Sometimes, it's just a cigar

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Giving advice and being accountable

According to an old friend who, when drunk, fancied himself a philosopher, there were two things you should never give a stranger; advice and blowjobs.

I disagree on both.

However, I think that there’ s a degree of accountability with regard to both.

There’s a degree of agreement here, in fact it’s one of our principles, that sex is something to which you secure consent on the basis of sufficient disclosure.

So it should be with advice. If you give advice, or offer a service which will lead to others being better informed or wiser about their choices after the provision of the service than before, you should also make sufficient disclosure to enable the person being advised or helped to understand the degree of credibility they should give your advice.

Amanda Williamson, for whom I have a very high regard, writes wisely here about the perils of unregulated or badly regulated advice in counselling and psychotherapy. Her campaigning work, at some personal cost to herself, is a reflection of the best traditions of a caring professional.

Having said that, and having read volumes on this, I’m not persuaded by compulsory regulation. I think it’s a process related solution that tries to manage the inevitability that some counsellors or psychotherapists will be charlatans. My problem is that if you introduce a process regulating counsellors or psychotherapists, the charlatans will just call themselves something else. Life coaches for instance, or grief managers, or aura readers or some other nonsense as yet undiscovered or unnoticed.

How to prevent defects, or process failures, is a common debate in management. One usual approach, based on GIGO, (garbage in garbage out) is to improve quality control of components and raw materials before they go through the process. There’s a strong argument that clients of psychotherapists and counsellors get a poor service, in the very worst cases, because they don’t know enough about what to expect and the parameters of reasonable behaviour from their professional. In this case a stronger up front client care contract, setting out the limits of what a professional will and won’t do would seems an essential, but only if all the clients and potential clients know that that’s what they should expect, and to reject anyone who doesn’t offer such a comprehensive statement.

As an aside, the client care contract, as we should probably call it, would probably provide a very good and clear way to weed out the charlatans and the fraudsters (or homeopaths, as some people call them) by requiring a statement about the evidential base for the interventions proposed. As Phil Dore points out here, there is an accredited voluntary register for homeopaths, but no legal duty for them to explain that there is no scientific evidence that their interventions have any measurable causative impact on clients (beyond the placebo effect, that is).

How to enforce such a requirement though? There’s the rub. At present anyone can offer advice. Go to a slimming class and there’s a good chance you’ll find some idiot in glamorous clothing with immaculate nail varnish and a faint whiff of the perfume counter at Fenwicks dispensing advice about motivation and body image that would shame a reasonably intelligent sixth former. Would we really want to regulate slimming clubs who promise that you can have the perfect bikini body if only you want it enough? (in case you think I’m over egging this particular low calorie pudding here’s a link to a Slimming World page where they state they offer Image Therapy. People who provide therapy must be therapists, right?) Would we want to create a cumbersome regime that required every Slimming World Consultant to sign up to a statutory register? Or a situation where Image Therapy was still dispensed but surrounded by caveats such as ‘We used to call this Image Therapy but the government won’t let us so it’s still therapy but it’s not called that?’ (I have a mental image of someone doing that bunny ears things with their fingers that signals ironic inverted commas for the hard of thinking.)

The solution, I would argue, is to abandon process focused remedies, and to look to client focused remedies.

If you promise me that you will deliver a therapeutic service, using scientifically proven methods, within the rules of your governing body, and you don’t, then my remedy should not be that I have to wait for you to be disciplined by your governing body. I should be able to sue you, for all the costs of my therapy, and for any associated damages, including compensation for the wasted opportunity to have received treatment from a professional, not a charlatan.

There is a strong current of argument that professional regulation, as much as it is about protecting the patient /client, is also about keeping huge areas of activity away from the courts. In so many ways, so many places, that remedy isn’t working. So a new approach, based on strict contract law and advanced disclosure that forms part of the contract, with a presumption in favour of the client if the contract or the regulatory bodies rules are breached, is the obvious alternative remedy. Throw in conditional fee agreements to the mix and you’d have a system that would drive up standards, because the only  people capable of getting the essential professional insurance would be the ones who joined the most successful and least sued professional bodies.

In terms of dealing with the charlatans, the beauty of such a solution is that the only way out for them would be to issue every client with a plain English statement that says that what they do is not therapy, and not likely to have any measurable beneficial impact, or that they have no recognised code of conduct or professional standards. What could be simpler?

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2 comments on “Giving advice and being accountable

  1. Pingback: Psychics and morality | Sometimes, it's just a cigar

  2. pwkilleen
    November 18, 2014

    “[T]here is an accredited voluntary register for homeopaths, but no legal duty for them to explain that there is no scientific evidence that their interventions have any measurable causative impact on clients (beyond the placebo effect, that is).”

    That’s not quite true. To become an Accredited Voluntary Register the Society of Homeopaths (SoH) legally had to meet the criteria set by the Professional Standards Authority (PSA), one of which is:

    “Standard 6: the organisation demonstrates that there is a defined knowledge base underpinning the health and social care occupations covered by its register or, alternatively, how it is actively developing one. The organisation makes the defined knowledge base or its development explicit to the public.”

    The PSA’s assessment can be found here:
    http://www.professionalstandards.org.uk/library/document-detail?id=7cdac3eb-99e6-449b-ad9a-98d73d0bb34f
    and that independent government body concluded that the SoH met the criteria.

    In fact if you look at their website then you will see that there is a significant section dedicated to research (including a page on the placebo effect http://www.homeopathy-soh.org/research/evidence-base-homeopathy/placebo-effect/).

    You might not accept the evidence offered by HoS, but the important points here are that they are under an obligation to make their evidence public so people can make up their own minds, and the decision is reviewed each year. So next year, when the HoS’s register’s accreditation is up for renewal you will have the opportunity to raise your concerns with the PSA as part of their Call for Information”, and if the PSA agrees with you then the HoS will be forced to change their practice, it they don’t (or can’t) satisfy the PSA’s demands then their register can be stripped of its AVR status and all the homeopaths on it would lose their claim to belong to and AVR.

    There are no laws governing homeopathy in general, but because the HoS has decided to take part in the AVR scheme the governance it provides is independently assessed and open to public review.

    As far as suing therapists goes, if you refer yourself to some sort of therapist then you are taking the responsibility for assessing the effectiveness of that therapy, and the AVR system ensures that the information you need to make an informed choice is made available by the body running the relevant register. So you wouldn’t have a case based on the therapy not being “scientifically proven” because you should have check that out for yourself in advance. However you would have a case it the therapist abused their position, in which case they would have breached the regulations of their register as well.

    Like

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This entry was posted on November 6, 2014 by in Uncategorized.

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