Ministers face calls for the urgent regulation of psychotherapists and counsellors to protect vulnerable people, as lawyers report a rise in lawsuits by patients for alleged harm done during therapy.
Unlike most other healthcare roles, including doctors, midwives and osteopaths, "psychotherapist" and "counsellor" are not protected titles nor statutorily regulated professions in the UK.
Experts have told the Guardian that few people realise that anyone without a qualification can call themselves a therapist, and that they can continue to practise after an episode of misconduct.
There has been a rise in the number of people seeking help for mental ill-health in recent years, with services in England receiving a record 5m referrals during 2023, up 33% from 2019.
While the vast majority of people find professional help beneficial and even life-saving, lawyers have reported a significant increase in the number of inquiries over alleged cases of malpractice and even abuse.
Although clinical psychologists are statutorily regulated, psychotherapists and counsellors can apply for accreditation at one of several bodies voluntarily. These include the British Association for Counselling and Psychotherapy (BACP), which requires a minimum level of training with recognised courses, and operates a complaint process that is not legally binding.
Catriona Rubens, a solicitor at Leigh Day, said that since representing Ella Janneh - who in June successfully sued her therapist for sexual assault in the first high court case of its kind - she had been "inundated" with inquiries, with approaches quadrupling from people who claim to have been sexually, psychologically or emotionally abused.
"I'm sure it's probably the tip of the iceberg," she said. "One of the very difficult aspects of this nature of abuse is it occurs in such a position of trust, when you're already vulnerable.
"If you're seeking therapeutic services you're probably talking about intimate, personal disclosures. If someone abuses that trust, it's hard to challenge that and take further action. Women talk to me about how embarrassed and humiliated they feel, how under control of the therapists they feel."
She added that for most clients their priority was to prevent other people from suffering the same harms, since even after a successful lawsuit therapists were not prevented by law from continuing to practise.
Janneh was awarded £217,000 in damages in the high court after a civil case against the TV sex therapist Michael Lousada, who she accused of raping her. She waived her right to anonymity so potential victims would know to avoid him.
Janneh and Rubens are now launching a campaign for the introduction of statutory regulation, and are organising an event with MPs and experts in December with a view to introducing a draft text for possible new legislation to parliament.
"Ella and I feel very strongly that the state is failing to protect therapy patients and clients. Many would assume that psychotherapists, counsellors, and therapists must be registered and regulated by a professional standards body, but that is not the case," Rubens said.
The BACP has reported an increase in complaints against its accredited therapists of 24% since 2020, though not all of these will result in sanctions. Most complaints are about competence, breaching professional boundaries and offering medical diagnoses, for example of autism or narcissism.
The BACP has long supported statutory regulation of the profession, but Lisa Morrison Coulthard, its director of professional standards, said that in the meantime its accreditation offered some "confidence and reassurance" for the public.
The BACP is also working with NHS England and the Professional Standards Authority on a framework for registrations and accreditations for psychological professions for NHS practice, which is intended to provide greater clarity for the public.
David Greenwood, a solicitor at Switalskis specialising in therapy abuse, said his firm had seen cases more than double since the pandemic. Emma Crowther, a solicitor at Irwin Mitchell, said therapy abuse was a new area for her firm, with people now "more willing to come forward".
Statutory regulation of psychotherapy has been discussed on and off since the 1970s, and was included in a white paper published by the previous Labour government in 2007.
Rachael Maskell, a Labour MP and co-chair of the all-party parliamentary group on mental health, said she and other MPs would consider lobbying the government to revisit statutory regulation of psychotherapy and counselling.
"This is unfinished business from a long time ago, so the government should be minded to find a way through," she said. "Regulation is really important, including protection of title, not least when dealing with mental health professionals. There are a lot of people who are called therapists and counsellors, without the voluntary regulation or competencies, who are working, and therefore the best way to keep the public safe is to introduce regulation."
Dan Poulter, a psychiatrist and former health minister, said therapists were out of step with "all other healthcare professionals", resembling a contractual arrangement rather than a patient-clinician relationship.
The fact that psychotherapists deal with people with a complex history of trauma, who might be suffering from post-traumatic stress disorder, or who are trying to remain abstinent after alcohol or drug abuse, "is a strong argument to say they should be formally regulated", he said.
"I have no doubt the vast majority of people practising work to a very high standard and have a very valuable skillset, but it's also the case that there are some rogue practitioners out there, and it's very difficult for the public to be able to necessarily easily differentiate between ... someone who is well qualified and who isn't," he said.
Jonathan Coe, a specialist in professional regulation who was involved in looking into a regulatory framework under the last Labour government, said the issue had been sidelined by the coalition government, for whom "it wasn't a priority".
While many psychotherapists wanted to see regulation, others had opposed it on the grounds that they want the "freedom to be in a dynamic relationship", he said. Yet the British Psychological Society viewed statutory regulation of some psychologist titles as a "sign of confidence in their profession", he added.
Coe pointed to a recent example where a therapist had been struck off a professional register, then had set up a new website making no mention of the misconduct allegations. "Nothing in law prevents him doing that," he said. "How is that protecting the public?"
Callout
A government spokesperson said: "Anyone seeking therapy deserves to have confidence and trust in their healthcare professional, which is why we urge the use of qualified practitioners accredited by the Professional Standards Authority for Health and Social Care [PSA]. To meet the standards for PSA accreditation, an organisation must have a focus on public protection and robust processes for handling complaints against practitioners."