Counselling Psychology Review - Amazon Web …bps-dcop-uk.s3.amazonaws.com/cpr/cpr_2009_24_1.pdfCounselling Psychology Review Editor: Heather Sequeira City University London Reference

Volume 24 Number 1March 2009

CounsellingPsychology Review

ISSN: 0269-6975

Special Edition:Counselling Psychology –

The Next 10 Years

Counselling Psychology ReviewEditor: Heather Sequeira City University London

Reference Library Editor Waseem Alladin Hull University, Centre for Couple, Marital & Sex Therapy andand Consulting Editor: Hull & East Riding Health NHS Trust

Book Reviews Editor: Kasia Szymanska Centre for Stress Management

Consulting Editors: Malcolm C. Cross City UniversityNicky Hart Wolverhampton UniversityStephen Palmer Centre for Stress Management and City UniversityLinda Papadopoulos London Metropolitan UniversityJohn Rowan The Minster CentreMary Watts City University

Editorial Antony Daly Regents CollegeAdvisory Board: Barbara Douglas The University of the West of England

Jacqui Farrants City University LondonAlan Frankland APSI Nottingham and North East London Mental Health TrustRuth Jordan Roehampton UniversityYvette Lewis University of Wolverhampton Del Lowenthal Roehampton UniversityPeter Martin Private PracticeMartin Milton Surrey UniversityNaomi Moller The University of the West of EnglandVanja Orlans Metanoia Institute, LondonFenella Quinn University of East LondonSheelagh StrawbridgeÁine Thompson Southern Health and Social Care Trust, Northern Ireland

International Greg Harris University of Calgary, CanadaAdvisory Board Annie Maillard Independent Advisor to ACC

(Accident Compensation Corporation), New ZealandMichael Duffy Counseling Psychology Program

Texas A&M UniversityTim Carey University of Canberra, Australia

SubscriptionsCounselling Psychology Review is published quarterly by the Division of Counselling Psychology, and is distributed freeof charge to members. It is available to non–members (Individuals £12 per volume; Institutions £20 per volume) from:Division of Counselling Psychology, The British Psychological Society, St Andrews House, 48 Princess Road East,Leicester LE1 7DR. Tel: 0116 254 9568

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DisclaimerViews expressed in Counselling Psychology Review are those of individual contributors and not necessarily of theDivision of Counselling Psychology or the British Psychological Society. Publication of conferences, events, courses,organisations and advertisements does not necessarily imply approval or endorsement by the Division of CounsellingPsychology. Any subsequent promotional piece or advertisement must not indicate that an advertisement has previouslyappeared in Counselling Psychology Review.Situations vacant cannot be accepted. It is the Society’s policy that job vacancies are published in thePsychologist Appointments. For details, contact the Society’s Leicester office.

CopyrightCopyright for published material rests with the Division of Counselling Psychology and the British Psychological Societyunless otherwise stated. With agreement, an author will be allowed to republish an article elsewhere as long as a note isincluded stating: First published in Counselling Psychology Review, volume no. and date. Counselling psychologists and teachers of psychology may use material contained in this publication in any way thatmay help their teaching of counselling psychology. Permission should be obtained from the Society for any other use.

Abstracting and Indexing CoveragePsycINFO

Guest EditorialYvonne Walsh & Alan Frankland

Counselling Psychology Review, Vol. 24, No. 1, March 2009 1© The British Psychological Society – ISSN 0269-6975

WE THINK this could be a contro-versial Special Edition and are verygrateful to all those who have

contributed interesting papers and ideas.Even though we do not agree with all thecontributions we are happy to present themto you as part of an on-going debate aboutour specialism. As well as some more formalpapers we have tried to get a breadth of viewsfrom various Counselling Psychologiststhrough response to a short questionnairecirculated in relation to this Special Edition,and we are also grateful to those whoresponded to this innovation for helping towiden the discussion.

When we started this series of threeSpecial Editions they were rooted in a senseof the potential for Counselling Psychologyto continue its growth and to take its place asa mature branch of the profession ofpsychology. What has transpired during thelast three years, both within CounsellingPsychology and, in the wider context ofpsychological care, has caused many of thecontributors to this Special Edition to posit aworld in which Counselling Psychology nolonger exists in any meaningful way. This maybe because of the nature of those who havecontributed (mostly individuals whose workis closely identified with the NHS), but thisdoesn’t seem to be wholly the case. Whatappears to have happened is that there is agrowing sense that individual’s cannot reallyaffect the changes that are being suggested/implemented from the centre of the Divisionand the British Psychological Society, and inthe world in general, and so the discipline isbeing swept along in a tide of change withwhich many have little sympathy.

We are putting together this SpecialEdition at a time when there is clearly a viewthat Counselling Psychology has a limitedshelf life, which appears predicated on the

moves that are coming from the Govern-ment to change and adapt NHS psychologyto meet its vision of what it sees as a moreegalitarian world, and to cope with the staffshortages that the demographic shift willbring, whilst also cutting costs. Such anapproach could have a marked impact onthe shape of Counselling Psychology overthe next 10 years.

Nevertheless, it seems appropriate at thispoint to remind ourselves of the five themeswhich we picked out in the editorial for ourlast Special Edition two years ago, as runningthrough the accounts given to us by contrib-utors. These were: ● Flexibility: Counselling Psychologists,

whether trainees or Consultants,successfully engage in a wide variety oftasks in any one day or any one week andthis may entail operating from differenttheoretical frameworks and models,sometimes even in differentorganisational settings.

● Relationships and focus on the client:Even if they are not working directly withindividuals there is clear evidence thatCounselling Psychologists maintain asense of the centrality of relationshipsand the perspective of the client.

● Enterprise: Colleagues discovering andcolonising new areas of work and beingwilling to take things on and try thingsout whilst still maintaining a sense oftheir identity as a CounsellingPsychologist is often delightfully clear.

● Evidence: There is also a clear sensecoming through much of whatCounselling Psychologists write that theyconsciously relate how they work and thedecisions they make to the literature andto the evidence – often doing evidencebased work from work-based evidence.

2 Counselling Psychology Review, Vol. 24, No. 1, March 2009

● Being not doing: From the authors weworked with in the second SpecialEdition it was apparent that what we werehearing about a fundamentalengagement with the whole approach ofCounselling Psychology rather than themechanistic application of a set oftechniques masquerading as therapeuticwork.

Given that it is our view that these themes areno less valid for Counselling Psychology nowthan they were at the time of the secondSpecial Edition in this series we suggest thateven in a time of change and challenge, theyput our approach to Psychological work in avery strong position to ride out the threat ofa disappearing discipline.

Those who believe that CounsellingPsychology has a place within a vibrantgrowing psychologically-minded world bothinside and outside of the NHS, need toremember that we are no longer the little

sister or brother Division. We have largenumbers of Chartered members (with thelargest number of trainees of any of theApplied Psychologies) and really have comeof age. We have much that can not only helpto ameliorate the negative effects of currentdifficulties in our society, but also to enactchange in our own right, not just to followblindly, because a ‘bigger boy’ says so. If wedo not take up the gauntlet that the paperswithin this Special Edition throw down; tochallenge the status quo and those whowould see us disappear (whether theirbeliefs are well intentioned or not) and tostand up for the value system that explicitlyunderlies this branch of psychology then wemust ask the question is CounsellingPsychology, as we know it, worth saving?

Yvonne Walsh & Alan FranklandGuest Editors, Special Edition.

Yvonne Walsh & Alan Frankland


The Division of Counselling PsychologyAnnual Report

THIS YEAR has been a significant year ofactivity for the Division as we look to thefuture and our place in a learned

society who works in partnership with ourregulator the Health Professions Council(HPC). This driver has focused our activityon revising our committee structure so it ismore proactive and responsive to memberneeds. Our focus has been and will continueto be one of focusing resources to delivervalue added services to members. We havebeen challenged by the question: Whyshould our members choose to maintainmembership of the Society and the Divisionwhen the Society ceases to be the regulatorand provider of a ‘licence to practice’.

In the area of communication tomembers we have reinvigorated our webpresence, which will have a front page aimedat the public, describing what we as Coun-selling Psychologists do and why members ofthe public should access our services. Behindthis front page are a range of resourceswhich we hope will address frequently askedquestions and support members in theirpractice. We have committed to publishingthe minutes of all Divisional meetings in abid to enhance transparency and facilitatemember engagement.

Training has been a major focus ofactivity as the division looks toward the impli-cations of HPC regulation and accreditation.We have been working jointly with theTraining Committee in CounsellingPsychology to ensure that those trainees,who seek to practice CBT in the NHS,achieve competencies which are aligned tothose demanded by the Improving Access toPsychological Therapies (IAPT) agenda. We will shortly be contacting Trainees and

Co-ordinators of Training for the Qualifica-tion in Counselling Psychology to identifytheir experience of the qualification andareas in which we can better support them.

Trainees are our future and to this endwe have hosted a number of FREE trainingevents open to all counselling psychologytrainees. These have been very well attendedand received. They have provided bothlearning and networking opportunities, facil-itating interaction between trainees who mayhave previously not had the opportunity tomeet and exchange ideas. The wine andcanapés have enhanced social interactionand I would urge more trainees to takeadvantage of these in the coming months aswe role these events out to other locationsbeyond the London Office. For those on theQualification Route I am pleased to say thatwe have listened to your feedback and areworking with the Board of Assessors toenhance openness and transparency ofprocess along with beefing up feedbackmechanisms along with complaints andappeals procedures.

Our members are committed to Contin-uing Professional Development and this isevidenced in the high take up of Master-classes and the much valued Annual Confer-ence. We have taken the decision this year tosubsidise the Annual Conference by £10,000,which will mean that our members shouldexpect that the fee for conference will beadjusted accordingly. Our conference groupcontinue to seek and respond to feedbackand the programme this year will have aseries of pre-conference workshops as a

Chair’s NotesMalcolm Cross

direct result of member requests. Theprogramme for CPD Masterclasses will bepublished annually giving members’ signifi-cant notice of events and we are grateful tothe Society’s Learning Centre for theirsupport. Further activity of the division hasbeen in working with the Society to revisethe CPD electronic platform so that it betterfits with the regulators requirements.

Training programmes have finally movedfrom being exclusively English phenomenawith the launch of a collaborative venturebetween Glasgow Caledonian University andthe University of Strathclyde. Thisprogramme has recently received an accred-itation visit and the outcome will shortly beknown. The energy and enthusiasm of theprogramme team and trainees is palpable.Scottish Branch members have also taken upthe challenge of facilitating placements fortrainees and it is exciting and heartening towatch the entire Scottish CounsellingPsychology community support this impor-tant initiative.

In the coming year (2009) a new-lookCounselling Psychology Review and Newsletteraimed at members will be launched. Wecontinue to work toward full recognition ofCounselling Psychology Review as a learnedjournal of the Society’s portfolio of journals.We have replaced the Annual OutstandingContribution Award with an AnnualResearch Prize as part of our programme tofurther strengthen Counselling PsychologyReview.

This is truly a dynamic time for AppliedPsychologists. It has never been more impor-tant for the public to understand who we areand what we do; this along with support ofour members is, and will continue to be, a clear focus for activity.

Dr Malcolm CrossChair of the Division of Counselling Psychology.


Malcolm Cross

CRYSTAL BALL GAZING is not reallymy thing, because I do not likecommitting myself when I am

inevitably going to be wrong. So I have toacknowledge that there is a large amount ofguesswork here. When I studied sociologyand economics as an undergraduate, we allthought that the social trends which welooked back on were very easy to see but thefuture was much more complex, and we putthat down to society becoming morecomplex and history becoming simpler. Partof the problem was that you can identify atrend in society but the future trajectory canbe either continuance, a decline in the trendor that some unexpected event occurs whichwipes out the trend altogether.

What I intend to do in this article is toexamine some of the areas of CounsellingPsychology in which I have a particularinterest, to try to identify any trends whichmay be developing, and then make my guessabout which way the trend may go and whatthe outcome may be in the next 10 years.The first area I have chosen is Psychophar-macology or the practice of prescribingdrugs to people who are psychologicallydistressed, a field I have been involved insince the 1980s. The second area is that ofthe training of Counselling Psychologists,since I have been involved with the inde-pendent route to qualification for manyyears as a co-ordinator of training, examinerand board member, and made a contribu-tion to several accredited courses. The thirdarea is about children, young people andfamilies, which has interested me in differentways throughout my career.

PsychopharmacologyPeople have been using psychotropicsubstances for centuries to bring them joy oroblivion and sometimes as with alcohol both,as one quickly follows the other. It is inter-esting that opium which was used medicallyfor a number of years eventually becameproscribed and then became used bothlegally as the source of morphine and ille-gally as heroin. The dividing line betweenillegal mood-altering drugs and prescribeddrugs is a narrow one but to many peopleprescribed drugs are morally correctwhereas illegal drugs are depraved. I quiteoften hear people comment that not onlyare prescribed drugs safe, beneficial andobligatory if prescribed by a medical practi-tioner, but that they are good for youwhereas illegal drugs are bad for you. In fact,they are often very similar in being essen-tially sedative or stimulant in their actionupon a person’s mental state.

BarbituratesIn the earlier part of the last century whenthere had been a good deal of experimentingwith hallucinogenic drugs by medical practi-tioners such as Freud and his contempo-raries, barbiturates were later in common useas a sedative drug with the unfortunate sideeffect that people became addicted ordependent on them. Once a person hadbeen taking them for a number of years,medical practitioners found it too difficult tohelp their patients to give the drugs up andso they were left taking them. Subtly thepatient became blamed for this and wasfrequently dismissed as ‘undeserving’.


Counselling Psychology:What I see in the crystal ballDiane Hammersley

BenzodiazepinesWhen the benzodiazepines were introducedin 1961, they were seen as a safe alternativeto barbiturates and those people who couldeasily be transferred had their prescriptionsfor the new wonder drugs. The ‘problem’ ofdependence was solved and a trend wasunderway.

Of course, satisfaction with benzodi-azepines and reliance on them was a mutualdeception between the general practitioneror psychiatrist, and their patients becausedrugs were cheap, quickly prescribed andnobody had to delve too deeply into thecause of the problem. There is often collu-sion on both sides with not delving toodeeply possibly because it might be difficultand painful.

By the time I got involved in dependenceon benzodiazepines in the 1980s, mostpeople thought that the problem was thatsome people had ‘inadvertently’ becomedependent on their medication and thiscould not have been predicted norprevented. I recall there was considerablepaper used up in the medical journals in thesearch for the elusive traits of the ‘depen-dent personality’, who must be identified sothat they could be prevented from harmingthemselves in future. So much for the art ofprediction! I noted that it seemed to havenothing to do with the drugs or theprescriber, but quite a lot to do with weak-ness of willpower. Coincidently while I wasworking with people dependent on benzodi-azepines I was approached by several peoplewho had been taking barbiturates for yearsand in spite of the prevailing wisdom thatthey were beyond help, I quietly helpedthem withdraw.

Selective serotonin reuptake inhibitorsOnce the embarrassment of over one-and-a-half million people in the UK in the 1990sdependent on benzodiazepines was over-come by quietly ignoring their appeals forcompensation, and exonerating the pharma-ceutical companies, the medical professionand the public carried on the trend of

welcoming a new generation of wonderdrugs, the SSRIs. These were safe, harmlessand non-addictive. What has always puzzledme is that the general public in the 1960sand 1970s used to suffer from illnesses called‘nerves’ and ‘nervous breakdowns’ for whichthey had been prescribed sedatives, but theirillnesses have changed. In the 1990s and2000s the general public is suffering from‘stress’ and ‘depression’ and needs stimu-lants such as SSRIs. What has brought thatchange about? How did we all have illnessesthat needed sedatives but now have illnessesthat need stimulants? And how fortuitouswas it that the pharmaceutical industry hadanticipated that change and developed theappropriate drugs!

The repeating patternUnfortunately it is now apparent that peoplecan easily become dependent on SSRIs andcontrary to the previous explanations usedin the early 1960s, it is not a resurgence ofthe underlying illness but a full abstinencesyndrome which proves that is the case.During the 1990s, concerns were beingraised about the number of people whoseemed to become more depressed takingSSRIs and it is now known that people arefive times more likely to attempt suicidewhile taking them compared with placebo(Healey, 2003). What a pity the pharmaceu-tical industry omitted to mention that intheir marketing material. They were too busyspreading the myth that depression is causedby low serotonin levels in the brain (Lacasse& Leo, 2005). Even worse, it now appearsthat SSRIs are very little better than placebo(Kirsch, 2005) which at least is harmless.Why am I not surprised? Probably because I am getting slightly better at history.

PredictionI will now see whether I am getting anybetter at predicting trends. The period ofthe trend seems to be about 25 to 30 yearsand this may be because long-term drugeffects often do not manifest themselves asdangerous to the general public until then.


Diane Hammersley

Some professions usually know immediatelybut nobody believes them. For example, thefirst study which showed dependence onbenzodiazepines might be a problem waspublished in 1961, the same year they wereintroduced. If SSRIs were introduced about1985, then we shall have a new wonder drugwidely available which will be safe, harmlessand non-addictive in about 2015. I do notknow what the new form of illness whichstrikes down huge numbers of the generalpublic will be, because I do not believe thatthese illnesses exist. They reflect the igno-rance or unwillingness of the public and themedical profession, seduced by the pharma-ceutical industry, to acknowledge that wehave created our own psychological mess.Counselling Psychologists with their critiqueof the medical model and higher thera-peutic skills will be invaluable in sorting outthe mess and addressing the psychologicalproblem.

Training of counselling psychologistsI was enormously grateful not to be asked towrite a chapter in the forthcoming thirdedition of the Handbook of CounsellingPsychology on training. This is because I wrotea chapter in the second edition based uponthe Diploma in Counselling Psychology andby the time it was published it was out ofdate. Worse, since I was involved in devel-oping the Qualification in CounsellingPsychology at the time, I was responsible formy own downfall. I hope to be more circum-spect about predictions this time but I maynot have learned the lesson in spite of seeingwith the benefit of hindsight how entirelypredictable that was, especially if I hadlistened to myself.

Looking first at history to see where thetrend started, some of us who were in at thebeginning had trained as counsellors orpsychotherapists and some like me had not.Much the same happened to me as ateacher; it had once been enough to be agraduate and by the time I got around tothinking I should be trained, I was trainingteachers and as it was pointed out to me,

I ‘would have to examine myself’. Not badadvice really but that was not what he meant.What I brought to Counselling Psychologywas my experience of being critical in mythinking especially about psychopharma-cology. And that is crucial in the training ofCounselling Psychologists; the ability tothink not just to know.

I have reflected on a visit to a universitywhere the discussion was all about thedissemination of ‘knowledge products’ andmy playing with the idea that in our profes-sion the clients already know, and we have touse our critical thinking informed by ourtheory to discern what it is that they know. Ina way, we use intuition as a means to know,not just knowledge products. So that takesme beyond syllabi and practice placementsinto the importance of the person them-selves and the ability to form relationshipswith people. How often did I hear in thebenzodiazepine service that clients hadnever spoken to anyone about themselvesand their problems! Recently a client toldme of the time of her first prescription afterbeing admitted to a psychiatric hospital forthree months that she spoke to nobodyabout what had been going on in her life.That was, and continues to be, an appallingjudgement on the ignorance and incompe-tence of our mental health facilities. Weneed far more Counselling Psychologistsable to talk to and relate to people indistress, rather than incarcerating them fortheir safety but refusing through fear toengage with them.

The trendThe trend in training has been towards ahigher academic level as practitioner doctor-ates have become the norm and a focus oncompetence has had the unfortunate effectof adding more and more to the trainingrequirements without doing any subtraction.In my opinion this has been driven by envy.We want to be as good as anybody else butparticularly our competition with clinicalpsychologists whom we envy for their status,paid training and better jobs. So we have to

Counselling Psychology Review, Vol. 24, No. 1, March 2009 7

Counselling Psychology: What I see in the crystal ball

be able to do everything required of a Coun-selling Psychologist such as being self-awarethrough personal therapy, competent thera-pists through 450 hours of supervisedpractice, and skilled at qualitative and quan-titative research. Then we have to sound andbehave like Clinical Psychologists so thatnobody can tell the difference.

So while one part of the trend is onwardand upward, proving we are clever, confidentand well-informed psychologists, the otherpart of the trend has been ‘dumbing down’.It is uncomfortable to write this but there isonly so much you can fit into three years oftraining. What you gain in breadth you losein depth. If you can do everything required,you probably cannot do it very well. ClinicalPsychology training does not produce well-rounded therapists because they do notlearn to examine themselves and their thera-peutic skills are scanty. My view of theirtraining in research is that it is very narrowand mostly consists of outcome studies.

PredictionIf the current trend continues, recently qual-ified Counselling Psychologists will bejoining the ranks of the NHS, doing dumbeddown therapy consisting of what the NHSrequires in terms of adherence to ‘guide-lines’ and supervising untrained deliveryagents. The NHS is driven by a politicalideology which values staying within budget,fulfilling a management agenda thatprovides numerical evidence of goodoutcomes, and protects the organisationfrom complaints and litigation. This is inspite of all the committed and hard-workingpsychologists who will wish it were otherwise.If that is the case Counselling Psychologistswill be no different from the other dronesregulated as registered psychologists and willhave no need to be Chartered Psychologists.

On the other hand, there may be a trendfor Clinical and Counselling Psychologists toleave the NHS as soon as they can, to findmore fulfilling work elsewhere, particularlyin private practice. Hopefully they will beconfident enough in their therapeutic skills

and professional judgement not to botherwith NICE guidelines which are devised formedical practitioners and the untrained NHSdrones. They may then retrieve what is at riskby thinking for themselves and behaving inan ethical rather than a defensive manner. Soin 10 years time I unconfidently predict thatthe Divisions of Clinical and CounsellingPsychology will both split to form two Divi-sions, one of NHS registered psychologistsand the other of independent practitionerswho are independently minded.

Young people and families

Youth clubsI began my professional life as an organiser ofa county association of youth clubs andalthough I worked with young people whowere involved with groups, I was also fasci-nated by those who were then known as ‘Theunattached’. These were the dispossessed, theones who were too young to get involved withadult social life in the pub, or had escapededucation and found there was nothing muchon offer beyond. I guess the public agendawas to get them off the streets but that wasusually where I met up with them, and tried tosupport their efforts for collective action tograb a handhold on society and find a placewithin it. I had much to thank the youth clubmovement for, as it had earlier sent me toJamaica and changed the course of my life.

When I came back to live in the UK someyears later, I discovered that the youth clubmovement had been closed down andreplaced with something else although I have never discovered with what. Thingsclosing down after I have left, has been atrend in my career that I do not usually shoutabout for fear other people will regard myinvolvement as the kiss of death. Perhapsthat says something about the future ofCounselling Psychology but let us not pursuethat idea. In recent years I have constantlythought that we should revive and updatethe idea of the youth club, particularly whenrun and organised by the membershiprather than a provision of the state.


Diane Hammersley

Child protectionMy involvement with the legal system andchild protection has made me aware thatwhen children are abused or neglected, thereis always a dysfunctional family and usually ahistory which may include physical and sexualabuse, violence, crime, drugs and alcoholproblems, family break-up and conflict,poverty and poor education. Looking back atthe history it is easy to see the trend, butlooking forward the problems and their solu-tions seem highly complex. What does notalways get acknowledged by the authoritiesand the legal system is that at the bottom ofthe story are significant problems about aseries of relationships which have left peoplepsychologically damaged particularly in theirattachments to others.

Social workers, drug workers, supportworkers and probation officers, incidentallywhose job titles have been changed to coverup and disguise their professional back-grounds, are being organised by a systembased on management theory which is asunsuccessful in this field as in others such aseducation and therapy. So quality has nothingto do with professional conduct, judgementand decision-making and the importance ofestablishing and using a relationship, butrelies instead on systems and procedures. Ithas long struck me that Social Services depart-ments need to employ Counselling Psycho-logists to work with their clients.

However, I would not advocate Coun-selling Psychologists should run what areknown as ‘programmes’, they already haveplenty of those, as does the health service,schools and the prison service. Thoseprogrammes have their place in the earlystages of achieving abstinence from drugs,establishing reasonable conduct or trying tosort out a life of crime or prostitution, butthey are short-term and can only skate overthe surface. It is the deeper work which islacking and what is needed if real and morelasting change is to be achieved, the resultsof which will then be passed on to futuregenerations of children perhaps after two orthree generations. I think that Counselling

Psychologists should be employed to worktherapeutically in the longer-term on attach-ments issues which underlie many of thesocial and conduct problems of families, butonly when people are ready, motivated andwilling just as we should only offer therapywhen those conditions are met elsewhere.Therapy cannot be imposed, but the cost ofone psychological legal report would fundtwo years of therapy.

PredictionIf children and young people are seen asproblems to be contained or controlled, iftheir behaviour is condemned rather thanunderstood, if those who have been abusedand neglected themselves are ignored, ifsocial workers are forced to make recordkeeping and targets their priority, then I think we shall see a growing trend towardsconfused and disaffected young people in allsocial classes and every minority andmajority group. Maybe this is the sectorwhere a particular event will shock us out ofour complacency and reverse the trend.

CorrespondenceDiane Hammersley,52 Hanbury Road,Droitwich Spa,WR9 8PR.

Diane Hammersley is a Chartered CounsellingPsychologist and Senior Practitioner on theRegister of Psychologists Specialising inPsychotherapy, who works in independentpractice.

ReferencesHealy, D. (2003). Lines of evidence on the risks of

suicide with selective serotonin reuptakeinhibitors. Psychotherapy and Psychosomatics, 72(2),71–79.

Kirsch, I. (2005). Medication and suggestion in thetreatment of depression. Contemporary Hypnosis,22(2), 59–66.

Lacasse, J.R. & Leo, J. (2005). Serotonin anddepression: A disconnect between theadvertisements and the scientific literature.PloS Med. 2(12), e392 DOI: 10.1371/journal.pmed.0020392


Counselling Psychology: What I see in the crystal ball

What for you is the essence of CounsellingPsychology?Client not system orientated, partnershipworking together, no experts. Summed up bythe phrase – the client is the expert on them-selves. The role of a Counselling Psycho-logist should be to assist the client to maketheir own discovery of who they are and howthey wish to live for the long term. It is notabout ‘fixing’ immediate symptoms.

If you could look into a crystal ball whatwould Counselling Psychology look like in 10 years time?Apart from a few private practitioners Coun-selling Psychology will have disappeared. Itwill have been subsumed into ClinicalPsychology which will continue to be systemorientated. Opportunities for thoseunwilling to be ‘Assistant Psychologists’ etc.,for some years, with a one-in-three chance ofbeing accepted on a training course or withnon-mainstream ideas, will be diminished.Training courses, as exemplified by ‘Doctor-ates’, have already become status and expertorientated. Clinical Psychologists willbecome ‘experts’ who offer ‘consultation’and supervise single approach practitionerswho are short-term ‘outcome’ orientated(e.g. IAPT).

Will this be what you had hoped for when youfirst entered into Counselling Psychology?No.

If this is not what you had hoped for whenyou first entered into CounsellingPsychology how would you wish CounsellingPsychology to be shaped?For Counselling Psychology to continue inall but name it would need to return to itscore values, but I think this is very unlikely.Ironically the name will probably continuelong after the reality because it will beenshrined in the legislation for statutoryregulation.

What do you think would have to happen forwhat you predict to come about?A change to the philosophy behind the treat-ment of mental illness especially by the NHS.In short, to work holistically on the wholeperson rather than to objectify them into aset of symptoms.

With job insecurity, privatisation, short-term funding and the like comes a need forpeople to secure their positions, which leadsto acquiring and in turn respecting titles,status, etc., and above all regression to thenorm. Also, with a focus on short-term meas-urable outcomes comes a shift from dealingwith the underlying issues to dealing with thesymptoms, which is fine if the problem isshort-term but not if it is long-term or devel-opmental.

Unfortunately both major politicalparties are quickly going down this route inthis area as well as others, such as civil andhuman rights so that the likelihood of achange in direction appears remote.

David Giddings works as a Counselling Psycho-logist in a large Mental Health Trust in London.

10 Counselling Psychology Review, Vol. 24, No. 1, March 2009© The British Psychological Society – ISSN 0269-6975

Counselling Psychology and the next 10 years: Some questions and answersDavid Giddings

THE FIELD OF psychological therapies isgoing through a rapid transition, as theeffect of the implementation of

evidence-based practice in the public andprivate sectors becomes clearer. The resultalters the practice in all the psychologicaltherapies professions, towards a managedcare process, which uses diagnostic cate-gories and to select interventions. In somesectors this can restrict choice and innova-tion. This short invited paper is notevidence-based, but unfashionably draws onindividual experience and personal judge-ment. It will address these issues from anindividual and service perspective, consid-ering the implications for counsellingpsychologists, and offer a few suggestions toour still relatively new profession aboutsurvival within the field.

My own career in mental health andpsychological work spans 30 years so far, andI will indulge in a short narrative about thisto illustrate my perspective on the changes.Perhaps I should say first that I do notconsider that counselling psychology has amonopoly on anything in terms of philosophy, values or psychotherapeuticapproaches. I have learned this through myfirst profession, mental health nursing, aswell as counselling, counselling psychologyand psychotherapy trainings, and workingextensively over the years with clinical andcounselling psychologists, in a number ofdifferent clinical and academic settings. Theinfluences and tensions of the variousschools of psychotherapy and counsellingare present in all helping professions. Theyare present across professions, within organ-isations, services and teams. In the world of

psychological therapies, I believe it pays tobe ecumenical and not fundamentalist,inclusive and not schoolist. Cooper andMcleod (2007) have set out a pluralisticmodel, and have considered its implicationsfor research. It is similarly inclusive to myposition.

I started my professional life as a mentalhealth nurse. This gave me a chance to dosomething to help people, and I experi-enced success, which gradually helped me tobuild some confidence and skills. I can recalllittle of my training – although I doremember a day of psychodrama and asingle lecture on counselling. In spite of thislack of training, I discovered that being withpeople in distress was helpful. Peopleresponded (sometimes anyway) to a wetbehind the ears student nurse simplylistening to their concerns, and not runningaway from them behind tasks and proce-dures, as can happen in stressful mentalhealth care environments. I learned that agedoes not matter when it comes to helpingpeople. Later I discovered the humanisticmovement in mental health nursing, theconcept of the therapeutic use of self, andtherapeutic communities. Independentstudy gained me a place at university on afull grant to do a psychology degree as a so-called mature student at 23-years-old, real-ising a long-held ambition. The ideas fromnursing shaped my choice of undergraduatepsychology dissertation, where I was eager toapply my knowledge to the real world. Thetopic I chose was nurse-patient relationshipsin acute psychiatric settings. I tried to inves-tigate and contrast the experiences of bothnurses and patients, the two sides of the


Adapt, research and survive! Taking Counselling Psychology forwardinto the next decadeRuth Jordan

therapeutic coin. I was struggling with thepractice of how to be helpful to people indistress, how to investigate it, and how totheorise it, and finally, how to apply thatknowledge to be helpful effectively.

The unsophisticated and ill-informedstruggle I undertook 25 years ago I believedemonstrates that little has changed. I amstill pre-occupied with making sense ofhelping relationships and how to amelioratedistress effectively. Many hours of practicewith clients do not bring certainty aboutthese things, to this practitioner at any rate.As a community, though, I believe that thehelping professions still do not know enoughabout how to conceptualise, research andinvestigate how to help people in distress.We still have a large number of contrastingand conflicting theoretical ideas about thenature of distress, and the processes ofchange for human beings coming out ofdistress. We still do not know enough aboutwhat it is to be therapeutic and to knowwhen we have achieved it. Our field becomesever more complex, though we do knowmore than we did in 1983 when I started didmy undergraduate dissertation. It is notnecessary to summarise the developmentshere, as many better authors have tackled italready, such as Roth and Fonagy (2006).

The current orthodoxy is that of theestablishment of good practice throughmultiple randomized control trials. This hasmeant that idiosyncratic practices inpsychotherapy I encountered in the late1970s and early 1980s are out of fashion,discouraged. Evidence-based practicecontains an ethical imperative: if it works, weshould be providing it. Outcome takes prece-dence over process. Cognitive behaviourtherapy is ahead of the rest of the therapiesin this regard, so it gets preferential treat-ment by those who fund therapy, publicallyand privately. This is how it is, although thepluralistic counselling psychologist, or onewho prefers to practice models other thanCBT, might wish that it were different. It is apowerful orthodoxy, and whole services aredesigned based on this orthodoxy: early

interventions in psychosis is one, IAPTanother. However, orthodoxy should be chal-lenged, and there is a need for alternativeviews. A colleague from RoehamptonUniversity, Richard House, is particularlygood at providing these. His view on this is:‘You are either outside the tent p***ing in orinside the tent p***ing out.’ There are coun-selling psychologists in both positions, tryingto remain on speaking terms. We need thedebate to continue, but we also need to earna living. Individuals have to make choicesabout where to position themselves, insideor outside the tent. Both are to some extentuncomfortable.

Disconcertingly for the helping profes-sions, people get better without intervention.They also move forward with the newestdevelopments of the day, the psychologicalinterventions with less reliance on thera-peutic relationships. An example of this is thelow intensity work in IAPT. It will be sometime before we gather sufficient informationabout both the effectiveness of this and theacceptability to the client group. In this initia-tive the difference between the two is that inlow intensity interventions, the principles ofCBT are learned by clients for self-help,psycho-education, with the support of a lessqualified member of staff. This has beenworking, unacceptable to some as it is. I haveheard anecdotal reports from GPs whodelighted to find out useful computerisedCBT is to some clients, besides the researchevidence which already supports this inter-vention which cannot be ignored. This is notabout watering things down or depersonal-ising our work, but about reaching morepeople in way that is acceptable to them. Thehigh intensity interventions involve indi-vidual therapy, which is formulation driven –this is the personal, individual element. Prac-ticed well, CBT is creative, individual, and, orit could not be effective, relational. You cantell by now where I am in the tent scenario.However, I have no wish to be destructive ofmy colleagues outside it, and maintainalliances and conversations with many whotake different positions.


Ruth Jordan

Efforts to establish a separate, distinctiveprofessional identity are problematic, evenmisguided, though I may be unusual inholding this view, not to mention unpopular.Peeing into the tent perhaps? My view is thatefforts to establish the distinctiveness ofcounselling psychology tend to be inwardlooking and unproductive. Our history isthat of psychology graduates who wereinvolved in the counselling movement, wholooked for a way to get established profes-sionally. Our identities are varied accordingto individual experience, orientation totherapy, and preferences. My observation isthat what many have done is to use theirchartership as a counselling psychologist as alicence to practice. They get qualified, andmove on into other related fields: coaching,supervision, academic management, inde-pendent practice and consultancy. This is agrowing market as I have shown elsewhere inthis paper, in spite of the economic situation.Few of us remain and contribute to theprofession at a senior level by doingresearch. The area in which counsellingpsychologists are strongest is practice.Having been involved in counsellingpsychology training since 1993, trainees aremainly interested in the practice of theprofession, more so than doing theirresearch. To be fair, many clinical psychologytrainees say the same thing, and their careerpaths bear this out. Apologies to those whoare enthusiastic and committed researchstudents of counselling psychology – weneed you. However, it is a hard truth – thearea in which we are weakest as professionalgroup is research.

Psychologists and other professionalswith doctorates will be required to use theirresearch skills, not only their practitionerskills, or opportunities for work at highergrades will not be open to them. The NHS asan employer is flattening hierarchies andreducing the power of the professions.Applied psychologists as a group are lessinteresting and important than we used to bein this environment. Many others are waitingin the wings to get involved in psychological

therapies and training for them is beingfunded through the IAPT initiative, amongstother initiatives (see the New Ways ofWorking material on the Society’s website fordevelopments). The Government wantsplenty of Indians to do the psychologicaltherapy, and only a few chiefs to superviseand manage services. Increasing this willrequire research involvement, as the NHSbecomes a more research-driven organisa-tion (Department of Health, ResearchGovernance in Health and Social Care,2008). The ethical requirement will be notonly to practice evidence-based psycholog-ical work, but also to produce the evidenceitself. The NHS will in due course becomelike higher education, a place where part ofthe output is research, and pressure isapplied of staff to produce it. The Society inits wisdom has introduced doctoral leveltraining, and risks pricing itself out of themarket, whilst maintaining its standards.NHS services are full of many competent andhelpful practitioners without doctorates, andindeed without psychology degrees. Theircontribution is valuable, not to say vital –doctorates are not needed to be a goodpsychological therapist. Are they needed tobe an applied psychologist? I have managedwithout one so far. However, the researchskills can and should mark us out at char-tered level, doctorate or no doctorate.

So what happens next? My view is that thefuture is about adapting to the pressures ofthe field of work in order to be able topractice and develop the practice of others. I have practiced CBT for some years andknow that it works better than some otherapproaches for many clients. Psychologicaltherapies as a whole are valued more andmore and the IAPT initiative is a significantdevelopment. Many counselling psycholo-gists are finding work in this area, and it isone way to go for the future. Trainingprogrammes need to ensure that the corecompetences for CBT are delivered on theirprogrammes as one approach to therapy, inorder to help graduates find work shouldthey wish to be inside the tent. This crosses


Adapt, research and survive!

all types of contemporary NHS services, sothere should be good teaching about theorganisation of the NHS and how coun-selling psychologists are contributing to it.

Secondly, to survive as a profession, weneed to encourage individuals who areresearch orientated to take that forward.Like New Ways of Working, I suggest that weneed researchers at different levels – senior,inspirational talented individuals, andcollaborative research in teams. This wouldrecognise that not all of us can operate at thesame level in terms of practice, theory andresearch, but can contribute. In my experi-ence higher education is poor at this as indi-viduals want to develop their own careersand are not collaborative, and researchmentorship is hard to find. Perhaps the NHSwill foster its researchers more successfully,be less competitive and more collaborative?Let’s hope so. Outcome research is one way,but also process research is vitally importantto look at the subtle areas in between. Thisway the debates between orthodoxy and thealternatives can be fostered, kept live andproductive. There are numerous areasaround the practice of the helping profes-sions that are under-researched: aspects ofeffective teaching of the psychotherapies,supervision, the nature of reflective practice(potentially a self-serving practice and badlyunderstood), the impact of supervision andteaching on practice, the selection oftrainees for counselling psychology (or otherpsychotherapeutic training), the acquisitionof competence in psychological therapy arebut a few.

So the future is bright and varied forcounselling psychologists, if we adapt to theopportunities the political situation providesus with, are prepared to operate at differentlevels according to our skills at the differentaspects of our work, and urgently foster anddevelop talented researchers and collabora-tive research in order to survive as a separatediscipline in the field.

CorrespondenceRuth JordanChartered Counselling Psychologist,Berkshire Healthcare IAPT Service,Dukesbridge House,23 Duke Street,Reading RG1 4SA.E-mail: [email protected]

Ruth Jordan was until recently a Senior Lecturerin Counselling Psychology at Roehampton Univer-sity. She is now employed by Berkshire HealthcareNHS Foundation Trust in the Talking TherapiesService, which is part of the IAPT initiative.

ReferencesCooper, M. & McLeod, J. (2007). A pluralistic

framework for counselling and psychotherapy:Implications for research. Counselling andPsychotherapy Research, 7(3), 135–143.

Department of Health (2008). Research Governance inHealth and Social Care: NHS Permission for Researchand Development Involving NHS Patients (2nd ed.).London: DoH.

Roth, A. & Fonagy, P. (2006). What works for whom? A critical review of psychotherapy research (2nd ed.).New York: Guilford.


Ruth Jordan


What for you is the essence of CounsellingPsychology?Relational therapy in the context of psycho-logical discipline.

If you could look into a crystal ball whatwould Counselling Psychology look like in 10 years time?Still struggling, but more surefooted aboutits blend of emphases.

Will this be what you had hoped for whenyou first entered into CounsellingPsychology? I had hoped for something more vigorousand with less apologetic leadership.

If so what would you value most about this?N/A

If this is not what you had hoped for whenyou first entered into CounsellingPsychology how would you wish CounsellingPsychology to be shaped?We need to develop a confidence and a self-valuing that is less apologetic.

What would you value most about this?I would like to feel proud of what I am doingin the sure knowledge that I am accompaniedby differentiated, sometimes opinionated,and always energetic fellow-professionals

What do you think would have to happen forwhat you predict to come about?We need to get over any in-fighting. Nurtureour conferences and our publications, andabove all respond to leadership and grass-roots with respect and with integrity. Weneed to rediscover our democratic spirit.

Peter Martin is an academic Counselling Psycho-logist and works in private practice.

Counselling Psychology and the next 10 years: Some questions and answersPeter Martin

Background: Policy initiatives inpsychosocial carePsychosocial approaches to the delivery ofcare are central to a wide range of currentpolicy developments. Many recent reports byprofessional bodies, strategy documentsfrom policy makers and proposed changes inlegislation emphasize the role of psycholo-gists and of psychological perspectives inmental health. Psychological models ofdistress, such as the mediating psychologicalprocesses model (Kinderman, 2005a;Kinderman & Tai, 2006; Kinderman, Sell-wood & Tai, 2007, Kinderman, in press),support an unapologetically psychosocialmanifesto for mental health care.

This emphasis on psychosocialapproaches can be seen in the currentDepartment of Health review of the NationalService Framework (NSF) for Mental Health(Department of Health, 1999) – a piece ofwork referred to as ‘New Horizons’. Currentindications are that the psychosocialperspective seen in the original NSF will beenhanced and developed. Once again,

psychosocial approaches are emphasisedand reinforced. It is noticeable, however,that contributors – including the BritishPsychological Society – have responded bywelcoming the general thrust, not by advo-cating for protectionist measures for anyparticular profession. The British Psycho-logical Society response (Kinderman & Tai,2008) recommends that continued invest-ment in mental health services shouldremain a priority for Government, butservices should be planned on the basis ofneed and functional outcome rather thandiagnostic categories. We suggest thatmental health services should fully embracethe recovery approach, and services shouldbe commissioned on the basis of individualsocial need and functional outcome as muchas on the basis of ‘treatment’ and clinicaloutcome. New assessment and evaluationframeworks should, we recommend, bedeveloped to match these priorities. In thesame vein, we recommend that there shouldbe an emphasis on and investment inpreventative and health promotion work,


The future of Counselling Psychology:A view from outsidePeter Kinderman

Counselling Psychologists, individually and collectively, contribute hugely to the delivery of psychologicaltherapies in the NHS and more widely. The significant and welcome emphasis on psychosocial and ‘well-being’ approaches from Government and the wider civic society implies that this contribution byCounselling Psychologists will continue and grow. But this apparently positive picture also contains verysignificant threats for the ‘profession’ of Counselling Psychology. Counselling Psychology is – in reality andin the policy-making, regulatory and commissioning spheres – a branch of psychology, and indeed acomponent of psychosocial services. In that context, the major issue for Counselling Psychology to addressis the manner in which the competencies of Counselling Psychologists are generic and shared (shared withother caring professions, shared with psychosocial professionals, shared with psychological therapists andshared with other branches of professional psychology) versus specific to the ‘profession’. It may be a matterof some concern to Counselling Psychologists that the ‘Venn diagram’ of overlapping competencies leaveslittle apparent unique territory for Counselling Psychology. In particular, the overlap between Clinical andCounselling Psychology is preternaturally close. The future, then, for Counselling Psychologists may,therefore, best be secured through reversing the historic split between the branches – even if that meanspermitting Clinical Psychology to assimilate Counselling Psychology.

with particular attention to adolescentmental health.

Clearly, were such recommendations tobe acted upon, psychologists should see theirroles develop and strengthen as clinicalleaders in psychological therapies and thescientific evidence base for psychologicalmodels. We recommend that such therapiesneed to incorporate ‘stepped care’ princi-ples, but guided by expert assessments andbased on psychological formulationsaddressing a person’s wider well-being.People have a right to expect the NHS todeliver those evidence-based, effectivepsychological therapies recommended byNICE – and for these to be delivered bycompetent therapists.

The psychosocial aspects of health caredelivery are again stressed; mental healthservices, together with JobcentrePlus andindependent sector employment providers,should, we recommend, help clients toreturn rapidly to work wherever possible,and to keep them in work. Discriminationagainst people with mental health problemsshould be as unacceptable as racism orsexism, and services should adhere to theprinciples of Fairness, Respect, Equity andDignity – the FRED principles – to helpensure human rights compliance. Servicesneed to facilitate genuine service userinvolvement; service users and carers shouldbe involved at the outset in setting strategiesfor mental health services, and in theproduction and monitoring of all compo-nent policies.

In a radical move, the British Psycho-logical Society does recommend thatCentres for Psychological Health and Well-being should be established in all major UKtowns. These would be new entities, butwould largely incorporate services alreadypresent (or planned) within the NHS andrelated social care and educational services,as well as the agencies of the Department forWork and Pensions. They would, therefore,predominately constitute a re-organisationof existing services; although investment innew provision is also proposed. Such centres

should be integral elements of the NationalHealth Service, and would be one-stop shopsfor mental health care, employmentsupport, educational support, forensicmental health services, and liaison withmainstream healthcare services.

Clearly, then, the existing and recom-mended policy framework, therefore,strongly emphasises psychosocialapproaches and – implicitly – the approachof most counselling psychologists. It explic-itly does not permit counselling psycholo-gists to claim exclusive ownership of thisterritory, however. Instead, explicitly, suchroles and competencies are considered to beshared by many professions.

Psychologists and the delivery ofpsychological therapiesService users increasingly demand psycho-logical therapies of a variety of forms (Sains-bury Centre for Mental Health, 2006) whichhas been reflected in the media (Pidd,2006). Policy directives reflecting thedemonstrable effectiveness of manualisedpsychological therapies such as cognitivebehavioural therapy (CBT) in randomisedcontrolled trials (summarised in numerousNICE recommendations) and the likely cost-effectiveness of investment in this area(Layard, 2004, 2006; Centre for EconomicPerformance, 2006; Department of Workand Pensions, the Department of Health andthe Health and Safety Executive, 2006)support these demands. The well-publicisedImproving Access to Psychological Therapies(IAPT) Programme (Department of HealthPress Release, 2006) is now actively imple-menting strategies to manage the develop-ment of psychological therapy services(Turpin et al., 2006).

Currently, Skills for Health is consultingwith professional bodies and relevant stake-holders to validate the Knowledge and SkillsFramework for Mental Health (Skills forHealth, 2006) as it relates to this issue, todevelop a set of National Occupational Stan-dards for psychological therapy, and to estab-lish career frameworks for psychological


The future of Counselling Psychology: A view from outside

therapists. This work is closely allied to thepolicies in respect to the regulation of medicaland non-medical professions (Department ofHealth, 2006). The New Ways of WorkingProgramme (National Institute for MentalHealth in England, 2004) has outlined thedistinctive contributions of a range of profes-sions to multidisciplinary working in mentalhealth. It is explicitly recognised that whilstmany professions in mental health services arehighly competent in the use of psychologicalinterventions, psychologists are unique inhaving a single focus on psychologicalprocesses and the systematic study of mindand behaviour throughout a lengthy and high-level training path.

Possessing competencies in the deliveryof psychological therapies is, therefore,different from being registered as a prac-ticing psychologist – of whichever branch.Competency in clinical case formulation iscentral to a psychologist’s distinctive contri-bution to mental health care (Quality Assur-ance Agency for Higher Education, 2004;National Institute for Mental Health inEngland, 2004; British Psychological SocietyDivision of Clinical Psychology, 2001). Butmany professions in mental health care use(or claim to use) ‘formulations’, and formu-lation is considered an integral part of CBTwhichever professional is practicing it(Morrison, 1991).

Once again, then, the competenciespossessed by counselling psychologists arecentral to these policy drivers, but coun-selling psychologists themselves cannotregard their jobs to be protected. Thecompetencies and approaches are verystrongly supported; but this does not at allimply that one particular professional groupis guaranteed its future.

Statutory RegulationThese issues come to a head with the Statu-tory Regulation of psychologists. Two imme-diate issues arise. First, the currentconsultation over regulation of psychologistsvia the Health Professions Council (HPC)does speak to the future of counselling

psychologists by virtue of the fact that ‘coun-selling psychologist’ is one of the sevenadjectival titles to be protected by theCouncil (clinical, counselling, educationalforensic, health, occupational, and sportsand exercise psychologists). This reflects thecurrent and immediate future status of coun-selling psychology. But it does not speakclearly to the medium and longer-termfuture.

Second, although it would have beenpossible – and may have been advisable – forpsychologists to have addressed the complexand contentious issue of the distinctive andshared competencies across the Society’sDivisions of applied psychology, the adventof HPC regulation permits a detailed anddispassionate review of the issue.

The Statements of Proficiency used by theHPC offer a clear architecture of the regula-tory system as it applies to the competenciesof counselling psychologists. Generic compe-tencies apply to all registrants under theHPC. These encompass, and subsume, someof the competencies of counselling – and allother – psychologists, and include issues ofethical practice, respect for human rights,etc. Below this level, all registrant counsellingpsychologists must possess a set of competen-cies common to all psychologists – i.e. sharedby all the seven specific branches ofpsychology. Below that, there are sevenspecific sets of competency – such that thecompetencies of counselling psychologistsare not identical to those of, for example,forensic psychologists. To be clear, a coun-selling psychologist must, therefore, possess:(a) HPC generic competencies; (b) genericpsychology competencies; and (c) specificcounselling psychology competencies.

This leads to two potential issues –threats, if you like – for counselling psycho-logists. First, to what extent do these compe-tencies overlap with other professions?Second, to what extent do these competen-cies overlap with other branches ofpsychology?

The generic pan-HPC competencies canbe discounted, as they set out what is


Peter Kinderman

expected of any health professional. Theearlier discussion of psychological therapiesindicates that there is discussion over thepresumed considerable overlap between thecompetencies of various forms of psycholog-ical therapist, counsellor, psychotherapistand counselling psychologist. This overlapwill be specifically addressed, and clarified,over the next few months and years as regu-lation – and associated Statements of Profi-ciency – will be developed for these groups.Indeed, a Professional Liaison Group hasalready been convened by the HPC to takeforward this issue for psychotherapist andcounsellors and Skills for Health haveopened consultation on the National Occu-pational Standards for psychological thera-pists. In that context, we can see thepossibility of very considerable overlapbetween the competencies of these groupsand the competencies of counsellingpsychologists.

The picture for counselling psychologistsis also difficult in respect to the overlapbetween the competencies for counsellingpsychologists and clinical psychologists.Although there is little doubt that coun-selling psychology will be recognised by theHPC, the future is more doubtful. A simpleanalysis of the statements of proficiencydrafted by the HPC reveals that 79 comprisethe generic HPC standards, 17 are generic toall the psychologist divisions, but then 23 ofthe remainder are exact duplicates, sharedby up to five of the seven divisions (and mostcommonly shared by counselling andclinical psychologists). Furthermore, manyof the other (non-identical) statements areso similar in wording as to be consideredoverlapping in content. For example, while aspecific competency for counsellingpsychology is; ‘be able to conduct psycholog-ical assessments and make formulations of arange of presentations’, clinical psychologyincludes; ‘be able to develop psychologicalformulations using the outcomes of assess-ment, drawing on theory, research andexplanatory models’. There appears consid-erable (potential) overlap.

TrainingThe competency framework of the HPCrelates, of course, to training. In 2005, I published (Kinderman, 2005b) a review ofthese issues and recommended a radicalapproach to professional training of allapplied (i.e. all HPC-registered) psycholo-gists. I recommended that training be regu-larised into a modularised doctoral-leveltraining programme in which generic skillsand knowledge bases would be developedfor all relevant psychological branches, withcomplementary specific training for eachbranch of psychology.

Clearly, if the competency framework ofcounselling vis-à-vis other psychologists (aswell as vis-à-vis other professions) impliesconsiderable overlap in competencies, theoverlap in training is considerable too. Atpresent, the training route for counsellingpsychology is rather different to that ofclinical psychology and indeed the otherbranches of applied psychology. Regardlessof any plans envisaged for future trainingmodels, there must be an open question asto the continuing sustainability of thistraining. And, of course, if it is perceived thatthe specific and distinctive set of competen-cies possessed by counselling psychologists israther small, then the differential benefit ofthe training route for counsellingpsychology becomes marginal.

This does not mean, however, the death-knell for counselling psychology trainingroutes. It does mean change, but thatchange may be minimal, straightforward andevolutionary. If, as I believe, the competen-cies of counselling psychology map closelyonto other branches of psychology, themarginal difference is (by definition) small.That means that the difference between‘meeting the HPC accreditation require-ments for training in counselling psychol-ogy’ and ‘meeting the HPC accreditationrequirements for training in clinical psychol-ogy’ may be very small. It follows that itwould not be difficult for training courses totransform.



ConclusionsThere are two possible conclusions. The firstis that, despite the overlap between thecompetencies of counselling psychologistsand counsellors, counselling psychologistsand psychotherapists, counselling psycholo-gists and psychological therapists, coun-selling psychologists and other branches ofpsychology and finally counselling psycholo-gists and clinical psychologists, thereremains an area of specificity remaining forcounselling psychology. The other possibilityis that, in this picture, all areas of the coun-selling psychologist’s competency are, infact, subsumed within the competency set ofother professions.

The future of counselling psychologyrelies on what perception is dominant. In myopinion, the most likely outcome is thatpolicy-makers, regulators, commissioners andindeed other psychologists will conclude thatthe competencies of counselling psycholo-gists are indeed fully subsumed by otherprofessions. In that picture, many of thecompetencies of counselling psychologistswould be found within, variously, counsellors,psychological therapists, psychotherapistsand – to a very large degree indeed – clinicalpsychologists. This view will, I believe, be crys-tallised and clarified when the HPC assumesresponsibility for regulating these profes-sions. In particular, I think that any distinc-tions between counselling and clinicalpsychology are becoming nugatory.

While it may be appropriate to commis-sion counselling psychology services, if thecompetencies of counselling psychologymap onto the specific needs identified in aparticular service, I believe that it will bemuch more likely that these other profes-sions or branches of psychology will becommissioned. So … in 10 years time … I suspect there will no longer be manypeople registered with the HPC as ‘coun-selling psychologists’. For individuals, thatwould mean that they would either pursueregistration in another branch of psychologyshould their experience and qualificationsequip them so to do or pursue a course of

further training and study to develop theircompetencies to that end. In 10 years time, I suspect that few people will find it useful topursue initial training in counsellingpsychology and I suspect that existingtraining schemes for counselling psychologywill transform so as to meet the accreditationcriteria for clinical psychology – a processpoliced (efficiently) by the HPC. To reflectthese developments, I believe that within theSociety the Division of CounsellingPsychology will have re-merged with the Divi-sion of Clinical Psychology. I do, however,believe that individual practitioners of coun-selling psychology will survive and indeedbenefit from these developments.

CorrespondenceProfessor Peter Kinderman,School of Population, Community & Behavioural Sciences,Whelan Building,University of Liverpool,Liverpool L69 3GB.

Peter Kinderman is Professor of Clinical Psychologyat the University of Liverpool, and an honoraryConsultant Clinical Psychologist with Mersey CareNHS Trust. His research activity and clinical workconcentrate on serious and enduring mental disor-ders such as schizophrenia, bipolar disorder andpersonality disorder, and on how psychologicalscience can assist public policy in health and socialcare. Professor Kinderman is Head of the School ofPopulation, Community and Behavioural Sciencesat the University of Liverpool, which comprises theDivisions of Clinical Psychology, Psychiatry,Primary Care, Public Health and Clinical Effec-tiveness. He sits on the Department of Health’sMental Health Advisory Group and the New Waysof Working National Steering Group. ProfessorKinderman chairs the British Psychological SocietyStanding Committee for Psychologists in Healthand Social Care, and is Policy Director for theBritish Psychological Society Division of ClinicalPsychology. Professor Kinderman is also a member ofthe Health Professions Council’s ProfessionalLiaison Group for applied psychology and chairs theHuman Rights Committee of Mental Health Europe


Peter Kinderman

– Sante Mentale Europe (a European umbrellaNGO and the EU Liaison Office for Mental HealthPromotion).



ReferencesBritish Psychological Society Division of Clinical

Psychology (2001). The core purpose and philosophyof the profession. Leicester: British PsychologicalSociety.

Centre for Economic Performance (2006). TheDepression Report: A new deal for depression andanxiety disorders. London School of Economics.

Department of Health Press Release (2006).www.dh.gov.uk/PublicationsAndStatistics/PressReleases/PressReleasesNotices/fs/en?CONTENT_ID=4134785&chk=HKLLdo

Department of Health (1999). National serviceframework for mental health. Modern standards andservice models. London: Department of Health.

Department of Health (2006). The regulation of thenon-medical health care professions: A review by theDepartment of Health. London: Department ofHealth.

Department of Work and Pensions, the Departmentof Health and the Health and Safety Executive(2006). Health, work and well-being – Caring for ourfuture. A strategy for the health and well-being ofworking age people. London: Department of Workand Pensions, the Department of Health and theHealth and Safety Executive.

Kinderman, P. (2005a). A psychological model ofmental disorder. Harvard Review of Psychiatry, 13,206–217.

Kinderman P. (2005b). The applied psychologyrevolution. The Psychologist, 18(12), December,744–746.

Kinderman, P., Sellwood, W. & Tai, S. (2007). Serviceimplications of a psychological model of mentaldisorder. Journal of Mental Health, 17, 93–103.

Kinderman, P. & Tai, S. (2006). Clinical implicationsof a psychological model of mental disorder.Behavioural and Cognitive Psychotherapy, 35, 1–14.

Kinderman P. & Tai, S. (Eds.) (2008). Psychologicalhealth and well-being: A new ethos for mental healthcare; a new service structure. Leicester: BritishPsychological Society.

Kinderman, P (in press). Understanding andaddressing psychological and social problems:The mediating psychological processes model.International Journal of Social Psychiatry.

Layard, R. (2004). Mental Health: Britain’s biggest socialproblem? Cabinet Office Strategy Unit: December.www.strategy.gov.uk/ downloads/files/mh_layard.pdf

Layard, R. (2006). The case for psychologicaltreatment centres. British Medical Journal, 332,1030–1032.

Morrison, A.P. (2001). A casebook of cognitive therapy forpsychosis. Oxford: Routledge.

National Institute for Mental Health in England(2004). Guidance on new ways of working forpsychiatrists in a multi-disciplinary and multi-agencycontext. London: National Institute of MentalHealth in England.

Pidd, H. (2006). A little more conversation. The Guardian, Friday 30 June.www.guardian.co.uk/g2/story/0,,1809389,00.html

Quality Assurance Agency for Higher Education(2004). Benchmark Statement: Health CareProgrammes, Phase 2, Clinical psychology.Gloucester: Quality Assurance Agency for HigherEducation.

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Skills for Health (2006). Career framework for health:Validation process. London: Skills for Health.www.skillsforhealth.org.uk

Turpin, T., Hope, R., Duffy, R., Fossey, M. & Seward,J. (2006). Improving access to psychologicaltherapies: Implications for the mental healthworkforce. Journal of Mental Health WorkforceDevelopment, 1(2), 7–15.


What for you is the essence of CounsellingPsychology?Bringing counselling (and psychologicaltherapies in general) and psychologytogether; Humanistic value base; research.

If you could look into a crystal ball whatwould Counselling Psychology look like in 10 years time?Higher standards of competency whilstvaluing diversity; competency-basedapproaches that value diversity; adapting tothe constantly changing environment.

Will this be what you had hoped for whenyou first entered into CounsellingPsychology? If so what would you value mostabout this?Strengthening the link between counselling(and psychological therapies in general)with psychology and the reverse.

What do you think would have to happen forwhat you predict to come about?More research on Counselling Psychologistsand by Counselling Psychologists to bepublished (it is surprising as to how comethe research of trainee counselling psycho-logists is not published and freely accessible,when we take into account that CounsellingPsychology accepts that research competen-cies are core competencies); Better commu-nication of our contributions.

Pavlo Kanellakis is a Consultant CounsellingPsychologist working in the NHS.

Counselling Psychology and the next 10 years: Some questions and answersPavlo Kanellakis

Under-investment in mental healthservices

LTHOUGH PSYCHOTHERAPIES andpsychological interventions have been

well-established and indeed recog-nised by the Department of Health (DH,2001, 2004), the investment in the properdelivery of these services was frequently inad-equate and rarely treated as a priority butusually left as the cherry on top of thefunding cake. The usual position has been‘desirable but probably not essential’, espe-cially if budgets were tight. To a degree thishas reflected under-spending on mentalhealth problems generally, and governmentsin many countries stand accused of under-providing the supply of effective care topeople with mental health problems. Forexample, a recent policy paper (Chisholm etal., 2007) in The Lancet, which argues formore effective socio-political action byprofessionals and voluntary bodies, esti-mated that 27 per cent of people experi-enced a mental health problem but 74 percent received no adequate treatment in themajority of European counties.

Within the UK we have seen a number ofresponses to the under-funding of mentalhealth services. Firstly, there have been stren-uous and co-ordinated efforts to improve theprovision of care for people experiencing

enduring mental health problems such aspsychoses, bipolar disorders and personalitydisorder. These have largely resulted fromthe publication of the National ServiceFramework for Mental Health (DH, 1999)and subsequent review (DH, 2004) whichsaw the establishment of community-basedassertive outreach teams and early interven-tion services for people with psychoses.Although many of these recent develop-ments, strictly only apply to England due tothe separate nature of our health caresystems across the devolved nations, similarimprovements in service provision havetaken place across the UK generally. Thefocus on improving community mentalhealth services, particularly those focused onpeople with serious mental health problemswas a consequence of the roll out of care intothe community and the closure of the oldlong-stay hospitals.

Services for people with commonmental health problemsThe increased attention to service provisionfor those with serious mental healthproblems is clearly to be welcomed, however,it raises questions as to how the relativelyscarce resources devoted to mental healthare distributed. Whereas the prevalence ofanxiety and depression accounts for around


The future world of psychologicaltherapies: Implications for counsellingand clinical psychologistsGraham Turpin

We live in interesting times whereby a decade or two ago, psychological therapy services were a Cinderellaservice, playing second fiddle to psychiatric care and medication. Today and hopefully well into the future,there has been an unprecedented recognition of the unmet need experienced by many people attending theirGPs who are either in emotional distress and/or with mental health difficulties, and a consequent majorinvestment in the provision of psychological therapy services. Within this paper, I aim to account for thereasons why this change has come about and also to discuss the far-reaching implications for counsellingand clinical psychology as professional groups located within the NHS.

A

15 per cent of the population, and 17 percent of recorded disability, the servicesprovided for these people account foraround two per cent of the NHS (Hague &Cohen, 2005; Layard, 2005, 2006; Layard etal., 2007). This has lead many people to askthe question about how adequate has beenour provision of services to people withcommon mental health problems such asanxiety and depression. Hague and Cohen(2005) in their report published by theSainsbury Centre for Mental Health, citesome stark statistics about the coverage ofmental health service provision withinprimary care. Whereas, around 30 per centof GP consultations can be considered tohave a mental health component, only eightper cent of attenders are referred to aconsultant psychiatrist and less than threeper cent to a psychologist. Although manyprimary care attenders would wish a psycho-logical intervention, the majority of GPsconsider themselves unable to access such anapproach and the majority of attenders havehad a choice of either medication, a fewsessions of counselling or a protracted stayon a waiting list for psychotherapy. They alsoreport that the drug budget for antidepres-sants alone at the time of their review was£338m and rising. This is in contrast to thelack of provision of ‘talking therapies’ whichleads to poor choice and inadequate accessto services. The lack of provision of ‘talkingtherapies’ has also been highlighted innumerous campaigns by mental health char-ities (e.g. We need to talk: SCMH, 2006a;2006b; Rankin, 2005; Wooster, 2008). More-over, whilst serious mental health problemshave grabbed the attention of the public,policy makers and politicians alike, due tothe frequent and obvious disability anddistress experienced by these individuals andtheir relatives, together with somewhatmisplaced concerns about dangerousnessand public safety, the pendulum is in fullswing as regards the consequences ofcommon mental health problems.

Why has there now become a renewedinterest in primary care mental health?

Many psychologists were involved in theestablishment of primary care mental healthservices a decade or so ago but have beendirected recently by commissioners andservice managers to dealing with referralstypified as being more ‘serious’ or complex.Primary care mental health has itself devel-oped through psychiatry liaison services(Gask & Croft, 2000) and also the growth ofgraduate mental health workers (Harknesset al., 2005). Consequently, psychology withsome notable exceptions, has not been at theforefront of these developments and indeedfairly recent guidance on the provision ofprimary mental health care by the CareServices Improvement Partnership (CSIP,2006) only mentions psychology services inthe context of secondary care. Indeed, thisreflects the relatively recent demands ofmental health managers and commissionersto direct psychologists to work with peoplewith more complex and severe mentalhealth problems, usually within the contextof mental health trusts. Despite these recentdevelopments in primary mental healthcare, the issue of access to evidence-basedpsychological therapies still presents a verysignificant problem both in terms of qualityand access to services. As Hague and Cohenso cogently argue, the majority of patientswho present with mental health problemswithin primary care are denied choice oraccess to psychological interventions.

The situation that psychologists are nowcurrently faced with, however, has changeddramatically. A number of factors havecontributed to a renewed interest in howeffective is the delivery of primary careservices for common mental healthproblems. The first, as emphasised earlier,concerns an epidemiological approach toplanning service provision and is based onthe overwhelming numbers of people whopresent to primary care, especially withanxiety and depression (Boardman &Parsonage, 2007; Bower & Gilbody, 2005a;Hague & Cohen, 2005). Rather than thetraditional psychotherapy outpatient modelwhereby clients are referred by their GP to a


Graham Turpin

psychology or psychotherapy service offeredby an extensively trained therapist, andplaced on a waiting list for both assessmentand treatment, more recent service modelssuch as stepped and/or collaborative care(Bowers & Gilbody, 2005; Richards & Suck-ling, 2008; Turpin et al., 2006, 2008) haveadvocated the use of brief interventionsfocusing around medication management,supported self-help, computerised CognitiveBehaviour Therapy (CBT) or behaviouralactivation. Such brief interventionspresented in the context of ‘Stepped Care’,whereby the least burdensome interventionis offered first and coupled with regularreview and ‘stepping up’ for those clientswhere such interventions are insufficient,pose marked advantages for the overall effi-ciency of the service in reducing waitingtimes and allowing greater patient flowsthrough the system. This is because briefinterventions require fewer sessions and canbe delivered by less extensively trained staff,such as graduate mental health workers.Moreover, such interventions may also bedelivered within non-NHS settings and ‘out-of-hours’ which may reduce the stigmaperceived by clients.

Although stepped care provides a moreefficient service model, the implementationof such models within services to meetpatient demand is still determined by theoverall level of resource. Some commis-sioners have approached this challenge byservice re-design, which has effectivelyshifted resources from secondary care toprimary care. However, this appears toassume that there is an overprovision ofpsychological interventions in secondarycare, which clearly is not the case since manyindividuals with serious mental healthproblems are also unable to access to talkingtherapies (Wooster, 2008).

Improving access to psychologicaltherapiesThe solution to this dilemma has been arecent Government initiative called theImproving Access to Psychological Therapies

(IAPT) programme, which has seen theplanned investment of around £300m intoprimarily primary care mental health servicesover the next three years (see DH 2007a, b, c,2008a, b, c). Why has the Governmentdecided to invest such a relatively large sumin these services? There are essentially threemain drivers (Layard, 2006). The first is apolitical emphasis on well-being and dealingeffectively with common mental healthproblems in order to promote well-beingthroughout the population. The second isthe impact of anxiety and depression ondisability and its consequences for employ-ment and welfare benefits such as incapacitybenefit. Surprisingly, common mental healthproblems account for the largest number ofpeople registered disabled and claimingbenefit. Moreover, their level of dysfunctionand disability usually results in either under-performance at work (i.e. presentism) asidentified by (SCMH, 2007) or the loss ofemployment or difficulties regaining employ-ment following recovery (Black, 2008). All inall, economists such as Lord Layard haveargued that the failure to provide adequatetreatments for people experiencing commonmental health problems has a significantimpact upon the nation’s wealth both interms of lost productivity, payment of benefitsand the provision of care and rehabilitationservices (Layard et al., 2007). However, thisargument by itself doesn’t necessarily identifya course of action reliant on greater invest-ment in psychological therapies. The tippingpoint has been the accumulation of evidencethrough clinical guidelines developed by theNational Institute of Clinical Excellence (e.g.NICE, 2004 a, b). Although the efficacy ofpsychological therapies has been well estab-lished for many years (Parry, 2000), invest-ment in these services has always beensubsidiary to more traditional aspects ofpsychiatric care such as medication. Theevidence accrued by NICE demonstratesconvincingly that for many conditions,psychological therapies compared to medica-tion are at least as effective, maybe moreeffective in the long-term and are probably


The future world of psychological therapies

safer (Pilling, 2008, but also see Nutt, 2008).So the case for investment in effective psycho-logical treatments, as recommended byNICE, in order to promote well-being,reduce distress and disability, and to allowpeople the choice of return to work and anopportunity to move off benefits, was hailedby its proponents as a ‘spend to save’ initia-tive which demanded Government action.

Implications for counselling andclinical psychology The emergence of IAPT has been hailed asboth an important opportunity and a seriousthreat for psychology services (ClinicalPsychology Forum, 2008). In terms of oppor-tunities and the recognition of the efficacyand demand for psychological therapies, it isentirely consistent with the profession’s long-standing arguments, as evidenced bypsychologists such as Mowbray, Parry andRichardson, over the years for greater invest-ment in psychology or psychological therapyservices (MAS, 1989; MPAG, 1990; DH, 2001,2004). The unmet demand for psychologicaltherapy services within mental health hasbeen documented both within (Lavender &Paxton, 2004) and outside the profession(Boardman & Parsonage, 2005; Glover et al.,2007). The threat, however, derives from thefact that psychologists no longer have apresumed monopoly over the delivery ofpsychological treatments within the NHS. Itcould be said that they never had such a posi-tion of supremacy given that manypsychotherapy services have been frequentlylead by consultant medical psychotherapists,that psychotherapy training and provision bynon-psychologists has a long history, espe-cially within the private sector, and thatother professions such as social workers andnurses have typically trained as family ornurse therapists, together with the emer-gence of counselling as a distinct profession.Moreover, the design of IAPT services hasbeen specifically underpinned by identifyingthe necessary competences of staff to deliverthe care pathways involved rather than iden-tify service provision by any one particular

profession (e.g. Roth & Pilling, 2007; Turpinet al., 2006). This emphasis on competencesis consistent with successive Government’sattempts to present rational systems of quali-fications and competency frameworks asenshrined by the work of Skills for Health(2006). Moreover, similar ideas have beenpromulgated within the NHS, first by thenow defunct Modernisation Agency and nowthrough the New Ways of WorkingProgramme of the National Institute ofMental Health England (NWW, 2005, 2007a,b). Within IAPT, interventions are deliveredaccording to the stepped care principle, andby a workforce divided into low and highintensity therapists. Training for both typesof interventions is closely defined and isopen to a wide range of mental healthprofessionals with varying degrees of experi-ence in either mental health or psycholog-ical therapies (DH, 2008c). Indeed, appliedpsychologists have also been subject to aNWW review leading to recommendationsfor the future development of the profes-sion, which we will return to later on. It isdifficult to ascertain currently the number ofpsychologists involved with the IAPTprogramme but we do know that the recruit-ment of high intensity trainees onlyaccounted for around 10 per cent fromapplied psychologists. It should be noted,however, that recruitment was notablyhigher in some SHAs (i.e. London) wheremore specifically targeted job-adverts andAgenda for Change Banding were employed(i.e. Band 7). It will be important for thesuccess of the IAPT programme, and also forthe sustainability of applied psychology, thatboth clinical and counselling psychologistsare actively involved in IAPT services (Clark& Turpin, 2008). In the short term, thisinvolves actively attracting and recruitingnewly-qualified applied psychologists toIAPT high intensity training courses.

Other challenges emerging within the NHSIn addition, to the emergence of IAPT withits multi-professional approach to the


Graham Turpin

delivery of psychological therapy services,other changes within the NHS have placedadditional pressures on the stability ofpsychology services. The NHS as a result ofthe recent reform programme (DH, 2005)has aligned funding to follow the patientthrough the introduction of ‘Payment byResults’, has emphasised the importance ofvalue for money and encouraged a commis-sioning process whereby providers have tocompete in terms of efficiencies andcommissioners have to demonstrate‘contestability’, patients are given a greatersay in services and offered more freedom ofchoice of proven therapies, and a greaterdiversity of provision is encouraged forservice providers which now include Foun-dation NHS trusts, NHS trusts, and thevoluntary and private sectors. For clinicalpsychology, the diversity of service providers,especially those outside of the NHS, repre-sents a sea-change in the philosophy ofservice provision. Clinical psychologists have,by and large, operated within the NHS andindeed their origins and training have beenvery much intertwined (see Turpin &Llewelyn, in press). This rather symbioticrelationship has operated successfully; theprofession has one of the highest staff reten-tion rates within the NHS (Lavender &Willis, 2007). Whether the profession isprepared for a more competitive andpossibly commercial environment with aplurality of service providers is one of thefuture’s main challenges. To support theprofession within such a changed environ-ment, the Division of Clinical Psychology hasoverseen a project specifically aimed atmarketing clinical psychology services (DCP,2008). How does counselling psychologystand in such a new business environment? It maybe that the traditional position ofcounselling psychology, straddling both theNHS and private practice, may mean that itis better placed to compete in such a newsituation. Nevertheless, the question arises asto whether applied psychologists providevalue for money when compared to othertherapists.

Comparisons of the costs of providingpsychological therapies is a key issue and onethat has been made easier to accomplishthrough the introduction of a new and trans-parent system of remuneration throughoutthe NHS; ‘Agenda for Change’ (DH, 2004c).Psychologists, relatively speaking, haveemerged reasonably successful whencompared to some other professionsfollowing assimilation to new pay scalespopulating bands 6 to 9. Indeed, the trans-parency of pay across different professionalgroups has lead to professional rivalry andresentment in some services, especially thoseinvolved with the delivery of psychologicaltherapies, where on the one hand nursemanagers and therapists can be banded atband 6 whereas consultant psychologists andpsychotherapists can be at band 9, and evenabove if medically qualified. Some haveargued that such a system is inherently unjus-tified since to a degree, many psychologicaltherapists could be said to be providing asimilar service to clients, and this has lead tothe consideration of ‘Career Frameworks’for psychological therapists whereby suchcomparisons can be made in terms ofcompetences and responsibilities held bydifferent practitioners (NWW, 2007; Skillsfor Health, 2006).

The future of applied psychology?The key question emerges, therefore,around what is distinctive or unique aboutan applied psychologist, compared to otherpsychological therapists? However, beforeanswering this, we need also to consider thecomparison of counselling and clinicalpsychology. These two traditions of appliedpsychology arose from very differentcontexts (e.g. NHS versus private practice)and philosophies (e.g. scientist practitionerversus reflective psychotherapist). Although,there have been notable differences in thescope of practice between counselling andclinical psychologists, especially in thebreadth of role offered and the breadth ofclient groups and clinical problems workedwith, the differences as reflected in proposed



Quality Assurance Agency benchmarks(www.qaa.ac.uk/academicinfrastructure/benchmark/health/clinicalpsychology.asp)and/or Professional Statements of Profi-ciency (www.hpc-uk.org/aboutus/consulta-tions/index.asp?id=48) have become lessand less over the recent past. Indeed, it hasbecome common for psychological therapyposts within the NHS to be advertised asopen to either clinical or counsellingpsychologists. The British PsychologicalSociety, itself, is also faced with a number ofexternal challenges arising from imminentexternal and statutory regulation of theprofession (DH, 2007d) by the HealthProfessions Council (HPC), together withEuropean models of accreditation ofpsychologists and psychotherapists whichmay well sit uneasy alongside the UK distinc-tion of counselling and clinical psychology. A major question, therefore, for the profes-sion is whether the continuation of thedistinction between counselling and clinicalpsychology is still a useful one? Indeed, thedisappearance of the terms CharteredClinical and Chartered Counselling Psychol-ogists due to their introduction as protectedtitles by the HPC, has prompted some topredict the disappearance of the Society’s‘Divisions’ and the emergence of perhapslarger representational bodies of appliedpsychologists based around the concept of‘Colleges’. Clearly, within uncertain times,there are opportunities for critical reviewand new thinking.

Perhaps one way to approach this ques-tion is to consider the question of addedvalue or a unique selling point for appliedpsychology. An answer to this question is verymuch how we define our role and ourapproach to therapy, relative to other thera-pists. Until recently, a distinctive feature ofboth counselling and clinical psychology wasthe ability of individual therapists to operateacross a range of therapeutic models andprovide an individually determined formula-tion. Counselling psychology has tradition-ally prepared its trainees with exposure to arange of therapeutic models whereas clinical

psychology had until recently through itsaccreditation process required courses toexpose trainees to a number of therapeuticmodels, although the specific requirementswere not clearly specified. This implicit focuson therapeutic eclecticism had in some waysbeen a strength of applied psychologytraining but has also been considered bysome as its Achilles Heel: ‘Jack of all tradesand master of none’ being the frequentlyquoted metaphor. Indeed, this approach wasenshrined in the Society’s Register ofPsychologists Specialising in Psychotherapy(RoPSIP; www.bps.org.uk/e-services/find-a-psychologist/register/register_home.cfm),which was based on standards of sharedgeneric psychotherapeutic and psycholog-ical principles, as opposed to specificmodality specific competences. Recently,however, this emphasis on the utility ofseveral different psychological approacheshas been criticised from several perspectives.Firstly, the evidence base to support specifi-cally eclectic approaches is not forthcomingsince many randomised control trials havetended to focus on specific models orapproaches (Roth & Fonagy, 2005).Secondly, the evidence to support individualformulations as opposed to standardisedintervention allocated by disorder or diag-nostic category also seems to lack strongempirical support for its presumed advan-tage (Kukyen, 2006). The absence ofevidence to support such an approach,coupled with a lack of clarity over exactlywhich therapeutic approaches appliedpsychologists have been trained in, haveprovided an opportunity for other profes-sions and psychological therapists to criti-cally appraise the therapeutic standing of theprofession. No doubt the future regulationof psychological therapists (e.g. counsellorsand psychotherapists) by the HPC mightrequire both counselling and clinicalpsychologists to address this issue. Moreover,the recent work of Skills for Health aroundNational Occupational Standards forpsychotherapists and the importance ofcompetency frameworks (e.g. CBT) for the


Graham Turpin

implementation of the IAPT programme,are major drivers for applied psychology tobe more specific about the therapeuticcompetences that should be expected ofpsychologists. Recently, clinical psychologistshave revised their accreditation criteria toinclude a basic competency in CBT and theRoPSIP has been contemplating a modalityspecific structure. So a major challenge forapplied psychologists is to evidence theirclaimed expertise within psychological ther-apies, either as a consequence of their pre-registration training or as a result of ongoingcontinuous professional development.

However, the practice of appliedpsychology is not merely the provision oftherapeutic skills. Indeed, many clinicalpsychologists and perhaps those counsellingpsychologists employed within the NHSwould advocate that their unique sellingpoint goes far beyond just therapeuticcompetences. The real question, therefore,is what determines a quality psychological(therapies) service? I would suggest, asargued elsewhere (Turpin, et al., 2006, 2008)that a quality service is dependent on agreater range of skills and competences thanthe provision of good quality evidence-basedtherapies. Areas such as supervision, clinicalgovernance, research and development,audit, outcomes development and moni-toring, service innovation an clinical leader-ship, social inclusion and user advocacy,education and training of other staff,employment and social inclusion, etc., are allrequired by a forward thinking and devel-oping service. These additional skills areportrayed in Figure 1. I would wish tomodestly suggest that these skills and compe-tences are part of the applied psychologycurriculum and are frequently absent inother forms of more narrow psychotherapiestrainings. Moreover, many applied psycholo-

gists working outside of adult mental healthin areas such as children and adolescentservices, neuropsychology, learning disabili-ties and older adults will have a greater focuson assessment and staff consultancy/organi-sational interventions than direct one-to-onedelivery of therapy. Finally, it should also berecognised that our tradition of trainingacross the age range, across therapeuticmodalities, and our knowledge of the associ-ated body of evidence base across bothmental and physical health, represents abreadth of knowledge that is not typical ofmany specific psychotherapy trainings.

SummaryIf applied psychologists, particularly coun-selling and clinical psychologists, are toremain competitive as judged against otherpsychological therapists they need to clearlyand concisely assert why they are different,what specific competences they are trainedin, and the added value that they bring tohealth care systems. This should reflect theirdepth of training to a doctoral level, theirfamiliarity with a number of specified theoret-ical approaches, their ability to contribute atdifferent levels (i.e. therapeutic, staff &organisational) of the healthcare system andin a variety of different roles (e.g. assess-ment, intervention, consultancy, leadershipand team working, innovation, outcomes,and quality assurance and governance).Many of these themes have been identifiedrecently by Darzi (2008) as to what consti-tutes quality health care and I would suggestthat quality cannot be realised within theNHS without significant inputs from appliedpsychologists. Finally, the question shouldperhaps be addressed as to whether there isstill any added value to the distinctionbetween counselling and clinicalpsychology?




Graham Turpin

Figure 1: Areas of competences required for a safe and effectivepsychological therapies service.

Research,Audit and service

re-design

Therapy skillsSpecialist Skills

andCompetencies

Social inclusionand

User participation

Education andTraining:

Mental healthpromotion

ClinicalGovernance

leadership andmanagement

Work andEmployment

MedicinesManagement

ClinicalSupervision

andCase

management



CorrespondenceProfessor Graham Turpin,Department of Psychology,University of Sheffield,Western Bank,Sheffield S10 2TN.Telephone: 0114 2226570E-mail: [email protected]

Professor Graham TurpinUndergraduate degree and MPhil from Universityof London; PhD from the University ofSouthampton. Fellow of the British PsychologicalSociety and the Royal Society of Medicine; Acade-mician of the Academy of Social Sciences. Memberof the RAE sub-panel for Psychiatry, neuroscienceand clinical psychology.

Director Clinical Psychology Unit, Departmentof Psychology, University of Sheffield. Currentlyseconded to CSIP as Associate Director, NationalWorkforce Programme (IAPT) and also Director ofthe Professional Standards Unit, Division ofClinical Psychology, British Psychological Society.Former Chair of the Division of ClinicalPsychology, British Psychological Society. Co-convenor of the IAPT Workforce Group withRoslyn Hope and linked to the Skills for Healthprojects around developing National Occupa-tional Standards for Psychological Therapists,together with a Career Framework for practitionersworking into Psychological Therapy Services.

Interests include training and workforce plan-ning around applied psychology and psychologicaltherapies. Research interests include the efficacy ofsupported self-help for PTSD. Clinical workincludes CBT for people with psychoses andcomplex mental health problems.

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Roth, A. & Pilling, S. (2007). The competencies requiredto deliver effective cognitive and behavioural therapy forpeople with depression and anxiety disorders. London:Department of Health.www.ucl.ac.uk/clinicalpsycholgy/CORE/CBT_Comptencies/CBT_Comptence_list.pdf

Sainsbury Centre for Mental Health (2006). We needto talk. London: Sainsbury Centre for MentalHealth.http://scmh.org.uk/pdfs/we_need_to_talk.pdf

Sainsbury Centre for Mental Health (2006). Choice inMental Health: Briefing paper 31. London:Sainsbury Centre for Mental Health.

Sainsbury Centre for Mental Health (2007). Mentalhealth at work: Developing the business case. Policypaper 8. London: Sainsbury Centre for MentalHealth.

Skills for Health (2006). Career framework for health:validation process. London: HMSO.

Turpin, G., Hope, R., Duffy, R., Fossey, M. & Seward,J. (2006). Improving access to psychologicaltherapies: Implications for the mental healthworkforce. Journal of Mental Health WorkforceDevelopment, 1, 12–21.

Turpin, G. & Llewelyn, S. (in press). ClinicalPsychology as a profession: Development,organisation and dilemmas. In H. Beinart, P. Kennedy & S. Llewelyn (Eds.), Clinicalpsychology in practice. Oxford: BPS/Blackwell.

Turpin, G., Richards, D., Hope, R. & Duffy, R. (2008).Delivering the IAPT programme. HealthcareCounselling and Psychotherapy Journal, 8, 2–8.

Wooster, E. (2008). While we are waiting: Experiences ofwaiting for and receiving psychological therapies on theNHS. We need to talk alliance.www.mind.org.uk/Information/reports.htm


What for you is the essence of CounsellingPsychology?Counselling Psychology is the enrichedprocess of scientific usage and practice ofcounselling and psychotherapy which ismarked out by the persona of the practi-tioner.

If you could look into a crystal ball whatwould Counselling Psychology look like in 10 years time?Counselling psychology will not exist in 10years time unless radical action is taken todistance itself from Clinical Psychology.Clinical Psychology is not becoming domi-nant – it is dominant and becoming more soin the profession of Applied Psychology.

Will this be what you had hoped for whenyou first entered into CounsellingPsychology? No – I wanted something different, some-thing akin to what I experience whenmeeting with fellow Counselling Psycholo-gists.

If so what would you value most about this?That as Counselling Psychologists we stoppretending that we are the smaller (numeri-cally speaking) cousin/brother or sister, orwhatever. We are not. We are fully formed,fully functional, and fully grown-upmembers of the human race, able andwilling to be heard.

If this is not what you had hoped for whenyou first entered into CounsellingPsychology how would you wish CounsellingPsychology to be shaped?As the NHS costs more in a recession, cutswill be made, soft options first, then the cutswill move forward. It is at this time thatCounselling Psychology needs to positionitself to avoid amalgamation with ClinicalPsychology, which would simply mean anni-hilation.

What would you value most about this?Living in truth and honesty, and enrichingthe world in which we live.

An anonymous contributor

Counselling Psychology and the next 10 years: Some questions and answersAn anonymous contributor

NY praxis is embedded in a wider socio-political context as well as an intellec-

tual one. The intellectual contextitself is part of a broader cultural history, butit is the intellectual content and directionwhich an individual, or small group, maycome closer towards influencing. It followsthat we might do better in terms of peeringforwards if we emphasise the intellectualtrend of Counselling Psychology. However,any future for Counselling Psychology mustassume a certain continuity of psychologyitself and this is by no means as certain as wemight have assumed just about five years ago.I will list some of the forces shaping thefuture of psychology itself, before consid-ering what kind of future we might envisagefor Counselling Psychology. It should beobvious that this line of argument appliesequally to all Divisions within the Society.

The kind of issues which are partlyformed by the wider cultural contextconcern some old chestnuts; namely, ques-tions of professional identity. Historically,psychologists have always worried a greatdeal about our academic and professionalidentities; a classical question used toconcern the scientific status of psychology asan academic discipline and this identity maystill be open, in the light of the difficulties offunding a laboratory-based subject in HigherEducation. For professional psychology,there have been two recent issues of over-arching importance; the academic level of a

professional qualification and the funding oftraining. Only Clinical Psychology has latelybeen in a position not to worry about thesetwo issues, but the changes in the NationalHealth Service have created a whole newanxiety about professional identity. Thenecessary expansion of these issues has beenpresented elsewhere, under the heading ofthe future of counselling psychology, so I willnot repeat them here (Goldstein, 2009).

The intellectual context is also an issueforming identity; for CounsellingPsychology, that intellectual identity was amotivating force in the establishment of theDivision in 1994. Since then changes to thephilosophy and the syllabus in 2003 havealtered that identity in directions which havebeen consistent with wider intellectualdebates in psychology and psychotherapyand in the academic level set for the achieve-ment of chartered status. Perhaps the keyquestions for all of us now are which identity,why, and for whom do we wish to project thisidentity into the future? Developments inimproving access to psychotherapy will shapethese debates as will questions of syllabus –who owns the setting of appropriate compe-tencies – and the standard of attainment ofthese competencies. Has the setting ofdoctoral standard helped us, or hindered us,in the face of statutory regulation and themany changes in the NHS?

There is one other issue which seemsabsolutely central both to identity and to the


The future of Counselling Psychology:A view from insideRalph Goldstein

Claims about the future of Counselling Psychology, or any other Division within the British PsychologicalSociety, depend ultimately on the future of psychology itself. The foundational question to be debated by usall concerns the kinds of psychology we generally wish to espouse and to bring to the public, as the Society’scentennial motto had it. In order to achieve such ends, psychologists must lead the setting of our owncompetences and philosophical value systems. Current obstacles to this vision are set out, so that they maybe overcome in the next 10 years.

A

offering of psychology we wish to make; whatkind of psychology do we wish to bring toSociety? Counselling Psychology is unique inthat its competencies are founded upon aphilosophically-oriented and explicit state-ment of values. Too often professional valuesare left implicit, or else left to broad state-ments in codes of ethics. How is this defen-sible? Nothing we do is value-free nor aphilosophical orphan. Cognitive BehaviourTherapy, for example, has a specific stance inrelation to the problematic conceptual cate-gory of the emotions (see Dixon, 2003, foran exegesis). This stance of philosophicalreductionism – particular emotions arereduced to specific cognitions – is generallynot discussed.

My contention is that the future ofpsychology, let alone CounsellingPsychology, depends on explicitly addressingthese implicit assumptions and value-systems. Perhaps an example arising frompractice will reinforce this claim. Theapproach to widening access topsychotherapy has rested on the assumptionthat individual psychotherapy is, in someform, the best way forward. But perhaps, asKinderman implicitly suggests in this issue,that is not so. I am referring here to thepolicy initiatives in psychosocial care brieflyoutlined in his paper. The social part of thisagenda cannot be met by the psychothera-pies alone and the contributions ofpsychology in general will in large part cometo be valued by what clinical/counselling/health/educational and other psychologistscan contribute to psychosocial developmentspractically and theoretically. One well-argued critique of a Counselling Psychologysyllabus, which has its major focus on indi-vidual therapy, was recently published in thisjournal by Thatcher and Manktelow (2007).

Much of any success enjoyed by psycho-social developments will rest on academicwork at the interstices between conventionaldisciplines and this might even be encour-aged by changes in the undergraduatesyllabus, as well as changes in the requiredsyllabus for chartered status – or professional

qualification, if this becomes different as theHealth Professions Council feels its powers.Perhaps this has given some furthersubstance to the view that that the future ofCounselling Psychology is inextricably tied tothe future of psychology itself.

The trouble may come in finding spacein a postgraduate syllabus for introducingdeveloping concepts and practice, such aspsychosocial interventions. What will bedropped from the current syllabus? Will webe prepared to give up some psychothera-peutic competences in exchange for somenew ones? If so, how will we also argue, as inthe IAPT programme, that we, as psycho-logists, should become the supervisors of client-facing practitioners/therapists?Psychologists, other than those on theRegister of Psychologists Specialising inPsychotherapy who could indeed providesupervision, may need to find a new space inorder to differentiate themselves from themany psychotherapists and counsellors whowill also be regulated by the HPC in future.

The next 10 years will be shaped in thefollowing ways:● statutory regulation by Government;● institutional governance issues in the

NHS; ● efficacy and effectiveness questions; do

our interventions benefit our clients? ● academic, research and training issues; ● cost of salaries in public (i.e.

Government) employment;● more subtle politico-economic issues

such as privatisation;● ethics; a matter of principles rather than

rules;● and, finally, whether we collectively,

under the aegis of the Society, work out aphilosophical stance and its associatedcompetencies effectively.

The last point listed requires that somepsychologists somewhere are allowed tospend time thinking and not just adminis-trating. It does still happen, else we wouldnot be reading journals such as this, but canwe make a bigger and better place for ourcollective thinking? Is this one role for the


Ralph Goldstein

Society over the next 10 years? We need aSociety that is more than a conventional‘learned society’; we need a Society ofmembers who are empowered to influencethe direction of our discipline. This is why itis a profoundly serious matter that the regu-latory body (HPC) has also taken control oftraining standards and thus conflated twofunctions that other modernised professionsseparate. What leverage can we have overunaccountable bodies such as Skills for Healthwho are taking on an ever-widening role indefining the nature of training in healthcare, including mental health?

How can we as practitioners be properlyaccountable to the public who ultimately payfor our services, if we are not to be respon-sible for our own competencies? In 10 yearstime, we may have a revitalised psychology,or else a rump who do the bidding ofexternal bodies. In that light, the preserva-tion of one or other of the professional Divi-sions in psychology is trivial.

In this context, we might say that an opti-mist may be someone who thinks things willsafely continue more or less as they are; arealist may be someone who thinks thingswill change in an even more centrallydirected manner and a pessimist knows theywill get worse before the public finally givesvent to its dissatisfaction!

CorrespondenceE-mail: [email protected]

Ralph Goldstein, PhD, pursued academicresearch into emotional learning theories andhormonal influences on animal brain andbehaviour, funded by the UK Medical ResearchCouncil and then took up a lecturing post atUniversity College of Worcester. But the motivationfor all this study was really to do clinical work witha Jungian orientation. He has also been chair ofthe Division of Counselling Psychology(2006–2007) and a member of the PsychotherapyImplementation Group, which devised the Society’spost-qualifying Register of Psychologists Special-ising in Psychotherapy.

Current research interests are mainly directedto the somewhat neglected field of emotions inpsychology and pyschotherapy.

ReferencesDixon, T. (2003). From passions to emotions: The creation

of a secular psychological category. Cambridge:Cambridge University Press.

Goldstein, R. (2009). The future of counsellingpsychology. In R. Woolfe, S. Strawbridge, B.Douglas & W. Dryden (Eds.), Handbook ofCounselling Psychology, Vol. 3. London: Sage.

Thatcher, M. & Manktelow, K. (2007). The cost ofindividualism. Counselling Psychology Review,22(4), 31–43.


The future of counselling psychology: A view from inside

IN DECEMBER, 2001, one of us (Frank-land, 2001) wrote a piece endeavouring topredict developments for Counselling

Psychology in the following decade (to 2011).With only a couple of years left it is perhapsinteresting within the context of this SpecialEdition to reflect on these ‘predictions’ andto wonder anew what will happen to Coun-selling Psychology in the next 10 years.

Ignoring Sam Goldwin’s wise edict aboutprediction (Never prophesy, especially aboutthe future) the chapter: CounsellingPsychology: The next 10 years (Frankland,2001) built on experience and the results oftwo Delphic studies (Haste et al., 2001;Kennedy & Llewellyn, 2001) and suggesteddevelopments under three headings: (1) thefuture of psychology as a discipline, andCounselling Psychology’s place within it; (2)developments in Counselling Psychologypractice; and (3) Counselling Psychologyand the British Psychological Society.

The issues specific to CounsellingPsychology that were predicted in thischapter can be summarised within thefollowing areas:● Developments in Counselling Psychology

Practice;● Employment;● Counselling Psychology and the British

Psychological Society.

Developments in CounsellingPsychology practiceFrankland (2001) predicted that: therapeuticpractice will be (re-)established as a keystone of thediscipline (psychology as a whole), with an impacton how the discipline is defined, how it conductsresearch and develops its focus and epistemology.

This seems to be happening right acrossthe board within psychology. If we look at thework of psychologists now focussing on posi-tive psychology (see, for example, the workof Seligman, 1990 onwards) we can see thattheir focus on nurturing the more positiveaspects of individuals, thus helping commu-nities and individuals to thrive (althoughthey don’t aim to ‘cure mental illness’) couldbe seen as therapeutic. This moves main-stream psychology towards a more human-istic approach (Robbins, 2008) and this fitsextremely well within the explicit valuesystem of Counselling Psychology; rein-forcing its humanistic cornerstone andresonating with its ideographic episte-mology.

Although it seems obvious now, theprediction that: technology will change how wework; from changing administrative practice(record keeping, making appointments, etc.) tocomputerised therapy it was not so easy to see in2001. Technology is impacting hugely onhow we practice. We now have computeriseddata bases such as those used within theNHS, which can be accessed throughoutmuch of the NHS, and it is planned thatthese systems will be linked so that all NHSfunded services (and other services workingin partnership with the NHS) will be givenaccess to these systems. This allows for theuse of computerised diaries for appointmentmaking and recording and a much tighteroversight (at least numerically) of what ishappening within these services (if usedproperly, as Mark Twain said in 1907, ‘Thereare lies, damn lies and statistics’). Interestingly,it is now common practice to offer comput-erised CBT at an early stage within stepped


The next 10 years: Some reflections onearlier predictions for CounsellingPsychologyYvonne Walsh & Alan Frankland

services (Turpin, 2009) and computers arebeginning to be used for e-mail counsellingand video counselling. We can easily predictthat: the impact of technology will continue togrow over the next 10 years.

Frankland’s prediction that: CounsellingPsychologists will bring an appreciation of thevalue of evidence, which the Health Service andother employers will require and the on-going redef-inition of ‘legitimate’ research to embrace more qual-itative analyses and methodologies, will becomemore salient. His prediction that: there will bea closer melding of research and practice, ratherthan a fragmentation, has only partially beenfulfilled. We are all now very focussed on thenotion of evidence-based practice (especiallythose who work within an NHS fundedservices); this in theory should lead to goodpractice enshrined within the organisationswe work within. However, there are seriousdifficulties emerging here about what consti-tutes appropriate evidence particularlywithin the NHS (where RCTs have often beenunreasonably privileged as the only properresearch), about who funds the acceptedresearch, and whether or not services aregenuinely commissioned on the basis of thislimited (in all senses of the word) research.For example, how many services are actuallycommissioned according to even the mostbasic NICE guidelines? How many primarycare psychological services are commissionedto provide the evidence-based 16 to 20sessions (albeit CBT) for depression oranxiety (NICE, 2007a, b) for those clientswho have travelled up the stepped careladder? And how many secondary careservices (with, one would assume, morecomplex cases) are commissioned even tothis basic level? It seems that there isincreasing lip-service being paid to ‘evidence’but the practice (from commissioners atleast) may be leaving something to bedesired. Perhaps the prediction isn’t as closeto being fulfilled as one would wish.

Nevertheless, the redefinition of whatconstitutes legitimate research is happeningacross the Society (a Qualitative Methods inPsychology Section has been developed),

and especially so within the Division withpapers and books from people like Lane andCorrie (2006, for example) adding to thedebate. Much of the research carried outwithin Counselling Psychology is basedfirmly within a qualitative epistemologicalparadigm and hopefully this type of researchwill eventually be used to direct client care.

Employment Employers who initially took on CounsellingPsychologists because of a shortage of ClinicalPsychologists will increasingly look to CounsellingPsychology because of the skills and attributes fitmore precisely what is needed.

This has begun to happen and one of us(YW) continues to work for such an NHSTrust. One where there are at least equalnumbers of Counselling Psychologistsemployed within the Trust, and perhaps evenmore Counselling Psychologists thanClinical Psychologists in some areas of theTrust. We now find Counselling Psycholo-gists in senior positions, becoming respon-sible for the shaping of services andprovision and helping to guide the princi-ples that underlie the employment ofApplied Psychologists.

This has meant that: Counselling Psycholo-gists will need to be effective as rounded profes-sionals; working with others who do not alwaysshare our world view, developing business acumen,with a sense of the legal and financial responsibil-ities and applying both ethical skills and values asprofessionals in practice. As we have matured asa discipline Counselling Psychologists haveachieved seniority in different organisations;as stated previously we now have CounsellingPsychologists in senior posts, from Heads ofPsychology Departments in Universities, tosenior Consultants in the NHS. There areCounselling Psychologists Heading Depart-ments within the NHS and managingservices in the Prison Service, we have Coun-selling Psychologists running successful prac-tices and holding senior posts in Charitiesand other not for profit organisations. Thisis a direct result of the coming to fruition ofthe next prediction, which was that: there


The next 10 years: Some reflections on earlier predictions for Counselling Psychology

would be an increase in the need for psychologicalexpertise in organisation, management, occupa-tional assessment and clinical audit within theNHS and other fora.

Frankland (2001) also predicted that: the number of Counselling Psychologists workingin private practice will grow, due in part to theflexibility of self-employment and also a growth indemand for therapeutic services. There will be agrowth in the use of EAPs (and demand for thera-peutic work funded by insurance) as stress andreactive depression is identified as putting aburden of cost onto employers.

There has been a steady growth in thistype of work and more of the CounsellingPsychologists who have a portfolio approachto their careers are doing work for EAPs.Given the state of the economy, the likeli-hood of redundancies as businesses gounder, it seems likely that this area of workwill continue to grow. Quite a few of thecolleagues that we talk to have either movedtowards private practice as either part or allof their work practice and many if not actu-ally in private practice are exploring theiroptions and making plans for this.

The reasons we are given are in part, asFrankland said in 2001, due to the flexibilityof self-employment. There is also the moveby the Government to increase choice forpatients by locating services within the inde-pendent sector, and Counselling Psycholo-gists are bidding for contracts to service thisneed. If the Government’s way of fundingNHS services continues in this manner itseems likely that the expertise that Coun-selling Psychologists have in working acrossorganisations and different modes ofworking will lead them to develop this areaof work even further. There is also a move-ment (small but perhaps growing) of confi-dent, able practitioners away fromorganisations which are target, rather thanclient lead, into situations where they feelthey can put their clients at the heart of theirwork, rather than working to fulfil others’targets and aims for services.

Many more jobs will be found within the NHS.Yes, this is happening, but the danger here

(for those who want to work within the NHS)is that these jobs are going to psychologicaltherapists rather than psychologists, aspsychologists are seen as very expensive.

Counselling Psychology and the BritishPsychological SocietyIn 2001 Frankland predicted that: statutoryregistration will become a reality, and whateverform it takes will make professional coherence andco-operation between the competing therapeuticsub-groups (i.e. counsellors, psychotherapists) moredifficult than it needs to be.

Statutory registration is becoming areality; this will probably come about in July,2009, for Applied Psychologists. There isincreased possibility that registration withthe Health Professions Council (the Govern-ment body that has been charged with thistask) will, as predicted by Frankland in 2001,make inter-therapeutic sub-group rivalrymore likely, as these professions will have aseparate register to Applied Psychologists.This rivalry is likely to be increased particu-larly between Counsellors and Psychothera-pists as there are large discrepancies in theNHS banding between these groups of ther-apists post Agenda for Change, often withthe competencies shared by the groupsbeing very similar. Unfortunately, the predic-tion that: the Society will recognise the qualifica-tions of psychologists who are psychotherapists didnot happen and it is perhaps to be regrettedas there are many Psychotherapists whowould add considerably to our branch of theprofession; those, for example, whoobtained GBR post-qualification as aPsychotherapist and so have been stopped bythe Society from either obtaining a State-ment of Equivalence or APL for theirlearning prior to GBR.

One of the more controversial predic-tions that Frankland made in 2001 was that:A ‘College’ or super Division of Mental HealthPsychology could be formed, dominated by membersemployed by the Health Service.

This is becoming more of a possibility, assome very senior members of the Divisionsseem to support this (see both Peter



Kinderman and Graham Turpin’s papers inthis Special Edition). Malcolm Cross in theSociety’s Annual Review 2007, says: ‘Ourprofession has, however, now come of age, andfrom a secure base, we can move away from reifyingdifference between ourselves and other psycholo-gists, towards taking advantage of our criticalmass and commonalities, … As we look to thefuture it is clear that we will need to work evenmore closely with others who perform functions thatoverlap with ours …’ In fact in the informationposted by the Society’s President, Liz Camp-bell, on 18 December, 2008, containedwithin the document ‘The Society Post Statu-tory Regulation – some initial decisions’point xiii there is a plan to ‘… set up a smallWorking Group of Trustees, led by President-Elect,Sue Gardner, and including the Chair of theRepresentative Council, Gerry Mulhern, toconsider the Member Network structure …’ Divi-sions would come under the heading ofMembership Network Structure.

However, it might be interesting to verybriefly consider some of the practicalities ofthis coming to pass and the drivers behindthe push for this unification. It could besuggested that one of these is the wish forequal treatment for all Applied Psycholo-gists. This would need to begin with eitherpaid training for all NHS Applied Psycholo-gists or alternatively the end of paid trainingfor all NHS Applied Psychologists; there canbe no double standards within equality.Looking at this with a view to costing thefinances concerned we are told that thereare now 523 Clinical Psychologists intraining at a cost of well over £30,000 pertrainee per annum (based on the Society’sWorkforce Planning Advisors Standing Sub-Committee estimate for benchmarkingminuted December, 2007, of £14,000, plusAgenda for Change Band 6 salary starting at£24,103). There are over 1100 other AppliedPsychologists in training, who offer skills,competencies and knowledge base, etc.,which would be useful to the NHS and whoare (other than those in exceptional circum-stances) not funded by the Government.This would mean that the Government

would have to agree a huge uplift in fundingto meet these costs. It seems very easy topredict that this is unlikely to happen giventhe financial state of the country. What ismore likely is that funding for Clinicaltraining would either be withdrawn or thefunding that is presently available would bedivided amongst all Applied Psychologists asbursaries. A change in funding arrange-ments would have an immediate impact onthe viability of Clinical Psychology courses,which are financially dependant on thismethod of funding.

Another driver for unification is theoverlap in competencies shared by AppliedPsychologists, this seems a sensible movetowards simplification and ease of training,until Applied Psychologists look in depth atwhat they would have to give up to enablethis to come about. If the uniqueness of thedifferent Divisions was solely that of compe-tencies a strong case could be made forshared unified training. However, this is notthe case, for example, Counselling Psycholo-gists are the only Division which is builtaround an explicit value base (PersonalCommunication, Strawbridge, November,2008, and see the Divisional Code of Practiceand the Qualification in CounsellingPsychology). This ideographic epistemolog-ical humanistic and relational value basecannot be tacked on to training; it has to bewoven throughout training and develop-ment. Will the other Divisions be happy tohave this happen? Would there be room inan amalgamated training programme forthis? Or would we have to sacrifice this (andother characteristics unique to each of theDivisions) to enable us to develop all thecompetencies that the NHS (who providethe funding, and direct the content of theClinical Psychology courses) would want?

Lastly, in this brief review of driverstowards unification is the notion of criticalmass and using this to effect changes. Frank-land (2001) predicted that: Psychologists willhave a greater presence in society, for example,within the media, as advisors to Government andeven replacing medical practitioners. This is not



happening quite as fast as one would wish,but some progress has been made, forexample, the Society’s Working Party set upto lobby the Government regarding the newMental Health Act (2007) was effectual inadvising members of the Government (andthe Opposition and members of the Houseof Lords) and in influencing the shape ofthe new Mental Health Act. The new Actnow means that psychologists can replacemedics; as under the new legislation, oncean Approved Clinician (Applied Psycholo-gists with the appropriate training areeligible for this role) takes on the responsi-bility for a patient’s care, they become aResponsible Clinician (RC) replacing theprevious role of Responsible Medical Officer(RMO). This huge step forward was broughtabout by a unified working party, which tookadvantage of all of the competencies andknowledge bases of different Divisionsworking together, putting their experts to atask (and working in allegiance with otherprofessions), which resulted in significantchange in the way society addresses mentalhealth. This is either a reason for unificationor an argument against; saying that we canalready work together to have a powerfuleffect without losing the uniqueness of theApplied Psychology Divisions.

However, the Society and members of thedifferent Divisions should be aware that ifunification comes about, with the resultantlose of the uniqueness of the differentApplied Psychology Divisions, this then maybring about the fulfilment of another predic-tion made by Frankland in 2001. This wasthat: there may be a split between CounsellingPsychologists (and others) that are not uncomfort-able with the values of profit-led organisations,and those who value their roots in a radical, evensubversive, tradition that puts the unique value ofthe person as their first consideration.

Thus, if the work of the small SocietyWorking Party examining MembershipNetworks, mentioned previously, does leadto the building of a ‘college’ or Divisiondominated by NHS psychologists who do nothave the explicit value system that underliesthe Division of Counselling Psychology, orother unique differentiators within theApplied Psychology Divisions, it could bepredicted that: there will be a split and that like-minded psychologists and others who espousedifferences such as our explicit value system, willlook elsewhere than the British PsychologicalSociety for the professional camaraderie, support,professional development, and in effect, for a ‘placeto call home’.

ConclusionsWe seem to be once again at something of acrossroads. The earlier predictions for thisdecade may have had some validity, but it isclear that many current issues were barelyforeseen. Who will dare to make predictionsfor the next 10 years? The only one thatseems inevitable as we look both backwardsand forwards is that there is another struggleahead for the ‘soul’ and independent spiritof Counselling Psychology. We hope thatothers will want to stay engaged with main-taining and developing CounsellingPsychology rather than see this approachand our Division as an interesting footnotein the development of an amorphous profes-sion of Applied Psychology (which mightwell really mean nothing more than NHSPsychology in the long run), but only timewill tell.

CorrespondenceE-mail: [email protected]




Yvonne Walsh is a Consultant CounsellingPsychologist working in a large Mental HealthTrust in London. She is Professional Lead forCounselling Psychology for the Trust andcontinues to have the pleasure of working with 30+employed Counselling Psychologists, and hasworked with many Trainee Counselling Psycholo-gists over the years. She also has a research interestin the psychology of cults and works with adultsurvivors of childhood abuse.

Alan Frankland is a Consultant CounsellingPsychologist in Independent Practice, both inNottingham and London. Formerly a PrincipalLecturer at Nottingham Trent University, he was afounder member of the Division and served Coun-selling Psychology for more than 13 years in rolesas varied as Chair of the Division and Registrarand has also been on a number of senior Societycommittees over the years

ReferencesFrankland, A.M. (2003). Counselling Psychology:

The next 10 years. In R. Woolfe, W. Dryden & S. Strawbridge (Eds.), Handbook of CounsellingPsychology (2nd ed., pp.656–670). London: Sage.

Haste, H., Hogan, A. & Zachariou, Y. (2001). Back(again) to the future. The Psychologist, 14(1), 30–33.

Kennedy, P. & Llewelyn, S. (2001). Does the futurebelong to the scientist-practitioner? ThePsychologist, 14(2), 74–78.

Lane, D.A. & Corrie, S. (2006). The modern scientist-practitioner. East Sussex: Routledge.

NICE (2007a). CG22 Anxiety: NICE Guideline(amended).www.nice.org.uk/Guidance/CG22/NiceGuidance/pdf/English

NICE (2007b). CG23 Depression: NICE Guideline(amended).www.nice.org.uk/Guidance/CG23/NiceGuidance/pdf/English

Robbins, B.D. (2008). What is the good life? Positivepsychology and the renaissance of humanisticpsychology. The Humanistic Psychologist, 36(2),96–112.

Seligman, M. (1990). Learned optimism: How to changeyour mind and your life. Free Press.

Snyder, C.R. & Lopez, S.J. (2001). Handbook of PositivePsychology. Oxford University Press.

Twain, M. (1907). Chapters from my Autobiography.North American Review, No. DCXVIII.


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All submissions should be sent to: Dr Heather Sequeira. E-mail: [email protected]

Book reviews and books for review should be sent to: Kasia Szymanska (CPR Book Reviews Editor), Centre for Stress Management, Broadway House, 3 High Street, Bromley, BR1 1LF.

St Andrews House, 48 Princess Road East, Leicester LE1 7DR, UKTel: 0116 254 9568 Fax: 0116 247 0787 E-mail: [email protected] www.bps.org.uk

© The British Psychological Society 2009Incorporated by Royal Charter Registered Charity No 229642

Contents1 Guest Editorial


3 Chair’s NotesMalcolm Cross

5 Counselling Psychology: What I see in the crystal ballDiane Hammersley

10 Counselling Psychology and the next 10 years: Some questions and answersDavid Giddings

11 Adapt, research and survive! Taking counselling psychology forward into the next decadeRuth Jordan

15 Counselling Psychology and the next 10 years: Some questions and answersPeter Martin

16 The future of Counselling Psychology: A view from outsidePeter Kinderman

22 Counselling Psychology and the next 10 years: Some questions and answersPavlo Kanellakis

23 The future world of psychological therapies: Implications for counselling andclinical psychologistsGraham Turpin

34 Counselling Psychology and the next 10 years: Some questions and answersAn anonymous contributor

35 The future of Counselling Psychology: A view from insideRalph Goldstein

38 The next 10 years: Some reflections on earlier predictions for Counselling PsychologyYvonne Walsh & Alan Frankland

Documents

Counselling Psychology Review - Amazon Web …bps-dcop-uk.s3.amazonaws.com/cpr/cpr_2009_24_1.pdfCounselling Psychology Review Editor: Heather Sequeira City University London Reference