General ethics information
The therapy relationship is a professional relationship between a practitioner and a paying client. In order to be effective in helping clients reach their goals, the therapeutic relationship can and should be warm, friendly and accepting, but it is not to be confused with a friendship. All professional associations have codes of ethics that govern the way the therapeutic relationship is managed, and set professional boundaries around it.
I abide by the current BACP Ethical Framework.
Prohibition on dual relationships
It is not unusual for clients and therapists to come to respect, even like each other as human beings. However, one of the most important ethical rules in my profession is a prohibition on developing dual relationships with clients. This means that therapists are prohibited from developing any other relationship with their clients, business, social, or personal. I do not make exceptions to this rule.
- I do not see friends and family members as clients at the same time, unless it is for relationship or family therapy.
- In relationship therapy it is sometimes helpful to have occasional individual sessions with each partners. If this is necessary, it is always on a completely even basis (same number of individual sessions with either partner, and with complete agreement from both). Any individual sessions held during relationship therapy are for the purpose of the relationship. They are not to be confused with individual therapy.
- I do not see people who are in a close relationship of some kind for individual therapy. This includes people who are in an intimate relationship, friends, family members, or even housemates. Relatives, friends, or partners of clients can only see me once therapy with the original client is well and truly over. I do not make exceptions.
- I do not work individually with either member of a couple, or a former couple I saw for relationship therapy. If people who see me for relationship or family therapy feel they need extra support, they will need to find their own therapist to work with separately. I do not make exceptions.
Relationships with former clients
There is an indefinite & strict prohibition on engaging in a sexual relationship with a former client. This is regardless of how much time has passed since the end of therapy. Under no circumstances is a sexual relationship between a therapist and a client helpful to the client during, or after therapy.
As you can see from item 37 in the new BACP Ethical Framework, there is no strict prohibition on changing a relationship with a former client into a friendship or a business relationship after therapy is over. However, any such change is to be considered carefully and the decision has to be governed by strict rules, which are mainly concerned with the former client’s safety. As an experienced practitioner (I have been in practice since 1999), I do not agree with this rule.
During my years of practice I have been asked many times by clients if I would be prepared to be friends at the end of therapy after a certain, agreed-upon ‘cooling off’ period. I recognise this as an expression of respect, and affection towards me and am deeply honoured. However, I do not develop friendships with former clients.
Apart from the guidelines in the Ethical Framework, there is something a bit uneasy for me about changing something that started out as a one-way relationship into a two-way one. Therapists are hired to accompany their clients somewhere along their journey to develop to their full potential. Therapy relationships should last as long as clients need them to, but they are always temporary. Psychotherapy is not a ‘lifestyle’ option, or a crutch to help people cope. It is there to fulfil a purpose. Once the purpose has been fulfilled the therapy is over.
How relationships with therapists begin, how they develop, and the reason they exist in the first place are highly incompatible with friendships. They are meant to be this way if they are to be helpful. Therapy relationships are artificially one-sided. They need to be safe for clients to feel free to explore, develop, heal, grow, integrate, etc, without worrying or considering the needs or feelings of the other partner in the relationship.
In natural friendships or relationships if we only focus on ourselves, our needs or feelings and never consider the needs or feelings of the other, or give them the space to share and get support from us, it’s not going to work. Friendships can be hugely therapeutic in their own way. But they have to be equal. Therapy is something that people use when they temporarily need an uneven situation, deliberately, in order to take care of their own needs without interruption.
Another reason to avoid friendships with former clients has to do with whether a client ever wants to come back and do some more work. I believe this should be available to former clients if they ever need this, and as long as the therapist is still in practice. If you have any questions about any of this feel free to contact me.
Therapeutic safety
People can be vulnerable when they come to therapy. They need to feel safe and confident that they will be treated respectfully and with care. It is not a client’s job to meet the emotional (or any) needs of their therapist. In real life outside therapy, friendships and personal relationships are a two-way street. Each person is there for the other.
By contrast, therapy is a one-way relationship, and it is there to meet the client’s needs only. Therapists are expected to have appropriate ways to meet their own needs outside their work so that clients can feel safe to concentrate on themselves. The only obligations a client has are simple and straightforward: be on time, observe your therapist’s cancellation policy, pay for the sessions and respect the therapist’s person, and physical environment.
Professional boundaries
The Highlands & Islands, and in particular Inverness and the area around it are a relatively small and intimate environment where many people know each other, or of each other. It’s not uncommon to bump into clients in public places like shops, the cinema, or in functions. Clients are always in charge of how they wish to manage things if they bump into their therapist in public. If a client says ‘hello’, I will always reciprocate, but I do not initiate contact with a client or former client in public. I would wait for their cue. Clients or former clients are under no obligation to obey social norms when bumping into their therapist in a public place. I do not expect my clients or former clients to be social with me in public. I know it can feel uncomfortable to some people to ignore their therapist in public, but it is all perfectly OK, and I will never feel offended.
I explain this rule and all the other rules listed in this ethics page to my clients in the first session.
Continuing Professional Development (CPD) and Clinical Supervision
Accredited therapists like me are required to attend a certain number of hours of CPD and clinical supervision every year. Therapists select their CPD activities based on their professional interests and their developmental needs. I choose courses and workshops that enhance my work and refresh my knowledge and skills.
Professional supervision is a formal relationship bewtween a therapist and his or her supervisor who is usually an older and more experienced therapist. I am both a supervisor myself and have a trusted supervisor that I see every three to four weeks for two hours at a time. In supervision, we are required to demonstrate our ongoing commitment to improving our knowledge, our skill and our awareness of ourselves and our role as therapists. Supervisors help therapists debrief if needed and talk about any issues that may come up for us in the course of our work. Supervision is seen as a way for therapists to maintain their emotional balance and objectivity in order to ensure that they continue to provide safe and effective therapy to their clients. A healthy, well-informed and well cared-for therapist is also a safe and effective therapist, not to mention a positive role model…!
Confidentiality & limits to confidentiality
Therapy is confidential. It takes a great deal of courage to open up your inner world and share it with a complete stranger. Clients need to know that they are safe to do so and that what they say and even the fact that they see the therapist, are going to remain confidential. This means that therapists are not allowed to disclose content of sessions or talk about who they are seeing, outside the strictly confidential setting of professional supervision. Any notes the therapist takes during or after sessions are kept secure.
As with all other health professionals, psychotherapists and counsellors in private practice are required to abide by the Data Protection Act. Depending on the circumstances of the therapist’s work, he or she might be required to register with the ICO (Information Commissioner’s Office), which is the body responsible for enforcing the Data Protection Act in the UK. I am on the ICO Register and am required to renew my registration every year. Client files and notes are kept for seven years from the end of therapy, after which time they are securely destroyed.
There are three important limitations to confidentiality in the UK:
1. Harm to self or others:
If a client discloses that he or she plan to harm him or herself or someone else, or that they are abusing a child, therapists in private practice have a discretionary right to report this or otherwise to get other people involved as appropriate. In such circumstances the right to confidentiality may no longer take priority. The client may or may not be consulted depending on the circumstances. If a therapist in private practice chooses to take such action it must be defensible. This means that the therapist has to have a good reason or justification for waiving client’s confidentiality.
In psychotherapy and counselling services that aren’t private, such as with the NHS or other organisations, therapists have compulsory disclosure if harm, potential for harm, or child abuse are disclosed.
2. Money laundering, terrorism and other serious crime:
It is compulsory for all psychotherapists and counsellors, including those of us in private practice to report to the authorities if a client discloses any involvement with terrorism, money laundering, drug trafficking, or any other serious crime. The penalty for non-disclosure is a long jail term. Please remember that the therapist will not be able to keep such information confidential if you disclose it in a session.
3. Court cases and client notes:
If there is a court case that involves you, whether or not it relates to the reason that sent you to therapy, your therapist’s notes might be requested by the courts. Your therapist might also be called as a witness by your side in the case or the other. Once notes are requested by the courts, or if a therapist is ordered to act as a witness, therapists are obliged to the courts and are not allowed to alter notes or bias their testimony in favour of their clients. They are required to give honest and truthful evidence in court. Lying to the court is a serious criminal offence.
If you are involved in a court case it is your choice whether or not to disclose to your solicitor that you saw, or are seeing a psychotherapist or counsellor. If your lawyer doesn’t know there is little chance that the therapist’s notes will be requested by the court. Even if you think it might help your case to let your solicitor know about your counselling, remember that it is possible for the other side to try to use this against you. Because all counsellors are aware of this we write our notes in the most respectful way possible. If you are the subject of criminal proceedings the choice about disclosing your therapy experience might not be in your hands.
There is no rule that therapists have to take notes in sessions although this can be helpful to the therapeutic work. Be aware that you have a right to request that your psychotherapist or counsellor does not keep notes about your sessions.
Data Protection & the new GDPR
Fully Human Psychotherapy is registered with the Information Commissioner’s Office (ICO) and complies with their data protection regulations.
What’s GDPR?
GDPR is a new data protection law which has come into full effect on the 25th of May 2018. It sets out the main principles of data protection and the responsibilities organisations have when handling personal data. It protects individuals’ personal information and improves their control over how it is collected, stored, shared and used.
If a company or organisation has legitimately collected some personal information from or about you – such as your home address, medical history, religion or ethnic background – you’d want them to keep it secure and not misuse it or pass it on inappropriately.
Businesses in the European Union (EU), which includes the UK, had until 25 May 2018 to comply with GDPR. From this date, GDPR replaces the Data Protection Act 1998 (DPA 1998) as data protection law across the EU.
Client Records — I keep basic information about clients mainly for contact (name, address, email address, phone numbers). On the ‘Client Details’ form I also ask for marital/relationship status, and names and ages of children. Clients can volunteer additional information about medication or medical condition if so they wish, as well as say how they were referred to me. I ask my clients to sign a declaration that they do not have a formal psychiatric diagnosis of a serious mental illness (e.g. psychosis, schizophrenia), or a personality disorder. I do not see clients with a serious mental illness, or a personality disorder. I understand that psychiatric diagnoses can sometimes be wrong, but nonetheless, I do not make exceptions.
Clients have a right to request that I do not keep notes. I explain this when I tell clients about the limitations to confidentiality. A typical reason to ask a therapist not to keep notes can be that the client is involved in a court case and does not wish there to be a record of their sessions, because they could be used as evidence. It is the client’s right to request this.
Therapists in private practice do not have to keep notes. (Therapists working in services and organisations have to comply with their organisation’s policy).
For BACP guidance on note keeping see here.
Psychotherapists’ and counsellors’ notes are very different from the notes kept by psychologists and psychiatrists whose work is based the medical model of diagnosis. In my profession, we are instructed to write notes respectfully, and to avoid making assessments, diagnoses, or anything we are not openly discussing with our clients.
All information about clients is kept in locked and secure metal filing cabinets. Clients are free to see the records we keep about them whenever they wish. The records are kept during the therapy relationship and are destroyed within five years of the last session. Clients can request that we destroy the records as soon as they finish therapy.
All my session notes are handwritten during the session. However, clients do contact me by email occasionally and also by text. Email correspondence can range from bookings and changes of appointments, to sharing something that is going on with them and requesting advice or support. Computers are password protected, and any cloud backup is encrypted.
In the event of the therapist’s death there are arrangements in place for a trusted professional who has a confidentiality agreement with the practitioner to access client records in order to inform clients. This professional will also see to it that all client records are securely destroyed. Otherwise, no one else has access to any client information either electronic or physical.
There is no obligation on therapists in private practice to keep the notes for any length of time after the end of therapy. In fact, it is good practice that notes are destroyed fairly quickly after the end of therapy, as clients records are only there to support their therapy. Once therapy is over, there is no reason for confidential and potentially sensitive information to be kept.
Sharing Information — Under normal circumstances client information is never shared with anyone. Psychotherapists cannot even confirm to anyone that a particular client sees them or saw them in the past. Information can only be shared with explicit written consent from clients. This can happen if a client needs a letter to a GP, another medical or mental health professional, their workplace, teaching institute or someone else. When a letter is required the client always has the last word about the letter, how it is written, what information it includes, who it is addressed to and the manner in which it will be sent.
Please read the section on limitations to confidentiality above. It covers the rules under which client confidentiality can be intentionally compromised. When it comes to session records, if there is a court order to hand over client notes to the courts, therapists are obliged by law to do so. Therapists can also be called as witnesses and if this happens, they are obliged to the court, not to the client! We don’t like this of course, but we do not have a choice about it. It is the law.
Clients can decline to tell their solicitor that they are/were seeing a therapist if they don’t wish to be in a situation where their session records are used as evidence. But if they do tell, and their notes are brought in as evidence, they need to know that the other side in the case will see them too. It is important to remember that therapists can be called to give evidence in court even if no written notes are kept.
Therapists are not allowed to change their records to help their clients’ case. It is an offence to lie the courts no mater how sympathetic they might feel to their clients’ case.