Open Letter to the CHRE/PSA’s consultation on Accreditation Standards

by Bruce Scott on July 5, 2012

To: Council for Healthcare Regulatory Excellence (CHRE), 157-197 Buckingham Palace Road, London, SW1 9SP

From: Dr Bruce Scott,   c/o Studio E, 39 The Avenue, London, MW6 7NR or brucescott@gmx.co.uk

05/07/2012

  Open Letter to the Council for Healthcare Regulatory Excellence (CHRE)/Professional Standards Authority(PSA) [i]

Dear CHRE,

RE: Voluntary registers consultation 17th April to 10th July 2012, from your document “Accreditation standards for organisations that hold voluntary registers for health and social care occupation” (CHRE, April 2012) for psychotherapists and counsellors.

I am writing to you regarding the above named document that you have published for consultation, which is applicable for counsellors and psychotherapists and their potential future voluntary registration with the CHRE/PSA.

Firstly, I apologise for not using the official form which you provided for recording feedback. Unfortunately, I found this form constraining and not applicable to the feedback I wanted convey to you. As a first point, the containment of such a questionnaire highlights the disadvantages of using such a method and also how peoples’ views can be manipulated and guided into a form whereby an individual’s narrative becomes distorted and lost (Nisbett & Wilson, 1977). Therefore, I hope you consider my feedback despite it not being recorded on the form you provided.

The consultation document, “Accreditation standards for organisations that hold voluntary registers for health and social care occupations” (CHRE, April 2012) is on a first superficial reading, a seductive and convincing document. This is perhaps partly due to the seductive use of such words and phrases such as “focused on public interest, independent, fair, transparent, proportionate, and “to promote good practice and high-quality healthcare” (CHRE, April 2012, p 2).

However, upon a closer, deeper and more thoughtful reading there are numerous discrepancies, mystifications, tautologies, lack of clarity and an apparent minimalist divulgence of specific information which makes for a very unconvincing and incomprehensible document. This consultation document, with its constant reference to standards for future regulation, does refer the reader to another document you have authored, “Right-touch regulation” (CHRE, 2010).  I presume to enable the reader garner more information of how the CHRE/PSA set standards and how you will regulate the field with them. However, on perusal of this document I felt I was led further down a rabbit warren of empty rhetoric, which actually made it no clearer what these “elusive” standards were and how an individual or organisation would be judged to meet these standards.

Returning to the present consultation document, an example of empty rhetoric and mystification is in section 1, 1.2 on page 4 (bold italics and underlining my emphasis):

 

1.2.The Government’s overall intention for this accreditation scheme is set out in the Command Paper Enabling Excellence,

“…the Government proposes to enable a system of assured voluntary registration to be developed for professionals and occupational groups which are currently not subject to statutory professional regulation. At present, there are a range of voluntary registers, but no system which allows the public, employers or professionals to gauge whether they operate effectively and to high, or common, standards”.

 

My question in regards to the last point above is this: Will the CHRE/PSA structure be able to let the public, employers, or professionals  gauge whether they (counsellors and therapists) operate effectively and to high or common standards? I read no convincing formula as to how you would make sure this would occur. You also make no mention or quote any research evidence to show that standards amongst counsellors and psychotherapists are operating ineffectively or to low standards, and that existing systems are failing the public. Therefore, how can you assert what is written in 1.2 of your document?

Point 1.2. in section 1, page 4 continues and it is stated:

 

“A system of assured voluntary registration is a more proportionate way of balancing the desire to drive up the quality of the workforce with the Coalition Government’s intention to avoid introducing regulation with its associated costs wherever possible.”

 

My question in response to this point is this: whose desire are your referring to? You do not make this clear. Is the quality of psychotherapists and counsellors so low that it needs driving up? Again you quote no evidence to back up this claim. Indeed, the Health and Social care Bill 2011 essentially states that there is no need for Statutory regulation of counselling and psychotherapy as there seems to be no need for it, as it seems the talking therapies are relatively risk free; this is why the CHRE/PSA has been given the task of creating VOLUNTARY registers. I highlight the word voluntary because in the propaganda of the launch of these voluntary registers you used the term “mandatory through choice” in your publication “Voluntary Registers: Setting the bar” (CHRE, 2011) to describe how you wish your voluntary registers to be adopted by potential registrants. Such a statement is an oxymoron and has the feel of a totalitarian demand; a demand I must add that is based upon no evidence to justify the demand. [ii]

However, what is more confusing, considering this claim of wanting to drive up the quality of the workforce is that in section 2, 2.5 on page 7 of your document you state regarding organisations and individuals who could be on your registers:

 

“2.5. It will not be an endorsement of the therapeutic validity or effectiveness of any particular discipline or treatment.”

 

This is obviously mystifying. You say there is a “desire” somewhere to drive up the quality of the workforce but yet you will not be endorsing any specific therapeutic validity or effectiveness of any specific modality of counselling or psychotherapy. So, my question is, what quality in the workforce are you wanting to drive up? I am at a loss to ascertain what this magic quality is and how it will promote good practice and high quality healthcare as you assert on page 2 of the consultation document.

Referring to section 1, 1.3, on page 3, there are further mystifications and vague assertions. I will add my brief comments to each point after the point in bold.

1.3.The Health and Social Care Act 2012 provides that the Professional Standards Authority will:

-Set criteria and publish them.

What are these criteria? In your consultation document the criteria is vague and elusive.

 

-Accredit or refuse to accredit the register.

You will refuse to accredit a register on what basis? This point is discussed later in this letter below.


-Carry out periodic reviews.

Carry out periodic reviews on what criteria? The criteria are elusive in your consultation document.

 

-Publish a list of accredited registers.

Therefore in effect you will publish a list of organisations who comply with a list of criteria that are not clearly stated. This strategy seems a divisive way of creating a good list of compliant organisations and a “black list” of organisations. However, how can you create such a list when the registers are only voluntary? One may choose not to join your voluntary register on the basis that one thinks your voluntary registers are not beneficial to the practice of psychotherapy and counselling from a myriad of practical and political reasons. If one does not join for these reasons, is it fair that one should be identified on your website as a second-class psychotherapist or counsellor, which is what the CHRE/PSA voluntary register scheme seems to want to create; a two-tier system of psychotherapists and counsellors, with the CHRE/PSA counsellors and therapists being privileged over the others.

 

-Carry out an impact assessment before accrediting a register, paying regard to guidance on impact assessments, and can publish the assessment, and using the assessment in the accreditation decision.

What is this impact? Impact on what? This is never made clear in your consultation document. You also say you will publish this assessment. Again this feels like a punitive measure for those who fail to reach your criteria. However, do you have any evidence that your criteria are superior to others? You quote no such evidence to back up the claim that your criteria are effective or well-researched. You also do not quote any evidence that your voluntary registers will be any more effective than what already exists within the field of counselling, psychotherapy, and psychoanalysis.

 

-Consult with appropriate persons before accrediting a register.

This statement is mystifying. Who is it that you will consult with? I was under the impression it is the CHRE/PSA who set the criteria and has the final say of who is allowed on your voluntary register. It seems that if the “appropriate people are consulted you will override them (see below for further elaborations on this point).

 

The reader is mystified further at point 3.6. on page 8.

“3.6. Pre-application self-assessment

We will encourage organisations to complete our self-assessment tool before they apply so that they can check that they are likely to be ready. We propose to use some initial criteria to allow us to quickly sift out at an early stage any applications that are manifestly unlikely to succeed so that we limit costs.” 

What function does this self-assessment tool serve? If an organisation completes the self-assessment, will they realise they are ready or not? Presumably the self-assessment tool will be based on your criteria outlining the eligibility of how to be included on your register? But then you state how you propose to use “some initial criteria to allow us to quickly sift out at an early stage any applications….”

My question to this last point is this; what is this “initial criteria”? Referring to section 5, point A3, page 13 you outline the eligibility criteria for an organisation to be included on your register:

“A3. The organisation has completed our self-assessment tool and its governing body has confirmed their belief that the organisation meets our Standards and has sufficient evidence to demonstrate that.”

 

So am I right in concluding from this that the self-assessment tool is actually a pointless and worthless exercise as you will go to an organisation’s governing body and ask them if the organisation is lying and/or misguided? After consulting the results of the self-assessment of an organisation that is applying and then having consulted their governing body, will you then peruse your “standards” and decide if the organisation meets them? But surly the self-assessment will outline “your standards” and there will be a method to help show the organisation that is applying that they meet them the standards? I get the feeling from this Kafkaesque bureaucratic rhetoric that one never truly gets to know what the standards are and the decisions to what they might be and how organisations are accepted as meeting them is a process that is not transparent and even sinister.

My suspicions, I feel, are confirmed when one reads point section 3, point 3.7 on page 9:

 

“3.7. When an organisation applies, we will post a notice on our website inviting people to notify us if they have concerns about them. We will take steps to verify whether those concerns have foundation and will take these views into account. We will ask the organisation to post a notice on their website too. We will write to interested parties informing them of the application to be accredited and asking for comments.”

 

So potentially the criteria is based upon random notifications (e.g., from the public and/or other organisations) informing you that an organisation who has applied to get on your register (a psychotherapy training institute) is an institute of charlatans who do harm to the people they come into contact with? Presumably people with grudges against an organisation or a person who is a member of an organisation can make their comments known about the organisation and you would have to investigate this fully? Further, if a hard-line cognitive behavioural therapist had issues with a psychoanalytic way of working and claimed that it was a wasteful pointless endevour, or a medical/biological psychiatrist felt that psychotherapy was worthless or even harmful, then you may use these concerns as evidence to keep an organisation off your register? And I am correct in thinking that if an organisation that completes your self-assessment tool and applies to join your register they must put a notice on their website and ask for comments from the public to see if they think that the organisation is good enough? Presumably if the organisation receives comments from people they must forward these to the CHRE/PSA, for further investigation, or would the organisation investigate these comments themselves? What if an organisation does not have a website, and does not believe in using internet technology (which many people do), will this exclude them from joining the CHRE/PSA voluntary register?  Lastly, who are these “interested parties” you will write to? At no point do you make this clear.

“The Standards”

 

I will now make some comments of the “standards” (highlighted in italics) that you set out in section 5, page 10-12., which I feel are extremely vague and which leave the reader quite uncertain as to how one could reach them.

 

“A2: The organisation can demonstrate that it is committed to protecting the public and promoting public confidence in the profession it registers.”

 

The above standard is incompatible with many ways of working within psychoanalysis and psychotherapy. A therapist and patient cannot know beforehand what the work together will bring up. One therefore cannot have confidence in what emotions, feelings, perceptions, and thoughts will emerge as a result of the process. Indeed, it may be a success if a patient loses confidence in the notion of therapy, as a result of taking part in therapy, and is able to live life fully after such an experience. A patient may be full of confidence when entering the process, but then become very unconfident about their hopes, ambitions, desires, and again this may be a positive outcome. Therefore, it is an oxymoron to demand of organisations to make the public confident of the therapeutic act.

 

“A6: The organisation can demonstrate that it is respected within its field.”

 

It is quite clear that many psychotherapy and psychoanalytic organisations and their mode of treatment or intervention are not respected with the field in which they operate (e.g., NHS, or rival organisations who disagree with the mode of treatment or certain organisations). In the field of psychotherapy for example, a cognitive behavioural therapist may not respect the work of an existential psychotherapy organisation, or a humanistic psychotherapy organisation may have serious issues with a psychoanalytic way of working. The dynamics are endless, but as I hope you can see, there may be as many people/organisations that respect a psychotherapy organisation as do not have respect for it.

 

“B3: The organisation can demonstrate that it understands the views and experiences of consumers and takes them into account in its decision making.”

 

            Some “consumers” may have the view that there is such an entity as mental health and that there is such a thing as a cure. They may have had experiences of other treatment (e.g., cognitive behavioural therapy) where they felt that this was the case and would expect it of all of the talking therapies. However, for many psychotherapy and psychoanalytic organisations, notions of mental health and cure are not compatible with their way of working. Therefore, such an organisation would be going against their way of working if they based their decision making on such ideas of mental health and cure.

 

“D2: Where an organisation permits a vocational entry route, registrants successfully complete an independent assessment that meets recognised quality assurance standards.”

 

            Many psychoanalytic and psychotherapeutic organisations permit entry onto their training on a case by case basis. The selection of a candidate for training can at times be independent of their academic qualifications (or lack of) and based upon certain personal qualities that are not measureable by academic standards or other varied assessments. In the case of your mention of an “independent assessment”, what would this entail? If your independent assessment supposedly meets “recognised quality assurance standards” this assessment may exclude many potential talented and able counsellors, psychotherapists, and psychoanalysts due its bias on academic ability; academic ability alone does not make certain that suitable training candidates will be admitted on trainings.

 

“E3: The organisation only admits applicants who meet its standards.”

 

             This statement is inaccurate. An organisation who wishes to be on your voluntary register will be asked to meet your (the CHRE/PSA) standards. As I have already outlined throughout this letter, these standards are either mystifying and/or not applicable in many cases.         

“E4: The organisation checks at appropriate intervals that registrants continue to be fit for practice.”

 

            I am unsure as to how you envisage organisations check that its registrants are “fit to practice”.  Against what standards would you expect organisations to apply to its members? What would be an appropriate interval to check this? Thus is quite unclear and therefore at present this standard is unworkable due to its lack of clarity.

 

Summary: Some thoughts on the philosophical and political position of the CHRE/PSA voluntary registers

What Foucault (see Foucault, 2008 for example) was afraid of in the reign of the norm (or I would say the normative and so-called normality, i.e., CHRE/PSA registers/standards) was that the norm becomes dictatorial and tyrannical. Subsequently people find it difficult to rebel against the average (or the so-called normality of CHRE standards), against the dictatorship of the norm. The CHRE/PSA have indicated that they will push for their standards to be seen as the mark of excellence and for employers to accept their mark as the mark of excellence. While organisations that opt out and/or feel that the CHRE/PSA standards are incompatible for them will be ruled out/excluded of earning an income based upon the CHRE/PSA push for dominance in the field of talking therapies.   Isolating this reference to the norm allows us to see that, even if it comes from CHRE/PSA dictatorial standards, deciding to conform to the norm (CHRE/PSA standards), to make the norm into the “law” (or pseudo-law; “mandatory through choice”) is a political choice. It seems to be the CHRE/PSA’s desire to making their standards “law” or the “the norm” for all, and banish all deviant or non-conforming ways of conceptualising counselling, psychotherapy and psychoanalysis. It is for this reason that I oppose the CHRE/PSA voluntary registers. Making the CHRE/PSA scheme the “kite mark” of excellence and pursuing/rejecting all the deviants from CHRE/PSA standards will be a factor of stagnation and curtailing of creativity and innovation within counselling, psychotherapy, and psychoanalysis; innovation which is so important to the freedom to be able to create one’s own discourse free from “the law” or “standard of an “Other”. In order to preserve innovation in a society, it is essential that the norm or standard should not be “law” from an over-bearing “Other”.  Much of psychotherapeutic and psychoanalytic discourse allows such innovation to flourish, which the CHRE/PSA registers/standards will stunt.

The CHRE/PSA discourse seems so benign with its discourse of normalism, but it is couched within a faltering rhetoric of certainty guided by a master discourse (i.e., “mandatory through choice” and encouraging employers to favour people on their books). The CHRE/PSA is also mystifying; it holds up its hand of fairness (i.e., self-assessment), but ultimately takes it away in a Kafkaesque mode (i.e., inviting random comments from unnamed “interested parties” and conducting investigations into the validity of comments from interested parties).

The CHRE/PSA is encouraging the collectives of counsellors, psychotherapists, and psychoanalysts, to be its subjects and a step in this direction is self-evaluation against an unknown or veiled bench-mark. This is a subtle management of our “population”. As Foucault (2008) discussed the management of populations structurally implies a rejection of difference in terms of individual singularity. It reabsorbs difference into a divergence in relation to the norm defined by the average in terms of behavior. In other words, difference is not allowed to flourish.

As Brousse (2007) argues, difference in the psychoanalytic sense (difference apprehended outside of all comparative references) is not relative in within the realm of CHRE/PSA. On the contrary it is hated; the CHRE/PSA will publicise on their website those who they hate. It is hate because it carries with it in the CHRE/PSA eyes the law of failure (to be incorporated into their fold). Brousse describes how from the psychoanalytic perspective this ideal (in other words CHRE/PSA regulation) is in the realm of the imaginary, the semblable, or from Baudrillard’s (1981) position, the nightmare of the simulacra; the CHRE/PSA voluntary registers masquerading as “real” whilst excluding the reality of its faulty symbolic (i.e., claims to its  excellence).

Roch (2007) describes the psychoanalytic act as interrupting the forced mode (i.e., the A, B, C or normalization, of the cure, of audited perfection or perfected audit); it introduces inconsistency. This hole, this edge disturbs the defense, or the semblance (the CHRE/PSA structure). The analytic act makes the semblance/simulacra tremble; its gets rid of knowledge’s misunderstanding or the idea that there is certainty of understanding; i.e., in the case of the CHRE/PSA, the certainty that its registers are the best, the ideal, the mark of excellence.

The CHRE voluntary registers are a product of the desire of control; is this the desire mentioned in the consultation document and discussed above on page 2 of this letter. Control societies and systems operate on the basis of indefinite postponement; this is in relation to acquittal of the “accused” (see Fisher, 2009). The talking therapies are the accused within the proposed CHRE/PSA voluntary register scheme and because of their monitoring and vetting procedure, indefinite acquittal will be the modus operandi; nobody will be able to relax, because once we are in, we could be put out at anytime. The “education” needed to get on and stay on the registers like in control societies is lifelong; training (pointless CPD) that persists for as long as one’s working life continues. This leads to a situation where control and self-monitoring control becomes obsessive and ridiculous whereby we all become control addicts or obsessed with self-monitoring (on both sides). One just has to look at the Government’s Supporting People’s housing “standards” and their imaginary idealism of forever and infinite progress for its clients in terms of mental health (e.g., moving on, employment etc), despite the disastrous economic situation in the UK which will curtail any hope of  an individual’s idealism and mental well-being.  No amount of regulation within the talking therapies or “mental health” services will be able ever be able circumvent misery and poverty within a system where inequality of material resources and opportunities is supported by those who wield power and by those who want power.

Conclusion

The CHRE/PSA proposal for voluntary registers is an ill-thought out and inappropriate system that many counsellors and psychotherapists of all persuasions will view as a thoughtless conceptulisation of their work. I hope the CHRE/PSA will look again at its proposals and consider the implications of its master discourse, its false claims for promoting excellence, and its authoritarian claims of creating voluntary registers which will become “mandatory through choice”.

Yours sincerely

Dr Bruce Scott

Psychoanalytic Psychotherapist

(In my capacity as an independent practitioner).

References

Baugrillard, J. (1981). For a critique of the political economy of the sign. Candor NY, Telos Press Ltd.

Brousse, M. H. (2007). Love of the sinthome against a hatred of difference. Psychoanalytical Notebooks. The London Society of the New Lacanian School: Regulation and evaluation, 16, 161-166.

Council for Healthcare Regulatory Excellence (2010). Right-touch regulation. Retrieved from: www.chre.org.uk

Council for Healthcare Regulatory Excellence (2011). Voluntary registers: Setting the bar. Retrieved from: www.chre.org.uk

Council for Healthcare Regulatory Excellence (2012). Accreditation standards for organisations that hold voluntary registers for health and social care occupations. Retrieved from: www.chre.org.uk

Fisher, M. (2009). Capitalist realism: Is there no alternative? Winchester UK, Zero Books.

Foucault, M. (2008). Psychiatric power: Lectures at the Collège de France, 1973-1974. New York, Palgrave Macmillan.

Health and Social Care Bill (2011). Retrieved from: www. dh.gov.uk

Nisbett, R.E., & Wilson, T.D. (1977). Telling more than we can know: Verbal reports on mental processes. Psychological Review, 84, 231-259.

Roch, M.H. (2007). The psychoanalytic act and its paradoxes. Psychoanalytical Notebooks. The London Society of the New Lacanian School: Regulation and evaluation, 16, 167-175.

Scott, B (2010). The professional liaison group meeting for the proposed regulation of psychotherapists and counsellors on the 12th May 2010: An example of how not to dwell in un-knowing. This can be accessed at: http://hpcwatchdog.blogspot.com/2010/06/guest-post-by-bruce-scott-on-plg.html or a reprint requested from the author at brucescott@gmx.co.uk

ENDNOTES

1)  The covering letter sent with this consultation to CHRE/PSA

Date: Thu, 5 Jul 2012 17:42:27 +0200

From: brucescott@gmx.co.uk

Subject: CHRE voluntary registers consultation response

To: accreditation@chre.org.uk

Dear CHRE,

Please find attached my response (in my capacity as an independent psychoanalytic practitioner) to the proposed CHRE voluntary registers.

Yours sincerely

Dr. Bruce Scott, PhD.

Psychoanalytic Psychotherapist

UKCP Registered

www.psychotherapy.org.uk

Member of the Philadelphia Association, London

www.philadelphia-association.co.uk

Member of the College of Psychoanalysts-UK

www.psychoanalysis-cpuk.org

2)  This text was originally presented on Saturday 26th May 2012 as:

‘The Council for Healthcare Regulatory Excellence’s (CHRE) voluntary registers for the talking therapies: A faltering symbolic in search for certainty?’ to the LacanianWorks Working Group.  This group is registered with the New Lacanian School’s cartels as ‘Jouissance & symbolic (dis)order’.

3)  This text has been circulated widely within Parliament

Circulation list

Ms Cheryl Gillan, MP for Chesham and Amersham & Bruce Scott’s constituency MP

Rt Hon Andrew Lansley CBE MP , Secretary of State for Health

Mr Paul Burstow MP, Minister of State for Health (Care Services)

Rt Hon Andy Burnham MP, Shadow Secretary of State for Health

Baroness Thornton, Shadow Minister for Health, Health Spokesperson – the House of Lords

Lord Beecham, Shadow Health Spokesperson, House of Lords

Lord Carlile of Berriew, Former Lib-Dem Spokesperson & member of the Joint Committee on the draft Mental Health Bill

House of Commons Select Committee on Health

Government Members

Rt Hon Stephen Dorrell  (Chair)

Mr Andrew George MP (Lib Dem)

Dr Daniel Poulter (& Member of Mental Health All-Party Parliamentary Group)

Mr Chris Skidmore MP

Mr David Tredinnick MP

Dr Sarah Wollaston MP

Opposition members

Ms Rosie Cooper MP

Ms Barbara Keeley MP

Mr Grahame M Morris MP (& Member of Mental Health All-Party Parliamentary Group)

Mr Virendra Sharma MP

Ms Valerie Vaz MP

Member of the Constitution Committee

Baroness Falkner of Margravine  Lib Dem

Former member of the Merits of Statutory Instruments Committee

Viscount Eccles  Conservative

Title:  Mental Health All-Party Parliamentary Group

Purpose:  To inform parliamentarians about all aspects of mental health.

Chair:  Mr Charles Walker  MP  Conservative

Vice-Chair: Ms Alison Seabeck MP, Labour

& Ms Nicky Morgan MP Conservative

Secretary: Baroness Murphy of Aldgate, Crossbench

Sir Peter Bottomley MP – Conservative

Mr Chris Heaton-Harris MP – Conservative

Mr Damian Hinds MP – Conservative

Mr Guy Opperman MP – Conservative

Mr James Morris MP – Conservative

Ms Penny Mordaunt MP – Conservative

Ms Jo Swinson MP – Lib Dem

Mr David Wright MP – Labour

Ms Kerry McCarthy MP – Labour

Mr Mike Gapes MP – Labour/Co-operative

Mr Alun Michael MP – Labour/Co-operative

Mr Jim Dobbin MP – Labour/Co-operative

Dame Anne Begg – Labour

Mr Russell Brown MP – Labour

Mr Jon Cruddas – Labour

Mr Hywel Williams – Plaid Cymru

Notes from the text (Endnotes)

 


[i] The Council for Healthcare Regulatory Excellence is to be renamed the Professional Standards Authority.

[ii] In Scott (2010) Peter Fonagy asserted that therapists have to be regulated as one study showed that 5% of therapists do either harm or no good. This statistic may fit with remit of the HPC/CHRE/PSA about protecting the public, but even if Fonagy’s statistic is true it is a deceptive statistic for several reasons. Firstly, in any distribution of therapists’ effectiveness, at either end of the distribution you will always have therapists who do not “cure” the patient, and at the other end therapists who do “harm”. It all depends of course what is meant by harm and doing no good or not “curing” a patient and thus we could get into a long discussion about what is harm and doing no good. Nevertheless, regulation would never make this 5% of ineffectual or harmful therapists disappear; you will always have patients who do not get “cured” and patients who feel they have been harmed. Regulation will not stop this statistic occurring so Fonagy’s argument does not hold any weight. Another example of how this is nonsense is when one thinks of antidepressant treatment. Most medical practitioners worth their salt know for a fact that some people will not get better taking antidepressants and some people will get a lot worse and be harmed. The same can be said for clinical psychologists giving CBT to people; some people will never get better and CBT might make them worse; CBT therapists know this fact well. As it stands, both these treatments are regulated as are the practitioners who apply them.