Creative Ethical Practice in Counselling & Psychotherapy
Publication Year: 2012
Subject: Counseling Ethics & the Law
This book considers the necessary structures and processes that must inform creative, humanistic practice for it to be a safe, ethical therapeutic framework. Packed with reflective exercises, summaries, case examples and step-by-step guidance, this book takes the reader from establishing the therapeutic relationship to worst-case scenarios like complaints procedures and legal action.
- Front Matter
- Back Matter
- Subject Index
- Chapter 1: Contemporary Therapeutic Practice
- Therapy and Ethics
- ‘Practical Wisdom’ in Therapy
- Therapy and Consumerism
- Practising Therapy Ethically, Creatively – and ‘Safely’
- Chapter 2: Cornerstones of Therapy
- Balancing Safety and Creativity
- The Philosophical and Theoretical Frame
- Boundaries in Therapeutic Practice
- The Therapeutic Relationship
- Methodologies or Styles of Intervention
- The Therapist's Need for Self-Care and Self-Compassion
- Chapter 3: Creating and Maintaining Therapy Agreements
- Making an Initial Agreement with Your Client
- Personalising the Therapeutic Agreement
- Re-Contracting: The Review and Renewal of Agreements
- Ending a Therapeutic Agreement
- Chapter 4: Framing the Therapeutic Process
- An Aesthetics of Therapy: The Language of Frames
- The Environmental Frame
- The Contractual Frame and the Therapeutic Alliance
- The Embodied Relational Frame
- Extending Therapeutic Frames
- Chapter 5: Dealing with Mistakes in Therapeutic Practice
- The Inevitability of Making Mistakes
- Minimising Mistakes in the Therapeutic Field
- Ethical Review as a Support for Safe and Creative Practice
- How Complaints Can Arise
- The Role of Mediation in Resolving Complaints
- Chapter 6: Reviewing Your Practice and Looking Forward
- Conducting a Personal and Professional Practice Review
- What Kind of Therapist Am I?
- How Can I Take an Overview of My Practice?
- How Do I Balance Safety and Creativity in My Everyday Practice?
- How Well Supported Would I Be If Something Went Wrong?
- Am I Developing Practical Wisdom as a Therapist?
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© Patti Owens, Bee Springwood and Michael Wilson 2012
First published 2012
Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act, 1988, this publication may be reproduced, stored or transmitted in any form, or by any means, only with the prior permission in writing of the publishers, or in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to the publishers.
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About the Authors
We are very grateful to Sydney Bayley, Bridget Grant and James Ryan, experienced psychotherapists, supervisors and trainers, who found time to read our early draft material and provide detailed feedback. We also wish to thank each of our peer professional support networks for time spent on discussing ideas for the book. Sydney Bayley's work on the booklet Safer Practice Guidance for Psychotherapists (2009) provided an important initial stimulus for our exploration of therapeutic practice in the text. That, in turn, was inspired by Anne Kearns's supervision course, ‘The Seven Deadly Sins’, in which Patti Owens and Sydney Bayley were participants. We also wish to thank members of UKAHPP for sparking off ideas that led to the writing of this book, and the organisation itself for giving us permission to reproduce extracts from their ethical codes and procedures. Last, but by no means least, we wish to thank our SAGE editors, in particular Alice Oven for her encouragement and support throughout the book's production.
Resource 1: Card Index Summary[Page 104]Client/Supervisee
[Some categories apply to clients only.]
Tel: (h) (m) (wk)
[indicate where messages can be left]
Date of birth:
GP's address and phone number: [including emergency phone number]
Initial contact date: Contract signed:
First therapy session date: Fee: [includes dates when fees are re-negotiated]
Final therapy session date:
Code number: [for split record systems]
[reverse side of the index card is an accumulative record of session dates]
Resource 2: Initial Meeting and Assessment Proforma[Page 105]
Telephone: [indicate preferred mode of contact] Email:
Agreement signed: [this might include frequency, duration, agreed review periods, boundaries around confidentiality, fees, focus, goals, etc.]
CORE form completed: [if appropriate]
Reason for wanting psychotherapy:
Presenting problems and their duration:
Current conflicts (and further problems):
Underlying conflicts (and past problems):
Criteria for change:
Offer and responses:
Significant names, relationships (including losses), places mentioned by client, and family tree. Date any updates to this initial information:
Outcome (refer to criteria for change):
Correspondence (attached): code no: [for split records only]
Resource 3: Process Session Notes Proforma[Page 106]
[These notes, which do not identify clients, should be kept in a separate journal or folder.]
Date: time/duration: missed appts: code no: [for split records only]
Content: [summary of client's narrative, manner, behaviour, feelings, and therapist's interventions. Also themes, transference/counter-transference, significant dreams, etc.]
Process: [any comments made by client about the process, therapist's observations and/or speculations about the process]
Family: [information from here might be used to update Initial Meeting and Assessment Proforma information]
Notes for next session: [e.g. any agreement about what client or therapist would do between sessions, issues to be reviewed during the session or for the therapist to be aware of]
Issues for supervision:
Issues for own therapy:
Notes about any correspondence or telephone conversations:
Resource 4: Process Session Notes – An Example[Page 107]
Date: 23 May 2011 Time/duration: 60 mins Session No: 10 Code No: AB0511
Content: [e.g. summary of client's narrative, manner, behaviour, feelings, and therapist's interventions. Themes, e.g. transference/counter-transference, significant dreams, etc.]
A. spoke about depression again, and how the origins of this began when he was 24 years old (four years ago), and after the sudden loss of his father. Spoke about what his father meant to him. Felt quite emotional with statements like: ‘He will never see how my life turned out’; ‘I want him to know that I haven't disappointed him’.
I stayed close to his feelings and his grief throughout the session. I was aware that he might possibly be beginning to view me as a father figure in the transference. I felt fatherly towards him, as if he were six years old. I enquired about his early life experiences with this father. A. remarked that he was ‘daddy's boy’ up until the age of seven when ‘father accepted a job abroad, but the family remained behind in the UK’. Exploration of what this was like for a seven year old. A. remarked how grief stricken he had been, and although he knew that his father would be returning in six months this time period felt like eternity for him. He also remarked that he had to be the ‘brave boy for his mother’ who was frequently upset by the father's absence. I said: ‘It sounds as if the little boy in you had to hide his tears’. At this point A. became very upset. I felt strong fatherly counter-transference feelings at that point, and imagined that A. became the little boy in that moment. I stayed close to his feelings throughout.
Process: [comments made by client about the process, therapist's observations and/or speculations about the process]
A. remarked how he felt lighter at the end of the session, and that he had not cried so much in years, ‘perhaps ever’. It feels as if he is grieving the double loss of his father; both at seven and 24 years old.
Family: Mother consumed with sadness when father went to work abroad when A. was seven.
[Page 108]Literature/web-links/other information given: N/A.
Notes for next session: [e.g. any agreement about what client or therapist would do between sessions, issues to be reviewed during the session or for the therapist to be aware of]
N/A other than to remain with whatever A. brings to the session.
Issues for supervision: Explore transference and counter-transference issues. Perhaps voice fact of my own loss of father at the age of 22.
Issues for own therapy:
Notes about any correspondence or telephone conversations: N/A
Resource 5: Contract Example A: Health Centre Counselling Contract[Page 109]Notes
- Please try to arrive promptly for your appointment.
- Wait for your counsellor in the reception area as usual.
- Sessions last 50 minutes. If you arrive late sessions will still finish on time as other patients should not be kept waiting.
- If you are unable to attend for any reason please ring the health centre in advance to let your counsellor know.
- Any sessions you miss will still be counted as part of the series of sessions that you have been allocated.
- All records associated with your counselling are subject to the Data Protection and Freedom of Information Acts.
Resource 6: Contract Example B: Psychotherapy Contract[Page 110]
This agreement expresses the commitment each of us makes at the outset. Once we have discussed and agreed the details, we will each sign and keep one copy to register our shared understanding.
- We have agreed to meet weekly on _____ at _____. This is an open-ended therapy contract which can be reviewed at any time. We will check in with each other periodically to see how you are experiencing the process.
- Your therapy appointment is ‘your time’ each week that I have set aside for you. Each session lasts one hour. It is important for effective therapy that we try to maintain a regular commitment. If a change of circumstance makes this difficult for you, we can discuss the possibility of a different date and time and I will do my best to rearrange things if I can.
- The fee we have agreed is £_____ per one hour session. Fees are due each session/on the last session of each month. Fees will rise from time to time and I will give you adequate notice of this.
- I will be ready for you at the appointed time. Please try to arrive on time as I do not have a waiting room. If you arrive late for any reason the session will still finish at the appointed time.
- I will take all reasonable precautions to keep our therapy space safe from interruption and intrusion, such as from telephone calls, deliveries and workmen, though there may be rare occasions when this is not feasible. I ask you to respect the therapy space too, as far as possible.
- You have my phone number in case you need it. My telephone answering machine will usually be on if I am not available when you call.
- Please avoid taking mind-altering drugs or alcohol before a session.
- I will take holidays during the year – usually in the summer period, at Christmas/ New Year, and Easter/Passover, plus ‘half term’ weeks where appropriate. I will let you know the dates well in advance. If you decide to take a holiday yourself please [Page 111]let me know at least four weeks in advance. I will then only charge you half the usual fee for sessions missed. If you give me less notice than this, I will expect you to pay the full fee for any missed sessions.
- If you are unable to attend a session due to unforeseen circumstances, please call and let me know, and we may be able to re-schedule. Please bear in mind, however, that such re-arrangement may not always be possible. My flexibility is limited by the fact that I see most clients on a regular basis, at the same time and day each week, so alternative appointment times are not freely available.
- The therapeutic relationship is intended to be a healing, supportive and sometimes challenging relationship. We need to be aware that there may be times, as in any human relationship, when things feel difficult and it seems hard to persevere. These times, if worked through together, can be very fruitful. We both need to have the intention of seeing things through in such circumstances.
- If either of us thinks it is time to bring the therapy to an end, we will discuss this together and decide if and how to do that. Sometimes one session is enough to make sure the decision is a good one. Sometimes it is better to have a series of sessions to review the work, and decide either to go on with therapy after all, or else find a way of making a good ending for you. Ending the therapeutic relationship should ideally be a mutual experience and not a one-sided or impulsive act.
- Everything that happens in our therapy session remains confidential between us, with the following exceptions:
- I may discuss aspects of our work for supervisory or other professional purposes but your identity will in all circumstances remain completely protected.
- when required by law, which is very rare; for this reason, I will keep a copy of this contract and a record of your attendance for seven years from the date of termination of therapy.
- I may contact your GP or any other appropriate professional if I believe there is a serious risk to yourself or others.
Therapeutic issues we have identified at the outset:
Further comments (if appropriate):
Resource 7: Contract Example C: Hillside Therapy Centre: Client Agreement[Page 112]
Please read this before you attend your first therapy session
All our therapists are registered members of the BACP, UKCP or HPC.
You are considering entering into an open-ended therapy contract. This means that you are undertaking to make space in your life for personal growth and change. Your therapist will make a commitment to support you in this endeavour. At the first meeting you will talk about the approach your therapist uses and be able to reflect on its suitability for you.
After an initial session to discuss your reasons for seeking therapy at this time and to ensure that therapy seems the right option for you, you will undertake to meet with your therapist at a regular time and day each week/fortnight/month.
The process of therapy will be reviewed from time to time. Sometimes this will lead to a change of emphasis or focus; sometimes it will mark the end of one phase of therapy and begin a new one; at a later point you will discuss ending the therapy. Therapy continues only by mutual agreement between you and your therapist.
We ask you to arrive on time for your appointment as the session will always finish on time, even if you are late. If you arrive early, there is a waiting room where you can make a hot drink and use the toilet if you wish.
If you know that you are going to miss a session, or if you are going to be late, please ring the centre if possible before the session is due to start. Our normal policy is to charge a cancellation fee for unplanned missed sessions. Your therapist will discuss this with you at the first meeting.
Please make a note here of your reasons for seeking therapy and what you hope to gain from the experience. Thank you.
Resource 8: Contract Example D: Jones & Co. Employee Assistance Programme About Your Counselling[Page 113][Page 114]Counselling Questionnaire
Make some notes about these questions and discuss your responses with your counsellor at the first appointment.
- Why are you having counselling?
- How do you think counselling might help you in your job?
- What are your objectives over the eight sessions?
You will be asked to complete a client feedback form when you have completed the series of counselling sessions. This will be sent to the Human Resources Dept. and used as the basis for your ‘improving performance’ interview.
Resource 9: Therapeutic Executor – UKAHPP Guidelines[Page 115]
The UKAHPP strongly recommends that all members in practice have a therapeutic executor, and this is a requirement for all accredited/full members.
A therapeutic executor is a person who deals with the closure of a member's practice in the event of the member's death. The death of a therapist or counsellor may have a profound effect on his/her clients – at the very least, clients have to be informed, future sessions cancelled and supervision/insurance/membership/consulting room arrangements terminated. In the same way that the making of a will is a responsible act and a caring act for one's family, the arrangement of a therapeutic executor is a professionally responsible and caring act for one's client.
The UKAHPP suggests that one's partner or close family member, who would have to deal with the emotional and practical family-centred consequences of one's death, may not be the best person to also act as one's therapeutic executor; a close friend may also find it too emotionally difficult. If partners or close family members are therapeutic executors there may also be unknown or unexpected boundary issues in dealing with one's clients, especially regarding confidentiality. It may well be that a professional colleague would be better placed, both professionally and emotionally, to communicate with clients in such circumstances. However, as such circumstances vary widely and the choice of a therapeutic executor is a private and personal matter, the UKAHPP presents this not as a requirement but as advice only, for every member's consideration in choosing who could best act as therapeutic executor (and the AHPP does not intend to enquire into such arrangements).
What is required for a therapeutic executor arrangement to work well is that:
- the member maintains a list of every client's contact details (their address as well as phone or email) and a diary of future appointments; this has to be kept up-to-date;
- ‘clients’ should include both therapy-clients and supervisees; additionally, the ability to contact professional bodies, colleagues, trainees, etc. would be helpful for the therapeutic executor;
- the member's therapeutic executor knows where to access the contact-list and diary, and has written consent from the member to do this;[Page 116]
- further arrangements have been discussed and agreed for the therapeutic executor to access and dispose of all files and notes on clients and client-sessions;
- the extent of the therapeutic executor's role has been discussed and agreed; minimally it should start with informing clients, and might extend to offering support (and/or sessions), helping to find new therapists, informing insurers etc., dealing with the financial side of the member's practice … One major issue that has arisen in some cases is whether clients can attend the funeral.
- all these arrangements have to be made with due regard to confidentiality; for example, the therapeutic executor should know how and where to access this information in the event of the member's death, but probably should not have prior access to it.
- the member's partner/immediate family should be aware of who is the therapeutic executor, and that this person will be taking care these matters.
One possibility is that acting as a therapeutic executor can be a reciprocal arrangement between two UKAHPP members, or between colleagues whether or not they are both members. Another possibility is that this becomes part of a long-term supervision arrangement. A lot of time and emotional energy can be involved – probably more than expected; one AHPP member who acted as therapeutic executor for another member with quite a small practice concluded that she would not ask someone to be her therapeutic executor without arranging some remuneration from her estate.
Although we are all tempted to postpone making wills and may also prefer to avoid these ‘intimations of mortality’ in relation to our professional practice, the UKAHPP believes that arranging a therapeutic executor is a responsible, humanistic and caring act in relation both to our families and our clients.
Resource 10: Extracts from the UKAHPP Complaints Procedure[Page 117]
A full and up-to-date version of the document from which these extracts have been taken can be found at http://www.ahpp.org/ethical/complaints.htmOnce a Complaint Is Received the Procedure Follows the Stages Summarised Below
Facilitation and Mediation Stage (Before Making a Formal Complaint)Facilitation
- Appointment of coordinator, facilitators and mediator – the ethics officer receives a copy of the complaint from the general secretary. The ethics officer appoints a complaint coordinator (or acts as the coordinator) to oversee the complaint and appoints facilitators to assist the parties involved.
- Facilitation – the complainant is offered a facilitator to assist them to clarify the nature of the complaint in terms of UKAHPP's Codes of Ethics and of Practice. The complainant is encouraged to use the mediation process to resolve the complaint. If the complainant agrees, the member complained against is then informed of the complaint, offered their own facilitator to assist them and encouraged to participate in mediation. If either party is not willing to proceed to mediation the formal complaint procedure is implemented.
- Mediation – If both parties agree to mediation they and their facilitators meet with an independent mediator appointed by the ethics officer. If, as a result of mediation, a resolution acceptable to both parties is agreed the case is closed. If resolution is not achieved the formal complaint procedure is implemented.
- The complainant is contacted by a facilitator (a member of UKAHPP who has no relationship with the member complained against) to offer confidential help and support in making their complaint. Such support can be advice on the procedures [Page 118]involved and help in formulating what the complainant may wish to say in the meetings that follow. Complainant and facilitator explore the possibility of resolving the issue by mediation, prior to entering the lengthy formal complaints procedure.
- This facilitation process is confidential with the identity of the complainant and member complained against known only to the general secretary, ethics officer, complaint coordinator and facilitator at this stage. If it is necessary to discuss the complaint within UKAHPP the identities of the parties involved are not revealed. As the object of this process is in part to determine whether a complaint would be appropriate, the member complained against will not necessarily be informed of the complaint until mediation is sought or a formal complaint entered.
- Should the complainant choose to proceed, the member complained against is informed of the complaint. The member is allocated their own facilitator to support them through mediation or the complaints procedure. If both parties agree to mediation, the ethics officer appoints a mediator who may be a member of UKAHPP but with no connection with the member complained against. If mediation is rejected by either party, or is deemed inappropriate, the formal complaints procedure is implemented instead.
- If the person complained against is no longer a member of UKAHPP (resignations are not permitted while a complaint is in progress) the matter cannot be handled by UKAHPP as an official complaint. However, the ex-member will be encouraged to attend a mediation process. If they refuse UKAHPP cannot take the process any further. The complainant can be advised alternative courses of action, such as a complaint to a professional body of which the person complained about is a member.
- The complaints coordinator arranges a mediation meeting, which the parties and their facilitators attend. This meeting is to take place within sixty (60) days of the appointment of the mediator. In the event that the parties are unable to agree a date for this meeting within the time limit the mediation process is deemed to have lapsed and the formal complaints procedure will be implemented (as long as the member is a member of UKAHPP).
- The mediator receives from the coordinator all the relevant information about the complaint. At the meeting the role of the mediator is to help the parties clarify their issues and reach a satisfactory outcome. The mediator first hears from the complainant, then from the member, and allows comments of clarification from the facilitators. This initial expression of views is heard without interruption or contradiction. Time is then given for responses to this initial round, and for the complainant and the member to put forward their wishes for a satisfactory outcome. If no agreement can be reached at this stage, then one future meeting will be arranged.[Page 119]
- If agreement is reached after one or two meetings, the mediator documents in writing the agreed resolution and any agreed future action for either or both parties, together with a time scale or date for completion. Both sign this document and a copy is sent to them. If future actions within a time scale have been agreed then the complaint coordinator is informed when they're completed, or they are pursued if defaulted upon. The complaint is then deemed resolved.
- Alternatively, if no agreement can be reached this is recorded in writing by the mediator and signed by both parties and a copy sent to them. The formal complaints procedure is then implemented, as long as the member is a current member of UKAHPP, or unless the complainant wishes to withdraw the complaint.
- [Page 119]
- The mediator's report is filed by the ethics officer, but any other documents or other records used or created during the mediation stage are destroyed or returned to the relevant ‘owning’ individuals, even if a formal complaint is to be pursued. If a formal complaint procedure is to follow the mediator cannot be involved, but the complainant's and the member's facilitators may continue with these roles.
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