February 17, 2020

Unregulated therapy may seem harmless, until it’s not

In a discipline like medicine, rogue practitioners have more potential to do harm than most other professions. It was therefore alarming to read about a recent BBC investigation which found that anybody can work perfectly legally as a therapist, psychotherapist or a counsellor in the UK.

Perhaps more alarmingly, the BBC uncovered a plethora of online courses with dubious standards: some were very basic, and others even allowed candidates to cheat in order to pass.

It may seem less likely that a careless therapist will leave you with an injury than a careless surgeon. However, patients who require psychotherapy are usually at a vulnerable juncture in their lives – that’s why they’ve sought the help of a professional. Both the surgeon’s and the therapist’s patients require help, and both are entitled to expect that their clinicians act with a reasonable degree of skill.

The lack of regulation uncovered by the BBC reflects an outdated notion of medicine. ‘Shrinks’, ‘head-shrinkers’ and ‘quacks’ are terms that would virtually never be applied to surgical teams, even the ones that do brain surgery. And yet any, some, or all of these terms might have been used to describe psychotherapy until quite recently. If a patient’s problem was all in the mind, what was wrong with fantastical treatment?

The dangers of rogue psychotherapy

Well, potentially quite a lot. In the 1890s, an American neurologist (in)famously treated a patient who had been bed-bound for years and couldn’t walk. There was no explanation for her symptoms. The physician duly consulted with her family… and then set fire to her bed. Gratifyingly, she not only got up; she ran off down the corridor.

Let’s suppose, by contrast, a patient with PTSD goes to a therapist for cognitive behavioural therapy. Her speech and behaviour are quite confused. As the treatment goes on, this gets worse. She also starts having difficulty in walking and standing up. The therapist assumes she may have been self-medicating with alcohol and does nothing. Things get worse still. After a while, the patient consults her GP, who makes a referral – and a brain tumour is belatedly diagnosed.

The difference between these two stories is that in the first one the doctor ruled out a physical explanation first. In the second, the therapist carried on treating for a psychological condition, even though the symptoms were getting observably worse, and new ones were developing. Unfortunately only the first could be fixed through unconventional means and without medical intervention, and the second will mean a much worse outcome for the patient.

Then there is the question of therapy. Treatments of any sort rarely have a neutral effect: if they don’t work, the patient may well get worse. There is nothing like failed treatment to cement low mood, depression, increased pain responses and potentially destructive behaviours into place. This is most commonly seen in settings of chronic pain, but it can equally well apply to psychological treatment.

If a therapist doesn’t treat you properly, because they don’t know how, your underlying illness will probably not get better: at the very least, it will persist for longer than it might have done.

Unqualified therapists are potentially a menace, and it is time that the area is regulated. It is heartening to see that this is now being discussed more widely.

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