SCoPEd and the threat to the person-centred approach

Person-centred therapy is facing an existential crisis. Not only is the approach shrinking in terms of presence in the professional field and training organisations but SCoPEd (Scope of Practice and Education) is escalating the process with a ‘ground-breaking shared standards framework’. The thorny issue of standardisation and regulation has plagued the profession for years with the general response being one of resistance and scepticism. The design and implementation of SCoPEd signifies a change of direction with the six main Professional Standards Authority accredited bodies adopting the framework. We believe that the hierarchical and mandatory nature of SCoPEd is an affront to the underpinning relational and philosophical principles of the person-centred approach.

As an external locus of evaluation SCoPEd is loaded with conditions of worth, consisting of three graded columns of ‘competencies’ that divide and rank practitioners according to training and accreditation. Such hierarchical bias bestows those at the top with status, knowledge and privilege and implies that those in column A are less equipped to help individuals with serious psychological problems. This is a familiar trope for person-centred practitioners who do not take an ‘expert’ role and instead believe in the self-directing actualising tendency and the power of the six conditions to facilitate therapeutic change. As we help clients to understand their introjected values we are battling our own conditions of worth imposed by the very membership bodies that claim to represent and support us.

Unfortunately, despite a hasty and late addition of representatives of the PCA/humanistic approaches to the Expert Reference Group, the ERG is still heavily dominated by the influence of the BPC (British Psychoanalytic Council) According to the BPC website, person-centred therapy is described as having a similar role to that of ‘a good friend’. The framework itself is steeped in medical model language and psychodynamic terms such as ‘transference’ and working with the unconscious. Such favour effectively downgrades modalities that do not share this philosophical approach and gives the illusion that therapists in column A are less competent and ‘not as good as’ those in column C (the ‘top’ column). This is a fallacy and there is no evidence base to demonstrate that client outcomes are better for those who see therapists aligned to column C.

There is no explanation provided of how SCoPEd will improve upon the existing ethical framework or why it is therefore insufficient despite the assertion that the framework will ‘protect clients from unsafe or unethical practice’. The claim that SCoPEd will ‘help distinguish qualified therapists from other unqualified and unskilled people promoting themselves as therapists’ is concerning, any therapist choosing to join a regulatory body that does not adopt SCoPEd for philosophical reasons will therefore be perceived as unqualified and incompetent. Members of regulatory bodies which will be adopting the framework are already registered and deemed fit for practice so it is hard to see what SCoPEd and indeed accreditation adds to the assurance for clients or our profession.

Despite the many references to the word ‘diverse’ throughout the document, SCoPEd is elitist and divisive and perpetuates and consolidates existing power structures. The hierarchical framework bolsters inequality and largely maintains the privilege of white, middle class, university educated practitioners at the expense of those from more diverse and challenging backgrounds. Counselling is a financially precarious profession favouring those who can afford the economic outlay of training fees, supervision costs and personal therapy, not to mention the time taken to attend training and placements. The column C proviso to undertake 450 hours of client work as part of a more expensive (and longer) training course requires financial resources and a luxury of time that most individuals simply do not have access to. Furthermore, this will increase competition in places where student placements are already oversubscribed - will students studying on column C courses be selected over those from column A training? It is not unreasonable to assume so. Third sector organisations are already struggling financially and an increase of unpaid client hours undertaken by trainees is likely to impact on the availability of paid roles for qualified counsellors in an already saturated sphere. Far from widening the field, SCoPEd instead increases the prospect of privileged therapists reaching the top of the hierarchical pyramid and maintaining this position by way of training, status and financial ability.

This reflects wider unequal societal power structures based on classist and colonial belief systems. Nowhere is this more evident than the astonishing claim that therapists in column A are unable to critically challenge their own ‘identity, culture, values and worldview.’ Thank goodness there are therapists in columns B and C that can do that for them. Nor can they be aware of or respond to emotional shifts within the session or actively use their own responses to the client in a way that is therapeutic. This is nonsensical, therapy is by nature an emotional experience and the relationship between therapist and client (including therapist responses) are key to the process, particularly within person-centred therapy. What individual seeking therapy would enlist help from a professional who is unable to provide this? Those in column A are excluded from the ‘ability to communicate about the harm caused by discriminatory practices’ while those in column C ‘aim to reduce insensitivity to power differentials within therapeutic service provision, training and supervisory contexts.’ The irony is striking. The ‘ability to evidence reflexivity, self-awareness and the active use of self to work at depth in the therapeutic relationship and throughout the therapeutic process’ is reserved for therapists in column C. However, this describes the very core of the person-centred approach. It is very hard to see how the membership bodies can get buy-in to SCoPEd when the stated hierarchical competencies so clearly go against the realities of day to day practice for those in all columns - underpinned by many years of quiet, dedicated ethical practice.

Therapeutic work is a complex interwoven tapestry of co-created relational dynamics that cannot be categorised, stratified and measured as illustrated by the framework. It is virtually undisputed that the quality of the relationship is crucial to all therapeutic outcomes – however, if a therapist in column A is unable to follow emotional shifts in a session then what exactly is the nature of the relationship? Therapists ‘can practice competences from other columns if they have the skills to ethically do so’. What does this mean? Who decides if it is ethical? Will there be protection from insurance bodies? What does this say about existing ethical frameworks and their sufficiency? SCoPEd raises more questions than it answers.

The framework is political, in general terms hierarchy promotes inequality. Pathways between the competencies are currently unclear but will cement therapist ranking. Movement ‘up’ the ladder will undoubtedly involve a costly accreditation process placing a further financial burden on practitioners while sustaining a golden goose for membership bodies. The philosophy of the person-centred approach conflicts with a framework based on hierarchy, evaluation and ultimately competition for paid employment.

The radical, anti-medical model stance of the person-centred approach will exclude it to the margins even further. There is no indication that there will be an ‘opt-out’ choice for those who do not agree with SCoPEd, effectively coercing members on to a framework they do not want or ethically align with. Unfortunately, opting out is in itself problematic as it would further exclude practitioners from the professional field of potential clients, employers and other stakeholders. There is no meaningful arena for those who disagree with SCoPEd to be heard and this is deliberate and political. As advocates for the person-centred approach, we stand in opposition to the framework and the inequality and fallacious evaluation that the competencies embody.