For a three-hour session at his clinic in Belsize Park, in north London, Mike Lousada charged £750 (at the time equivalent to $1,025). He branded himself a sexual therapist, claiming he had pioneered “a new approach”. Ella Janneh went to him for help with trauma she had experienced after being sexually abused as a child. According to court documents, she alleged that during the session he raped and sexually assaulted her; he denied this and claimed she gave her consent. During the alleged assault, she said in court, he told her that his penis was like a “laser beam”—one that could “burn up” and “absorb” trauma. She reported the incident to the police in 2016, but the Crown Prosecution Service decided not to press charges, after which Ms Janneh brought a civil claim against Mr Lousada.
Last year, eight years after that fateful session, a judge ruled that he had “no doubt” Ms Janneh was suffering a “full-blown dissociative panic attack” and that she “entirely lacked capacity” to consent. He awarded her more than £200,000 in damages for “trespass to the person” and breach of contract. But there is nothing to stop Mr Lousada from calling himself a “therapist” in Britain today.
Anybody can. The title “therapist” is not protected by law. Nor are “psychologist” and “counsellor”. Regulation is voluntary. Practitioners can opt in to accreditation by professional bodies such as the British Association for Counselling and Psychotherapy (BACP), for example, but they are under no legal obligation to do so. Even if the BACP strikes someone off its register, it does not have the power to stop them using the title.
More than a million people are on the National Health Service’s waiting list for mental-health services in England, and many are turning to the private sector. Only one in ten people are aware of the lack of statutory regulation, according to the BAcP. The rise in online therapy and the growth of international apps (run by companies that in some cases are based outside Britain) further complicate accountability. Confusingly, a smattering of titles for mental-health practitioners, including “clinical psychologist” and “art therapist”, are statutorily regulated in Britain. Consumers are left to navigate this messy landscape themselves.
Ms Janneh is leading a campaign for the statutory regulation of therapy. Vulnerable people are sharing their deepest traumas in rooms with a “one-way power dynamic”, she says, noting that you are simultaneously expected “to be a detective and an expert on the industry”. The absence of regulation means that patients are vulnerable to exploitation.
Thomas Plimmer, a former general practitioner, was struck off the medical register for “serious misconduct over several years, including non-consensual sexual touching and engaging in sexual activity whilst at work”. Although it did not involve patients, Mr Plimmer’s behaviour, said the General Medical Council, was “so egregious” that it was “fundamentally incompatible with continued registration”. But that did not stop Mr Plimmer from using a different name and embarking on a second career as a therapist.
Catriona Rubens, a solicitor who represented Ms Janneh, says that she frequently gets inquiries from people who have suffered abuse by therapists and psychologists. Critics of proposed changes are against state regulation, fearing that it could stifle innovation and reduce the variety of practice available to patients. But the confusion that arises arguably poses a greater risk.
Clinical psychologists must undergo seven years of training to earn the right to use this title, says Professor Mike Wang, chair of the Association of Clinical Psychologists UK. Many of the association’s members are unhappy that their profession risks being brought into disrepute by unqualified practitioners. Unregulated psychologists deployed to family courts as expert witnesses can be pivotal in custody cases involving children.
A patchwork of practice
Beyond Britain, the approach to regulation is mixed. Austria, Germany, Italy and Malta are among the countries that mandate statutory regulation of psychotherapy and psychology, with varying degrees of strictness. But in Albania, Greece and Portugal, for example, anyone can use the title “psychotherapist”. America regulates it on a state-by-state basis.
The last time statutory regulation was seriously considered in Britain was under a previous Labour government. The idea of a health-professions regulator had momentum, despite strong opposition from groups of psychotherapists and counsellors. But discussion ground to a halt after the Conservative-led coalition government took over in 2010.
Successive governments have spoken of the parity between physical and mental health. Regulating those who offer mental-health services would seem a sensible place to start. ■
We’re hiring:The Economist is looking to hire a Britain economics writer, based in London. Journalistic experience is not necessary. The ability to write clearly and entertainingly is crucial. So is knowledge of economics and an ability to work with data. For details go to economist.com/britain-econ-jobFor more expert analysis of the biggest stories in Britain, sign up to Blighty, our weekly subscriber-only newsletter.