General ethics information
The therapy relationship is always professional. In order to be effective in helping clients reach their goals, the therapeutic relationship can and should be warm, friendly and accepting but it is never to be confused with a friendship. All professional associations have codes of ethics that govern the way the therapeutic relationship is handled and set professional boundaries around it. I abide by the BACP Ethical Framework and the COSCA Statement of Ethics and Code of Practice. You can find information on COSCA’s complaints procedures here.
Prohibition on dual relationships
One of the most important ethical rules in our profession is a prohibition on developing dual relationships with clients. This means that once we meet a person as a client, we are not allowed to develop any other business, social or personal relationship with him or her. It also means that we cannot work as therapists with our friends and family members. Do not take it personally if I refuse to come to yours or your children’s birthday party or to your wedding or house-warming. It’s not because I don’t like you, it’s because it would not be appropriate for me and there is a risk of “contaminating” the professional relationship between us.
Clients are often vulnerable when they come to therapy and they need to feel safe and confident that they will be treated respectfully and with care. It is not a client’s job to meet the emotional (or any) needs of his or her therapist. In real life, outside therapy, friendships and personal relationships are a two-way street. Each person is there for the other. By contrast, therapy is a one-way relationship and is there to meet the client’s needs only. Therapists are expected to have appropriate ways to meet their own needs outside their therapy work so that clients can feel safe to concentrate on themselves. The only obligations a client has are simple and straightforward: come to sessions on time, observe your therapist’s cancellation policy, pay for the session and respect the therapist’s person and physical environment.
The Highlands & Islands and in particular Inverness and the area around it are a relatively small and intimate environment where many people know one another. It’s not uncommon to bump into clients in public places or functions, especially if you have been working as a counsellor for a number of years. In the first session I ask my clients how they wish me to treat them if I do bump into them by chance in the community. Most clients say that they would like to say ‘hello’ and move on. But over the years I have also had clients who said that that they preferred me to not acknowledge them and that if I do see them I should just move on and ignore them. This is absolutely OK. There are many situations where a client would prefer to not explain to the person they’re with, who I am and how they know me. No therapist should ever take this personally. I always remember that the therapeutic relationship is strictly for the client.
All these rules are there to protect clients and I am strict about them. They also mean that my relationship with my clients will not change over time. If a client did some work with me at some point and then a year or two later wishes to come back for a few more sessions the relationship is still available for them. I explain these rules to my clients in the first session because I believe that if rules and boundaries are clear from the start, the relationship will progress smoothly, safely and without problems.
Continuing Professional Development (CPD) and Clinical Supervision
Accredited therapists like me are required to attend a certain number of hours of CPD and clinical supervision every year. Therapists select their CPD activities based on their professional interests and their developmental needs. I choose courses and workshops that enhance my work and refresh my knowledge and skills.
Professional supervision is a formal relationship bewtween a therapist and his or her supervisor who is usually an older and more experienced therapist. I am both a supervisor myself and have a trusted supervisor that I see every three to four weeks for two hours at a time. In supervision, we are required to demonstrate our ongoing commitment to improving our knowledge, our skill and our awareness of ourselves and our role as therapists. Supervisors help therapists debrief if needed and talk about any issues that may come up for us in the course of our work. Supervision is seen as a way for therapists to maintain their emotional balance and objectivity in order to ensure that they continue to provide safe and effective therapy to their clients. A healthy, well-informed and well cared-for therapist is also a safe and effective therapist, not to mention a positive role model…!
Confidentiality & limits to confidentiality
Therapy is confidential. It takes a great deal of courage to open up your inner world and share it with a complete stranger. Clients need to know that they are safe to do so and that what they say and even the fact that they see the therapist, are going to remain confidential. This means that therapists are not allowed to disclose content of sessions or talk about who they are seeing, outside the strictly confidential setting of professional supervision. Any notes the therapist takes during or after sessions are kept secure.
As with all other health professionals, psychotherapists and counsellors in private practice are required to abide by the Data Protection Act. Depending on the circumstances of the therapist’s work, he or she might be required to register with the ICO (Information Commissioner’s Office), which is the body responsible for enforcing the Data Protection Act in the UK. I am on the ICO Register and am required to renew my registration every year. Client files and notes are kept for seven years from the end of therapy, after which time they are securely destroyed.
There are three important limitations to confidentiality in the UK:
1. Harm to self or others:
If a client discloses that he or she plan to harm him or herself or someone else, or that they are abusing a child, therapists in private practice have a discretionary right to report this or otherwise to get other people involved as appropriate. In such circumstances the right to confidentiality may no longer take priority. The client may or may not be consulted depending on the circumstances. If a therapist in private practice chooses to take such action it must be defensible. This means that the therapist has to have a good reason or justification for waiving client’s confidentiality.
In psychotherapy and counselling services that aren’t private, such as with the NHS or other organisations, therapists have compulsory disclosure if harm, potential for harm, or child abuse are disclosed.
2. Money laundering, terrorism and other serious crime:
It is compulsory for all psychotherapists and counsellors, including those of us in private practice to report to the authorities if a client discloses any involvement with terrorism, money laundering, drug trafficking, or any other serious crime. The penalty for non-disclosure is a long jail term. Please remember that the therapist will not be able to keep such information confidential if you disclose it in a session.
3. Court cases and client notes:
If there is a court case that involves you, whether or not it relates to the reason that sent you to therapy, your therapist’s notes might be requested by the courts. Your therapist might also be called as a witness by your side in the case or the other. Once notes are requested by the courts, or if a therapist is ordered to act as a witness, therapists are obliged to the courts and are not allowed to alter notes or bias their testimony in favour of their clients. They are required to give honest and truthful evidence in court. Lying to the court is a serious criminal offence.
If you are involved in a court case it is your choice whether or not to disclose to your solicitor that you saw, or are seeing a psychotherapist or counsellor. If your lawyer doesn’t know there is little chance that the therapist’s notes will be requested by the court. Even if you think it might help your case to let your solicitor know about your counselling, remember that it is possible for the other side to try to use this against you. Because all counsellors are aware of this we write our notes in the most respectful way possible. If you are the subject of criminal proceedings the choice about disclosing your therapy experience might not be in your hands.
There is no rule that therapists have to take notes in sessions although this can be helpful to the therapeutic work. Be aware that you have a right to request that your psychotherapist or counsellor does not keep notes about your sessions.
Data Protection & the new GDPR
Avigail is registered with the Information Commissioner’s Office (ICO) and complies with their data protection regulations.
GDPR is a new data protection law which comes into full effect in 2018. It sets out the main principles of data protection and the responsibilities organisations have when handling personal data. It protects individuals’ personal information and improves their control over how it is collected, stored, shared and used.
If a company has legitimately collected some personal information from or about you – such as your home address, medical history, religion or ethnic background – you’d want them to keep it secure and not misuse it or pass it on inappropriately.
Businesses in the European Union (EU), which includes the UK, have until 25 May 2018 to comply with GDPR. From this date, GDPR replaces the Data Protection Act 1998 (DPA 1998) as data protection law across the EU.
Client Records — I keep basic information about clients mainly for contact (name, address, email address, phone numbers). I also ask for marital/relationship status, names and ages of children. Clients can volunteer additional information about medication or medical condition if so they wish, as well as say how they were referred to me. In my session notes I tend to summarise some of the information clients provide in sessions that I feel is especially important for me to remember. I might also write anything that I facilitated during sessions or any processes that I believe are significant for the client’s therapy. Notes are always written in a respectful way.
Clients have a right to request that I do not keep notes. I explain this when I tell clients about the limitations to confidentiality. A typical reason can be that the client is involved in a court case and does not wish there to be a record of our sessions because they don’t want them to be used as evidence should the occasion arise. It is the client’s right to request this. Therapists in private practice or in organisations or services do not have to keep notes. We do this mainly to remember better what each client is working on in therapy and to make sure there is continuity between sessions.
All information about clients is kept in a locked and secure metal filing cabinet. Clients are free to see the records I keep about them whenever they wish. The records are kept during the therapy relationship and I destroy them within five years of the last session. Clients can request that I destroy the records as soon as they finish therapy.
Some therapists type up their notes and keep them on a computer. I don’t. All my session notes are handwritten. However, clients do contact me by email occasionally. Email correspondence can range from simple bookings and changes of appointments, to clients sharing something that is going on with them and requesting advice or support. My computer is password protected. All cloud backup I have is encrypted. I am the only one with access to my computer but in the event of my death I have made arrangements for a trusted professional who has a confidentiality agreement with me to access my computer in order to inform my clients. This professional will also see to it that all client records are securely destroyed. Otherwise no one else has access to any client information either electronic or physical that I keep. I have an industrial-size, secure confetti-type ‘Royal Sovereign’ brand shredder. When records are destroyed they are destroyed securely.
Sharing Information — Under normal circumstances client information is never shared with anyone. Psychotherapists cannot even confirm to anyone that a particular client sees them or saw them in the past. Information can only be shared with explicit written consent from clients. This can happen if a client needs me to write a letter to a GP, speak to a GP or other medical or mental health professional about them, write a letter to their workplace, teaching institute or someone else. When a letter is required the client always has the last word about the letter, how it is written, what information it includes, who it is addressed to and the manner in which it will be sent.
Please read the section on limitations to confidentiality above. It covers the rules under which client confidentiality can be intentionally compromised. When it comes to session records, if there is a court order to hand over client notes to the courts, therapists are obliged by law to do so. Therapists can also be called as witnesses and if this happens, they are obliged to the court, not to the client! We don’t like this of course, but we do not have a choice about it. It is the law.
Clients can decline to tell their solicitor that they are/were seeing a therapist if they don’t wish to be in a situation where their session records are used as evidence. But if they do tell, and their notes are brought in as evidence, they need to know that the other side in the case will see them too. It is important to remember that therapists can be called to give evidence in court even if no written notes are kept.
Therapists are not allowed to change their records to help their clients’ case and are not allowed to lie to the courts no mater how sympathetic they might feel to their clients’ case. Knowingly lying to the courts is called perjury and it is a criminal offence.
Update to BACP Statement of ethical practice (1)
As of 18 September 2012 a new guideline has come into effect concerning homosexuality and counselling. The letter sent to all BACP members states the following:
BACP opposes any psychological treatment such as ‘reparative’ or ‘conversion’ therapy
which is based upon the assumption that homosexuality is a mental disorder, or based on the
premise that the client/patient should change his/her sexuality.
BACP recognises the PAHO/WHO (2012) recent position statement that practices such as
conversion or reparative therapies ‘have no medical indication and represent a severe threat
to the health and human rights of the affected persons’.
BACP recognises that the diversity of human sexualities is compatible with normal mental
health and social adjustment (Royal College of Psychiatrists). A recent research review (King,
et al 2007) showed that those who do not identify as heterosexual may be misunderstood by
some therapists, who see the client/patient’s sexuality as the root cause of their presenting
issue. The ability to appreciate differences between people, to commit to equality of
opportunity, and to avoid discrimination against people or groups contrary to their legitimate
personal or social circumstances, is central to ethical and professional practice (BACP 2010,
BACP believes that socially inclusive, non-judgemental attitudes to people who identify across
the diverse range of human sexualities will have positive consequences for those individuals,
as well as for the wider society in which they live. There is no scientific, rational or ethical
reason to treat people who identify within a range of human sexualities any differently from those who identify solely as heterosexual.
The full BACP Ethical Framework can be found here
If you have any questions about anything you have read here feel free to contact me at any time.