Emmy van Deurzen Smith
The Editors received a copy of the following report and decided to publish it as it con tains useful information on the current situation regarding psychotherapy regulation in Europe, and while it is particularly pertinent to the United Kingdom situation, it is also valid for the Irish context.
Emmy van Deurzen Smith is the Director of the Antioch University Psychotherapy Training Programme at Regents College, London.
To put the issues that we are discussing in context it seems important to once more remind you of the situation on the European scene.
In the first place we need to remember that at the end of 1992 we will find ourselves in a European community that will gradually efface its frontiers. It is also good to keep in mind that English is going to be one of the official European languages which more and more Europeans will acquire. One of the effects of this is the likely increased interest on the part of our fellow Europeans to come to live and work in an English speaking country.
It is of course with these considerations of mobility of the labour force in mind that the commission in Brussels has been considering the setting of common standards for the professions. The professions in this context are loosely defined as occupations that are at least on graduate level.
Some professions now already have what are called sectoral directives, which are basi cally European regulations on one particular profession that every EC country has to conform to. On this point it is vital to remember that EC legislation (although it isn’t yet called legislation) overrules national legislation when it comes to the crunch.
A good example of this is the general directive on the recognition of higher education diplomas or formal qualifications required for the pursuit of professions or other occu pations. This directive was drafted by the commission to speed up the mutual recognition of diplomas in all those professions where sectoral directives had not yet been agreed in time for 1992 (some sectoral directives have taken years and years to agree, when a particular profession was set up rather differently in different European countries, with well established professional bodies fighting for their own corner. Whilst the general direc tive is about mutual recognition of diplomas and equivalences, so that one does not have to requalify, sectoral directives are about harmonisation of professions and training standards across Europe).
The general directive was thus drafted and then sent through a long process of redrafting after consideration by the the different EC governments and representatives of the professional bodies concerned. Much of the important discussion on all of this took place within SEPLIS, the Brussels body for the Liberal Social and Independent professions, which functions as a watchdog and advisory body to the professions and rep resents them at the commission.
The directive was agreed and accepted two years ago and we have now reached the stage where the British government has implemented it by having put through parlia ment what is referred to as the “European Communities recognition of professional qualification regulations 1991”.
Since April 17, 1991 we find ourselves therefore in a position to have to recognise EC qualifications of a level comparable to ones’ own in a given profession. The power to set such a level of training is in the hands of what are now called designated authorities. These can check equivalences and decide whether a migrant needs an adaptation period or an aptitude test in order to practice a given profession in this country, but their deci sions have to comply with the above mentioned regulations. Adult psychotherapy remains in the position of not being a regulated profession for the moment so that anyone can still work as a psychotherapist in this country.
Of course the general regulations are superseded in the case of a sectoral directive on a particular profession. There is now no doubt that the profession of psychotherapy, if it were to be regulated by the general directives would fall within the category of the first directive (not the second which is intended for vocational training of less than graduate level). It is also clear that a sectoral directive on psychotherapy could be negotiated at some point in the future. This would define psychotherapy as a profession with par ticular competencies and training requirements and restrict its practice and title to those who fit the regulations.
There is little doubt that this is the route that the Dutch initiative on a European Association for Psychotherapy will have to take eventually (or in the very near future) if it is to have any significant impact at all. But before I go on to explain some of the advantages and disadvantages of the sectoral directive, there are a few more things to say about the general directive and its implementation.
As I mentioned before there is now a list of those bodies that have been assigned the status of designated authority in order to monitor and regulate the access to particular professions for migrants. It goes without saying that being given such authority amounts to being given the authority to regulate a profession full stop. In every case where there was a professional body incorporated by Royal Charter this body automatically became the designated authority. It is recognised by the DTI that further authorities will yet have to be designated for those professions not yet covered by existing ones.
It is important to note that with regards to employment in the National Health Service the following authorities have been assigned:
- Art Therapists – Council for Professions Supplementary to Medicine
- Dramatherapists – idem
- Music Therapists – idem
- Speech Therapists – The College of Speech Therapists
- Clinical Psychologists – The British Psychological Society
- Child Psychotherapists – Association of Child Psychotherapists
Also for state registered practice:
- Occupational Therapists – The Occupational Therapists Board
- Physiotherapists – The Physiotherapists Board
These are just some of the most relevant examples of professions that are now officially regulated. It is anybody’s guess where the adult psychotherapists will fit into the picture. But we will do well to remember that it is most likely that any request for the establishment of a competent authority in this area will be met by an exploration of the professional standards set with bodies already in place as designated authorities in adja cent fields, such as the British Psychological Society, The Royal College of Psychiatry and the Association of Child Psychotherapists.
There is little doubt that not everybody agrees that UKSCP should be the designated authority in the case of adult psychotherapy. At the moment of course UKSCP is not even ready to register its national members, let alone take charge of the equivalences in terms of EC migrants. We will need at least a code of ethics and firmly established entry requirements and curriculum standards for training, before we are ready to claim author ity. It would not be surprising to find that analytical adult psychotherapy is meanwhile rather closer to establishing a competent and to be designated authority in its own right.
It is therefore rather urgent for us to face these issues if we don’t want to let our authority as a broad professional body be gradually frittered away.
This brings me to the question of the EAP and the possibility of European standards and regulations on psychotherapy. I shall not speak of the issues around the selection of our own representatives on this body, but I want to say some words about the project itself and the speed with which it is taking shape.
In order to understand some of my concerns you will have to know a bit more about the implications of sectoral directives. So please bear with me as I relate to you the dif ficulties some professions have experienced with sectoral directives. The example of the chartered surveyors is probably the most telling.
In spite of having a chartered body in this country the surveying profession did not exist anywhere else in Europe. When the sectoral directive on architecture was agreed the competencies of surveying were included in it, so that chartered surveyors cannot now legally practice in any other EC country whereas migrant architects can come over here and fill their jobs. You can imagine the impact something like this may have on the future of even chartered bodies as the community and mobility of the professions becomes a reality.
We must therefore be aware of the possible implications of a European Association for Psychotherapy as it makes moves to working out the requirements for a sectoral directive. The directive that would ensue could set standards that would in effect curtail the freedom of a British body to set its own standards in psychotherapy. Moreover it could overrule other, related, professions such as, for instance, counselling, if the specific competencies overlap. By the same token inaction on the part of psychotherapists in set ting their own standards may result in another profession’s sectoral directive encompassing psychotherapy and superseding it as a separate profession.
When we remember that psychotherapy is in effect very much integrated with clinical psychology and psychiatry in European countries that do have regulation it becomes a real matter for concern that the EAP has selected only psychologists and psychiatrists on its steering committee.
The question that we need to ask is whether the profession of psychotherapy that the EAP aims to establish is the one we want. I have serious doubts about what is happening and I think you are entitled to know something about my own experiences and personal impressions, which I shall then leave you to judge by your own standards.
I made a point of checking back with the Dutch co-ordinator of the European Association for Psychotherapy about the progress of the EAP this week and I was told that things had gone very fast since December. When I asked why the next meeting was to take place in Brussels I was told that there was a logistic reason for this. When I prompted a little further I found that talks are not just planned with Brussels’ and with SEPLIS, but that they have already taken place.
When I asked why all of this had to be so secretive and claimed the right to know what exactly was happening, I was told that there was no question of co-operating with a democratic process at this stage. I was asked to remind you that this is a private initiative and that only those who have been selected onto the steering committee will be informed of the progress to date. Accountability will only be on the agenda after the steering committee has agreed statutes for the organisation and has defined the profession of psychotherapy and its standards.
When I suggested that such an attitude would giver a handful of psychotherapists in Europe the exclusive right to define and delimit the profession I was told that this was indeed the strategy opted for. When I enquired why only psychiatrists and psychologists were represented I was told that this was the standard aimed for and that, and here I quote, “the lay model of therapy has to disappear”. Apparently the Germans weren’t even willing to begin discussing a European standard until lay representatives were eliminated.
I was then reminded that the countries that already have regulations on psychotherapy are putting money and energy into this project so as to be able to guarantee a European outcome in line with the sort of standards in the countries in question. It was clear from my discussion that UKSCP has been extensively discredited in the process of selecting candidates for a European steering committee and that it had become a liability rather than an asset in terms of election onto the EAP steering committee.
Hearing these comments I was glad that we did have an EGM coming up to try and affirm some boundaries around UKSCP, so as to reaffirm a profession of psychotherapy that is broadly based. I have no doubt that if we want to have a voice, what is needed is for us to set clear standards and constitute ourselves into a British body for psychotherapy that can become a designated authority very soon indeed.
But it has also become increasingly evident that not all of us want this to happen through UKSCP. The setting up of EAP has made it abundantly clear that there are a number of organisations in the conference who have preferred to act under their own steam. I was sad that the letter that went out from these organisations to the Dutch was not made available for general circulation. What I object to is that this conference is not being used to discuss such matters and air the disagreements and tackle the conflicts. It defeats the purposes of the conference if people only come here as observers, whilst carrying out the real action elsewhere, behind the scenes.
Therefore, taking a leaf out of my own book, I need to say that, whilst I would have felt naively confident a year ago that the conference would speak for the profession, I now feel the need to ensure that I explore other contacts and different avenues. For it has become evident that not all of us have the same commitment to this organisation and it would be rather foolish to discover that the conference had just been a talking shop where some of us were kept occupied whilst others went out to bring home the bacon or the Brussels pate.
Emmy van Deurzen Smith, April 1991.