2. Understand the need to work within an ethical framework.
2.1 Evaluate the need for an ethical framework for counselling and psychotherapy.
In order for counselling to be effective and purposeful it must be conducted in an ethical way. The very act of seeking counselling predisposes that the seeker is vulnerable/troubled and needs assurance that the main focus of counselling will be their well-being and promote for them a greater sense of autonomy and not to serve any other purpose. Therefore the foundation of good counselling must be an ethical relationship, hence the need for an ethical framework. As Tim Bond (2010) states:
An ethical framework creates a basic conceptual structure within which we can all feel safe and supported to move around freely and make choices. There is enough of a structure to define the available choices and give a sense of distinguishing what is ethically acceptable from the unacceptable or unwise, the framework creates sufficient spaces where counsellors can position themselves in ways that fit a sense of personal and professional integrity and take into account the needs of clients.
In counselling there are five national organizations within Britain whose ethical requirements have been adopted as the minimum ethical standards for the profession. These organizations are:
British Association for Counselling and Psychotherapy (BACP)
United Kingdom Council for Psychotherapy (UKCP)
Counselling Psychology Division of the British Psychological Society (BPS)
Confederation of Scottish Counselling Agencies (COSCA)
Irish Association for Counselling and Psychotherapy (IACP)
These major professional organizations all stress these ethical concerns:
- Client Safety
- Professional Competence and Fitness to Practice
- Respect for Differences in Lifestyles and Beliefs between Clients
- Respect for Client Self-Determination
- Prohibitions on Exploitation of Clients
- Contracting
- Confidentiality
- Duty to Maintain the Profession’s Reputation
The linchpin to all these concerns is the client.
The BACP Ethical Framework is designed to regulate the work of the counselling practitioner in order to safeguard the needs of the client and to ensure that they are being treated with respect and dignity. It is important to emphasise that the framework are guidelines only.
The welfare of the client forms the foundation of the code of practice and consequently the client is protected through the principles outlined within it.
A counsellor must remain alert to the issues raised by the code of ethics and must adhere to the strict guidelines. The code protects the client, and the counsellor, by upholding a need for confidentiality and responsible behaviour throughout the client/counsellor relationship. The code encourages good practice and provides rules that govern personal safety and acceptable behaviour, without these guidelines it is more difficult and complicated for a counsellor to build an impartial relationship with their client.
The BACP suggests that competence in the practice of counselling skills and counselling depends on the following:
- Knowledge of theory
- Grasp of practical skills
- Specific personal qualities
They suggest that a number of different activities contribute to the development of competence:
- Training courses
- Experience in ‘client contact’ situations
- Supervision (reviewing what the counsellor has covered during client contact with a more experienced practitioner or their peers)
- Personal therapy (with the counsellor as the client)
The BACPS’s ethical framework allows conformity to ensure that counsellor’s work to the same standards provides protection to both the client and the counsellor by providing a mechanism for client’s complaints and ensures that complaints are dealt with.
The complaints procedure is designed to give an open and transparent route to help remedy any complaint and help get clarification.
Complaints can come from a client or any member of the public that has sought or received a service from a BACP member, however complaints can also come from members of the association itself e.g. a member may have witnessed poor practice delivered by another member. Other complaints may come from a legal guardian or a third party of someone that has received a service or a client in a service may ask for a practitioner to make a complaint on their behalf.
To have good ethical practice within counselling it is important that there are boundaries and contracts in place that are agreed to and understood by both the counsellor and the client.
At the start of each new counselling session it is important that a contract is set out between the client and counsellor. The BACP states 'good practice involves clarifying and agreeing to the rights and responsibilities of both the counsellor and the client at appropriate points in their working relationship'.
Within the contract such things as the type of counselling being offered, number of sessions, the frequency of sessions, timing of sessions, length of sessions, payment and confidentiality should be discussed and agreed to by both the counsellor and client.
Boundaries mark a safe place in which to provide counselling where the client can enter and exit, but inside the boundaries the focus is always on the client. It is important that counselling remains professional all times and by having boundaries in place it helps to differentiate the client/counsellor relationship from any other the client may have. With good clear boundaries in place it will help protect the client from any kind of exploitation, within the boundaries each person should know exactly what their role is and what they have to do within their role i.e. the counsellor is there to counsel and the client is there to be counselled.
2.2 Explain the main elements of one recognised ethical framework for counselling and psychotherapy.
Counsellors must respect a client’s dignity and value the individual and their personal concerns and difficulties, regardless of the client’s background. Maintaining confidentiality, integrity and principles are all part of a counsellor’s many duties and increases the amount of responsibilities he/she must take charge, and control, of. On top of this a counsellor must continually maintain a responsible attitude towards certain safety issues.
Counsellors are often faced with situations which require sound ethical decision making ability. Determining the appropriate course to take when faced with a difficult ethical dilemma can be a challenge. The intention of the ethical principles is to offer professional counsellors a framework for sound ethical decision making and assist in considering all relevant circumstances and be accountable for decisions made.
Ethical principles:
Autonomy: respect for the client’s right to be self-governing
Autonomy is the principle that addresses the concept of independence. The essence of this principle is allowing an individual the freedom of choice and action. It addresses the responsibility of the counselor to encourage clients, when appropriate, to make their own decisions and to act on their own values. I feel there are two important considerations in encouraging clients to be autonomous. First, helping the client to understand how their decisions and their values may or may not be received within the context of the society in which they live, and how they may impinge on the rights of others. The second consideration is related to the client's ability to make sound and rational decisions. It is the practitioner’s responsibility to protect the client’s privacy and confidentiality. The client must be made aware of any foreseeable conflicts of interest as soon as they become apparent. The principle of autonomy opposes the manipulation of clients against their will, even for beneficial social ends. It is important that an explicit contract be entered into in advance of any commitment by the client.
Beneficence: a commitment to promoting the client’s well- being
Beneficence reflects the counsellor’s responsibility to contribute to the welfare of the client. Simply stated it means to do good, to be proactive, prevent harm when possible and to ensure the client’s best interests are considered. To help achieve this the counsellor is obliged to commit to regular and ongoing supervision to enhance the quality of the service provided and to commit to continuing professional development.
Non-maleficence: a commitment to avoiding harm to the client
Non-maleficence is the concept of not causing harm to others. This principle reflects both the idea of not inflicting intentional harm, and not engaging in actions that risk harming others; this includes the avoidance of sexual, financial emotional or any other form of client exploitation. Practitioners have a personal and professional responsibility to challenge, where appropriate, the incompetence or malpractice of others; and to contribute to any investigation and/or adjudication concerning professional practice. It is the practitioners responsibility not to provide a service if unfit to do so, this could be due to ill health, personal circumstances or intoxication. Taking out appropriate insurance cover is advised.
Being trustworthy (fidelity): honouring the trust placed in the practitioner
Being trustworthy or Fidelity involves the notions of loyalty, faithfulness, and honoring commitments and is fundamental to understanding and resolving ethical issues. Clients must be able to trust the practitioner and have faith in the therapeutic relationship if growth is to occur. Therefore, the counsellor must take care not to threaten the therapeutic relationship nor to leave obligations unfulfilled honouring promises and agreements.
Justice: the fair and impartial treatment of all clients and the provision of adequate services
The principles of justice is to provide equality and fairness, to provide nonjudgmental support whilst treating everyone with dignity and respect. For the practitioner to understand his-her legal and moral obligations and being aware of the differences whilst avoiding discrimination providing appropriate and accessible services to anyone
Self-respect: fostering the practitioners self-knowledge and care for self
All that has been mentioned in this section (Ethical Principles) the practitioner must strive to achieve them for him/her self. Practitioners should seek out opportunities to further develop themselves, this can include counselling, therapy, training and other life-enhancing activities and it is an ethical responsibility to use supervision to enhance the personal and professional standards of the practitioner thus helping to maintain competence and further assist development. Practitioners have a responsibility to care for themselves.
Providing a good standard of practice and care:
Clients are entitled to a good standard of quality, care and protection, to achieve this the practitioner must have a good standard of practice, care and professional competence (giving good consideration to the limitations of their training and experience and work within these limits) showing a commitment to being ethically mindful and having a good and trusting relationship with both client and colleagues whilst fundamentally respecting the privacy and confidentiality of all concerned.
Under the BACP Code of Ethics, practitioners must have certain personal moral qualities when dealing with their clients. These are providing services with an ethical and moral component. The qualities should be developed in the individual as a personal commitment rather than because they “have to”. They should aspire to the following personal qualities:
- Empathy – understanding things from another person’s perspective. Putting your self in “their shoes”.
- Sincerity - Be consistent between what we say and what we do.
- Resilience - Work with the client, supporting them in their concerns, without diminishing us personally.
- Integrity - Be moral, honest, coherent and straightforward in our dealings with others.
- Respect - Hold others in esteem and understanding.
- Humility - Be able to assess our own strengths and weaknesses.
- Competence - Use the skills and knowledge that is required.
- Fairness - Apply appropriate criteria to inform decisions and actions.
- Wisdom - Have sound judgment that informs your practice.
- Courage - Act in spite of any risks, your own fears and uncertainties.
To maintain good standards of practice all counsellor’s, trainers and supervisors must have regular and on-going formal supervision and support, keeping themselves up to date with the latest knowledge, laws and training and be aware of changing circumstances. Counsellors must continue their on-going personal development ensuring their fitness to practice whilst being mindful of their own needs and safety.
2.3 Analyse the similarities and differences between their chosen ethical framework and the requirements of at least one other professional body or employing organisation.
Buddhist Psychotherapy Programme Code of Ethics
The BACP and the IBAP (Institute for Buddhist and Psychotherapy) both split their ethics into three groups:
BACP IBAP
Values Inspirational
Principles Normative
Personal moral qualities Minimal
In many respects both the BACP and the IBAP are similar, one thing that strikes me is that the BACP is client lead, by this I mean that the whole of the BACP Frame work revolves around the safety, well-being and the needs of the client as this is paramount, where as the IBAP is more therapist led and the therapist is seen as a ‘healer’. The framework revolves around the values of the therapist not only as a therapist but how they perceive life in general. To show how therapist led the framework is for example the word ‘client’ is only mentioned seven times throughout the IBAP framework.
I feel that in reading the IBAP Framework the emphasis is on the therapist to reach self harmony and lead by example not just in the therapeutic relationship but in life beyond therapy, being a therapist is a lifestyle ethic rather than a career ethic and is very spiritual in its dealings with therapy and life.
Here are some statements taken from the IBAP framework to show what I mean by this:
- We speak words of peace and reconciliation
- We work for ecological harmony
- We are hospitable and generous
- We use what we have for generous, hospitable and wholesome purposes, avoiding accumulation in a world where poverty and exploitation persists
I understand that the BACP has ethics that cover Values and Ethical Principles but also boundaries are put in place to protect the client and counsellor and to keep the relationship a therapeutic relationship. The BACP advises to avoid ‘dual relationships’, that when the therapy/counselling ends the relationship ends, where as the IBAP states that ‘The therapeutic relationship does not end when formal therapy ends’ and ‘accepting a client is a long term responsibility and we should always be willing to see a client again’. It is acceptable to befriend the client and continue that friendship beyond the therapy. I sense that the IBAP see boundaries as a block to therapy. However the IBAP does state like the BACP that therapists should not allow themselves to engage in a sexual relationship with a client and goes as for to say that the therapist will be open to charges of serious misconduct.
The ‘Minimal Ethics’ of the IBAP are very similar to the ‘Guidelines on good practice’ of the BACP in that they both refer to; confidentiality, abuse of client trust, supervision and the protection of a client anonymity, fitness to practice, own limitations to practice, working under the influence i.e. drugs or alcohol, discrimination, professional conduct etc.
Confidentiality is relatively the same in both frameworks, however when it comes to breaches of confidentiality neither framework states what the legal requirements are for breaching client confidentiality i.e. if the counsellor should become aware of drug trafficking, money laundering, acts of terrorism.
Both frameworks give an example where under exceptional circumstances confidentiality may be breached without the clients consent. This may happen when a client may have the intent to cause serious harm to themselves or others; the BACP advises that ‘the practitioner has an ethical responsibility to act in a way which balances the client’s right to confidentiality against the need to communicate with others’. The IBAP under these circumstances states ‘the therapist should discuss with the client what action should be taken’. This would seem to happen despite the frame of mind of the client.
A key difference in both frameworks is the complaints procedures. The complaints procedure for the BACP is very methodical and structured as mentioned previously.
The complaints procedure for the IBAP states that the complaint should be first put in writing, then both parties, where both parties feel able to do so, be invited to meet to see whether the matter can be resolved informally, no records will be kept of the content of this meeting.
Where resolution is not reached the complaint will move to the next level. The complaint is then bought to the attention of a mediator, both parties may appoint themselves or have provided for them another member of the institute who will act as a friend and help with supporting the individuals concerned. Records of these proceedings are now kept. The point of mediation is to arrive at a written ‘final statement’, this can be a statement of an apology by either or both parties or a specification of actions to be carried out by either party or both parties. If both parties agree on and are happy with the ‘final statement’ both parties along with the mediator will sign the document bringing the matter to a close.
In the event of the dispute still not being resolved by the above method, the parties now involved shall attempt to agree a best procedure resolving or arbitrating the matter acceptable to both sides. If no such procedure can be agreed, the Ethical Committee shall appoint one or more neutral adjudicators, who may or may not be members of the institute who shall investigate the matter and give a final ruling to which all parties will be bound.
Any appeals beyond this point will be at the discretion of that Ethical Committee, if an appeal is accepted it will then go to the General Meeting of the Institute.
2.4 Using examples analyse potential conflicts between the requirements of organisational and other codes of professional practice and their chosen ethical framework for counselling and psychotherapy.
I believe I have already answered this question as far as the IBAP in the answer I gave above i.e.
- The BACP is client lead where as the IBAP is therapist lead.
- The ethical framework of the BACP revolves around the wellbeing of the client where as the IBAP revolves around the spiritual wellbeing of the therapist.
- The BACP discourages dual relationships where as the IBAP openly encourages dual relationships, however both organisations denounce sexual relationships.
- Both organisations have polices where confidentiality can be breached.
- Both organisations have similarities in their codes of ethics.
- Both organisations have differences in their complaints procedure.
BACP compared with General Hypnotherapy Register
I feel there are many similarities between BACP and GHR. They both cover the same Ethical principles - for example;
- The conduct and ongoing development of the practitioner.
- Relationships.
- The welfare of the client
- Data protection
- Confidentiality
The BACP Ethical framework is much more in-depth, methodical and looks more professional than the GHR Ethical framework.
The BACP is laid out in a more logical order with many sub headings allowing the user to easily find the section they need to refer to; however it is also wordy and technical. It uses professional jargon and is not particularly easy to follow and understand, particularly for a client who may be distraught.
GHR is written in plain English has a simpler overview and I feel is more user friendly and overall more informal.
BACP is focused on the client and their well being and safe guarding the reputation of the association where as the GHR is more focused on the practitioner’s code of conduct rather than the client’s entitlements.
In the BACP there are over six pages outlining the complaints procedure, In GHR there are two small paragraphs outlining the complaints procedure.
There are some similarities within the guidelines for respecting privacy and confidentiality. Both talk about safety of client or the possibility of the client causing harm to others.
BACP advise that a counsellor has an ethical responsibility to balance the client’s rights of confidentiality against the need to communicate with others. Within GHR I have noticed that there is no mention of ethics.
Both organisations talk about being bound by law to disclose, however, BACP stress that at all times the counsellor should be willing to be accountable to their clients and their profession for any disclosures made without their clients consent. In other words the counsellor must be able to justify why they acted as they did.
BACP includes the fact that in some situations the law forbids the counsellor informing the client that confidential information has been passed to the authorities, but clearly states that the counsellor remains ethically responsible to colleagues and the profession.
2.5 Summarise how these conflicts could be resolved.
To summarise how these conflicts can be resolved I have an Ethical Framework that I must adhered to and that guides me, that being the Ethical framework of the BACP. I also will be having managerial supervision where problems and conflicts with an organisation can be resolved.
Communication between agencies is crucial in resolving issues.
Ways in which conflicts can be reduced are:-
- Establishing clear roles
- Fostering commitment to inter-agency working at all levels within organisations
- Promoting trust and respect between professionals
- Raising awareness of the context, culture (including belief systems and values) and remit of other agencies
- Addressing issues of power, status and hierarchy
- Clear communication
- Consulting with service users and member agencies on issues, needs and priorities
- Establishing clear and realistic aims and objectives that are understood and accepted by all agencies
- Adequate resourcing in terms of funding, staffing and time including explicit agreements about how partnerships will share resources
3. Understand the environment in which counselling takes place.
3.1 Using examples analyse the key issues surrounding the following in relation to possible actions by clients.
It is important that I have adequate insurance, public liability and also professional Indemnity insurance. Public liability is necessary to protect clients and myself from any accidents or injury that may occur during the session which may result in a claim. Indemnity Insurance is necessary to cover against any possible negligence claims brought against me. An example of a claim for negligence could be if a client committed suicide and the grieving family decided to sue the counsellor as they felt the counsellor was to blame.
Ethical standards are integral in promoting safe and professional counselling in a safe and professional environment. It is important for all members of the BACP to deliver a professional level of service that caters for the best interests of the client and public at large.
The BACP states: - BACP members are accountable for their actions and also the actions of other BACP members. Ethical standards are important in promoting safe and professional counselling and psychotherapy practices. These are important in order that members deliver a professional level of service that caters for the best interests of their clients, and the public at large. Professional accountability is also key in ensuring public protection and allows the Profession to move forward enjoying the public confidence in the services provided. (BACP Guidelines 2010)
Problems can occur when professional conduct is not adhered to, especially if a counsellor is not fully qualified or is unfit to practice, e.g. too tired or emotionally unfit. This can lead to a breakdown of trust between the client and counsellor and could possibly prevent a client seeking the help they need. It could also damage the reputation of the counsellor and the profession in general.
Inappropriate touching, breach of boundaries, giving advice, working outside my chosen model are some examples that can result in me being sued and a case of negligence or malpractice bought against me.
All members are bound to abide by the guidelines set out in the Ethical Framework for Good Practice in Counselling and Psychotherapy. The Association relies on members of the public as well as members of BACP bringing matters of poor and unethical practice to its attention. Only in so doing, can the Association act in order to consider any matters of complaint and ultimately to protect members of the public and the reputation of counselling and psychotherapy. (BACP Guidelines 2010)
Ethics can be an extremely difficult subject to define and discuss as it closely related to one’s own unique moral, cultural, and spiritual values. Within the counselling profession however there is a strict ethical framework which must be adhered to. This framework has been developed over the years to insure integrity, confidentiality, and responsibility on the part of the counsellor.
Counsellors are often faced with situations which require sound ethical decision making ability. Determining the appropriate course to take when faced with difficult ethical issues can be a challenge. The five principles as stated in the BACP Ethical Principles of autonomy, justice, beneficence, non-maleficence and fidelity are each absolute truths in and of themselves. By exploring the issues in regards to these principles one may come to a better understanding of the conflicting issues.
An example of an ethical issue that could arise may be if I had recently suffered bereavement and get a client who was also grieving. I may feel too emotionally raw to offer the client effective counselling and may decide that it would be in the clients best interest to see another counsellor. Should such a situation arise I would be congruent and explain my reasons to the client. Failure to do this could harm the client and result in me being sued and a case of negligence or malpractice bought against me
In order that the client feels comfortable in expressing him/herself in an uninhibited way, the relationship between the client and the counsellor needs to be built on reciprocal trust. It is the counsellors responsibility (as set down in the BACP Ethical framework) to provide a safe, confidential environment and to offer empathy, understanding and respect. Failure to do this, for example, sharing the clients name and or information with a third party without permission from the client could result in me being sued and a case of negligence or malpractice bought against me.
Confidentiality is a fundamental ethical obligation owed by the counsellor to the client and a basic right of the client.
Counsellors are obliged to keep anything their clients talk about during counselling sessions confidential. Information that could identify a particular client will not be given to anyone else without the prior consent of the client concerned.
Clients should be made aware that as part of their ongoing professional and ethical requirements that the counselor may discuss the client’s case with a third party (a supervisor); this may be done for guidance on that particular case. These meetings respect and protect the privacy and identity of the client.
Under exceptional circumstances a counsellor may have to breach confidentiality, these are:
- Serious risk of harm to self or others (a referral may have to be made)
- Child abuse (child protection laws and social services would come into play)
- Actual mental health crisis (a referral may have to be made)
- Drug trafficking (legal obligation)
- Acts of terrorism (legal obligation)
- Money laundering (legal obligation)
Where child abuse is involved this can cause ethical and moral dilemmas for the counsellor as unlike the NHS and Educational bodies where child protection would be designate by law, this isn’t the case under the ethical framework (not legally obliged to disclose child abuse). Counsellors and supervisors would have to decide if ethically and morally, for example, social services should have to become involved or whether child protection laws should come into play.
All these scenarios should be discussed with a supervisor and where possible with the client.
A client’s right to confidentiality is never absolute. Counsellors may be forced to disclose sensitive personal data where refusal would make them liable to civil or criminal court proceedings.
As with any professional relationship the setting of boundaries is important. All relationships should be limited to a therapeutic setting and all social contact between a counsellor and client should be avoided. A counsellor should also never accept a friend or family member as a client or enter into a sexual relationship with a current or former client.
These boundaries form part of the contractual agreement between a counsellor and client and must be adhered to at all times.
Boundaries set the ground rules for counselling and the counselling relationship and are necessary for the comfort and safety of both client and counsellor and helps to provide a secure trustful working alliance. It also helps to emphasize that counselling is not the same as a friendship.
Establishing clear boundaries in counselling is designed to separate the realm between client and counsellor.
The terms on which counselling is being offered should be made clear to the client before counselling commences. These may be agreed verbally or they may be set out in a formal written contract and signed by both parties.
The setting of boundaries can include:
- Venue
- Fees, if applicable
- When confidentiality may be breached
- Frequency of sessions
- Duties and responsibilities of each party
- Details of counselling supervision
- The terms of the therapeutic relationship
- Touching
- Details of counselling supervision
- Broad details of the counselling relationship
- Procedures for missing or cancelling appointments
- Procedures for arriving late for an appointment
It is the counsellor’s duty to act in the best interest of the client and establish and maintain firm boundaries is of paramount importance.
Some ways a client may breach boundaries if not previously agreed to in a contract set by both client and counsellor are:
- Sending text messages between therapy sessions
- Turning up at the counsellors premises without an appointment
- Hugging the counsellor
- Inviting the counsellor out for a drink or to a party etc
- Offering the counsellor gifts
In trying to understand why a client may push, stretch or breach boundaries you may have to look at their background. They may feel needy because they have felt invisible, unloved, or unworthy of receiving care and attention so the client will attempt to be liked and accepted and will trying to gain extra attention. It may be that the client just isn’t used to having rules or boundaries.
Counsellors can also be guilty of breaching boundaries, which can cause bewilderment to clients over roles and expectations, create an unhealthy dependence, intensify their problems, or emotionally and psychologically harm the client. Counsellors are not only bound by the contract made by him/herself and the client but are also bound by the code of ethics, so the consequences of breaching boundaries are much more serious. Some examples of how a counsellor may breach boundaries are:
- Engaging in sexual activates with a client
- Touching the client without permission
- Taking a client out socially
- Not keeping time boundaries already agreed to
- Accepting gifts
- Giving gifts
- Inappropriate counselling self-disclosure (incongruously shifting the focus of attention from client to counsellor)
- Accepting a job offer from a client because they have a skill that the counsellor needs
- Not referring a client when it is clear that the counsellor is not qualified or sufficiently experienced to serve the client
It is a fundamental responsibility of the practitioner to be aware of the specific legal implications of their work; this can include Health and Safety Laws, Discrimination laws, legal requirements concerning the giving and withholding of information, Data Protection Act, client’s rights.
As a trainee counsellor there are legal responsibilities that I must adhere to:
- I will clarify before each session the terms and conditions on which my services are offered
- I will not mislead my clients about my qualifications
- My clients will have the right under the data protection act to see any information that is held about them
- In the case of complaints I will ensure my clients are aware of the professional conduct procedure.
An example of why I may be sued is if I mislead a client into thinking I am a full qualified counsellor I would leave myself open to being sued and a case of negligence or malpractice bought against me.
A counsellor/client Relationship is a very delicate encounter. It is the Counsellors responsibility to provide a safe environment for the counselling session but particularly because physical and psychological safety is a Premise for the counselling to succeed. Negligence is closely related to the concepts of beaches of confidentiality and safety. Observing Principles for duty and care is parts of the BACP Ethical Framework. It is the Counsellors responsibility to keep up to date with the professional codes of practice, Confidentiality guidelines and other relevant information.
Negligence is the failure to do something or meet my professional obligations. It is worth mentioning here that if a contract is agreed at the beginning of the counselling sessions there is less chance of claims for negligence.
Below are some examples of issues covered in my contract
- Duties and responsibilities of each party
- Goals of therapy
- Setting of boundaries
- Terms/limits/expectations of the relationship
- Time limits of sessions
- Provision for re negotiation of contract
- Process of referral if/when necessary
- Fees if appropriate
In order to minimise the possibility of negligence I must always endeavour to meet my professional obligations as failure to do so could result in me being sued and a case of negligence or malpractice bought against me.
There can be many ways in which counselling can go wrong. The following are just examples: -
- Failing to explain at the outset the style of psychotherapy or counselling
- Failing to establish a sufficiently clear working contract
- Changing days/times of sessions or cancelling sessions with insufficient notice
- Inappropriately increasing or decreasing the frequency of sessions
- Allowing sessions to go on for too long
- Holding sessions at inappropriate venues
- Acting in an aggressive, critical and abusive way
- Being directive or opinionated
- Being overfriendly
- Encouraging over-dependency
- Disclosing personal details and life experiences
- Giving or accepting gifts
- Encouraging overuse of telephone, e-mail or text contact between sessions
- Inappropriate comment relating to the client’s appearance or dress
- Social contact outside sessions
- Blaming the patient for ‘not wanting to get better’
- Failing to address issues appropriately
- Abruptly terminating treatment
3.2 Using examples, evaluate an appropriate working environment and contract which attends to the physical, emotional and mental safety needs of both the client and counsellor.
The environment in which counselling takes place should strive to create an atmosphere of comfort, safety and neutrality for the client.
One of the things to consider is the building in which counselling is going to a place, for example:
- Is it accessible
- Close the public transport or only accessible by car
- Parking facilities and disabled spaces
- Accessible to disabled clients e.g. with clearly signed level entrances, lifts etc
- A separate entrance to preserve clients confidentiality
- Is the building safe and free from potential hazards
Regulations require therapists to exercise a duty of care for their clients health and safety, it is important therefore to check out any potential risks or hazards, i.e. fire exits are open and accessible, no trip hazards etc. A first aid kit should be on the premises and knowledge of whom to contact in the case of an emergency (medical or otherwise).
The room in which the counselling is going to take place should feel therapeutic and provide a feeling of comfort and well being and a sense of physical and emotional security.
The practical steps the counsellor can take to create an atmosphere of trust, safety and neutrality include the following:
- The room should be as private and confidential as possible, not over looked and ideally sound proof.
- Make certain that the room is non clinical and inviting-warm but not too warm, light but not over bright. The colour scheme should be of a warm pastel shade.
- Ensure the room is uncluttered and free of personal belongings for example photographs (having pictures of babies or elderly people will not be conducive if counselling a client that may be struggling with the death of a baby or an elderly person). Remove possible ‘triggers’ from the room.
- Their can be some personal touches such as a vase of flowers (to make the room less clinical) a jug of water and a glass, a box of tissues discreetly place so the client can access them.
- Chairs should be comfortable and of the same height (to prevent an air of dominance) and placed a comfortable distance apart and at a slight angle to each other.
- Do not have potential barriers such as desks or tables between the counsellor and client, just as folded arms and crossed legs can create barrier.
- The counselling session should be free from interruption so the room should be in a quiet area with phones switched off and with a ‘no interruption’ sign on the door.
- A clock should be strategically place preferably behind the client so the counsellor can subtly keep track of the time without distracting the client.
Counsellor safety is also an important consideration, a panic alarm should be close at hand during counselling sessions and the counsellor should make sure that he/she is not be alone in the building making others aware of his/her presence.
The working agreement (contract) sets the building block of counselling for example boundaries set the ground rules for counselling and the counselling relationship and are necessary for the comfort and safety of both client and counsellor and helps to provide a secure trustful working alliance. It also helps to emphasize that counselling is not the same as a friendship.
Establishing a clear working agreement in counselling is designed to separate the realm between client and counsellor.
A counselling contract is the initial mutual agreement between the client and counsellor to commence a therapeutic relationship. Dryden and Feltham (1994) state "contracts are two-way agreements, explicitly negotiated, which are likely to enhance the counselling process".
The terms on which counselling is being offered should be made clear to the client before counselling commences. These may be agreed verbally or they may be set out in a formal written contract and signed by both parties.
Although I am not bound by the BACP code of ethics and indeed am not yet a member (I am a trainee) I do strive and I am encouraged in my training to work and abide by its ethical principles and standards.
The setting of a working agreement can include:
- Venue
- Fees, if applicable
- When confidentiality may be breached
- Frequency and length of sessions
- Duties and responsibilities of each party
- The terms of the therapeutic relationship
- Touching
- Details of counselling supervision
- Broad details of the counselling relationship
- Procedures for missing or cancelling appointments
- Procedures for arriving late for an appointment
It is the counsellor’s duty to act in the best interest of the client and establish and maintain a firm working agreement is of paramount importance.
The emotional and mental safety of both counsellor and client are of equal importance more so for the counsellor as he/she is ethically responsible not only for their own health, safety and ability to practice but he/she is also responsible for the client’s health, safety and ability to engage in counselling. Both counsellor and client should be in the right frame of mind and be grounded. The counsellor should be aware of his/her own issues and problems so as not to bring them into the counselling environment, it is also important for the counsellor to work within the limits of their competence as failure to do so could do more harm than good. The client should be psychologically stable to engage in counselling, for example, not be suicidal, aggressive or in the frame of mind that he/she is going to be a danger to themselves or others (consultation with a supervisor or a referral may have to be made in such cases). Both client and counsellor should be free from the influence of alcohol and/or non-prescribed drugs.
Providing a safe, supportive and confidential environment where a client can comfortably disclose is a basic requirement of a counselling relationship. Within this environment clients may express feelings, thoughts and emotions that will make them feel understandably vulnerable. When emotions run high there is often a shift in controlled behaviour, which can result in an outburst of anger.
Counsellors must protect themselves by limiting self-disclosure. Although it is necessary, and essential, to build rapport with a client in order to gain trust, a counsellor must not allow their own personal issues to become known. Maintaining that life away from the counselling environment remains totally private is important. Sharing personal information, feelings or thoughts with a client will not only breach the counsellor’s code of ethics, but will also place the counsellor in a vulnerable position.
Building a rapport and subsequent trusting relationship with a counsellor requires that a client is open and honest and willing to work at identifying issues and resolutions. Due to the personal nature of the exchange between a client and counsellor, there are strict guidelines that must be adhered to throughout the confidential counselling process. Whilst it is generally accepted that a counsellor must behave professionally, responsibly and appropriately, towards a client during contact and throughout the client’s counselling relationship.
3.3 Using examples analyse the importance of multi-professional working and co-operation.
It is essential for the welfare of clients that all professionals and organisations work together in the best interest of the client. To do this contracts should be written up, polices and procedures followed and Ethical frameworks adhered too i.e.
- Confidentiality should be maintained at all times and discussions about a client or discussions about his or her casework should only take place with organisations already agreed to by and with the clients consent, this will have been agreed in the making of the initial contract with the client. It is also important that a client’s identity should be kept anonymous.
The BACP ethical frame work is adhered to by many professional counsellors and psychotherapists just as other professionals adhere to their relevant codes of practice. There are many similarities between the various codes, especially between organisations or agencies offering health and social care. Some examples of the similarities are confidentiality, respect for the client and acting in the best interest of the client. However conflicts between different codes of practice can arise especially in multi professional organisations/settings. An example of this could be a counsellor working in a school has a client that reveals the name of a bully, the counsellor is bound to by their code to keep this information confidential, but it could be the schools policy that all known bullies are reported. Another example could be that a counsellor is working at a GPs could be told in confidence by a client that they have been in contact with someone who has a contagious disease e.g. TB. The ethical dilemma would need to be addressed as failure to notify the GP could result in a possible epidemic if left untreated or not contained. When situations or dilemmas such as these arise the counsellor and the other professionals need to look at their relevant codes of practice to see what compromises can be made. Whatever the conflict/dilemma the deciding factor has to be that the clients interests are protected at all times and maintaining trust in the counsellor must be paramount.
4. Understanding the importance of supervision in counselling.
4.1 Explain why both casework and managerial supervision are important for a trainee and a qualified counsellor.
Managerial supervision is important because it involves issues related to the job description or workplace, ensuring policies and guidelines are in place to ensure the counsellor is working ethically and professionally. Managerial supervises can also be responsible for ensuring room allocation and suitability, client referral and appointment procedures, prioritising workloads, identifying training and development needs.
I believe supervision exists for two reasons:
1. To protect clients and 2.to improve the ability of counsellors to provide value and safety to their clients.
Supervision protects clients by involving an impartial third party in the work of a counsellor and client, helping to reduce the risk of serious oversight and helping the counsellor concerned to reflect on their own feelings, thoughts, behaviour and general approach with the client. These opportunities to reflect on how they relate to the client, as well as to gather insights from the perspective of another therapist, also help the counsellor to improve the value they are providing to their clients.
Casework supervision is equally important for both trainee and the qualified counsellor as it is a BACP requirement no matter how experienced the counsellor.
Casework supervision is especially important for trainees. Supervision has as special role in helping the trainee to move beyond basic forms of counselling skills to develop a more sophisticated and sensitive form of counselling and expertise. Trainee Counsellors need careful management and structured support. The trainee experience should be encouraging and empowering rather than negatively demanding, supervision provides a solid base to help trainees make sense of their learning experiences and to facilitate their professionalism.
Supervision that is to encourage the therapeutic use of self by the counsellor will emphasise attention given to the person of the counsellor as he or she lives in relationship with the client....will focus primarily on the counsellor’s own dynamics and reactions to clients.....case discussion, analysis of client problems, case work management....skills and techniques...will need to take precedence on occasion (But)as a rule the counsellor will be principally encouraged to examine their own needs, drives, motivations and personal responses to clients as a way of developing their internal supervisor...and enhancing their use of self.
- Wosket, Val (1999)
For the qualified counsellor casework supervision is important as its monitors and reviews the quality of the counsellor’s work as well as their client’s progress. It helps to increase professional and personal development whilst making sure the counsellor is working within the guidelines of the ethical framework; it also monitors the counsellor’s fitness to practice. Supervision is a two way collaborative exchange in which the counsellor can ask for support, guidance, clarification and direction.
4.2 Using examples, evaluate the possible impact of effective and less effective casework supervision on the
Service provided for user:
I feel that good supervision benefits the client in four ways:
- It evaluates the counsellor’s effectiveness and progress ensuring the counsellor is working within his limits
- It ensures the counsellors ability and competence to practice making sure he/she is working within ethical guidelines
- it continuously enhances the counsellor’s theoretical knowledge, skills and personal development
- It helps to protect clients by involving an impartial third party, helping to reduce the risk of serious oversight and helping the counsellor to reflect on their own feelings, thoughts, behaviour and general approach with the client.
Examples of how bad supervision can affect the service user are shown in the next section ‘Examples of bad casework supervision’.
Professional development of a counsellor
A good supervisor would seem to have both the qualities of a good teacher and a good counsellor. They are empathic, genuine, open and flexible. They respect their supervisee as a person and as a developing professional. Supervision is a professional requirement for all BACP members; the reason for supervision is to facilitate the enhancement of the counsellors and trainees theoretical knowledge, skills and personal development. Supervision is an ongoing process even for the qualified counsellor.
Examples of good casework supervision can include:
- Assessing and maintaining standards.
- Build self confidence.
- Work in the best interest of the client.
- Work is being done within the limits of the ethical framework
- Evaluate work done by the supervisee.
- Advise on client progress or lack of progress.
- Ensuring that privacy is available for the supervision session.
- Managing time effectively during the session.
- Giving clear and constructive feedback and guidance.
- Challenging as well as supporting the supervisee in practice and where appropriate agreeing upon action with the supervisee to improve practice.
- Knowing the boundaries of the supervision process and what responsibilities each have if the boundaries are infringed.
- Helping the supervisee explore and clarify their own thinking, feelings and beliefs in order to become a reflective practitioner.
- Being non-judgmental.
- Show diversity.
- Being available and approachable.
- Maintaining confidentiality.
- Being trustworthy.
- Help to develop the skills of both the trainee and qualified counsellor.
- Plan and utilize personal and professional resources.
- Showing empathic understanding.
- Monitor the counsellor’s fitness to practice (the health and well-being of the client being paramount).
Bad supervision like any other skill can be acquired and developed with practice. Bad supervision can have a detrimental effect on the supervisee and in turn this will be passed on to the client, resulting in bad counselling practises and possible harm being done to the client.
Examples of bad casework supervision and supervisors could include:
- Being self-centred.
- Having lack of direction.
- Being manipulative or defensive.
- Being negative.
- Not be approachable.
- Being unavailable (too busy)
- Exhibiting lack of self-confidence.
- Encouraging counsellor/client dependency.
- Lack of interest
- Being late for supervision sessions.
- Finishing sessions early.
- Not turning up for sessions.
- Not showing empathic understanding.
- Being arrogant and overconfident.
- Having a ‘holier-than-thou attitude’.
- Being judgemental.
- Being racist.
- Being sexist.
- Failure to recognise issues.
- Failure to recognise or implement guidelines (ethical framework)
- Be argumentative.
- Showing a lack of respect.
- Not act in the best interest of the client.
- Not recognising the supervisee’s ability to practice.
- Not recognising the supervisee’s needs.
- Not keeping confidentiality.
- Giving bad and/or inappropriate feedback, advice and guidance.
- Letting standards lapse.
4.3 Using examples, evaluate the possible impact of effective or less effective managerial supervision on the
- Service provided for user
Managerial supervision acts more of a quality control function. Managerial supervision is usually carried out by a manger that may not be a counsellor and is there to assess how effectively a counselor is working and to make sure he/she is working to that agencies standards.
Examples of good managerial supervision for the user can include:-
- ensures the counsellor is fully up to date with policies and procedures
- ensures the counselor is working ethically
- ensures the counselor is up to date with training
- ensures the building has adequate health and safety procedures
- ensures and adheres to an effective complaints procedure
- ensures there is an equal opportunities procedure in place and that it's adhered to
- ensures time keeping is obeyed
- ensures an efficient admin system is in operation
- ensures Good provision of venues
- ensures an Effective appraisal system
- ensures Notes and records are kept safe, secure and up to date
Examples of less effective managerial supervision for the user can include:-
- Counsellor is not up to date with policies and procedures
- Counsellor is not working ethically
- Counsellor is not up to date with training
- Complaints not acted on or not taken seriously.
- Bad allocation of venues i.e. not safe, to noisy, inaccessible etc.
- Inappropriate allocation of clients i.e. gender or religious requests by client not being met.
- Bad time keeping
- No equal opportunities procedures
- No appraisal procedure
- No communication
- Notes lost or left insecure
- Professional development of a counsellor
Managerial supervision helps the professional development of the counsellor in that it:-
- Ensures counsellors are up to date with changes to policies and procedures
- Ensures counsellors are up to date with training
- Ensures counsellors are working within guidelines
- Ensures counsellors are working ethically
Less effective managerial supervision in the development of the counsellor can include:-
- Not ensuring counsellors are up to date with changes to policies and procedures
- Not ensuring counsellors are up to date with training
- Not ensuring counsellors are working within guidelines
- Not ensuring counsellors are working ethically
5. Understand casework management in counselling.
5.1 Explain the importance of good casework management.
It is essential in any counselling practice to have sound casework management, for example all casework is handled responsibly and professionally.
My case management is a process in which the client needs and or issues are addressed, this may involve multiple referrals to other agencies. Case management requires developing a case plan between client and counsellor, regular monitoring of client goals and evaluation of outcomes for clients.
It is essential that I follow and keep up to date with the guide lines of the BACP and the organisations I work for. These Ethical Policies and Procedures are designed to ensure that counsellors conduct themselves and provide services in a professional manner. They also help to ensure that both the counsellor and the client are protected by establishing guidelines for counsellors on issues such as responsibility, anti-discriminatory practices, contracts, setting boundaries, confidentiality and competency.
Managing my workload is important to prevent burnout. Burnout is a syndrome which occurs due to prolonged emotional strain of dealing extensively with other human beings, particularly in helper and recipient relationships. Burnout is categorised as a type of stress. Unlike normal workplace stress which predominately affects individuals physically, burnout affects individuals emotionally. I will have both clinical and managerial supervision to help prevent this occurring.
Confidentiality is also important with regards to any notes or audio tapes used in sessions. I would stress to my clients at the very beginning that these would be kept in a safe place and not seen by anyone else. I would also discuss with my clients who had ownership of any such material after the sessions had ended and for how long they would be kept. As a counsellor I have to be accountable not only to my clients but also my profession for the management of confidentiality.
It is vital to the counselling process that my client's physical, mental and emotional needs are met.
5.2 Using examples analyse the importance of the following aspects of casework management.
Counsellors and clients are all unique and sometimes for various reasons it may be necessary to refer a client to another counsellor or agency.
Some reasons for referral:
- An alternative model of counselling may be more beneficial/appropriate i.e. drug or alcohol addiction may need specialist intervention.
- The counsellor may not have sufficient knowledge/expertise in a particular area.
- A client may request a particular type of counsellor (Different sex/religion/age etc).
- Counsellor may have blocks with the presenting issue or with client.
It is important that the counsellor is able to recognise the need to refer a client so that the client gets the best possibly therapy available. If a counsellor attempts to work beyond their limits they run the risk of negligence and bringing the counselling profession into disrepute as well as running the risk of being sued. Working beyond a counsellors limits may also have a detrimental effect on the client. It's useful to remember that although counselling can help clients become autonomous it isn't going to help finding a homeless person for example accommodation and this is where referrals would take place.
It is important to be aware when making notes of legal and ethical issues:
- Clients must be notified if notes are to be kept
-
Any notes must be locked away to avoid them being seen by 3rd parties
- Clients have the right under the Data Protection Act 1998 to gain access to their records
- Factual information must be clear and accurate
- Records must be factual and specific, selective and brief
The reasons for keeping notes and records:
- As a record of the sessions the content and how the client is progressing
- For supervision purposes to measure me effectiveness as a therapist
- For the assessment and management risk
- Written evidence
Counsellors may receive requests for information from external agencies. Possibilities include:
- Solicitors acting on behalf of counselling clients or ex-clients
- The Criminal Injuries Compensation Board (CICB), which may be involved when clients or ex-clients are claiming damages etc.
- The police investigating a criminal matter---Courts of law.
Clients or ex-clients may also ask their counsellor to release confidential information to such agencies.
The information may be sought in various ways. Counsellors may be asked to:
- Write statements concerning attendance at councelling
- write reports about the client, such as the nature and extent of their difficulties, or write character testimonials
- release counselling records
- appear at court ( Occasionally counsellors received court orders, or requests from the police or the Crown Prosecution Service to reveal records).
It is my understanding that counsellors are not legally obliged to release session notes unless a subpoena is issued and even this may be contested. Counselling records may contain information that would be actively unhelpful to the client's case, as well as possibly containing material about other people, the counsellor's own responses etc. Once information is released, it is made available to ALL parties involved in a case. The client may be unaware of this or loath to consider the possible consequences.
- Legal rights of clients to access records
It is essential in any counselling practice to have sound casework management, for example all casework is handled responsibly and professionally. At the start of the counselling relationship when the contract is being agreed it is vital that matters relating to notes/recordings are addressed. Issues such as ownership, length of time notes are held and where they are kept should also be discussed. As a counsellor I will need to keep some notes unless there is adequate reason for not doing so. Any notes should be free from personal detail yet accurate. All notes and report letters should be protected from unauthorised disclosure.
I am aware of both clients and my own rights with regards to the data protection act 1998. Under this act clients have the right to see any information held about them.
5.3 Explain the importance of the need for casework evaluation for the ongoing professional development of the reflective practitioner.
It is very important that as a trainee counsellor I am constantly reflecting on my casework and practise.
I need to be sure I am using my skills to the best of my ability in order for my client to grow.
It is a requirement of he BACP that member have regular supervision, one hour thirty minutes for every eight casework. Just as the client comes to the counsellor for support so does the counsellor when they go for supervision. Counselling is very demanding and supervision helps to overcome some of those challenges e.g. I can become over involved or dismissive of important aspects of therapy. I may have doubts about my own usefulness in the process.
I can now see that a counsellors learning does not end when they become qualified. On the contrary, the learning, experiencing and continual development is fluid and ongoing. In order to give my clients effective therapy I shall always strive to develop both as a person and a counsellor.
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