Boundaries in Counselling

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So, welcome. Welcome to this lecture. To make the most of your time today, shut the door if you can, remove any distractions, switch your phone off and turn off everything that's operating in the background of your computer including email, Skype, instant messaging, and anything you might have running. Write notes and remember that this lecture will be available after Thursday as a play-again, more of like iPlayer or something like that. So if you've not caught any of it or you want to see it again just to compound your learning, you can play it again in the Counselling Study Resource. It'll be a video (sound and visual).

Okay. So, the aim today is to review areas of practice where clients may have grounds for complaint, and discuss ways of avoiding potential ethical conflicts. Now, it's not my intent to lecture or talk down to people today, but over the years of being a tutor and a practitioner, I've seen people come spectacularly unstuck in their practices, because they crossed boundaries either knowingly or sometimes they didn't know. So, nowadays, course contents are usually very, very precise about boundaries and ethical conflicts, but just in case you wanted your learning compounded, this is why I've done this. I don't want to start a lecture or preach, but I've seen people get spectacularly unstuck.

So we're going to look at boundaries today and I'm going to start off by asking the question 'what are boundaries?' It's a really good question, I think. I took a reference from Merriam Webster, which is an online dictionary. And I like this. It says 'a point or limit that indicates where two things become different". The reason I like it is because boy, oh boy, if you cross a boundary and it goes wrong, things become really, really different.

So I'll like to take that away as a learning point that once boundaries are crossed (you work with clients or maybe with other professionals), it can be spectacularly different and there can be consequences of it as we'll see as we go through.

So boundaries can be broken down into professional conduct (how we kind of conduct ourselves as professional people in the world), ethics (ethical issues that we might breach), confidentiality, boundaries themselves (I put boundaries in again, and I'll explain that as we go through), and negligence (where someone's been absolutely negligent and not doing their job properly).

Now, before I continue, I realise there are lots of people in different parts of the world who view this. I'm going to be talking about the British Association of Counselling Psychotherapy Good Practice, but when I designed this presentation, I designed it really for anyone who works in counselling and psychotherapy, so no matter which ethical code you work under, I think you'll find that they are pretty much the same and no one wants to get in a very difficult position.

So the lessons that can be taken away from this, really, I guess are that if you follow this, you're not going to go too far wrong. There we go.

So professional conduct covers how we conduct ourselves as professionals with clients and colleagues. So the first position really is our entire working life as therapists. It's not just clients and colleagues. It's also, to a great extent, how the general public perceives us, because if we bring the profession into disrepute, it might put off a general member of the public who wants to come for help and doesn't. The consequences of that can be quite grave. So it's a whole package. It's how we are in our professional world with everybody we meet.

It can also describe how our actions in our private lives can impact on the work we do. I'm going to spend a bit of time about social media because it's really, really important. So as professionals, we are accountable for our actions on social media, and it's almost certain that some clients will Google your name. When I started in counselling a long time ago, the Internet was very young. I was the only person, I think, with an email address. People would ask me what the Internet was. Can you believe that? People would say, "What is this Internet, Rory? What does it do?" Nowadays, everyone knows what the internet does and everybody knows how to use Google to search and we've gone on, as professionals, from being quite anonymous in our lives to being easily found. I think the last time myself and Ken looked, it was a while ago on Google Analytics, which is the tool we use to look at how many people visit our pages on the website. I just put my name in and I found that 100 people a month were looking for me. That was kind of a bit of a wake-up call, really, because they were searching for me particularly. Now I've got a very unusual name. It's a double-barrelled name, but some clients will search for you. And what will they find? So the first message really from this is, if you've got a Facebook or social media profile, have a look at it. I'm not saying that you should live like the life of a nun, but if there is anything on there that a client could see and bring up in the therapy session. Could you imagine being in front of a client and talking about their families and then the client saying, "Well, you've got a family. I've seen you on holiday". That's happened. I know colleagues that it's happened to. It becomes very difficult. So it might be worth thinking about what's on your profile. It's also worth thinking about what you post.

Now, I'm going to read from a couple of slides here. This is a testimony from a counsellor who had their complaints upheld by the British Association of Counselling and Psychotherapy. Now, I'm not going to give this person's website in the references because although he has made this available to the public (he's published this on his website and anyone who does an advanced search can find it), I thought that I'd just be respectful and not name this person. What happened was… I'll read this out.

He says, "Unfortunately... and this is to my shame, I made oblique comments about the parents and the support on the Facebook page I then ran". He was a child therapist. He said, "I did not and still do not believe that the comments made the family identifiable to anyone whom they had not previously confided". He contends that he didn't breach confidentiality. And then he goes on to say, "However, the parents recognised themselves in the comments and, thus, there is no doubt I breached that their trust and caused them hurt and offence".

So, on one hand, he's saying, 'I'm so oblique that no one would absolutely know who they were, apart from their parents who knew. They, of course, made a complaint and he goes on to say he's apologised. He does so again and he's apologising on his webpage for this, but it just goes to prove that even though he thought that the comments he was making wouldn't be recognised, he did. And because he published those, he breached their confidentiality because they recognised themselves in the public domain.

And then he goes on to say, "I can only attribute the mindblindedness that led me to make the errors to my own mild psychoticism". I'm not even quite sure what that is, but I think what he's saying is that he wasn't aware of what he did. As someone who runs a Facebook page for students (I mean you are on it. All the people who are watching tonight), I've had to remove posts time and time again because people are talking about clients. Clients will search for you. And if they see that you're asking a question (even if it's just the most innocent question), they can say, "Why are we asking the Facebook group about what I was talking about?" It can get you in all sorts of trouble. And to be fair to him, give him a little credit, he says that he's 'betrayed their trust, caused hurt and for that offence, I'm deeply sorry'.

I'm sure part of that sorrow is because the consequence of the action being brought against him and it being upheld. The therapist was asked to re-train (completely re-train
) and reapply for BACP membership. So it effectively means that the person in question isn't a therapist anymore because they would have to retrain and they would then have to go in front of the BACP to be interviewed again. So we can see there are quite serious consequences for someone who makes an error, certainly, on social media.

I want to look also at professional conduct, because it covers reviewing our knowledge and skills in supervision and discussing areas with experienced practitioners. So as part of being a professional, there are some things that you have to do. The new BACP framework which went live since July of this year is implicit. It says that we have to review our knowledge and skills in supervision or a discussion with experienced practitioners. Now, in other words, we are professionally obliged to talk about our work and to gain knowledge from it. Not to do is really professionally... I was going to use the word 'dodgy'. I don't know if that translates across the world very well, but 'professionally worrying' because if someone thinks, "Well, I've got my qualification. I don't really need to know anything else", that's a really dangerous place to be.

The framework also asks for regular Continuing Professional Development to update knowledge and skills. So again, it's not a case of coming to the end of the qualification and thinking, "Oh, that's it. I've got my degree or my master's or my diploma. I'm done. I don't need to do anything else". Over the years, a lot of ideas in counselling and psychotherapy have changed. So part of professional conduct is to update skills. There was a recent court case where a woman sadly killed herself. She had what's known as postpartum psychosis. It happens to about one in a hundred women who become mentally ill after giving birth. It's called postpartum psychosis. And the therapist who was working with this client was asked by the coroner, "Have you ever done any training on postpartum psychosis?", and the answer was no. That question was kind of left in the air a bit. So, really, if we're working with some certain client groups or we're working in certain areas, we really do need to keep our professional competencies up. It doesn't mean we need to know everything, but if you're working with a certain client group, then I think you're ethically and professionally bound (professional conduct) to know about that area and at least know the danger areas.

Keeping up to date with the law, regulations, and any other requirements: Laws change; so do regulations for frameworks change. I'll touch on that. In other words, if you're using our website or using the BACP website or you're in a group or you're in a profession where you meet other professionals, you really have no defence if you say 'I don't know the law changed'. In the UK, there's a saying that says ignorance of the law is really no defence, and it isn't. I know Ken and myself spend quite a lot of time.  We went through the ethical framework. I went through the ethical framework with my supervisor when I returned to practice, just to be clear about what our roles and functions were. So it's really, really important that you keep up to that. You could have a complaint made against your professional conduct if you didn't.

And the BACP says, "...including guidance, from this association, relevant to our work." I'm going to come to relevance as we move on. So just keep that in mind.

Professional conduct also covers Continuing Professional Development; reading professional journals, books or reliable electronic resources (that could be counsellingtutor.com) to gain information, and also things like training courses and research. If you're a member of the BACP, they send out a research journal every so often. It's really useful.

Again, discuss with colleagues working with similar issues. So if I'm working with a client who has a particular presentation, I'm very fortunate I've got a very wide range of contacts through the years I've been in therapy. I would quite happily phone up a colleague and say, "Have you ever worked with this presentation? Tell me what you know". You could get some really, really good information.

And again, not finding out about something and just saying 'Well, I think I'll just leave that' could get you into hot water. This is a boundary issue, really. It's a professional conduct issue.

So professional conduct in summary: Be thoughtful how clients may perceive you from your social media profile. So what I would say, and again I don't want to preach to people, but if you have got a social media profile, it might be worth you having a look at it and you can lock them down. You can just have friends in. You can have one that's totally impenetrable like mine is. All I've got is a flower, I think, and a logo and that's it. But it's well worth it because, really, clients will look for you.

Be aware that you can be held to higher standards than people in other occupations. So I don't want to diminish people who do other work, but as professional people, we have to keep the standards really high. A misthought post on Facebook, in some occupations, would just be considered a bit of fun. In our occupation, it could lead to quite a serious complaint.

The new ethical framework outline areas that are prohibited in the counsellor-client relationship. And one of them, which is under ethical issues, is 'don't have sexual relationships or behave sexually towards our clients, supervisees, or trainees'. Now, I've actually known someone who spoke to me about someone they knew who had actually had a relationship with one of their supervisee and that was a huge amount of trouble. And again, it had to go through a professional conduct panel. So that's worth thinking about. For the very first time, the BACP have put this in the ethical framework. It never was in before. I think the reason they've done it, maybe, is because people could plead 'well, it's not in the framework. So if it's not in, it can't be followed". Now, it's really implicit.

Other ethical issues: encouraging paid or pro bono (one of my favorite words, which means free of charge) clients to stay in therapy longer than is necessary. It's been known for paid therapists to keep clients in therapy because they're producing a monthly salary for them, or because, maybe, they like the clients, so they say, "just keep coming". That's incredibly dangerous. Again, to me, it's a boundary issue because what you're doing is, in terms of taking money off people, you're keeping them there longer than you should if you're doing that. Encouraging people to stay longer in therapy is really abusive.

There was some research done a few years ago about paid therapists and people who did work for free and they found that paid clients stayed longer in therapy than free ones and there was an argument. They weren't quite sure about this, whether that's because paid clients invested more into it. Because they were paying, they were more interested in getting their difficulty sorted out or because at some level, the therapists were encouraging longer engagements in therapy.

Practicing Gay conversion therapy, sometimes referred to as reparative therapy: It was only about two or three years ago that I got a letter from the BACP saying that they thought it was unethical for people practicing gay conversion therapy. In other words, someone comes who's gay and says, "I want to be heterosexual". There were therapists that would work with that and say, "Oh yes". There was one therapist who was eventually struck off because she told the client that being gay was a mental health issue and it's not. It's not. It used to be in the past considered a mental health issue, but it's not considered that now. So that's the kind of guidance I was talking about earlier own. Again, someone could call and ask for that. If you engage in that, that is really an ethical issue.

Engaging in a 'dual relationship (counselling your colleagues). Now, this might sound a bit far-fetched, but actually, I've known people who have been counsellors. Certainly, this has happened to me where I'd been asked by someone who didn't know anything about counselling, who was my line manager. "Someone is having a bit of a difficulty. Could you have a word with him?" So I said, "What you want me to do?" And he said, "You're a counsellor. Could you not counsel them?" And I said, "Absolutely no. They're my colleague. It's a dual relationship. So, no". But through the years, I've had four or five students who'd initially come because they worked in one field and thought it'd be a good idea to be able to counsel their colleagues. One person was a HR who worked in human resources and thought it'd be a jolly good idea when telling people that, maybe, they're in trouble for something to then go on to counsel them. And I said, "No, it's totally unethical. You can't do that. It's a dual relationship.

Also, confidentiality: Now, that's another area where boundaries can be crossed; discussing clients to a third party without their consent. So, occasionally, we might get phone calls, as private practitioners, asking if we're seeing someone. That's happened to me. When I first started, I got a message to phone someone up. I worked at Mind Organisation. I phoned back. I didn't know who they were. And someone said, "Are you counselling such and such a body?". And I said, "I don't discuss my clients". "Oh, well, it's alright". They said, "It was okay." And I said, "I'm not going to be talking to you about anything I do. You know full well that if a client wishes me to talk to you about them, they will tell me and we would have to form fill in a confidentiality agreement form. So that sometimes happens, but it also could cover things like discussing clients in the pub or in a coffee shop or on the dreaded Facebook, because that can get you into a heck of a lot of trouble if clients identify themselves. That can get you into a lot of trouble.

Storage of notes: How do you store your notes? Are they stored securely? Are they stored in a locked filing cabinet? If you're on a computer, is your computer secure? If you throw your computer away, what do you do with the hard drive? All that kind of thing is about confidentiality. When I threw my computers away, I wiped the hard drives and I stored them in a lock. Never ever take your computer to the tip with a hard drive in because smart people can plug in a hard drive. They're looking for your bank details but they could find anything else. So that's a boundary issue in that you could cross a confidentiality boundary by someone finding your notes. That is an awful thing to happen.

Speaking about the clients on social media: If you think I'm laboring this point, I actually am, because it happens so often. I think part of that is that we treat social media a little bit like turning to the person next to us. If you're talking to fellow professionals, I think sometimes it's easy to forget that. Certainly on, say, our Facebook page, yes, you are talking to fellow professionals, but also you don't know who else is in the room. So it's a little bit like being in the proverbial office talking about a client when there are general members of the public in the waiting area. It works in the same way.

And one that I always contract for, is acknowledging clients in a social setting, where this has not been contracted for. So when I worked in Ashton and based in Ashton near Ashton-under-Lyne in the north of the country, I only lived a mile or so away. As such, I occasionally bumped into clients just going shopping—that type of thing. So I used to arrange that. I used to say, "Look, if I meet you, how would you want me to acknowledge you?" Some people just say, "Say hi". Others would say, "I don't want you to acknowledge me at all". So that's what we did. And most of the time, I would actually say to clients, "Look, if I'm out with my family, I think it's probably best that we don't acknowledge each other". It can become quite difficult. You acknowledge someone and then someone says, "Who's that?" Already, you are in a very difficult area. So that's a breach of confidentiality; acknowledging clients in a social setting. It doesn't stop at the clients just waving at you and shouting you 'who'. That's happened to me. You can only do so much. So, maybe, that's about having a conversation with your partner or spouse and saying, "If that happens, maybe don't ask", but I've had that. I've had a waving, and on one occasion, I was buying some fat balls for the birds in our local gardens and the person in front of me unbeknownst to me was a former client. She engaged me in a conversation and my wife was stood behind me. It was kind of quite difficult really, because I was trying to be as neutral as I could. Bear in mind we were in a quite big shop. The client was speaking eloquently about 'When I had counselling with you, everything was fine'. I'm kind of nodding and thinking, "I wish the ground had opened". These things happen. It doesn't happen often, but when it does, you have to be very thoughtful about how you respond.

Acting on third-party information: Through the years. I've been told things in confidence that I could have either made money on or put to my advantage. I can't really say anymore than that, but it's amazing how much people will tell you about, certainly, their work lives. I've been privy to some pretty interesting information about how certain organisations work. And if you were to act on that, you could get yourself in quite serious trouble. I mean, one of them (this is just one I'm making up to help us with this) is if, say for instance, you work with someone that works in the city and they talked about a merger and they say, "We're going to buy The Bank of Counselling Tutor". You know that as soon as that's acknowledged, the share price of Bank of Counselling Tutor is going to go up. You go and buy a load of shares. You could make a lot of money, but also, if it's found out that you've acted on that information, you could be in a real whole host of trouble. It's amazing. Through the years, I've heard quite a lot of information that if I'd acted on, I could have benefited myself from. I'll just leave it there, I think.

Finally, boundaries; so, following clients on social media. So I've talked about clients following goals, but actually, there's been quite a bit of talk certainly on Facebook groups that I've been privy to. And also, I think it was covered in Therapy Today where following clients on social media where a therapist's gone and thought, "I wonder what they're doing", and typed their name in and there they are. I'm sure that more than one or two therapists have done that. It is a boundary issue. It definitely is a boundary issue because you've only got to click the wrong button and you could send them a friend request, or more to the point, if you're working with a client and you're talking and reflecting something back like, "Last week, you went to the cinema", and the client says, "I didn't tell you that. How did you know?" That is a boundary issue. I think it's one that's got to come up a lot, where people are inquisitive. Maybe, people need to really think about their actions there.

Looking up clients on social media: So the first is following them, sending clients friends’ requests. And the other is looking up clients on social media. Just to go back to following clients on social media, I was absolutely appalled the other day when I switched my phone back on after working with a client who found out that Facebook had actually recommended him as a friend. I thought, "Oh, how did they know that?" A lot of phones now have GPS and very clever software, so if you're in the proximity of someone for long enough, they'll recommend you as a friend. So it's very possible that if you see a client come up recommended as your friend, it's because the GPS system is located in the same place. Again, with lots of people on that friends list, you can accidentally put a client on.

Dual relationships: Again, this is a relationship where your therapist having something else becomes very, very difficult. It can be quite difficult for school counsellors who are teaching the same college. I was a college therapist, so I worked for the college. They wanted me to do some counselling and we had a very long debate about it. Eventually, I only took clients from a different kind of location to where I was, because you could get into a dual relationship. You don't want to be someone's teacher and their therapist. It can happen quite a lot. It might be that unbeknownst to you, you start a new job and discover that your client actually works in the same organization. I've known that before now.

Contracting clients outside agreed contractual times: So this is about contracting. It's just phoning up clients to see how they are. That occasionally happens. You see in the BACP sanctions list that someone's phoned a client up. It's really good practice if you've got a contract. I use a contract. I've been a private practitioner. I actually have it in my contract—"Can I phone you up during business hours if I need to change an appointment?" That's in the contract; so, contacting clients outside agreed contractual times.

Socialising with clients: Many years ago at an organisation I worked for, I was absolutely appalled where I saw a client and a therapist come out and they were having a kind of conversation about appointments. And as the client was just about to go, she said, "I'll see you in the pub later". I said, "You're not going to see a client in the pub", and she said, "Well, yeah." This was a long time ago, I have to say. That was a bit unfortunate because that had to be dealt with. Of course, it's just not on, is it? I mean there are some times where you go to a wedding and you find yourself looking at one of your clients. There are exceptions. You may go to a church or a place of faith where one of your clients is there, but you have to be very thoughtful about that.

Not having clear enough appointment times: So, saying to clients, "You can just drop in. I'm here all day. Just knock on the door if you want to come in". That's a boundary issue because you're not setting the client firm enough boundaries. And also, if you're not there, the client can turn up and there's no one there for them. So that could be certainly a boundary issue.

I'll give you an example; giving a client your phone number and saying, "If you feel low, give me a ring". That could be quite dangerous and I know some therapists do it. Make no mistake. Some therapists do it, but it could be quite difficult because if a client phones you up at 2:00 in the morning saying they're in the process of killing themselves, what do you do? If you're available all the time, you might be building client-dependency. You might be having what they call the symbiotic relationship where the therapist can't live without the client. That's been known, so that is a pretty difficult boundary area. And if you do have a phone, have an answering service. If you're working with clients who you think might be prone to phone you up at all hours of the day and night, it might be worth contracting for that and maybe just turning your phone off.

I'm kind of repeating myself here, but it's just happened a lot; counselling a client you may be involved with in another relationship (a work colleague or a family member) I know it's come up on Facebook about someone asking quite innocently, "Is it alright to counsel a family member?" Well, the answer's no because you've got too much invested in them and the reality is if it's someone you know, they're not going to tell you their innermost secret if you know them in a different capacity.

I'm back on social media; using social media to talk to your clients outside sessions. There are things like Facebook apps or all sorts of applications where people can contact you. So you need to be very thoughtful of that. It does happen with people on the Counselling Tutor page that occasionally, it'll flash up. Someone sent me a message. If they're Counselling Tutor people, my whole Facebook is set up for that. But clients couldn't do that; clients couldn't access it.

Also, legal responsibilities: Another issue is legal responsibilities such as data protection. In the UK, we've got exceptions to confidentiality, which is drug trafficking. When we talk about drug trafficking, we're talking about people shipping huge quantities of drugs. Money laundering: Money laundering is where someone sold a huge quantity of drugs and has a big pile of cash that they can't put in the bank because if you try and put 10,000 pounds in the bank, they'll want to know where you've gotten it from. So people start legitimate businesses off fish and chip shops or takeaway cafes and then put the money through the books. They will say we've sold 500 portions of fish and chips this week and try and launder the money that way. And in the UK, we have the Acts of Terrorism. So anyone who is involved in any kind of acts of terrorism.... and the interesting thing about the last three (drug trafficking, money laundering, and acts of terrorism) is if the client tells you about it and you say, "I'm going to have to inform the authorities", you could actually be prosecuted for perverting the course of justice because, effectively, you're tipping them off. I mean, personally, if someone said they were going to do a terrorist act, I don't think I'd be telling them directly that I was going to tell the police. If they're willing to kill loads of people, they'd probably be willing to kill me on the spot. So not to be too dramatic about it, but those are legal responsibilities. And again, by not disclosing them or, in terms of data protection, by sharing clients' information, you can get into quite a serious bother there.

Again, I've covered this; disclosing the client's details, phone number, or address to a third party without their consent is breaching data protection. It does happen. One needs to be careful of that. Someone could phone up and say 'I'm such and such a body from such and such a place. I'm trying to get a hold of someone. Can you tell me their address?" So you've got to be very careful.

And then, we are going to cover negligence. This is where someone is just being negligent and is just being so far away from professional standards that it borders on incompetence.

I'm going to look at the storage of notes (people storing their notes), timekeeping, endings, appointment keeping, working beyond limits, and again, I'm going to talk about dual relationships. The reason I keep repeating some of these is because they will come up more and more. The more you're a counsellor, the more that you work, the more these things will come up.

One of the biggest complaints that we receive by the BACP is clients not knowing that therapy has ended the client. The therapist just finishes it and then the client turns up next week and they're not there. So if you are going to finish with a client or you're coming to an ending, it has to be a properly managed ending. And to that extent, that needs to be discussed well ahead of time. It needs to be thought out. You need to map any form of support should the client want it. In fact, if you go into the CSR Study Resource, I've just done a video on that (Ending with clients). It's a mini lecture, so have a look at that.

Counselling a client when you know your modality or the time allocated is not enough: I think this is negligence. If I'm doing six sessions and the client wants to talk to me about, maybe, historic abuse and they've got serious issues in their life, I have to take two views; A) Is my modality of therapy going to be suitable for this client?, and B) Is the time I've got (certainly, if you work for an agency, you might have only six sessions in some cases) enough? And what you don't want to do is start to work with people and then say, "Well, we've run out of sessions now". What you can do is try and work with the most important stuff, but you really do have to take a view on it and you can come under quite a lot of pressure, I think, from agencies who say, "Oh, it'll be alright. Just work with this". But I think it's being negligent because if you open a client up, we know in therapy that sometimes things can get worse before they get better. And if you get into the point where things are getting pretty bad for the client and they're looking at their material and all of a sudden, you disappear and say, "We'll, we've finished", it can be really bad.

And also about modalities, if someone comes and they clearly have issues around, say, voice hearing or huge mood swings, I will be thinking, "Is my modality of therapy useful enough or wide enough to work with that client?" And again, if a complaint was made and you're working outside of your competence and outside your knowledge base, again, a boundary crossed and trouble ahead.

Also, things like a client with a clear plan and timescale for committing suicide and you take no action. A client tells you that they're going to commit suicide. They've got a plan and you just kind of 'hope you'll see them next week'. Again, that can be a difficult conversation with a client but to take no action is negligent. Most organisations and, indeed, the BACP ethical framework now implicitly talks about harm to self. So it might be a difficult conversation to have, but to just dismiss it and say, "I don't think they'll do it. They're always saying that", I think one day, they'll say that and they may not come back because they've actually carried out what they're going to do.

I made a reference list and what I've done is I've put in all the different ethical frameworks. It might be useful to go through all these frameworks. So when we upload the play-again video, I'll upload this as a PDF file, which means you can download it on your smartphones, your computers, and any other device. You can click on those links and it will take you through. It's worth having a look at how there are different ethical bodies, but they all roughly say the same thing.

So I hope you've enjoyed that presentation.