this question and reported in 1978. All the available evidence points to the fact that treatment by untrained and unqualified psychotherapists can be dangerous to their patients. There is every likelihood of wrong or inadequate diagnosis, of poor technique in treatment and of delay in using more effective methods to help people who are, for one reason or another, amongst the more inadequate in our community.

The longer such treatment lasts, the greater the danger of over-dependence on the psychotherapist and, thereby, of financial exploitation of the patient. The need for regulation to protect the public and to maintain proper 345 professional standards is widely accepted by reputable pychotherapists. It is our responsibility to help to bring to an end the long and unnecessary delay in taking action.

The Sieghart committee's proposals provide the framework within which that objective can be achieved. Because they rest on a wide measure of agreement between professional bodies such as the Royal College of Psychiatrists, the British Association of Psychotherapists and others, I have made these proposals the basis of the Bill. They are essentially along the lines of those by which other professional bodies, such as those ancillary to medicine, are controlled. The instrument through which regulation might be achieved would be a statutory body to be called the Council for Psychotherapy. Its members would be recruited by nomination from among a wide range of professional societies, including, perhaps, more behaviouralists than were originally represented on the Sieghart committee. The Secretary of State for Social Services would also be involved, together with a lay element. Later there would be elected members.

The council would have the duty of maintaining a register of recognised practitioners of psychotherapy and allied disciplines the power to enforce a code of ethics and to approve training courses. There is nothing remarkable about such responsibilities and powers. They are comparable to those granted to the board created by the Professions Supplementary to Medicine Act 1960. If those who fit hearing aids or who practise remedial gymnastics are subject to regulation by statutory bodies, I see no reason why psychotherapists should continue to escape effective control.

I take the view that the public are entitled to know what, if any, are the qualifications of those offering treatment in this delicate area. The creation of a statutory register would ensure that this could be done. Not only would the qualifications of a practitioner be stated and known, but so would the professional name—psychotherapist, analytical psychologist and so on—under which he or she offered treatment.

It would be an offence for anyone not on the register to offer treatment under the professional name. There would no longer be uncertainty in the minds of the public. Patients would at long last be offered protection against unscrupulous and incompetent practitioners and the standards and status of genuine experts would be enhanced. The invaluable work of those involved in social work—such as marriage guidance counsellors and ministers of religion—would not be affected at all. Obviously, there would have to be careful consultation between the professional bodies concerned, such as the Royal College of Psychiatrists and the British Psycho-Analytical Society, and the Department of Health and Social Security on the criteria for registration, and some allowance would initially have to be made for existing practitioners of repute without formal academic qualifications. But I have no doubt that such problems can be solved. Subsequently, the criterion for inclusion on the register ought to be the successful completion of a course of training endorsed and approved by the proposed council. When new disciplines arise in this field, it should be possible for their representatives to find places on the council, perhaps through the mediation of the Secretary of State. I believe that in a developing area like this it is wise to be flexible.

Whatever machinery the House might think it right to set up, two measures should be included. The Council for 346 Psychotherapy envisaged in my Bill would need to be able to assess existing training courses in the various disciplines as qualifications for registration and to have the power to approve them and any new courses that might be devised in the future. But more important still would be its duty to institute and enforce a code of ethics.

It is the element of exploitation by the charlatans in this field that leads to real harm to their patients in the present circumstances. I cannot imagine that sexual or financial advantage could be sought by any genuine practitioner, and I would certainly condemn any course of treatment given without a patient's knowledge and consent. If there should be a code of ethics, the duty and means of enforcing it should be in the Council for Psychotherapy's hands. The professional sanctions of reprimands, suspensions and, in grave cases, expulsion from the register should be available.

I am sure that the House will agree that there is a gap in the law to be filled. The means of filling it have been suggested by the Sieghart committee. We should not be deflected by the protests of those who would find themselves unable to continue their activities if legislation on these lines were passed. It is fair to say that the machinery to tackle the problem has been devised. Perhaps there may be details which require further discussion. But what matters to the profession, to the House and to the country is the protection of the patients. That ought to be the overriding consideration.

The need to act was clearly spelt out 10 years ago. Every year that we delay means that there are more cases of malpractice by bogus or unqualified practitioners of psychotherapy. The fact that we have waited nearly a decade for a solution to the tragic problems that so often arise means that we cannot afford to wait much longer. I ask the House for leave to bring in the Bill.