The Sound of a Train in the Distance

Did you see the recent IAHIP bulletin in relation to Statutory Registration of Counsellors and Psychotherapists? It directed members’ attention to the website of CORU, the body charged with regulation.

Or perhaps you saw the announcement from IACP that mandatory Garda vetting is to take place for all IACP members from late 2014, and will in the future be a pre-requisite to applying for membership.

CORU is Ireland’s multi-profession health regulator, and was set up under the Health and Social Care Professionals Act 2005 (as amended). CORU’s role is to protect the public by promoting high standards of professional conduct, education, training and competence through statutory registration of health and social care professionals. CORU will have statutory power to set professional standards, engage with educational bodies, maintain and publish a register, promote CPD and run Fitness to Practice hearings. More information about CORU can be found here.

trainSocial workers are the first profession to be registered, with other health care professionals to follow.

Registration has much to offer the profession. For a start, members of the public will be able to distinguish (possibly for the first time) between those practitioners who are appropriately trained to provide therapy services, and those who are not. Educational standards will be set, to ensure that those entering the profession comply with a minimum level of criteria. By consulting the online register, members of the public will be able to establish whether the practitioner they are proposing to consult has achieved those standards.

Garda vetting is already in place under the Children First Guidelines on the basis of a voluntary code, but is due to be put onto an expanded statutory basis when the 2012 legislation is fully implemented. The purpose is to ensure that those counsellors and therapists (and others) working, even in a passing way, with children and vulnerable adults have been vetted.

So, isn’t that all good news? Yes, of course it is. These measures will create greater public confidence in, and awareness of the profession, and provide more protection for those accessing our services. In relation to the education of therapists, standardisation may eliminate the current anomalies in Health Service recruitment. Members of the public may have greater confidence in choosing between service providers. However, there is likely to be increased focus on what can be measured and assessed. Perhaps this will lead to an increased focus on the academic side of the training, with less emphasis on process?

However, any changes bring consequences, seen and unseen. And these changes will undoubtedly impact our profession in ways we have not even imagined.

I worked for one of the accountancy bodies at the time when regulation of that profession was introduced, in the early 1990s. Nearly 20 years on, the light-handed regime originally envisaged is now an industry in itself. I’d like to set out my observations of some of the consequences of that process and what we might learn as practising therapists.

Regulation adds a level of administration to the management of a practice: Someone needs to keep an eye to the requirements of the professional and the registration bodies, and see that they are complied with. Returns will need to be made, fees paid, and any queries dealt with. This takes time, and knowledge. As the professional body in its turn will also have obligations and interactions with the registering body, there will be a further layer of administration in the bodies too. If managing these sort of tasks is something you find easy, then this is unlikely to be a problem for you. If not, you might need to buddy up with someone who can help you.

Regulation costs money: Someone has to pay for the bodies who register and monitor professionals, and for the additional level of administration. In other professions, this cost has been borne by the members of those professions, and more particularly, by those who practice. Additional costs will have to be passed on to clients in one way or another. This means charging more, working more hours, or being smarter about other costs.

Regulation draws a clearer line between those inside the profession and those outside it: For many practitioners this is a good thing. However, the additional administration and costs associated with registration and compliance will mean it’s “Make your mind up time” for those who are practising in a small way. In other professions, the introduction of even a low level of regulation has resulted in part time practitioners ceasing to practice, sometimes voluntarily, sometimes not. If you’re undecided about being in practice, this might the time to make that call.

Regulation changes the relationship between professional bodies and their members: This is particularly so if the body itself is involved in any aspect of the regulatory regime. Members expect the bodies to act in their best interests, but where the interests of the body, the public and the member differ, this can be a difficult line to navigate. As members, we need to take a greater interest in the discussions that are taking place within the body and between the bodies and government or regulators.

Regulation creates expectations: Regulation can reasonably be expected to improve the standard of care given to clients. However, it cannot and will not protect all members of the public being hurt, deliberately or accidently, in the course of receiving therapy services. Life is full of uncertainty: sh*t happens, things go wrong, people make mistakes, and therapy is a complex process. However, having a body whose function it is to handle complaints about standards of service may create an expectation that the public should not in any circumstance suffer any hurt or harm. Further it potentially creates an expectation that if an outcome is not what a client wants, the professional must be to blame. Outcomes in therapy are never easy to predict. So it behoves us to be very clear with clients about the parameters of the work. Our contracts with clients may need to be written rather than verbal, and to spell out explicitly what clients may or not reasonably expect.

It has been hard for me to write this article. I like to be positive and helpful in my writing, so this subject is a challenge. My hope is that you can start to prepare yourself and get ready for the changes that are ahead, whatever they may be.

If you have questions about any aspect of your practice, I’d love to help you. Contact me here with your queries or questions.

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