I'm all for making people aware & able to make their own choices. Maybe even government regulated labeling.

I don't like the idea of not being able to have access to the therapy that would be most effective for me.

It's trial an error, for sure. It's also a lot about being an informed consumer.

I really cringe at the idea of anyone other than me being in control of what therapy is available to me.

No, strike that-- I cringe at the idea of anyone *else* being added to this equation. My insurance has always paid for my treatment without any problems, but I know that for many people insurance already limits their options already.

Also, I feel that there's often a timeline attached to this kind of standardization. I really don't think there will ever be funding to evaluate the efficacy of therapy long term therapy-- I've been in therapy with the same psychologist for five years. Over the years we've addressed various ED/other things using different techniques. I can't imagine how that would be classified or typed.

[NB: I feel like some people will cringe at the length of time I've been in therapy, hold it up as proof of principle that therapy *needs* to be standardized etc. I'm not floundering in therapy, I'm doing quite well, and I've dealt with a number of issues aside from the eating disorder. Still, I can't imagine how I could receive the quality therapy I receive now under a 'standardized' plan.]

I'm not sure what to think about regulation, but the idea of certification in specific therapies has a lot of merit IMO. I'm especially glad to see that therapists interested in FBT can seek certification which requires review and supervision of cases post-training to insure treatment fidelity and addition advances training. http://train2treat4ed.com/ I think this not only helps therapists put treatment into practice but will be helpful information for families looking for care.

Our system here in the UK will regulate use of the word "psychotherapist" but not the actual practice of therapy. So anyone who has the right kind of academic qualifications, and who pays money to the right agencies, will be able to call themselves "psychotherapists". Anyone else will be committing a criminal offence if they do that.

But other words will not be regulated. For example, anyone at all will still be able to call themselves an "eating disorders specialist".

There's no evidence that this regulation will prevent misconduct and abuse. It hasn't prevented misconduct and abuse in other fields of medical practice. But a government department will get to increase its power and its revenues, and that's surely what counts. Perhaps one day they'll regulate the entire dictionary.

I agree with Jane, that skills-based certification in specific therapies would be a much better idea. In my field, CBT, much of the malpractice happens because people who are qualified in something else entirely (nursing or psychology, for example) think they can do CBT without full training in it.

I know that Lawyers need to earn so many Continuing Legal Education credits every year in order to keep their license. Is it the same with Doctors and Therapists? If not, I think it should be. And I think that some many of the CME credits should be in your area of practice.

Regulation/information/education aside, some people just don't click. Some people are just (really smart) jackasses. So even if the government tidies things up, there will still be trial and error for the patient.

The thought of Goverment getting involved terifies me. Let's face it they are just not qualified to make those kinds of choices. They are all, ok mostly, lawers. Choosing the right therapist is hard and if you don't fit with the right one, the expert, you might get a lot of benifits from one that is not an expert in that field but you feel comfortable talking to.

While I'm not opposed to government regulation of therapy per se, I really don't think it would do any good in terms of ensuring that patients get quality, evidence-based care. The field of psychology is already highly regulated. To become a clinical psychologist, you have to have a doctoral-level degree in psychology (Ph.D. or Psy.D.) which takes an average of 7 years to complete, including years of clinical training, a pre-doctoral internship, and passing comprehensive exams. You also need to pass a national examination which tests basic knowledge of psychology and a state exam which tests knowledge of the laws and rules in your state. After completing your doctorate, you need to complete 2,000 post-doctoral hours under the supervision of a licensed psychologist. We also have to complete 40 hours of continuing education every two years after getting licensed. NONE OF THESE THINGS guarantee that that the psychologist will use effective, evidence-based treatment. I know many experienced, licensed psychologists whom I would never consider referring to because their methods are simply ineffective. Some doctoral programs emphasize evidence-based practices and others don't. Psychologists trained in evidence-based practices don't necessarily always provide evidence-based treatment. For all intents and purposes, a psychologist can use whatever methods he/she wants. So tighter regulation will not necessarily lead to more effective therapy, because each psychologist is free to use his/her clinical judgment in any given case.
I think a good solution to this dilemma is to require that all therapists (including psychologists, social workers, licensed professional counselors, and psychiatrists) provide full disclosure in informed consent at the start of any therapeutic relationship. The process of informed consent should include the therapist's training and qualifications, the types of treatment methods available for the patient's condition (whether or not the therapist practices them), what method(s) the therapist plans to use and why, explanation of the evidence base (or lack thereof) behind the methods the therapist is using, explaination of other types of treatment available and the pros and cons of these other treatments, and referrals to other types of treatment if the patient or her parents request it.
I recently blogged about this issue:
http://www.blog.drsarahravin.com/depression/informed-consent/

I guess to me, this is less about bureaucrats telling me what kind of therapy I need, and how many sessions it will take until I'm "cured". To me, it's about who can call themselves an "expert" in treating a particular illness or using a specific type of therapy. There doesn't quite seem to be the patient pressure to insist about this, combined with other limitations in terms of geography and insurance.

I think many people in the US are science-phobic or science-illiterate, which I think is a huge problem. There is a fundamental lack of understanding about what "evidence-based" even means.

I guess I'm just frustrated with many of the so-called experts I've met and having no real way to judge on what basis they are calling themselves experts. Even membership in IADEP and NEDA is no guarantee. I love the idea of Lock and Legrange's training sessions.

Dr. Ravin, you are truly a diamond in the rough. I wish more therapists had your outlook.

I also agree with the approach recommnded by Dr. Ravin. I think there is a role for the government in drafting informed consent guidelines that, in the case of eating disorders, would discuss various treatment models, evidence of effectiveness, and other important information. After all, the FDA requires that drugs be labeled with specified information about effectiveness, risks, alternatives, and use guidelines. I'd like to see the National Institute of Mental Health require the same type of comprehensive information be given to eating disorder patients and parents of minors.

I think that what the Guardian is talking about is regulation against bad individuals (for example those who abuse the therapeutic relationship for sexual or financial gain) rather than bad (or indeed good, or indifferent) therapy.

There is a big drive for "talking therapies" and, as CBTish has pointed out, a danger of all sorts of partly trained people calling themselves or even being set up by cash-strapped health providers as specialists when they are not. Regulation against the "bad eggs" wont stop that, but it hopefully WILL call to account people who bring the professionalism of the word therapy (which we psych-phobic Brits tend to have problems with anyway) into disrepute.

In the more narrow world of eating disorders there is debate about what specialist treatment is and should be which I have already discussed with CBTish. We have the NICE guidelines against which most NHS (ie free at the point of use and technically available to all) provision should be measured (not that it measures up that well in terms of provision on the ground). These http://www.nice.org.uk/Guidance/CG9 advocate evidence based treatment and are at least somewhere to start from - or at least I think so but I know not everyone agrees.

Well, I'm both a therapist in training and in treatment for an e.d., so here goes! :-)

I agree with your point that we expect M.D.s to be up to date with research treatment methods (though many obviously are lacking), etc., but we don't regulate therapists in the same way, and perhaps we should. I think that it is crucial for therapists to be aware of new and changing methods of treatment, etc.

That said, I also think that it's necessary for them to draw their strokes broadly. What works for one client - be it Maudsley, be it Equine therapy, be it finding the root causes (which, honestly, has been incredibly helpful for me and spurred me to action), dbt, cbt, etc. - may not work for others. Treatments are not necessarily transferable. For example, I actually think that equine therapy would be incredibly useful to me. Having therapy dogs at my current treatment center has been very healing. More "directional," or "concrete" therapies (I think this would include Maudsley, in my case) have actually been harmful to me. I think that the client should have a strong say in the kind of treatment approach that is used.

I also think that different therapies can be useful to clients at different times, and though eating disorders are, in part, a "brain disease," I firmly believe that that is only a piece of the puzzle, and therefore only one aspect of many that treatment should address.

As someone who creates performance indicators for psychologists; most of the metrics for mental health are qualitative. Most (if not all) come from patient surveys. The sorts of negative things mentioned in the article would be caught on patient surveys.

Sure, you'll have some patients who give their therapist lots of negative scores here and there on something or another. And some patients will show less or slower progress towards reaching whatever goals they might have, but averages are likely to present themselves eventually and I'd assume outliers would get some sort of scrutiny. I don't know how they intend to design this structure, but it can be done in a way that protects patients, not to say it will.

Very interesting thoughts, everyone. Thank you so much for sharing!