Dr. Gerard O’Neill of the HSE in Conversation with Edward Boyne

Edward: Gerard, you are currently Director of Counselling with the HSE in the South East and an accredited member of IAHIP. We first met many years ago when we both served on the Executive of one of the professional bodies. Tell me something of your background and what influences brought you into this area of work?

Gerard: My original background was in psychiatric nursing and I trained in the National Health Service in the UK. As mental health services there moved from an institutional-based model to a community-based model during the 1980s, I quickly realised that my original training needed to be updated as my role developed and I was seeing clients in GP surgeries and other settings with a wide range of psychological problems. My involvement in counselling and psychotherapy dates back to then.

Edward: So you personally went through the process of moving from the hospital setting into more community-based settings and all that involves and demands of the practitioner. I know you have undertaken advanced studies to Doctorate level. What was your research field and how did it tie in to your therapy work?

Gerard: My Doctoral studies involved two separate projects. The first project involved the development of a short-term specialist counselling service for individuals who self-harm or experience suicidal ideation. This service, called the SHIP service (Self Harm Intervention Programme), is available across the south east. The second project involved completing a qualitative piece of research. With the help of colleagues I examined the impact of introducing and using a particular psychometric measure in a counselling service that deals with clients who have experienced abuse in childhood. I grew up in a village in North Kilkenny with a past coal mining heritage, so it comes as a natural instinct for me to look beneath the surface. Close examination of this particular clinical area revealed many important learnings, not least of which is the importance for therapists to be aware of the transferential implications of using measures with particular clients.

Currently, I think the profession of counselling and psychotherapy is at a very exciting stage of development in terms of what the research is saying about what makes therapy effective. The meta-analytic studies from the late ‘90s, when combined with the emerging consensus across neurobiology and attachment theory in the current decade, raise interesting questions about the wisdom of rigid adherence to one particular therapeutic orientation.

Edward: I agree that the profession is at a very exciting and important stage in a variety of ways. There are momentous changes in the offing. I have the impression that the HSE is now taking a greater interest in counselling and psychotherapy generally. Is this the case in your view?

Gerard: Well, certainly the mental health strategy document a ‘Vision for Change’ (2006) envisaged a comprehensive range of psychological therapies to be provided at primary, secondary and tertiary level. Provision of access to counselling and psychotherapy was then prioritised in the 2011 Programme for Government and specific funding was provided for Counselling in Primary Care (CIPC) in the 2012 and 2013 HSE Service Plans under the Mental Health in Primary Care Initiative.

My Director colleagues and I are specifically concerned with the National Counselling Service (NCS) which provides counselling to adults who have experienced any form of abuse in childhood and CIPC which provides short-term counselling to adults with mild to moderate psychological difficulties who have a current medical card. We are setting standards for recruitment for the range of competencies that are required for the specific clinical contexts in both these services. Both services are available around the country nationally. CIPC is coordinated by ten counselling coordinators nationally and although it was only launched in July 2013, it is now receiving approximately 1,100 new referrals nationally per month. In the south east, as already mentioned, we also have the SHIP counselling service for adults who are experiencing the impulse to self-harm or are experiencing suicidal ideation.

Edward: That is a very substantial number of referrals to CIPC and indicates the extent of the need for services. It’s interesting that you mention the development of standards. Many of us are aware that we are now in something of a transition phase where statutory registration of psychotherapists and counsellors is concerned. My understanding is that the HSE is now ‘driving’ the process and the timescale. This was not the case until recently. From your personal vantage point, as it were, and bearing in mind the constraints that apply as a member of such a large and accountable organisation as the HSE, is statutory registration likely to be in place soon and, if so, how soon?

Gerard: I don’t know the timeframe for statutory registration but I do agree that we are in a very important transition phase. Minister Reilly has indicated his intention to designate Counsellors and Psychotherapists under the Health and Social Care Professionals Act. His Department are consulting with all the relevant stakeholders (professions), before they can progress the Minister’s intention to the stage where a designation order is signed and a registration board appointed. Only when the registration board is appointed will CORU be in a position to advise on both the process and the timescales of statutory registration. I would encourage any counsellors or psychotherapists who are interested in the wider process of statutory registration to visit the CORU website (www.coru.ie) which is very informative.

Edward: I understand that it’s difficult to be definitive on the timescale and I won’t press you on it. My own view is that statutory registration will be with us in a substantial way by about 2017, i.e., three years from now. There are many questions that arise in relation to statutory registration. Clearly under the provisions of the 2005 Act, a new structure will have to be put in place, called a ‘Statutory Registration Board’. This new Board will be appointed by the Minister for Health and will take over the core accrediting functions of the current professional bodies. It’s definitely not planned under the legislation that the current professional bodies will have any role or function in the new dispensation where accreditation is concerned. It remains to be seen whether practitioners will continue to pay fees to a professional body which no longer offers them accreditation. Legally, it will become an offence to practice, for example, under the title ‘psychotherapist’ or ‘counsellor’ unless you are registered with this new Board and paying your annual fee for accreditation. Are these assumptions correct in your opinion?

Gerard: I don’t have any particular insight into how the professional bodies will work out in the new dispensation as you describe it. I do understand that the new Statutory Registration Board will identify threshold standards of proficiency for entry to the profession and will also set criteria for education and training programmes. The professional accreditation of a training programme is distinct from the academic accreditation of a training programme. Academic accreditation is based on the suitability of a programme for the award of an academic qualification and we all look forward to the publication of the QQI (Quality and Qualifications Ireland) document in this regard. Professional accreditation of a programme, on the other hand, is a judgement as to whether a training programme prepares the graduate for entry into that profession and will also involve monitoring the quality of placements, etc. Clearly there are implications here for all of the professional organisations in terms of their role and function.

Edward: I believe there is a widespread assumption among therapists that the existing membership registers of accredited therapists, from the more than 20 professional bodies in Ireland in the field of counselling and psychotherapy, will somehow be automatically ‘grand- parented’ into the new statutory register. My own view is that this is unlikely to be a correct assumption and that the reality will be much more complex. What is your own view?

Gerard: I do agree with you that the reality is much more complex. Statutory registration is causing all counsellors and psychotherapists to reflect on the future, as indeed are the professional organisations, because their role and function will also change. I think any statements on grand-parenting arrangements at the current time would be purely speculative.

Edward: Probably the most important question for many therapists hoping to be included in the new statutory register is about the qualifying training and post-training standard that is to apply under the new statutory registration regime. If grand-parenting is not automatic, a lot depends on where or how high the bar is set. For example, there is now a large disparity between the standard of accreditation for the ICP and related organisations including IAHIP, which require a four- year specialised training at postgraduate level on the one hand, and the standard required by, let’s say, other quite large professional bodies in the field which is a good deal lower. The recently published QQI standard for psychotherapy courses is four years of training with graduate entry to training. It does seem to me, if there is to be consistency, that the ‘statutory standard’ when it arrives is likely to be closer to the QQI parameter. What is your own view?

Gerard: I am not sure that anyone yet has the specific answers to the questions you are raising. As I understand it, the forthcoming QQI document concerns learning outcomes that are required to entitle persons to educational qualifications up to Level 9 — they do not prescribe the duration of the programmes leading to such qualifications. Minimum programme duration depends on the standard of learning required for entry, as well as on the nature, pace and breadth of the programme. I am aware of the wider debate between the professional organisations, but I think that this also reflects the underlying lack of synchronicity between the academic infrastructure and professional infrastructure in counselling and psychotherapy. Progress will need to be made on this as part of the journey towards statutory registration.

Edward: I think you will agree that these critical decisions will have to be taken by someone, or some entity, and probably very soon. There appear to be few certainties and a difficult balance to be struck between trying to be inclusive on the one hand and holding to a sufficiently high standard which will be credible and rigorous on the other. There was a useful position paper from the Psychological Therapies Forum in 2007 which stated that we should have two statutory registers, one for counselling and one for psychotherapy. This idea seems to have been abandoned in the wake of the recent IACP policy document which claims that counselling and psychotherapy are one and the same thing. It’s scarcely possible to argue for two registers now. However, accommodating the range of practitioners and standards from the counselling/psychotherapy spectrum into one single statutory and legally enforceable register will not be an easy task.

Gerard: I agree there are some difficult challenges ahead and I think practitioners should make the effort to inform themselves and stay in touch with developments as they unfold.

Edward: Many thanks, Gerard, for agreeing to help open up this discussion and for sharing your ideas and views.