The British Confederation of Psychotherapists: The background to its establishment and character
By Fred Balfour (1995)
[Please note that this is a historical document. Some of the references to the Constitution and other issues will have changed since the BPC became a limited company. The context for statutory registration has also changed.]
At the time of the establishment of the National Health Service, in 1948, there was little perceived need for the statutory regulation of psychotherapists. If psychotherapy were to be offered as the treatment of choice for a patient, there was a very high probability that it would be conducted by a medical practitioner. Very much less often, it was undertaken by a non-medical psychotherapist working with medical cover. Psychotherapy was not widely available. Those practitioners who had received a formal training in it, almost always at a post, post graduate level, had qualified from The British Psycho-Analytical Society or The Society of Analytical Psychologists. Though there were few of them, the greater majority of formally trained psychotherapists working at the time in the NHS were trained by the British Psycho-Analytical Society.
There has never been any direct statutory regulation of psychotherapy in the United Kingdom. Such protection of the public as might have been said to exist in those days came from the fact that psychotherapy was thought of as a medical specialty and therefore subject to the disciplines that regulated doctors. This position held for the 1950's and also for most of the 1960's.
The more than two decades that have passed since then have witnessed the maturing of the embryonic psychotherapy institutions which had started to form themselves in the post-war period and developed further throughout the '50's and 60's. In the psychoanalytic field, of particular note was the establishment of the Association of Child Psychotherapists and the gradual growth of the provision of mainly non-medical psychotherapy for children.
For adults, the formation of the British Association of Psychotherapists and the increased formality of the training offered by the Tavistock Clinic signalled the beginnings of the professionalisation of psychoanalytic psychotherapy both within and outside the Health Service. Parallel with these developments, psychiatrists and psychologists were establishing and refining behavioural approaches to psychotherapy, while beyond the consolidation and development of these endeavours there was a rapid increase in the number of training institutions in the field of psychotherapy and counselling.
Psychotherapy moved from seeming to be a medical specialty to one that increasingly contained specialist clinical psychologists, social workers and beyond them, particularly in the domain of private practice, non-medicals whose original training came from outside one of those core disciplines. These developments have raised problems. For some time now the public has been faced with the difficulty of judging whether the claims made by psychotherapists in relation to their training and subsequent professional association are legitimate and carry a proper recognition by colleague mental health professionals.
The government was first drawn into a concern with the way in which the public might be exploited as a result of the unregulated development of procedures offering themselves as psychological therapies when it instituted an enquiry, conducted by Sir John Foster, into the activities of the Scientologists. In his report, which came out in the early 1970's, Sir John recommended that, for the public protection, psychotherapists should be registered.
What followed this recommendation was a prolonged phase of discussions between the interested institutions throughout the 1970's and 1980's. Within that period, the Psychotherapy Section of the Royal College of Psychiatrists was created and the British Psychological Society established its own register for psychologists. A number of posts for medical Consultant Psychotherapists were established in the NHS together with just a few non-medical appointments in adult psychotherapy.
The Association of Child Psychotherapists had by the end of this time become recognised by the Department of Health as the professional organisation for child psychotherapists in the United Kingdom and the body which accredits trainings in child and adolescent psychotherapy in the United Kingdom. Later on, the Association also became the designated authority for the recognition of the qualifications of child and adolescent psychotherapists from European Union countries who wish to work in the United Kingdom.
By the time enough groundwork had been done and sufficient cohesion achieved by the many institutions which participated in the talks to encourage the idea that a single container body for psychotherapists might be established in the second half of the 1980's, there were so many organisations involved that it was realised that it would be impossible to proceed unless appropriate distinctions were made between institutions as to their titles and functions. The task proved to be difficult as the attempt was made to reconcile what reflected reality with what was acceptable to some of the organisations involved in the talks. Despite the difficulties encountered in settling a very large number of institutions into a workable number of categories without a distortion of their identities, the task was achieved sufficiently by January, 1989, for the organisations concerned to inaugurate themselves as The United Kingdom Standing Conference for Psychotherapy, now The United Kingdom Council for Psychotherapy.
However, a sign that, in the long term, the impressively plural field of psychotherapy was likely to need to be contained in more than a single register occurred just prior to the inauguration of the UKSCP. The Working Party of the then Rugby Conference, the UKSCP's precursor, had been set the task by the Conference to advise it about its future structure. The result was the suggestion of a federal structure in order to differentiate titles and functions as appropriately as possible. Apart from reflecting the catholic range of the membership of the new body, the suggested structure provided the most appropriate means by which applicant institutions could achieve membership. With certain exceptions, membership of the UKSCP was to be through meeting the standards set by one of its component Sections. That meant that membership could be achieved in the most appropriate way since the decision was made initially, and in the main, by an organisation's approximate peer institutions. It was thought that this would be the best gurantee of fairness and rigour and avoid the possibility that insufficiently related bodies might have to judge the adequacy of institutions far removed from their particular specialty.
While differentiation between the main psychotherapy modalities was important, it was also vital not to produce an unwieldy, fractured structure which might make the overall cohesion of the UKSCP difficult. Because of the way in which the field of psychotherapy had developed historically, some specialties consisted of a very considerable number of institutions, while some others had few institutions within them, though those institutions may have represented a very large number of practitioners. The field was complex and the structure devised to represent it, inevitably, could do only rough justice to it.
One of the pieces of rough justice could be seen in the way in which the Analytical Psychotherapy Section (which has recently been renamed the Psychoanalytic and Psychodynamic Section) was established. It was realised prior to the inauguration of the Conference that the Section would be likely to have a much larger number of institutions in it than would be the case of the other proposed Sections. As some of the organisations likely to gravitate to the Analytical Psychotherapy Section were not necessarily analytic but instead represented themselves proudly as more broadly "psychodynamic" or "eclectic", it was suggested that, in order to help them make common cause, they might best be formed into three Sections rather than just one. The Working Party to which the proposal was put when it met in informal session was unprepared to make such a last minute change to the structure that had been agreed earlier during a formal session. As a consequence, the proposal was not offered to the Conference the next day.
A year or so after the inauguration of the UKSCP, the difficulties that were anticipated might arise in the Analytical Psychotherapy Section did emerge. The nub of the problem arose among what might be referred to, broadly, as the psychodynamic group of institutions. As has been said, it contained the greatest number of institutions - some of which had been established in the very early part of the century, but many others which had been formed relatively recently. It was the senior psychoanalytic psychotherapy institutions, in the main, which appealed for permission to establish a separate Section for psychoanalytic psychotherapists. The Section debated the matter and tried to reconcile the difficulties but without success. A segment of the Section then appealed to the Conference, sitting in plenary, for permission to establish a separate Section for psychoanalytic psychotherapists. That request came from a minority from within the Analytical Psychotherapy Section and was opposed by a majority of the institutions within it. The arguments for both sides were put persuasively.
The Conference as a whole, perhaps inevitably, did not support the request of the minority. Properly conducted votes were taken both in the Section and in the Plenary Meeting in arriving at the conclusion that the Section was to remain as a single entity.
This solution meant that the problem was dealt with but not resolved. The wish for differentiation and a clear definition of psychoanalytic psychotherapy persisted. That then resulted in a number of organisations beginning the talks which, some years later, led to the formation of the British Confederation of Psychotherapists. With hindsight it can be said that the outcome was evidence of an insufficient appreciation of the seriousness of the request by the psychoanalytic psychotherapists for a proper recognition and differentiation on the part of the Council of the UKSCP. It gave no recommendation to the Section nor to the Conference as a whole at a time when the still fluid state of the Sections would have been able to accommodate further differentiation. However, this occurred not very long after the inauguration of the UKSCP. Democratically-conducted votes were taken and it was hoped that the matter had been settled.
Of course, simple democracy does not necessarily result in right action. Central to the reluctance on the part of the Council of the UKSCP to act to permit some organisations the right to be known as psychoanalytic psychotherapists was the problem of how the new organisation would determine its membership. Because no acceptable solution could be found to that question, it was hoped that it would cause less offence and produce less turbulence in the Section and the Conference as a whole if a limited number of organisations were not supported to have a separate Section as psychoanalytic psychotherapists and the title which went with it - a title that was seen to be more long-standing and prestigious, and that that was to be the case whether that title was appropriate to them or not.
The inability of the UKSCP to find a way of dealing appropriately with this issue reveals a problem which is at the heart of any attempt to create a realistically-conceived container body for psychotherapy and move it towards registration.
Historically, the absence of an indicative register that regulates psychotherapy has meant that an institution can claim any title which it feels corresponds to its theoretical preference and clinical position. As has been said earlier in this document, the problem that arises from this is how such claims are to be judged. The BCP organisations have felt it to be essential that they put forward what they believe is a critically important aspect of the answer. It is that those institutions that are linked historically with a particular position in the field, and are perceived by the national mental health professional bodies as well as the public as the organisations that are recognised as the holders of particular titles and functions, should be expected to have a substantial responsibility for determining whether claims to titles which attach to and, in a sense, borrow from their own, are legitimately held. Furthermore, in recognising that psychoanalytic psychotherapy has existed within developed institutions for a very considerable time prior to the current attempts to put a defining boundary to the profession as a whole, it gives no encouragement to the unrealistic notion that titles and functions can be claimed without an appropriate recognition by the senior institutions of the justice of any such claims. It also disavows any inclination to act as if the profession had no previous existence and that a new profession was being created. This position can also be said to emphasise the need for progress to occur in an orderly way in a profession known for its tendency to fragment and its inclination to under-estimate established developments.
The Preface to the BCP Constitution states that the roots of psychoanalytic psychotherapy lie first in psychoanalysis and then in analytical psychology. To this it might have been added that, historically-speaking, the institutions which are identified as those that have contained and projected the traditions of psychoanalysis and analytical psychology are the British Psycho-Analytical Society and the Society of Analytical Psychology respectively. It is this history, together with all that is implied by it in terms of the clinical and theoretical contribution made by these bodies to the field, that has required them, together with the organisations which identify with them and have developed within the same culture, to show, preferably in operational terms, how the field of psychoanalytic psychotherapy should be defined. To do otherwise, and not project a view of this legacy in a firm and reasonable way, would be a dereliction of their duty to the public and to their own heritage.
Therefore, in describing an appropriate identity for the BCP, the institutions concerned can be said to have made specific and operational a definition of their view of a critically important segment of the field of psychotherapy - a definition which, otherwise, can become unacceptably elastic when expressed in terms of statements of belief alone.
It was notable that, early, at the 'Rugby Conference' stage of the development of what is now the UKCP, the Working Party of the Conference was reluctant to invite representatives of the Royal College of Psychiatrists, the British Psychological Society and the British Association of Social Workers on to the Council of the then proposed UKSCP, permanently, as representatives of the mental health professions. In some over-simple sense, their inclination seemed to be to treat all organisations as if they were equal. Similarly, an initiative to invite the Tavistock Clinic on to the proposed Council was initially voted down by a special meeting of the Conference on the ground that, though it was a substantial provider of psychotherapy services in the public sector and a long-established training organisation of psychotherapists, it was associated in the main with psychoanalytic psychotherapy. Therefore, to offer it a seat on Council, because of its seniority, was unacceptable at that time since that might imply the pre-eminence of a particular kind of psychotherapy. These matters were later resolved satisfactorily.
Within the setting of the Rugby Conference and the UKSCP it was extremely difficult to be successful in arguing a case for the recognition of the seniority of some institutions over others. A great many of the institutions of what is now the UKCP are small and have a limited history. They have an understandable wish for recognition. In order to include as many legitimate bodies into the Conference as possible. structures and systems were put in place which were. and are. egalitarian and democratic in a way which has disregarded the fact that the field is fundamentally unequal. No single psychotherapy institution, irrespective of its history and contribution has been allowed any special authority. because that would suggest that they may be laying a particular, and possibly unjustified claim to pre-eminence. This fundamentally unrealistic state took on an additional seriousness in view of the Conference's tendency to err on the side of being over-inclusive in its membership and its claim to be the predominant representative of psychotherapy in the United Kingdom.
Such an arrangement was difficult for the senior psychotherapy organisations to accept. They felt quite acutely that an umbrella body had been created which, in the name of a catholicity of membership, allowed crucial distinctions between institutions to be blurred. The senior institutions were keenly aware that the recognition that they had painstakingly built up based upon their substantial public and professional performance. their durability as institutions and their prestigious public reputation was being overlooked. They were being expected to accept containment within structures which reflected a simple and unreal equivalence for all.
The legitimacy of the claim of the institutions that were parties to the talks that led to the formation of the BCP to represent a substantial voice in the psychotherapeutic field can be judged by the nature and reputation of the organisations involved. They are:
The Association of Child Psychotherapists (Est. 1948)
The Association of Psychoanalytic Psychotherapists in the National Health Service (Est. 1981)
The British Association of Psychotherapists (Est. 1951)
The British Psycho-Analytical Society (Est. 1913)
The Lincoln Clinic and Institute for Psychotherapy (Est. 1967)
The Scottish Association of Psychoanalytical Psychotherapists (Estab. 1972.)
The Scottish Institute of Human Relations (Estab. 1970.)
The Society of Analytical Psychology (Est. 1936)
The Society of Psycho-Analytical Psychotherapists (Est. 1983)
The Tavistock Clinic (Est. 1920)
In order to define the area that these bodies occupied, each institution's prospectus, selection and training standards documents and its code of ethics, as well as information about its structure, the way it governed itself and its policies and practices for the post-qualification association for those whom they trained had to be scrutinised carefully. It was necessary to confirm that the common ground which reputation suggested existed between these institutions was real and could be demonstrated by a sufficient correspondence between their policies and practices.
Out of that investigation a great many measures - i.e. standards, policies and practices common to the ten institutions emerged. A profile of each institution was made in relation to the established measures. Then each institute had to be asked independently whether the accumulated profile corresponded to its definition of an institute of psychoanalytic psychotherapy. On the basis of the detailed findings, the institutions which had been party to the talks all confirmed that a basis existed for the proposed linking structure of psychoanalytic psychotherapy organisations. A constitution together with a document providing guidelines for membership and the administrative procedures of the Confederation were adopted. Wherever appropriate the documents were written in a way to avoid the message that what might be regarded as an acceptable depth and range of training and future professional provision should be the maximum that institutions should ever aim for. The investigation into the policies and practices of institutions simply established the highest common factors between a relatively homogeneous population of institutions. They were represented as accurately as possible, and then submitted to the institutions involved. Each organisation was then asked whether it was prepared to recognise its colleague institutions in a formal way that would be sufficient to pursue together the aims set out in the constitution of the BCP.
The institutions that have created the BCP have not thought of it as a super-ordinate body with power to over-ride the sovereignty of member organisations. More accurately, it can be described as a secretariat which has the task of compiling, holding, keeping up-to-date and appropriately distributing a Register of its member institutions and the names of those who are the individual members of those organisations.
The Constitution makes it possible for the BCP to perform other functions required of it which take it beyond its register-holding function. If the BCP comes to exercise more authority or wider functions over the years, it will be because member institutions need it to take on tasks because they trust its capacities and judge that it may be better placed to perform them.
The BCP considers itself as a parallel organisation to the UKCP in those circumstances in which it has to represent its member organisations to the public, the professions and to government. It recognises that if it is to represent its member institutions at all adequately in such circumstances, it must speak for a discrete membership. In order to avoid for the future what has already occurred when the BCP and the UKCP have pursued different policies in the name of some of the same institutions, the' BCP has set in train a dialogue aimed to avoid the problems which can be caused by a partially overlapping membership.
In other respects the two umbrella bodies have quite different characters. The UKCP is an attempt to create a container body for as many of the legitimate psychotherapy bodies that meet its standards for joining. The BCP is restricted to a membership of institutions which, in its view, meet its criteria and standards as psychoanalytic psychotherapy organisations. It is to the advantage of all concerned that the UKCP exists. Its work to contain and further develop the catholic range of its membership is bound to be for the public good. It is a body with an altogether different scope - with all the advantages and disadvantages of size. Like the BCP it publishes its own register. The BCP Register and the UKCP Register, together with the Medical Register and the Register of the British Psychological Society can and are available to the public. The access this provides to those in need of guidance in seeking out reputable services and practitioners is considerable.
It may be a matter for regret that it has not been possible to group the whole of the psychotherapy field together within one register. The fact that that has not been achieved will not mean, however, that the development of the profession cannot take place with mutual respect and proceed in an orderly way. One benefit of the current arrangement is that it reflects most of the distinctions which exist within the profession of psychotherapy.
Another virtue is that it may also help to ensure that, should statutory registration occur, the nationally recognised umbrella bodies, the mental health professionals in psychiatry, psychology, social work and nursing as well as the BCP and the UKCP will all be involved independently in the consultation process that precedes it.
[Please note that this is a historical document. Some of the references to the Constitution and other issues will have changed since the BPC became a limited company. The context for statutory registration has also changed.]