- June 2021
Back in February, in the midst of the third national Covid lockdown in the UK, two colleagues and I attended a Zoom meeting with representatives of the SCoPEd Technical Group. We were invited to the meeting following our coordination of an open letter from members of the person-centred community who were concerned about the direction and potential impact of SCoPEd. The letter – which attracted over 400 signatories, including leading academics and international person-centred organisations – called for a halt to the project to allow a wider and more inclusive dialogue about the future of the field.
A few months later and after much reflection on the meeting, gradually something has come into view. There are ghosts haunting the clean and tidy columns of the SCoPEd framework and its accompanying rationale, ghosts the project sometimes calls on for support but which more often it ignores or exorcises from discussion.
First, though, let’s start with what we can see and hear quite clearly. In a noticeable shift in the narrative, the hierarchy inherent in the framework is no longer flatly denied by the SCoPEd team. It is, they now say, a reality of the training landscape, which the framework merely reflects. While the language about valuing different skillsets remains, the new spin here is that SCoPEd will help reduce the impact of this hierarchy by creating opportunities for movement between the levels via the proposed ‘gateways’, but this seems wilfully naïve about the economic strata the SCoPEd framework is built on and threatens to entrench. Building a wall along an existing socio-economic barrier, then offering tightly managed crossing points, no doubt with extra charges, is hardly a step towards greater social mobility and inclusion. The likelihood is that it further inflates the status, costs and inaccessibility of the higher tiers.
This new version of the SCoPEd story has also begun to reference the political history of our professions, something it previously preferred to ignore, and yet we find ourselves in the hands of an unreliable narrator. SCoPEd has long been sold as a tale of overcoming old conflicts between the organisations, with the much trumpeted ‘unprecedented collaboration’. Fair enough, I’m sure it feels really good to finally sit in a room together when before this was impossible. But who exactly found it so difficult and why? Ordinary counsellors and psychotherapists from different organisations have worked side by side for decades, been colleagues and friends. Now, though, ex-Chairs and other senior figures in BACP’s recent history are telling us to grow up and move on from our adolescent ‘growing pains’ (Therapy Today, March 2021, pp.18-23), by which they appear to mean that members should consent to SCoPEd and bury their differences on the nature of the human condition in order to impress the government and NHS. In this infantilising account, supporting SCoPEd is spun as professional ‘maturity’ (p.20). But how can therapists, of all people, equate maturity with the appeasement of power through compliance with a fabricated consensus?
The narrative hook for this developmental mythology, as shared with us in the meeting, is a story about how the field got ‘left behind’ by the IAPT project; a story supported by personal anecdotes suggesting that the reason IAPT started life as a CBT monoculture was because we – counsellors, psychotherapists and psychoanalysts – were too busy squabbling, so the powers-that-be gave the work to compliant CBT therapists and psychology graduates instead. The naughty children missed the school trip, in other words, because we just wouldn’t behave.
IAPT, then, is the first real spectre we encounter, invoked by the project for its power to trouble us as practitioners, to unleash its ghostly cry that we weren’t good enough, that we squandered a golden future of jobs and status in the loving arms of the NHS because we were too caught up in petty sibling rivalries. It is a potent tale and one that is perhaps more persuasive than ever when during a global pandemic the NHS is held in such high esteem. It is also one that speaks to an anxious professional reality of our times, that there’s little if any paid work on the near horizon for many counsellors – a therapy mountain of wasted potential, growing each year as more students qualify.
But this moralising and paternalistic fairytale of counselling and psychotherapy’s exclusion from IAPT, which will, the organisations claim, resolve happily in our post-SCoPEd welcome in the corridors of power – redemption arriving with the commissioner’s chequebook – forgets as much as it remembers. If we listen more closely, the spectre of IAPT tells a quite different story. The IAPT project’s vision was not for a universal therapy service to support the wellbeing of the nation, which we fluffed the chance to join through our own bickering and immaturity. At its outset, IAPT was never going to embrace the rich ecology of counselling and psychotherapy practice – if only we all got along better – because in truth it was created and driven by economists and CBT zealots who were recruited into the New Labour government’s desire to reduce the welfare bill by getting unemployed people back to work, with CBT the new psychological wonder-cure that would treat their medicalised anxiety and depression as quickly and cheaply as possible (Jackson & Rizq, 2019).
The leadership of the SCoPEd organisations expediently forget this history, perhaps because to remember it is to confront the complex reality of what happens when therapeutic values encounter the culture of contemporary healthcare practice and the political intentions of governments, different worlds the project desperately needs to be in alignment for its rationale to make any coherent sense. The person-centred critique of SCoPEd that informed our open letter is just the most obvious manifestation of the incongruence between these worldviews – not for every practitioner in every modality but for a substantial proportion of therapists for whom a standardised, manualised, instrumental and medicalised approach is at odds with our philosophies, trainings and, crucially, our experiences with and as clients (not to mention the research, which we’ll come on to).
Is this really the lost future we want to regain – absorption into healthcare, burning out in IAPT, cooking the data books to survive (Surviving Work, 2019)? Maturity, we are told, means ignoring such complex questions, swallowing our disagreements, deifying and coveting NHS jobs, agreeing shared standards and falling in behind a bland united front of semi-manualised legitimacy. We must now believe the fairytale because the real story of our professions is too awkward – and we don’t want those skeletons to come out dancing when we’re talking to the Department of Health.
One such skeleton is the actual evidence. The SCoPEd project has been keen to portray itself as ‘evidence-based’, but while presumably its ‘map’ of training is genuinely based on the course curricula it analysed, the project’s arrangement of this information into three distinct tiers of practitioner competency – with the clear outcome being that a higher tier therapist is automatically more competent than a lower tier therapist – is an ‘evidence-based’ claim too far.
Where is the evidence that longer and more academic trainings with higher personal therapy requirements and a tendency towards psychoanalytic thinking actually generate more competent practitioners at the point of completion, let alone after a couple of years of practice? When we’re discussing the relative ‘competence’ of differently trained therapists, where is the evidence that those destined for the highest tier of the SCoPEd framework are safer, more helpful with complex client concerns, or that they create more meaningful therapy relationships? If it exists, it has yet to be produced.
What we do know from research is that modality is a poor predictor of outcome, as in the famed ‘Dodo bird verdict’. Despite its training requirements, psychoanalytic psychotherapy has not proven itself to be any more successful than Person-Centred Therapy, which has a different training model but a substantial evidence base (e.g. Cooper, Watson & Hölldampf, 2010; Elliott et al, 2013; Murphy & Joseph, 2016). Research also suggests (Lambert, 1992) that practitioner techniques account for less therapeutic change than either factors outside the therapy or common therapeutic factors, such as the therapy relationship, findings which have contributed to our understanding of the co-created nature of therapy and the role of the actively ‘self-righting’ or ‘self-healing’ client (Bohart & Tallman, 1999).
Categorising practitioners by training alone, using a reductionist input-output model of education, and strongly implying that their relative placings in these categories meaningfully predicts or correlates with their ability to help clients, rather flies in the face of such findings. But the SCoPEd team deem the relevant outcome literature to be beyond the project’s remit, so just march on regardless, merrily declaring their efforts to be ‘evidence-based’ while ignoring some of the few consistent findings that have emerged from decades of therapy research.
Of course training matters in becoming a therapist, but what about training matters? What do people bring into it and how do they integrate and consolidate all of this experience, both within the formal training period and after qualification? It is faith-based, rather than evidence-based, to argue that a more academic training involving years of five times a week psychoanalysis generates a more competent therapist (more skilled, more likely to help, less likely to harm) than a training with a different set of values and expectations around personal development and how it facilitates growth and therapeutic ability in practitioners. Claims for the higher competence level of therapists with more – but not necessarily better – personal therapy experience might make sense within the culture of psychoanalysis, but to enshrine such modality-specific training norms as ‘evidence-based’ markers of competence among all practitioners is misleading at best.
None of which would matter as much if SCoPEd was only a map of available training curricula, but – despite the protestations of its architects – it manifestly is not just a map of training because it extrapolates the findings of its survey of courses into a hierarchical taxonomy of practitioners. The controversial category titles may have been temporarily removed from the framework’s column headings, but the pecking order is transparently obvious. Under pressure to explain how this categorisation system might work in practice without being detrimental to those placed in the lower tiers, we are supposed to be reassured by the organisations’ suggestion that it will all be sorted out during ‘implementation’.
It has been a key feature of how SCoPEd has been justified that there is a slippery movement between three aspects of the project: the mapping of training; the framework of practitioner categories; and the eventual implementation of that framework. Depending on which challenge the project is trying to refute, these areas gets emphasised or downplayed. When in our meeting we pressed the Technical Group members on aspects of how SCoPEd would affect the field, we heard that implementation was not something they were even working on because it is a matter for those higher up the chain of command. “We’re just the foot soldiers”, it was joked.
When my colleagues proposed an independent impact assessment to look closely at how SCoPEd’s implementation will affect modalities, training, employment, and equality and diversity, we were told that they don’t know yet how the framework will be implemented, so there is no impact to assess (make of that logic what you will). In fact there is already evidence of SCoPEd affecting the training market but even if there weren’t, you’d think the organisations would be interested in understanding how implementation might affect their members in ways they hadn’t anticipated. Surely it is imperative that such a far-reaching project is independently assessed for its unintended negative consequences?
The Technical Group representatives, however, were unwilling to engage with these issues. Perhaps they know that examining them too closely lays bare the project’s flaws, or perhaps it really is above their pay grade. Either way, it looks as if implementation is the poltergeist that threatens to disrupt the contrived order of the competence framework’s neatly arranged columns and rows, so – in our meeting at least – it was banished to other realms: to the top of the organisations’ power structures; to the apparently unknowable future, away from scrutiny.
What value is there in consultations, ‘listening events’ and the like, if the boundaries of what is amenable to change are drawn so narrowly? As coordinators of the person-centred letter against SCoPEd, we had been invited to discuss our concerns, but my experience of the meeting was that none of our concerns were seriously up for consideration, which rather begs the question, what is admissible? Ironically, we were asked if there are any gaps we could identify, anything the project has missed that they might consider including, but given that the substantive issues raised by our letter were either ignored or flatly refuted, all that leaves us to contribute is some peripheral tinkering along the unstoppable path to a final iteration.
In SCoPEd’s haunted house we are only welcome to comment on the soft furnishings. Never mind the location and architecture of the building, its environmental impact, or the phantoms that run its halls, perhaps a colour-coordinated cushion on that sofa would make the place feel more cosy?
Talking of the unspeakable, what of the SCoPEd team’s eye-rolling dismissal of enquiries about the project’s relationship with statutory regulation? Regulation is something decided by parliament, the organisations plead, so SCoPEd simply puts the profession in a state of readiness if it were to become a possibility in the future. The assumption here is that it would be a good thing not to face the obstacles encountered in the late 2000s, when there was an attempt to regulate the field under the Health Professions Council (now the Health & Care Professions Council).
But these obstacles actually helped save us from being legally defined and controlled by a highly medicalised regulator with a poor understanding of the values, complexities and nuances of therapeutic work. BACP’s ‘nothing to see here’ account also jars with the fact that the Professional Standards Authority (PSA), which accredits the registers of the SCoPEd organisations and sits as an observer in some SCoPEd meetings, has been consulting on a proposal for a system of ‘licensed’ practitioner titles (PSA, 2020). As the PSA documents make clear, such a system would require a profession to have agreed common standards (like SCoPEd) and could potentially give existing register-holders (like BACP) new regulatory powers.
We can never really know the extent to which a desire for regulation fuels the SCoPEd project. As the interests of different individuals and organisations align and feed off each other, the role of the pro-regulation agenda will likely go unacknowledged. Similarly, if we zoom out further, it can be hard to pinpoint the influence of the wider cultural and political milieu that nonetheless envelopes therapy like a spectral fog; but it’s clear that SCoPEd’s reductionist desire for standardisation and manualisation potentially does some of the work for those intent on the ‘uberisation’ of therapy (Cotton, 2019) and the alignment of mental health practice with the dominant economic and ideological narratives of the times. Typically, though, the project has little interest in the shadows of its own motivations and possible impacts, so just bats away such concerns as a distraction from the vital matter of signing off its spreadsheet of competences.
All of which hangs heavily in the air as 2021 progresses and BACP et al set their sights on adopting the framework in the months ahead. Grow up. Get taken seriously. Get more work. Get SCoPEd done! These are powerful rhetorical devices but even if they appeal to some fraught configuration of our professional selves, deep down we know we are being played. We know what our work is about. We know that SCoPEd is a misrepresentation of what makes therapy such a uniquely valuable experience. Personally, I’m concerned that this knowledge itself is under threat, that we will be so consumed by the anxieties of the times that the comfort of SCoPEd’s concocted certainties will unwittingly help diminish the human heart of counselling and psychotherapy.
To protect against this happening, we need to keep in mind that there are alternative futures for our field that are much brighter than SCoPEd would have us believe, and they won’t be found in competence frameworks, rigid alignment with healthcare, or carpet-bombing our diverse ecology of therapeutic practice in the pursuit of legitimacy. On the contrary, if these futures are not to be lost completely, we might need to tune into the echoes of the past and re-engage with their as yet unfulfilled potential.
After all, SCoPEd’s ghosts are nothing to be scared of or ashamed about. There is hope in what they have to say, whispers reminding us that the mundanely oppressive reality we are currently being sold is not the only way forward. So let’s do what we do best and listen. Perhaps then, rather than falling in behind the project’s anxious incongruence and expedient compliance with power, we might begin again to fulfil therapy’s potential as a diverse and creative force for understanding, relationship, compassion, critical thinking, and personal and political growth.
If the ghosts haunting SCoPEd tell us anything, it is simply that we can do better.
Bohart, A.C. & Tallman, K. (1999). How clients make therapy work: The process of active self-healing. American Psychological Association.
Cooper, M.; Watson, J.C.; Hölldampf, D (2010) Person-Centered And Experiential Therapies Work: A Review Of The Research On Counseling, Psychotherapy And Related Practices. Ross-on-Wye: PCCS Books.
Cotton, E (2019) Ubertherapy – working in the therapy factory. <https://survivingwork.org/wp-content/uploads/2019/07/UberTherapy_Final-Version.pdf>
Elliott, R., Watson, J., Greenberg, L.S., Timulak, L. & Freire, E. (2013). ‘Research on humanistic-experiential psychotherapies’. In M.J. Lambert (Ed.), Bergin & Garfield‘s Handbook of Psychotherapy and Behavior Change (6th ed.) (pp. 495-538). New York: Wiley.
Jackson, C. & Rizq, R. (Eds.) (2019) The Industrialisation of Care: counselling, psychotherapy and the impact of IAPT. Monmouth: PCCS Books.
Lambert, M.J. (1992). Psychotherapy outcome research: Implications for integrative and eclectic therapists. In J.C. Norcross & M.R. Goldfried (Eds.). Handbook of psychotherapy integration (1st ed.), pp.94–129. Basic Books.
Murphy, D. & Joseph, S. (2016) ‘Person-centered therapy: Past, present, and future orientations’. In D. J. Cain, K. Keenan, & S. Rubin (Eds.), Humanistic Psychotherapies: Handbook of Research and Practice, Second Edition (pp. 185 - 219). Washington: APA.
PSA (2020) ‘Authority consultation on the future shape of the Accredited Registers programme’ <https://www.professionalstandards.org.uk/publications/detail/authority-consultation-on-the-future-shape-of-the-accredited-registers-programme> Retrieved 8th April 2021.
Surviving Work (2019) The IAPT Survey. <https://thefutureoftherapy.org/iaptsurvey>