We were very interested by a piece published this morning on the BBC News website talking about how easy it is to set yourself up as a therapist or counsellor and how potentially damaging it can be to start providing services when your only qualification is a quick online course that costs a tenner and can be easily cheated.
Mental Health/ Counselling/ Therapy is definitely an area where there are a few cowboys around, and the piece rightly points out that it’s important to be careful.
You can’t call yourself a doctor or a psychiatrist in this country unless you’ve been to medical school and been certified by the right bodies, but terms like ‘counsellor’, ‘psychologist’, ‘therapist’, or ‘psychotherapist’ aren’t protected terms in the UK, meaning – surprisingly, perhaps – that anyone can use them freely.
The advice given to potential patients is to check qualifications before you sign up with a provider and to check whether they’re signed up with an overseeing organisation, like the BACP.
That’s good advice, and I for one would like to see those terms mentioned above becoming protected. The cowboys – of which there are more than a few – certainly need reining in.
But there is an important angle that the piece didn’t cover:
In an ideal world everyone suffering mental ill health would get as much time as they needed with a trained, experienced psychiatrist, but the world – and especially the world of mental health provision – is far from perfect.
In terms of young people (my area of expertise), it can be incredibly difficult to get a referral to CAMHS. I’ve written before about how frustrating it can be and about what little remains once CAMHS fail to show up.
One option is to go private, and that’s a good option. Or at least, it is if you’ve got the money. In the UK, you’re usually talking about £300 for an initial assessment and then something like £150-200 an hour thereafter.
For some families, that’s an option. For a lot, it isn’t.
And so, what remains is the option of either waiting for CAMHS, or going to a provider who hasn’t spent years in medical school.
And therein lies the issue that the BBC piece doesn’t really mention: these people are often quite good, and often quite necessary. Counsellors aren’t free, but you can probably find one near you who has a good level of training and qualifications for something like £40 an hour.
Moreover, it’s entirely possible for a counsellor to get to the point of being able to do some good – and to avoid doing serious harm – without years of training.
A few years ago, when I was taking up a pastoral role in a school, I did a distance learning course in non-directive counselling, and it helped me to do a great deal of good for more than a few students.
One student had been through something incredibly traumatic in his family and needed somebody to talk things through with. I was able to use what I had learned to really help him, and his family often told me how much good it had done him.
His problems were way too small to trouble CAMHS, and his family were in no position to shell out £150 an hour – or even £50. In short, it was me or nothing.
The course I did – if I recall – took about 15-20 hours, and there were assignments at the end of each module. I used it as a learning resource rather than a qualification, and it taught me a lot.
Crucially, it also taught me what not to do!
The key thing is not to overstep your boundaries and claim that you’ve got more competence than you have.
It’s also important to remember that claims like that can be subtle and implicit. In other words, you don’t have to say anything out loud or put fake letters after your name to make somebody think you’re more qualified than you are, so it’s important to be clear with people.
My policy when I worked in the school was to never use words like ‘counselling’ or ‘therapy’ and I made sure that my role and job title didn’t imply any qualifications that I didn’t have.
All I offered was the chance for students to ‘pop in for a chat.’ I used my non-directive counselling training to offer a listening ear.
I was also clear with myself and others that my training was, as noted, in non-directive counselling. I wasn’t there to suggest courses of action or to try to identify any ‘triggers’ or behaviour patterns. I was just there to listen and to help people to be able to express themselves more clearly. I only asked questions when it helped that process, and I only gave advice when I was absolutely certain of my ground.
I also made appropriate notes so that I could remember who I had spoken to and what we had talked about. One of the people interviewed in the BBC piece recalled an experience where a counsellor had forgotten the most basic details of his life – a real rookie error for anyone who works with people, let alone a counsellor
Counsellors (or whatever term they use) with minimal training need to be selected carefully, but we absolutely must not chuck out the baby with the bathwater, to use an old phrase.
Into this discussion comes the importance of Mental Health First Aid training. Counsellors should know how to spot the signs that they’re dealing with a mental health disorder like psychosis or depression and they need to know how to respond properly when suicidal ideation rears its head.
In other words, they need to know when they’re out of their depth and need to pass things on.
John, Lead Trainer