When the defenders of protected titles say that we cannot let just anyone receive vulnerable people after three weekends of training, they are raising a genuine public-health question. When practitioners from outside the university reply that there are qualified psychologists who are cold, clumsy or abusive, they are not talking nonsense either. Many patients have had that experience: an official title is not enough to create a therapeutic encounter of quality.

The debate turns toxic when each side takes the worst version of the other to stand for the whole.

This reduction prevents us from thinking about the real subject: what guarantees should we demand of anyone who accompanies psychological suffering?

Protected titles: a necessary but insufficient protection

In France, the title of psychologist has been protected by the French law of 25 July 1985. Its use presupposes degrees defined by regulation and a registration that allows the professional to be identified. The title of psychotherapist is also regulated: it presupposes official registration and, depending on the situation, training in clinical psychopathology as well as a practical placement. The legal texts and the ARS point in particular to the requirement of training in clinical psychopathology and a practical placement for use of the title of psychotherapist.

Certain words create an expectation of competence. When someone consults for severe depression, suicidal ideation, eating disorders, domestic violence, dissociation or complex trauma, they need a professional capable of assessing a risk, spotting warning signs, working within a network and referring on if the situation exceeds their field of competence.

The psychiatrist’s place must also be distinguished. The psychiatrist is not simply one “psych” among others: they are a specialist physician. The specialist diploma in psychiatry explicitly aims to train physicians specialising in adult, child and adolescent psychiatry, with a regulated length of training. This medical position gives the psychiatrist specific responsibilities: medical diagnosis, prescription, coordination of complex care, intervention in certain situations of crisis or legal constraint.

The regulatory camp also relies on an ethical argument. The psychologists’ code of ethics insists on respect for the rights of the person, competence, integrity, prudence, confidentiality and the need to recognise the limits of one’s intervention. The FFPP points out that this code aims to protect both the public and psychologists against misuses of psychology.

In a context where offers of care, wellbeing, personal development and spirituality mingle easily, this caution is essential. In its 2022-2024 activity report, Miviludes notes a significant increase in alerts and requests for information, particularly in the fields of health, wellbeing, training and coaching.

But this defence of titles also has its blind spots.

The therapeutic relationship: indispensable, but not sufficient

The second camp starts from an experience that is hard to dismiss: many people have been helped by practitioners who were neither psychologists, nor psychiatrists, nor psychotherapists in the legal sense. Some psychopractitioners or therapists from private schools have completed long trainings, are supervised, know their limits and work seriously. Lumping them together with improvised profiles would be unfair.

This camp recalls a fundamental clinical truth: therapy cannot be reduced to a degree. What helps is also the quality of presence, the listening, the alliance, agreement on goals, trust, the patient’s commitment and the therapist’s capacity to support change. On this point the research is solid: a meta-analysis by Flückiger and colleagues shows that the therapeutic alliance is associated with psychotherapy outcomes, over and above theoretical orientations.

There are also private organisations that set demanding standards. The FF2P, for example, presents institutes offering complete training in psychotherapy with pathways that can last five years, and insists on ethical and deontological professional practice.

The problem is that “unqualified” does not mean just one thing. It can describe someone who has done a short course, sells promises of healing on Instagram and works on trauma with no grounding in psychopathology. But it can also describe someone who has trained for several years at a serious school, who is supervised, who does not present themselves as a psychologist, who knows their limits and who refers on when necessary.

Here again, this camp has its own blind spots.

A symmetrical escalation: each side defends its identity

From a systemic point of view, this conflict looks like a symmetrical escalation. Each camp is defending something legitimate, but the more forcefully it defends it, the more it threatens the identity of the other.

Psychologists see the rise of poorly trained profiles, excessive promises, pseudo-scientific discourse and vague offers. They raise the alarm. Non-psychologist practitioners feel attacked in their vocation, their training path and their legitimacy. They reply that psychologists are arrogant, corporatist or locked into a logic of diplomas. Psychologists harden their discourse. The system loops.

Each camp says: “I am protecting patients.” But each accuses the other of not really doing so.

The patient then becomes a triangulated third party. People speak in their name. They are used as evidence. One camp mobilises the testimonies of people saved by an unqualified therapist. The other mobilises the cases of pseudo-therapeutic abuse. Both realities exist. But each becomes a weapon against the other.

Getting out of the false choice

The most solid position, it seems to me, is this: the degree is not enough, but the absence of a framework is a real problem.

A degree on its own heals no one. But a protected title gives the public verifiable information: a minimum training, a registration, an accountability, a possibility of identification. The therapeutic relationship is central. But a relationship without training, without supervision, without limits can become a relationship of influence, even of coercive control.

Four categories could be distinguished.

For the public, the right question is therefore not only: “Do they have a degree?” It is also:

• What training have they completed? How many years? What supervision?
• What method? What code of ethics? What official or professional recognition?
• Do they work with other professionals?
• Can they say: this is beyond my remit?

My view

We do not need a therapy war. We need a more adult debate about what we must guarantee to people who are suffering.

I have been through several phases myself. Coming out of university, I was convinced of the solidity of my tools. Then I doubted. I had the feeling that I did not really know how to practise therapy. My training in systemic psychotherapy then gave me a long, demanding, supervised, peer-validated framework, centred on real practice and on the capacity to think about relationships.

At one point, I called into question a large part of my university training. Then I understood what it had given me: a grounding in psychopathology, a structuring of thought, a common language with psychiatrists and other professionals — which is valuable, but does not make a good therapist. Today I think that the university brings real things, but that it does not evolve fast enough and does not sufficiently assess what makes a good therapist. I also think that private schools can be more agile, closer to practice, sometimes more demanding about stance. But I remain convinced that you cannot improvise being a therapist.

Therapy demands a long path, solid ethics, supervision, a capacity to think, to act coherently, to recognise one’s limits and to collaborate.

• The degree is not enough.
• The relationship is not enough.
• Charisma is not enough.
• Goodwill is not enough.