Considering a way to ethically monitor what I do with clients is a really interesting area for me. I said to my supervisor very early on in our working relationship that there was no way for her to know if any work was actually taking place in the room, because there was no practical way to observe my practice. Although this was part in jest, I am genuinely intrigued that there is so much work going on around individuals’ welfare, with no real way of ensuring it is healthy, productive, professional and appropriate.
My supervisor told me that, if work was not occurring, then this would be clear in supervision, and my retention of clients. I have kept this in mind if my thoughts have ever wandered since. I think, for me, there is a level of confidence, I can only hope this comes as a result of a level of competence. Within OnTrak it has been mentioned by my supervisor and senior staff that I am successful at retaining what can often be a very sporadic client group.
I think that the young people I work with must be getting something from the process, or they simply would not return! OnTrak work to ensure clients are aware of the Ethical Framework for Good Practice in Counselling and Psychotherapy from their initial assessment. It is covered (along with the agencies specific policies) during a client’s assessment with a senior practitioner. The core components are then covered by myself at the first session and then covered as and when necessary. An example of this would be a client who missed a session and, at the next session, told me he had done so because he was not entirely sure of the confidentiality boundaries around criminal activity. He had missed the session because he ‘knew I would make him talk about it’, after subsequent discussion we worked to clarify this to mean he would want to talk about it on some level, and knew I would encourage this as an empathic result. By restating the confidentiality conditions I was able to reassure the client, and positive work continued. I think, like any profession, there will be bad counsellors in operation, I believe that the reasons for (and importance of) working within an ethical framework ensure that clients can, at the very minimum, be met by an individual who will do no harm, even if they are not able to help the individual progress with their issues. In order to ensure that my relationships with clients are bounded by this professional framework they are invited to discuss the ethical guidelines throughout the sessions, and encouraged to research any areas they are unsure of on the BACP website.
When we did an exercise in class around the contracting and boundary setting that takes place in our own sessions some class members thought mine was a bit lengthy. In my experience my initial contracting would have been fairly focussed but, with experiences of subsequent clients, I have found it necessary to include more areas for the client to be aware of, which lengthens this initial exchange. As an example of this, I was approached in a bar by one client’s friends who asked about our counselling relationship. The client has obviously pointed me out, and this led to the encounter. I politely declined talking about any client issues, using client confidentiality as the reason, and have been really clear with subsequent clients what expectations we have if contact outside of the counselling room occurs. Considering the values covered in the Ethical Framework for Good Practice in Counselling and Psychotherapy, I think three stand out for me: Ensuring the integrity of practitioner-client relationships. This is key to me due to my professional background alongside these studies. I work at a local school and the pastoral role I have means there are frequent occasions where young people can be in a state of incongruence and display a lack of consequential thinking. This means it is crucial to be empathetic, but also aware of self-preservation too, both emotionally (to avoid transference) and also professionally (to avoid any questioning of professionalism or allegations of inappropriateness. I have found this lends itself really well to my counselling practice as I am hyperaware of any situations that could be misconstrued, and believe I can interpret clients struggling with boundaries in their own awareness. One female client was displaying inappropriate sexual overtones, so this was discussed with my supervisor and addressed within subsequent sessions. Fostering a sense of self that is meaningful to the person(s) concerned. With the clients at OnTrak, so many of their presenting issues can be attributed, at least in part, to an unawareness of self. Often exacerbated by a need to be what others (parents, teachers etc) believe they should be. For me, the real turning point is when these young people find their own voice, as I have managed to do myself, then they also begin to see that they can create their own sanctuary. Striving for the fair and adequate provision of counselling and psychotherapy services.
This one represents somewhat of a challenge for me, personally. Within OnTrak we are a self-referral only agency. A group I struggle with, due to my own beliefs, is the client base with OnTrak who simply don’t want to be there. Although self-referral suggests clients have made the autonomous decision to enter therapy, we have a number of clients who feel coerced to attend, this can be through pressure from parents, or heavy suggestion from GP and/or school. Due to my own reticence to access personal therapy, and feeling obligated to attend sessions. I can relate to clients who are in therapy against their will, I empathise with them (perhaps there is an element of envy as well!) and encourage clients to move on if they are not in a place to access therapy positively. Therefore, whilst I feel 100% that we have adequate facilitation of a therapeutic practice, I do sometimes question how ‘fair’ it is, from the perspective of clients who would rather be somewhere else. Something I have struggled with in many jobs since I returned from my time living and working overseas in the idea of professional standards. I am very reluctant to do anything which stops me from expressing my of creativity and style but, as this usually does not represent a very ‘corporate’ outlook, I understand there are some parts of my external appearance that clients may struggle with, particularly my tattoos and piercings. I resolved from fairly early on that it would be inappropriate to have my larger tattoos on show; I have experienced how judgemental people can be and did not want to risk the client-counsellor relationship to take on any negative connotations due to transference.
There was one occasion that this potentially represented an issue, my supervision overran one week and, although I had allowed myself time to get changed, it meant that I would potentially be meeting a client in a top that revealed my chest tattoo. This offered several interesting areas of focus, my supervisor offered to give me a lift to my home to get changed (I saw this as blurred lines, so politely declined), the supervisor was the one who initially highlighted there may be an issue (which raised the familiar sense of being judged) and it meant the client session would start a little later on this occasion, which could impact the client and myself. I think there is a definite expectation of clients (particularly being young at OnTrak) and I do not necessarily embody that. Clients have mentioned on several occasions that I am not what they expected, and I think sometimes I struggle with the behaviour, dress, and communication with professional peers due to my issue with supervision and being submissive. I believe I have competence and integrity when it comes to my clients’ wellbeing, but this sometimes goes missing when dealing with colleagues. I have the same perspective to my counselling as I do in my role at the school, to use the Ethical Framework for Good Practice in Counselling and Psychotherapy’s ideas of ethical principles I put great value in beneficence and justice. The clients (or, in my professional capacity, the students) are key, and thus they occupy most of my concern. This can put me out of sync with colleagues and classmates as I struggle to see the link between peer feedback & guidance, and professional progression. I am working to build bridges with colleagues, my supervisor and classmates, but I think there is a definite desire to relate to the clients, not the ‘experts’.
Although I have been at the agency for three years, I already have quite a varied anecdotal base of experience to draw from. Specific training at the agency allowed me to look at areas that may be accessed (consciously or unconsciously) while dealing with this client type, this fosters a sense of competence, but also resilience to the issues these clients may be bringing. There have been cases where I have had to consider my limits as a trainee, particularly a client who brought legal issues to our sessions. After disclosing her experience of sexual abuse from a sibling during one of our sessions I signposted a client to the local sexual assault centre. This was done after discussion with my supervisor and senior staff at the agency, and involved one of the senior staff joining us for part of a session. I initiated that, as I wanted to ensure the client’s needs were being met, but accepted that I may not be best placed to do so at the time. Another client believed her cousin was having inappropriate relationships with minors. Again, this was explored away from the sessions to help me see where I was struggling, and how much of my ‘self’ was potentially playing out in the sessions. The outcome of this was that a youth worker at the youth club where this boy was meeting young girls was made aware of his activity (with the client’s permission, and direction) and acted according.
One of the things my supervisor and senior staff at the agency acknowledge is my ability to recognise my responsibility to clients. When I started at the agency I had my probationary period extended by six months. This was not due to my inability to work with clients (which was made clear to me), but a result of my poor administration. Initially this was a struggle, I was working well with clients, having positive outcomes and keeping clients engaged, but I have since realised there is a responsibility I have to the wider profession. With CORE forms and client notes (for the agency, not myself) there was an initial distrust as I felt they were just box ticking exercises (in truth, a part of me still believes this!), but I now realise they are necessary parts of the process, to ensure the continuation of the agency, and the appropriate records are kept for clients. There is still a sense that I am a child in an adult world for me. Not just in my studies, but in life as a whole. This means I can sometimes struggle with expectations of my own conduct within my training group and in the agency setting. As I have said, I believe my time with clients is appropriate, positive and productive, but there is a definite need to be seen as a team player and contributor, which I have often struggled with.
There are times I will say things in class, or to colleagues in the agency that represent me as an individual, rather than as a professional. I think the gap between these two ‘sides’ is getting smaller as a result of my personal therapy, and just getting older, but there are still times when I feel the need to censor my views. Unfortunately, this is often retrospectively! I believe I can competently demonstrate professional standards in my therapeutic work, but there is still a side of me that can cause issues for me when it comes to peer relationships. However, the solace from this is something I feel within the counselling relationships I have. There is something about being in emotional contact with someone at that level that just unlocks empathy, sincerity, respect and humility in me that I struggle to access away from those sessions. I find that as a client as well, not just a practitioner. I agree that the challenge of working ethically means that I will inevitably encounter situations where I have competing obligations and perceptions. I believe that I have the courage to seek support and advice, to ensure that there are no ‘heroic’ actions I take in haste, which may result in dangerous decisions and consequences for my clients, or myself.