My understanding of professionalism is having the discipline to be aware of and work to a set of values made up of legal statutes, of professional body frameworks and guidelines and of employer policies, frameworks and guidelines, which together detail expected conduct. Those statutes, policies, frameworks and guidelines should be used to identify roles and responsibilities which in turn define boundaries. The British Association of Counselling and Psychotherapy (BACP), of which I am a student member, is the largest professional body in the UK for counselling and psychotherapy and lays down what standards of conduct counsellors, service users and the public expect at a national level.
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‘If a counsellor or therapist is a member of a professional body, he or she will be bound by a code of professional ethics framework or in the case of the BACP, the ethical framework’…’it recognises that choices are often not clear-cut, and that sometimes difficult decisions need to be made that, even when taken in good faith, may have unpredictable and unwanted outcomes’ (Merry, 2002:11)
Professionalism and ethics both relate to proper conduct. I view the ethical framework as a list of qualities for how the counsellor should ‘be’ and a list of behaviours for what the counsellor should ‘do’ and ‘not do’. Examples of the desired attitudes include possessing empathy, sincerity, integrity, resilience, respect, humility, competence, fairness, wisdom and courage. Examples of the desired behaviours include fidelity, autonomy, beneficence, non-maleficence, justice and self-respect.
The BACP produced the ethical framework to protect both the client and counsellor through good practice in counselling and psychotherapy. It sets out a series of professional and personal values, underlying principles and moral qualities which reflect my attributes as a trainee counsellor in order to promote a safe and professional environment, one where I could enable clients to allow trust to develop within our relationship. I abide by the BACP guidance on good practice which is concerned with client safety, counsellor responsibility and accountability, clear contracting and my competence as a trainee counsellor. It provides information for what counsellors are expected to do and sanctions for consequences of malpractice.
I have chosen a hypothetical ethical dilemma, albeit a realistic one, relevant to my chosen placement at The Truce YMCA in Lancaster.
A sixteen year old female client presents with news of her parents having separated two weeks previously. She lives with her mum who is drinking excessive amounts of alcohol and who is not coping with the day to day duties of looking after the client’s nine year old brother, who is now mostly in the client’s care. No other meals are being provided other than school dinners and no money is being allocated to them for food. Last night the client’s mum pushed the client against the wall and the client has a head injury. The client asks me not to tell anyone.
The ethical dilemma here is that my client has disclosed a Child Protection issue and asked me to maintain the confidentiality aspect of the contract. There are several implications, professionally I must breach confidentiality as there would be no way that I could hold that information, my integrity would be conflicted. I would have a professional obligation that would be impossible for me to ignore. However, by breaching confidentiality this could have severe consequences for the client, myself (our relationship), and the client’s family. A question I need to ask myself is:
What are our statutory duties and responsibilities?
We have a duty under the Children Act 1989 to safeguard and protect children who may be suffering from abuse. This may be physical, sexual, emotional or as a result of neglect http://www.tameside.gov.uk/childprotection/parentinfo#t2 date accessed, 21st April 2010
The YMCA has put together a procedure flow chart and as part of my training I have been made aware of it. It is a clear example of my role, responsibilities and boundaries.
Safeguarding means doing everything you can to protect children and young people from harm. A safeguard is a measure to help reduce the risk of children and young people being harmed. http://www.nspcc.org.uk/Inform/trainingandconsultancy/consultancy/cst/safe_communities_toolkit_english_wdf70126.pdf date accessed, 19th April 2010
The disclosure demands to be sensitively, sincerely and respectfully explored in order to honour the principle of non-maleficence because every child matters. As a trainee counsellor I have ‘an ethical responsibility to strive to mitigate any harm caused to a client even when the harm is unavoidable or unintended’ (BACP, 2007:03)
There are several implications:
I am aware that the principle of fidelity requires a responsibility to honour the trust that has been placed in me as a trainee counsellor and that how I move the process forward from this point could alter how the client and I may or may not work together in the future. Without confidentiality and empathy there is potential to harm the relationship, and as Bond (1993:46) states that, ‘responsibilities to the client are the foremost concern of the counsellor. The justification of counselling rests on this work being undertaken in a counsellor-client relationship’.
Where as a trainee counsellor can I find guidance on consent and disclosure?
I could check against the BACP guidelines, with my casework supervisor, my managerial supervisor, the agencies codes of practice and policies, my tutors and Social Services. To avoid the possibility of prosecution I need to respect my role and abide by the BACP guidance on good practice which is concerned with client safety, counsellor responsibility and accountability, clear contracting and my competence as a trainee counsellor.
‘Professional accountability is also key in ensuring public protection and allows the Profession to move forward enjoying the public confidence in the services provided’
http://www.bacp.co.uk/prof_conduct/ 4th February 2010
The principle of beneficence involves acting in the client’s best interest and maintaining the standards of competence and knowledge expected for members who continue to both personally and professionally develop by using supervision for support. As I am working within an agency I am expected, as a member of the BACP, to have ongoing regular supervision for my work with a clinical supervisor and with my managerial supervisor. Supervisors, managers and counsellors have a responsibility to maintain and enhance good practice, to protect clients from poor practice (promoting their wellbeing) and for the counsellor to acquire the attitudes, skills and knowledge required for each of their roles raising awareness and ensuring the fair treatment of all clients and the uniqueness of individual people regarding culture differences, gender or disabilities which involves the principle respect of justice.
When considering what action to take the first step I would take would be to explore what the client had told me by clarifying what had been said in order to check out my understanding with the client. It is important to identify that there is a problem and if so I would then work out whose problem it was and in this case it would be the client’s. Yet I would be responsible to her, myself and accountable up the chain of command within the organisation.
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By setting the contract provided by The YMCA clearly so that it is understood by the client there is less chance of misunderstandings and more chance of boundaries being clear at the onset. The agreement of a contract protects both the client and the counsellor. It proves that each party has agreed their responsibilities and boundaries and that they each know where they stand in the counselling process in relation to their obligations to each other. I would need to refer back to the initial contract to remind the client about our agreement that would be in place between us. I would have competently explained at the time that should harm to self or others be disclosed to me that I would need to breach confidentiality. I would use appropriate language for a sixteen year old to understand and include her in the process. I would respect the principle of respect for autonomy by discussing the necessity of safeguarding her, protecting her and her younger brother and, with her consent, checking whether the child protection officer would be available to enter the room to work it through all together by understanding my job roles and responsibilities and working within my training and experience competently I could deliver a professional level of service that promotes safety and both at the same time being fully aware that she has choices and human rights too.
Although I could have a conflict of interest in that I would have to breach confidentiality…
Human Rights Act 1998
Article 8.1
Everyone has the right to respect for his private and family life, his home and his correspondence.
Article 8.2
There shall be no interference by a public authority with the exercise of this right except as such as in accordance with the law and is necessary in a democratic society in the interests of national security, public safety or the economic well-being of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others (Bond, 2010:158).
…I would protect myself from litigation as I have a duty to observe the Code of Professional Conduct and the other guidelines issued by the BACP. Not all laws are perfect, the problem is that laws are often generalised and open to some interpretation and that’s where they can be exploited. The law regarding sixteen year olds (child versus Gillick competent versus adult) and the obligation of Social Services to look after somebody until eighteen years of age is not black and white. Somebody planning to go to the Dignitas clinic in Switzerland to end their life is within their own rights and it would be an example of a case where a counsellor could respect the client’s dignity.
At the first available chance I had I would follow the example of a child protection form, from my safeguarding policy and guidelines provided by the organisation and make very clear, accurate, brief, factual notes of who said what, when it was said, where it was said and the nature of the concern. I would bear in mind that the notes could be read by the client herself and if I was required to write a report for court I would be aware that I have not been trained to write such a report and seek advice.
According to Pollecoff, et al. (2002:58)
‘Counsellors and psychotherapists are in a unique position when asked to give evidence’…’…unlike other professionals, they do not necessarily keep detailed notes of each session held with a client’…’Problems can arise regarding client confidentiality in the context of presenting reports or giving evidence’.
I would file the notes confidentially and each client has a code to be used for anonymity purposes, store for six months, once the case is closed, then they are destroyed.
Bond (2010:158) suggests ‘The Data Protection Act 1998’…’…covers a wide range of requirements to do with record-keeping’.
I would call my case supervisor and I would explain what has happened, what I did (discussed with line manager and or referral to Child Protection Officer etc.) and ask him if there is anything else I should have done or could do.
Working within a multi agency can be useful as it can meet the needs of young people more effectively. Confidentiality procedures are in place and consent must be given by the person concerned and must be present when consented information is shared. There are exceptional circumstances.
At the same time how I present myself and interact with people (language, appearance, actions and interactions) influence impressions. There are informal expectations and continuing with both professional and personal development (supervision).
Questions like ‘What does the BACP say about this?’ are what I need to ask myself in during my evaluation in order to do the ‘right thing’ and knowing how important it is to not do the ‘wrong thing’ because that could cause damage to more than the client in the room. I hope that I have demonstrated that I understand that there is a need to act within the law at all times but in a way that provides as much support and protection as possible towards the client first and foremost, towards myself and towards the organisational structure and the profession itself. It is not always a case of knowing what to do to as an expert, but it seems to be a case of knowing what to do next and who to go to in order to get the answers needed.
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