In the UK, "counsellor" and "therapist" are not protected terms. We can all use them to describe ourselves. Even though there aren't many unregistered therapists, this doesn't change the fact that the people who try to get mental health services through them can get exploited and harmed. Their clients have no assurance regarding the practitioner's level of training, nor do they have recourse if something goes wrong.
As of this writing, over 1.6 million people are on a waiting list for mental health support or treatment, according to the mental health charity Mind. The Health and Care Professions Council keeps a register of qualified counsellors. This register plays an important role in protecting the public against harm caused by those who practice a profession for which they are not qualified.
Training to become a psychotherapist requires 400 hours over several years, which are usually paid for by the individual, as are their own therapy sessions – also a requirement for qualification. Counsellors have a shorter timescale but often need a relevant degree and several years of training to earn their certification.
Psychotherapists and counsellors who meet these requirements are permitted to practice in both the NHS and the private sector.
Those who work outside of the NHS can choose whether or not to participate in the voluntary accreditation system. If they join one of the accredited bodies, they will be bound by a code of ethics, a complaints system, and basic credentials, all of which are regulated by the Professional Standards Authority.
The British Association for Counselling and Psychotherapy (BACP) is calling for more awareness around these issues. Caroline Jesper, the association's head of professional standards, speaks about this in a recent BBC article about vulnerable patients that were exploited by unlicensed therapists.
The article describes the story of two patients - Jake and Laura - who have been deceived by alleged therapists they thought they could trust. Jack was paying £200 for a phone therapy session with what he believed was a reputable therapist willing to help him with his OCD. After the first few sessions, the patient noticed the therapist’s interest started to drop. He was constantly hearing loud noises throughout the conversation, hinting that the therapist was at lunch, running errands, or getting into cabs. Some of his sessions were also cut short because the therapist complained Jack was constantly looking for reassurance.
Laura was looking for a reputable therapist to help her overcome a deeply-rooted fear. The therapist asked Laura to film herself doing exposure therapy - exposing herself to her fears - so that this person could post the video on social media and market themselves to attract new patients. The video needed to be short so that it could be posted online, and if the therapist didn’t consider the clip good enough, they would require that the patient does it again. The fact that these counsellors have not been held accountable for their acts continues to surprise everyone.
Jesper stresses those seeking private therapy or counselling should opt for someone registered with a professional body such as the BACP or the UK Council for Psychotherapy. These mental health professionals have all been thoroughly screened to ensure that they hold the appropriate credentials and there is a system in place where you can report any issues or complaints.
If a mental health professional is not on the Health and Care Professions Council register, it means they are not qualified, and if they falsely claim to be on the register, they are breaking the law.
To find professional help, patients are recommended to look for reputable counsellor platforms where they can communicate with licensed therapists and select one whose therapeutic approach fits their needs. UK Therapy Guide, for example, can match patients in need with professional therapists all throughout the UK, be it for in-person meetings or online counselling. Similar reputable therapist platforms include BetterHelp and Talkspace.
Because of the current voluntary accreditation system, it is the patient's responsibility to check if the counsellors or therapists they intend to work with are registered. The onus is on the patient, not the provider.
Jordan Dunbar, a BBC journalist, wanted to show just how easy it is to get a certification online, so he obtained a counsellor qualification certificate for just £12.99, which is less than the cost of a 24-hour gym session or a wind-proof umbrella.
When someone is vulnerable and looking for help, a well-crafted certificate and a brass plaque can lead them to believe the practitioner they're speaking to is a good choice. We mustn't forget that these practitioners typically interact with people going through some of the most difficult times in their lives. Less than three-thirds of people know whether or not their therapist belongs to a professional body.
This problem is only getting worse. Patients who need mental health services outside of the scope of the NHS's primary care are increasingly resorting to private providers, who are less likely to be bound by the voluntary accreditation system.
Online therapy is also growing more prevalent, with little accountability for any harms incurred, making it easier than ever for vulnerable people to be exploited. Apps for improving well-being, gaining confidence, and resolving personal issues abound. However, we don't have a lot of research on the subject.
No regulation exists, no means to determine where the site is based, or the practitioner's qualifications, and there is no guarantee that patients will be connected to the same person each time they use the service.
We live in a world that is undergoing rapid transformation, with the digital revolution and artificial intelligence (AI) being two of the key driving forces that are reshaping our lives. This is uncharted territory for everyone, but children and young adults are particularly vulnerable.
The NHS estimates that in England, more than 75% of people with mental health challenges do not receive any care at all. Because of this, it should come as no surprise that the internet is flooded with unregulated and unregistered practitioners offering mental health services.
Although voluntary registers such as the BACP and the UK Council for Psychotherapy provide some protections, they are insufficient, and both organisations have stated that they would welcome regulation.
The most alarming aspect is that, even if these regulatory organisations disqualify a practitioner for misconduct, they are not legally required to stop practising.
It's encouraging to see the government attempting to address these challenges, both in the context of the NHS and more broadly. Their proposals include upgrading the processes through which health apps and other digital technologies are assessed and regulated.
In recent years, the government has made the excellent decision to prioritise mental health. Still, if mental health is to be taken seriously, we must also consider who is qualified to provide mental health services. We don't let unqualified people perform surgery, yet anyone can call themselves therapists or counsellors.
Statutory regulation is one possible solution. Although it's been discussed, this option has unfortunately been pushed off the agenda, but the time has come to address it. In the past, the government has indicated that it will introduce statutory regulation if it can be proved that a risk to the public is present and that this risk cannot be mitigated through other methods.
Statutory regulation would ensure that only people with the right qualifications are permitted to offer mental health services. Voluntary registers are not subject to the same legal requirements as statutory registers, even if the Professional Standards Authority has made efforts to accredit some of them and thus provide a certain level of assurance.
It's our duty to raise awareness around statutory regulation and voluntary registers in order to protect vulnerable people and help them navigate the complexities involved in getting the care they need. Regulators, professional bodies and mental health professionals should all contribute to this goal.