Talking therapy is on rise... but who are we talking to?
There is a bewildering choice of therapists and therapies out there - but little regulation
Talk therapy may be on the rise in Ireland, but clients still aren't asking their therapists about their qualifications and accreditations.
While Irish people may euphemistically concede that they are "talking to someone", they often don't know who exactly that person is, or what the letters after their name mean.
There is a bewildering choice of therapists and therapies available in Ireland, coupled with a woeful lack of consumer information. Furthermore, psychotherapists and counsellors are not currently regulated under the Health and Social Care Professionals Act 2005.
"The persistent lack of regulation in psychotherapy is profoundly concerning," says cognitive scientist and philosopher of medicine Dr Charlotte Blease.
"There is still no statutory regulation for therapists in Ireland (though there are moves in this direction with CORU). And unlike medicine, it is not possible to become a licensed psychotherapist.
"Anyone can stick a plaque on their door, set up an internet site, dub themselves a 'therapist' and start charging by the hour. I also imagine that many of these people are falsely calling themselves 'Dr' or even 'Professor'," she adds.
Counselling and psychotherapy are self-regulated industries in Ireland. Just as psychology is accredited by associations such as the Psychological Society of Ireland (PSI), counselling and psychotherapy are accredited by bodies such as the Irish Association for Counselling and Psychotherapy (IACP); the Irish Association of Humanistic & Integrative Psychotherapy (IAHIP); and the Association of Psychoanalysis and Psychotherapy in Ireland (APPI).
These bodies have stringent standards of excellence and therapists are required to partake in a mandatory number of client contact-work hours (450 hours for prospective IACP members) after successful completion of core work.
"Psychotherapists who are members of bodies such as the IACP, and similar organisations, must adhere to strict ethical codes of conduct to respect patient autonomy, client confidentiality, and to conduct themselves in a professional manner," says Dr Blease.
Non-membership doesn't disqualify therapists from practicing though, as psychotherapist and Love Rewired author David Kavanagh explains.
"People can do a course that is accredited to a proper organisation but then not necessarily go off and get the proper registration hours that they need. If they don't get the registration hours that they need, then they are not officially registered."
Kavanagh's clients often ask him to explain the difference between a counsellor and a psychotherapist.
"I always answer 'about seven years' training'. I have a degree, a diploma, three years post-grad and then two years to get registration. It was a nine-year educational process for me to become a psychotherapist with the Family Therapy Association of Ireland.
"Yet I could become a counsellor in six months after doing my Leaving Cert. Or I could do a six- week course in counselling online, get a certificate from America, put myself forward and nobody is legislating against me."
Dublin-based psychotherapist Liam Plant, who is accredited with three bodies, both here and in the UK, believes that therapists are ethically obliged to tell clients if they are still in the process of becoming accredited. He also offers a list of 'questions to ask your therapist' on his website.
"There was a proliferation in the noughties of private colleges offering courses that maybe didn't pay sufficient attention to the highest standards of practice," says Plant. "I personally think the minimum level of education should be a Masters."
Thankfully, the Irish industry is slowly moving in this direction. The IACP is increasing the minimum educational requirement for Counselling & Psychotherapy (for the purpose of accreditation) to Degree Level 8 on the National Framework of Qualifications from September 2018.
This will significantly up the ante of an already challenging programme, says copywriter Laura-Kelly Walsh, who is currently studying part-time for an IACP-recognised diploma in psychotherapy over two years. Her studies include 450 hours of training, 50 hours of personal therapy and 150 hours of supervised practice.
"I realised how important it is to do an IACP or IAHIP accredited course after researching the courses available in Ireland," she explains. "Also, given the nature of the profession, an online course was out of the question."
Psychotherapist Barbara Foley became IACP-accredited a year ago. She originally trained as a nurse before working in clinical research for 12 years. She started a degree in psychotherapy six years ago, practiced for two years before becoming fully accredited and is currently studying for a two-year post-grad in adolescent psychotherapy.
"My concern is the rise of online courses in things like CBT [cognitive behavioural therapy], NLP [Neuro-linguistic programming] and mindfulness," she says. "I'm not aware of the accreditation around them and I just wonder how vigilant people are about researching the regulatory process."
Dr Blease has similar reservations.
"A friend of mine suggested going to 'mindfulness classes'. I went along with her twice, purely out of curiosity for the standard of care. I was appalled. I have no idea what kind of training he received and I witnessed this 'therapist' tell one patient (who had made it known that he was grieving) that, 'cancer is caused by the food that we eat'."
"The problem with Ireland is that people don't ask enough," adds Kavanagh. "They don't say 'tell me about your qualifications and expertise'. They don't ask 'where did you train, who did you register with, are you insured?'"
Foley agrees. She says that while GPs will only refer patients to registered psychotherapists, clients are considerably less attentive about looking for accreditations. One way to navigate this is to find a reputable centre. MyMind, a not-for-profit provider of mental health care services, requires all therapists to be practicing under a recognised accreditation body and to be undergoing regular supervision.
"Finding a therapist in your area can be done through consulting the directories of professional bodies," explains MyMind communications officer Carmel Bryce. "It can also be helpful to have a recommendation from a trusted source, such as a GP or friend."
Patients should also be educated about the therapeutic process and the possible risks, says Dr Blease.
"They deserve to be made known about evidence which shows that some versions of therapy will be more suitable for their problems than other kinds of therapy.
"They also deserve to be told that therapy may carry risks: around 10pc of patients experience worsening of symptoms as a result of long-term therapy. Honest and competent therapists - therapists who are working within the sphere of evidence-based practice - will make patients aware of these facts.
"Just because psychotherapy involves talking does not mean it is harmless."