Categories
Confidentiality

A Word about Protecting your Confidentiality

Every so often, I receive an enquiry from a television producer, a radio researcher, a book author etc.

The enquiry is often very polite and it asks me, quite nonchalantly, to discuss cases that I’m working with or to put the enquirer in contact with some of the people I’m working with in counselling.

An example like this would not be unusual:-

Hi – my name is Sally and I’m putting together a programme on ‘marriages where one partner has had an affair’.  Would you telephone me on 000 000000 so that I can talk with you about getting in contact with some of your couples?  Best wishes…

Firstly, I find myself delighted that my work, experience & marketing has allowed knowledge of my practice to reach someone who’s interested in the work that I do (although, clearly, someone might simply have Googled ‘any old counsellor who works with couples’).

Secondly, I put fingers to keyboard… to decline the invitation.

An example response like the following would not be unusual:-

Hi Sally  – thank you for your message today. Because of the confidentiality and contracting that I practice with clients in counselling with me, I will not put you in contact with anyone I am working with – or have worked with – and I will not discuss any casework with you.  If there are other ways in which I may assist you, please let me know.

This isn’t intended to be unhelpful, though clearly I am choosing to not provide any information that the enquirer has asked for.

And you might think: ‘why wouldn’t you just ask your couples/individuals/groups if they would like to speak to the person?’ and that would be a good point.

The counselling relationship has a primary purpose: which is to create together a form of safe ‘containment’ that protects the clinical work and gives the client(s) a safe place in which to work.  It would be against my principals as a counsellor to “offer a safe containment until at least some TV producer asks to talk with me”.

Confidentiality doesn’t stop after a case is concluded, neither.

Most people find that the counselling relationship becomes a sanctum for them – and confidentiality is the outer casing that protects that container.

It’s my position that I will uphold my confidentiality contract with everyone who works with me where I have a choice (the law may supersede my position).  Even when it may appear unnecessarily to uphold confidentiality: such as an ex-client writing to a solicitor to say that the solicitor can ask me to disclose our clinical work; in such a situation where I have no opportunity to discuss with the client any implications of such permission-giving, my answer will default to ‘no’.

Notwithstanding my professional position, I adhere to the British Association for Counselling & Psychotherapy’s Ethical Framework for Good Practice in Counselling (http://www.bacp.co.uk/ethical_framework/) which includes sections on confidentiality:-

  • Being Trustworthy: ‘…regard confidentiality as an obligation arising from the client’s trust…’  and ‘restrict any disclosure of confidential information about clients to furthering the purposes for which it was originally disclosed.’
  • Autonomy: ‘normally make any disclosures of confidential information conditional on the consent of the person concerned’
  • Respecting Privacy and Confidentiality: ‘The professional management of confidentiality concerns the protection of personally identifiable and sensitive information from unauthorised disclosure‘ and Practitioners should expect to be ethically accountable for any breach of confidentiality.‘ and In some situations the law forbids the practitioner informing the client that confidential information has been passed to the authorities, nonetheless the practitioner remains ethically accountable to colleagues and the profession.

 

So, thanks for your enquiry, but I decline to discuss my casework with you.

Categories
Counselling Ethics FAQ

Will my Counselling be Confidential?

I abide by and adhere to the British Association of Counsellors and Psychotherapy’s Ethical Framework.

As part of that framework, I practice confidentiality with all of my clinical work.  This means that you can speak with me knowing that your friends, your family, your work colleagues and so on will not get to learn what you have said in a counselling session – and neither will my friends, family, work colleagues and so on.

But … what confidentiality also means is that I will discuss your case with a strictly limited number of other professionals for sound ethical reasons.  All clients and patients of therapists should be made aware of this (as you will be during our initial meeting), but unfortunately this is not the case with some other professional therapists.  I make it a particular point to discuss what confidentiality means – and what are its boundaries – with all of my clients at the start of counselling.  During our initial meeting I will also give you a printed copy of our counselling agreement.  After all, there’s a lot to remember during our first sessions.

Because confidentiality is not just about not talking about our therapy work, our written agreement explains what confidentiality means.

For example, in addition to the ‘not discussing what we say in the room’ part of confidentiality, I will have made you aware that:

  • I meet with my choice of clinical supervisor one a month to discuss my cases and my work.
  • During my yearly quota of continued professional development (eg training courses), I may refer to certain casework in order to review of reflect upon the case  (you details will be anonymised, meaning I won’t use your name nor other identifying information).
  • UK law may require of me to break our confidentiality if I learn of something that is unlawful.

The rest of this article expands upon these matters.

Confidentiality & Supervision.

As a private practising therapist who is a member of – and accredited by – the British Association for Counselling & Psychotherapy, I meet with a qualified supervising counsellor once a month for a minimum of 90 minutes. This is to discuss my practice and my case load and to check that I’m working to my best, keeping with ethical principals, and dealing with dilemmas that come up in most every case.

I will, from time to time discuss your case and our work together with my supervisor – but I will have first made sure that my supervisor does not know you, or is likely to come in contact with you (say, for example, though the workplace).  I will refer to you only by your first name (or another name if you prefer).  If I cannot assure your confidentiality in this manner – for example if my supervisor knows you in the work place or socially – then I will seek supervision from another supervisor for the duration of our work together.

Confidentiality & Continued Professional Development (CPD).

In seeking additional knowledge to keep me up to date with therapeutic thinking, it is sometimes useful to refer to an aspect of a case whilst attending a training course.  If, when we discuss our agreement, you request that I do not refer to you during my CPD then I will respect this.  Even so, it’s rare to-the-point-of-never-happens nowadays for me to bring up casework willy nilly, and I make sure that anything I discuss within the confines of other therapists in the context of CPD still keeps your identity anonymous and our casework vague enough to never identify you.

Confidentiality & UK Law.

Confidentiality sometimes has to be broken if I am required to do so by law (for example if you disclose to me your intent of harming yourself or others (including children) or if you disclose intent of committing a serious criminal offence or terrorism).  This may also apply if I learn of someone else who may be being harmed or in danger, or is planning to harm others.

This does not mean that I will go running to the police the moment that I hear about something illegal, but it is part of my ethical commitments to you to inform you that the law may not protect your confidentiality.

I will intend to discuss with you of my (admittedly very rare) intent to break confidentiality of our work before I do so, but you need to be aware that the law may require that I take action first and without your consent or knowledge.

Declining your request to break confidentiality.

I have been discussing where confidentiality is maintained but expanded in the form of supervision and CPD, and have discussed UK Law where I may not be able to keep knowledge confidential.

There is another aspect: your request to reveal information about our counselling work.

Confidentiality is very important – even to ensure it is not broken in situations where you request it (for example, giving your permission to a solicitor to request that I give a report about our case work).

If we are still working together it is best for us to have a sufficiently detailed discussion of the consequences of such events before I decide how I will respond – and I will not automatically respond with a ‘yes’.  What has been, up until this moment, vital to protect needs a serious conversation about why this need has now changed.

Should our counselling work have been completed, and we are no longer in contact, if I receive a request to reveal the contents of our counselling work with a third party… even having received your permission (eg written) to do so … I may decline [if I am unable to discuss the request and its consequences with you directly].

Confidentiality – In conclusion.

Counselling is not to be taken lightly – neither by therapist nor clients.  Clinical work such as counselling and psychotherapy requires ethics, respect and the highest form of protecting both the therapist and the client’s right to feel safe during the work.

I take a particularly thoughtful approach to protecting confidentiality – and this may surprise a number of clients who may assume that (a) nothing is ever revealed about the case to anyone … or conversely (b) I will summarise our casework to anyone when the client wants me to.

Confidentiality is vital.

Categories
FAQ LGBT LGBT

Counselling for Closet Gay People

Whilst my whole website discusses confidentiality, sexuality, gender and my therapeutic practice, it would not go amiss for me to produce at least a brief post that combines all of these counselling features into providing a safe containment for one particular area of society in which I specialise as a therapist: closet gay & lesbian individuals & couples.

Website Search – close, but no cigar.

Someone arrived on this website having searched for ‘counselling for closet gay’.  In response to the query, Google sent the visitor to my search page.  My search software dutifully produced a list of pages that were mostly about counselling, some about LGBT couple therapy, some about me, but none that expressly spoke about counselling for the closet individual.

Notwithstanding I’m taking a look at my search producing software, it was very clear that the visitor had not been presented with anything about what they were looking for from my website, and they went away.

Quite rightly.

But mistakenly so.

Counselling for LGBT People.

As male counsellor who specialises in offering counselling for the specific needs of lesbian and gay individuals & LGBT couples, it would seem to me that the whole of my therapy service would cater well for those people who are not ‘out’:

Yet, perhaps, my counselling information is (unintentionally) aimed at those LGBT people who are already out and leading happy and successful lives, regardless of their sexuality, but who sometimes wishes to meet with an LGBT counselling to work through some issues.

Being in, and coming out of, ‘the closet’.

The term being in the ‘closet’ means that a person’s sexuality or gender-identification is something other than what appears to the public, but that the person has not yet made a public declaration.  The term goes hand in hand with the phrase ‘out’ or ‘outing’ meaning that when a person becomes known for their homo or bi sexuality, or desire for a change in gender, they have come out of the closet, or they have been “outed” by a third party.

It’s perhaps interesting that it is sexual minorities that have to go through this process, as it is perhaps assumed that a person is heterosexual, gender-phoric (as opposed to dysphoric) or cis-gender until other facts are known.

It’s perhaps also interesting that as more people – particularly role (or pseudo-role) models – announce their sexuality or gender-reassignment (or gender ambivalence as not transgender people feel the need to make a full transition from one gender to another) – the process of coming out of the closet (outing ones self) is becoming easier and more socially acceptable (Seidman, Meeks, and Traschen (1999) argue that “the closet” may be becoming an antiquated metaphor in the lives of modern day Americans).

Nevertheless, society still assumes one is a heterosexual cis-gendered person until one corrects the notion.

Not everyone wants to be ‘out’.

It would not be surprising that some people would benefit from discussing their sexuality with a helpful & friendly professional, someone with whom they might feel safe, in order to find support before they go through a (sometimes) traumatic process as outing themselves.

It is not the counsellor’s position to encourage self-outing (or maintaining self-closeting) as the decision for action is down the client, with the counselling processing being available to assist the client on reflection: pros, cons, effects, affects.  LGBT counselling is not a solution of itself but a helpful tool.

In closing, I hope this brief post goes some way to correct, clarify and reconcile my services into a clearer statement of some of the kinds of counselling services that I offer.

Categories
News Uncategorized

“In Treatment” returns for Season 3 – Sky Atlantic

Saturday 12th November 2011 – Sky Atlantic – “In Treatment” returns for its third and final season (see http://skyatlantic.sky.com/in-treatment/gabriel-byrne-returns-for-the-final-season-of-in-treatment).

“In Treatment” is based on BeTipul – a drama portraying real-life psychotherapeutic sessions between psychologist and his patients.  Each episode is focussed upon one session between client and therapist and over time one sessions how the therapeutic alliance progresses as the therapy develops.  We are fortunate in that we get to understand what’s going on in the therapist’s mind by being able to attend his own supervision (and sometimes his own therapy) so that we sometimes can learn how the therapist uses his experiences and struggles of clients (eg his ‘counter-transference’) in order to help the clients themselves.

Gripping drama – accurately portrayed.

Because I do not video nor record any of my therapy work for reasons of confidentiality, “In Treatment” is an excellent demonstration to show people, who are interested in my work as a psychodynamic counsellor, how our clinical work could progress between us as client-and-therapist.

“In Treatment” episodes are on Saturdays at 10pm and 10:30pm, followed by Sunday at the same time.

Categories
B2B Ethics

Did your client read that Tweet?

Over on Facebook, the Business & Marketing Skills for Therapist Group (here) are helpfully discussing how they can get their message about their practices (etc) out into a wider world.  Some members of the group are professional marketeers, some members are professional therapists.  Something happened to me today that made me notice something that’s essential to therapists as we learn to market our services using public social networks. 

Let me share with you a story…

Tweeting? Twittering? Tweeping?

Over the past month or so I’ve been posting information about counselling on Twitter. I have only 90-or-so followers (compare this with Stephen Fry who has nearly 4 million followers). It’s good fun, it strengthens my reflective practice, it gets me known a little more and brings some new folk to my website.

One might think that 90 people – some of whom are porn stars, one of whom I’m sure is not really a hedgehog, and some of whom seem to hope I’ll be buying their obscure products any moment now – are all who are reading my posts. Maybe not even 10% of the 90 are really reading what I haven’t say.  So little feedback, you see.  So, what might it matter if I might casually slip in a small case example to demonstrate a point in a Tweet?  What harm could 140 characters cause?  It’s only 9-ish people that’ll ever read what I tweeted.

The issue, though, isn’t how few people are reading me (or you, dear fellow therapist, once you hit that Tipping Point).  The issue is that once my post goes into the world, anyone can get at it. 

Any.

One.

Do you know who reads your tweets?

Today, I was surprised (though delighted) to find that some of my Tweets have begun appearing in online newspapers recently. Surprised because these are online resources that I do not follow, they don’t follow me, and I haven’t sent them any of my tweets.  But they’ve still gotten hold of them (“public”, remember!). 

By some mathem-agical power of the InterWeb, my little tweets have somehow spread out into the big, scary world and, by chance more than design, have gotten included in publications that I’ve never heard of.  My words are circulating around (at least for 24 hours until the next publications go out tomorrow, at least).

How thrilling!!

But, can we return back to that little case example I might have Tweeted about?

I put to you – dear ethical reader – the query…

…what if one of the readers of these online papers happened to be the client that I referred to in my Tweet?

What if he recognised himself?

What damage would I have done by, perhaps imagining that non of my followers had anything to do with my client; that they were the only ones who would have read my misplaced comment* ?

Ethics & Marketing.

In the Facebook group earlier discussed, therapists and skilled marketers are passing around valuable information on how a therapist might get their message out there into the world.  I would suggest to you that sometimes it happens – and when it happens BOY does it get far and wide out there.

Marketing experts will teach us therapists these things… but the ethics in what we, as therapists, put out there are entirely our responsibility … and ours alone. 

Anonymising a case is not the same as protecting its confidentiality.

And anything you write on the Internet is not private :p

I’ll leave you with that thought.

Comments are welcome, below, but preferably back on the Facebook group if this is where you found this post.

Just to clarify – I don’t discuss online/in public forums any current case work at all.  When demonstrating a point, I tend to make references to generalised examples or to casework that is already in public circulation (eg a case discussed by Patrick Casement in one of his books) .

Categories
FAQ

What can Counselling Help with?

Whilst it would be unethical, and a breach of confidentiality to discuss individual cases and their details, I will give a list of the kinds of matters that I’ve worked with as a qualified therapist:-

 

[one_third]

  • Anxiety (feelings of panic or worry).
  • Aggression & Violence (acting out anger)
  • Anger (investigating triggers, managing responses, anger management etc).
  • Bereavement
  • Child parenting (male accused of fathering a child)
  • Depression
  • Despair (life feels worthless)
  • Disassociation (mental capacity impaired)
  • Drugs (recreational drugs)
  • Fear of Marriage (postponing engagement)

[/one_third]

[one_third]

  • Gender identification (male-to-female & female-to-male)
  • Grief (difficulties in losing a loved one, time of year)
  • HIV
  • Homesickness / isolation.
  • Lesbian, Gay lifestyle issues
  • Life Changes
  • Life decisions (reviewing choices made earlier in life)
  • Loss (eg death, or loss of significance: career, home)
  • Parental responsibilities (eg learning about becoming a father)
  • Rape (assailant: male)

[/one_third]

[one_third_last]

  • Rape (injured party: male)
  • Relationships
  • Retirement (life changes when a partner retires)
  • Self-harm (cutting, drinking, self-destruction)
  • Sexual aggression (acting out rage through sex)
  • Sexual identity/preferences (LGBT & questioning)
  • Sexual promiscuity
  • Suicidal attempts and thoughts.
  • Surviving a violent attack/accident.
  • Unemployment (being sacked, redundancy)
  • Unidentified sense of something being wrong
  • University/academic anxieties

[/one_third_last]

 

Categories
FAQ

I need Paperwork Completing by my Counsellor

Confidentiality is vital to the counselling work and to our professional therapeutic relationship.  Even when a client believes that breaking that confidentiality might assist them in some way, I will still have a say on whether or not I will comply with the client giving their permission. 

Ideally, the client(s) and I will discuss such matters before the client(s) take such action.  Where no such discussion takes place, the client may wish to be aware that operate with certain boundaries in these matters:

  • Solicitors letter – If I receive a letter from a solicitor asking to give information on our case, I will – for reasons of protecting confidentiality – decline to comment on our case.  This will be so even if you give your authority for me to discuss our clinical work with a third party. Due to the paramount of the confidential nature of our therapeutic relationship I will not reveal any contents of our work, nor will I confirm nor deny if you have been in counselling with me.  It is important that a client is aware of my position in these matters as to assume that giving your permission to your solicitor for him/her to contact me may surprise you by my response if you are unaware of my position. If I am required to write a response to your solicitor I will make a charge for doing so – even when it is to decline to respond to the request for information about your therapy with me.
  • Attendance forms for a Student-of-Counselling‘s Therapy Hours – I will co-sign a form that you have prepared/completed that shows the number of sessions that you have attended.  I will not reveal any information about our counselling work.  Attendance forms that I am required to complete on your behalf (e.g. noting dates of your attendance)  I may agree to complete this with you after first discussing it with you, however  I will make a charge for completing the form and I will not reveal any information about the content of our work.
  • Sponsorship/application forms – if I am asked to co-sign a form on your behalf (e.g. housing application form) I will decline.
  • Summary of Sessions (eg Insurance) – Some insurance companies that fund counselling on your behalf may request that I summarise our work for them (eg a treatment plan, measurements & a written summary of each session – or an overview of the counselling work).  It is important that you are aware that I will decline to do this.
  • Receipt – if you require a receipt for your payment for counselling I will provide one that only shows your name, the amount the session cost, that the receipt is for counselling, and my name.
  • Most other letters and/of forms that you (or a third party on your behalf) ask of me will require a discussion between you and I before I make my decision, but I will still not break our agreement with respect to confidentiality.  Should I not invited to discuss this with you, my position will be to decline to give a response to any such requests.  My position is that I will not choose to break the confidentiality of our work.

Charges for completing forms.

Should we have discussed, and I have agreed, to complete forms as discussed within the boundaries above, my charge will be my standard hourly rate for the type of therapy offered to you – rounded up to the nearest hour.

Categories
FAQ

Will my Doctor/GP be told I’m in Counselling?

When we begin our assessment for counselling,  I will talk with you about confidentiality and what it means with respect to your privacy and law. 

I have strict rules that protect your confidentiality: that where the law does not over-ride me, I will not discuss our work with anyone (other than my obligatory clinical supervision).

This means that I will not inform your doctor/GP about your counselling as a matter of course.

 

Let’s highlight a couple of potential exceptions:-

  • If you wish me to write to your doctor/GP, we will discuss this in session before I agree to do so.
  • If your health (physical or mental) appears to warrant intervention from your doctor/GP, in rare circumstances I may request your permission to write to your doctor/GP, but we will discuss this in session before I take any action.

So, when you come to me for counselling I will not automatically inform your doctor that you are receiving therapy from me.

My counselling practice is independent of NHS primary care services.

Categories
FAQ

What can I Talk about in Counselling?

Counselling focuses on you and the problems that you’re bringing into therapy.  So, it may not be such a surprise that you can talk about anything you wish to in counselling.

[iC_leaflet type=”bacp_c1″]You might be worried that your therapist may be shocked or distressed about what you might need to talk about.  This is usually not the case, but many trained counsellors also focus on keeping their feelings and responses contained so that the counsellor does not distress you.

You may even discuss your concerns about your counsellor if you wish; what they might think about certain topics.  Different therapists will respond differently, but they’re all focussed on the benefit of you.  Be assured that your counsellor is ready to hear what you need to talk about.

Counselling and the Law.

You should be aware that there are some subjects that would come under the law.

For example if you wished to talk about your part in terrorism, intended harm to self or others, you talk about a child who is in distress, not being looked after well or is being abused, or any other criminal activity, then your counsellor would be obligated by British law to break confidentiality.

This does not mean to say that your counsellor will immediately run out of the room to dial 999.

Again, different therapists will treat different matters with different approaches.  Most counsellors should inform you about confidentiality before the therapy begins (usually the first session).  Some therapists will give you a document that has everything written down.  Some therapists will remind you, if you begin to stray into legal subjects like these, about the law and confidentiality.

Sometimes, the law requires a counsellor to take action without informing the client – matters such as terrorism or child abuse can fall into this category.  Again, the client should have been informed at the start of therapy about this  – and whilst a counsellor may always wish advise clients beforehand that a subject which has been brought for discussion requires the counsellor to take action, the counsellor may be legally bound not to tell the client of the action before it is taken.