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 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 very strict about them. They also mean that my relationship with my client 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, nothing has changed and the relationship is still available for the client to use safely. I always 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 in a secure filing cabinet or a secure computer system. Notes are kept for seven years after the last appointment after which time they are destroyed.
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 and others:
If a client discloses that he/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, 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 give 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 do our best to 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 down notes in sessions, although this is 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.
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.