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. A new update of the BACP Ethical Framework comes into effect on 1st July 2018. You can download a copy of the new Ethical Framework here. I also abide by 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.
Relationships with former clients
It is not unusual for clients and therapists to come to respect and even like each other as human beings. As you can see from item 37 in the new BACP Ethical Framework, there is no strict prohibition on changing a relationship with a former client into a friendship or a business relationship. However, any such change is to be considered carefully and the decision has to be governed by strict rules, which are mainly concerned with the former client’s safety.
There is an indefinite and strict prohibition on engaging in a sexual relationship with a former client. This is regardless of how much time has passed since the end of therapy.
In my many years of practice I have been asked many times by clients if I would be prepared to be friends at the end of therapy after a certain, agreed-upon cooling off period. I recognise this as an expression of respect and affection towards me and am deeply honoured (not to mention flattered…). However, in my many years of practice I have decided against developing friendships with former clients. My clients are among the best people I have ever met. In another life I would have loved to have met many of them as friends, but once I meet someone as a client, that’s it…
Apart from the obviously reasonable guidelines in the Ethical Framework, there is something a bit uneasy for me about changing something that started out as a one-way relationship into a two-way one. When people meet in a true spirit of friendship, it’s balanced and even. Therapy relationships are not balanced and are not even no matter how friendly or warm they can be. Clients come to therapy when they are usually a bit vulnerable, at a low ebb in their lives, and they can be in a position of need.
Clients disclose information in therapy not because we’re getting know each other for the relationship’s sake, but because it is necessary for the client’s therapy. And this is the other important point. A friendship exists for its own sake, the therapy relationship does not. It is a means to an end. Clients seek therapy to achieve something. The therapeutic relationship is the tool or the foundation on which the change the client seeks to achieve, happens. Clients pay for the service because it is a service — we don’t pay friends to have a chat. In other words, although it is still a relationship between two human beings, it is there to fulfil a purpose. From a humanistic perspective I see myself as being hired temporarily to accompany my clients somewhere along their journey to develop to their full potential. I have a job to do and that’s what I am being paid for.
Relationships that start out as friendships are usually allowed to develop slowly over time. Both partners take their time to learn about one another and this usually happens evenly as the relationship progresses. The information we learn about clients in therapy is deeply personal. We learn a great deal about clients in a relatively short time compared with how it happens in natural, organic friendships. We often get to hear things that no one else in the client’s life has ever heard, or ever will hear. The only reason to share private information with a friend is for the friendship’s sake and for no other reason.
In other words, how relationships with therapists begin, how they develop and the reason they exist in the first place are highly incompatible with friendships. They are meant to be this way if they are to be helpful. Therapy relationships are artificially one-sided. They need to be safe for clients to feel free to explore, develop, heal, grow, integrate etc, without worrying or considering the needs or feelings of the other partner in the relationship. In natural friendships or relationships if we only focus on ourselves, our needs or feelings and never consider the needs or feelings of the other, or give them the space to share and get support from us, it’s not going to work. Friendships can be hugely therapeutic in their own way. But they have to be equal. Therapy is something that people use when they temporarily need an uneven situation, deliberately, in order to take care of their own needs without interruption.
It doesn’t feel right to me to just put all this aside and start a ‘new’ friendship with a former client as if none of this history existed. The truth is no matter what we do and how mature we are, we can never ignore our previous history together. Even with the best of intentions I think that the former client is always in some way disadvantaged in this kind of a situation. They don’t know as much about me as I do about them and they have never seen me in a position of need or a low spot in my life.
As I said above, I know that when former clients offer to become friends they trust me and feel safe with me and I am honoured by this. But the answer would still be ‘no’. I ask former clients to try to not take this personally. It’s not because I don’t like them. Quite the opposite, I do very much, but we have to accept that if we met as client-therapist this means that the possibility of friendship has been compromised from the start.
Another reason to avoid friendships with former clients has to do with whether a client ever wants to come back and do some more therapy work. I prefer to keep my door open and not change the relationship, just in case people need to come back. It’s not because I think I am the only one who offers decent therapy, but because the therapeutic history the client had with me is unique and valuable. The history is already there. A lot of work has been put into it by the client and it cannot easily be built from scratch with someone new.
Although I do pride myself on having the ethos of making myself redundant, it can happen occasionally that people want to come back even years after the end of their original therapeutic engagement with me. I believe this should be available to former clients if they ever need this. If we turned our relationship to a friendship, the option of seeing me again as a therapist will not be there any more. If you have any questions about any of this feel free to contact me.
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
Fully Human Psychotherapy is registered with the Information Commissioner’s Office (ICO) and complies with their data protection regulations.
GDPR is a new data protection law which has come into full effect on the 25th of May 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 or organisation 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, had 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 — We keep basic information about clients mainly for contact (name, address, email address, phone numbers). We 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 session notes we tend to summarise some of the information clients provide that we feel is especially important for us to remember. We might also write anything that we facilitated during sessions or any processes that we believe are significant for the client’s therapy. Notes are always written in a respectful way.
Clients have a right to request that we do not keep notes. We explain this when we 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 could 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. It is something we choose to do mainly to remember better what each client is working on in therapy and to make sure there is continuity between sessions and generally to make sure clients are getting the best service possible.
All information about clients is kept in locked and secure metal filing cabinets. Clients are free to see the records we keep about them whenever they wish. The records are kept during the therapy relationship and are destroyed within five years of the last session. Clients can request that we destroy the records as soon as they finish therapy.
Some therapists type up their notes and keep them on a computer. We don’t. All session notes are handwritten. However, clients do contact us 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. Computers are password protected and any cloud backup is encrypted. In the event of the therapist’s death there are arrangements in place for a trusted professional who has a confidentiality agreement with the practitioner to access client records in order to inform 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. When records are destroyed they are destroyed securely using a secure confetti-type shredder.
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 a letter to a GP, another medical or mental health professional, 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.