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Hearing Findings, Decision & Sanction

       

April 2014: Elizabeth Blissett, Reference No: 521582, Leicestershire LE16

The complaint against the above individual member was taken to Adjudication in line with the Professional Conduct Procedure.

The complaint was heard under the BACP Professional Conduct Procedure and the Panel considered the alleged breaches of the BACP Ethical Framework for Good Practice in Counselling and Psychotherapy.  

Ms Blissett, despite being invited to attend the hearing, did not do so.  However, a decision was made by the Registrar pursuant to paragraph 4.9 of the Professional Conduct Procedure, to proceed in the absence of Ms Blissett. 

The focus of the complaint, as summarised by the Pre-Hearing Assessment Panel, is that the Complainant allegedly made a telephone call on 23 April 2012 to Ms Blissett after she obtained information from a website about the [ . . . .] Counselling Service, run by Ms Blissett.  The Complainant had allegedly already completed an online contact form, asking for information about the costs of counselling and what the next steps would be.

After obtaining some details, such as name and address, Ms Blissett allegedly asked the Complainant what her issues were, which took the Complainant by surprise. 

The Complainant began to talk about her personal issues and reluctantly mentioned that she had had a termination.  Speaking about this issue was very upsetting for her.  Ms Blissett made a number of comments, which the Complainant found distressing including allegedly the assertion that the  Complainant had feelings of guilt because this was a child and that there was no getting round the fact that she had killed her child.  

The Complainant alleges that Ms Blissett made unwanted suggestions about how she might deal with such guilt and asked her if she had a faith.  Ms Blissett allegedly commented that those who had faith could normally deal with such an issue, through their faith.  Ms Blissett allegedly made other comments based on her own religious beliefs and informed the Complainant that during counselling sessions, the option of faith could be discussed.

There was then allegedly a discussion about another counsellor who would be asked to contact the Complainant, and Ms Blissett also gave the Complainant directions about how to get to the offices in [ . . . ].  

When the Complainant came off the phone, she felt stunned and distressed, and checked the website of the [ . . . ] Counselling Service and allegedly found no mention that the service was aimed at those with a faith but advertised their purpose as being, "available to provide counselling to all irrespective of age, gender, culture, beliefs or disability."  

The other counsellor then allegedly phoned her and the Complainant told her how distressing her conversation with Ms Blissett had been.  The Complainant allegedly said that she did not realise that it was a Christian counselling service and was told by this counsellor that it was not.

Later that day, the Complainant allegedly received a text message from Ms Blissett containing an apology, which the Complainant did not consider appropriate or adequate given how hurtful and damaging she felt her comments had been. 

The following day, the Complainant allegedly asked her sister [ . . . ] to contact Ms Blissett to discuss her concerns.  Ms Blissett then had a conversation over the phone with the Complainant's sister, in which Ms Blissett allegedly discussed the Complainant's issues in depth, without having first contacted the Complainant to confirm the identity of the caller or seek the Complainant's consent to speak with the caller. 

The Pre-Hearing Assessment Panel considered the issue whether Ms Blissett was in the role of Practitioner and the Complainant in the role of client, during the telephone conversation that took place on 23 April 2012.  The Panel was satisfied that Ms Blissett did engage in counselling with the Complainant and was in the role of ‘practitioner' from the point when she allegedly asked the Complainant what her issues were.  The Complainant was in the role of ‘client' and that a counselling relationship existed thereafter to which the Ethical Framework for Good Practice in Counselling and Psychotherapy 2010 applied.  The Panel also considered that dealing appropriately with a prospective client enquiring about the service is a part of the counsellor's professional role.

The Pre-Hearing Assessment Panel in accepting this complaint, was concerned with allegations made within suggesting contraventions of the Ethical  Framework for Good Practice in Counselling and Psychotherapy, and those in particular as follows:

1.    Ms Blissett allegedly failed to provide a good quality of care by asking the Complainant in her initial telephone call what her issues were and putting the Complainant under pressure to answer questions, without giving the Complainant any choice about whether she wanted to discuss such matters there and then and failing to ensure that she was adequately informed and that she had consented, before doing so.

2.    Ms Blissett allegedly failed to provide a good quality of care by continuing to question the Complainant and make comments in an inappropriate way on the telephone, despite the Complainant's distress and by allegedly failing to contain the conversation.

3.    Ms Blissett allegedly failed to provide a good quality of care by asking intrusive questions of a sensitive nature, such as whether the Complainant knew what was the sex of the baby.  

4.    Ms Blissett allegedly failed to provide a good quality of care, lacked empathy and was judgmental by saying that the Complainant should have feelings of guilt and there was no getting round the fact that she had killed her child.

5.    Ms Blissett allegedly failed to provide a good quality of care and lacked wisdom and sensitivity by referring to the experience of other clients who had
undergone terminations with knitting needles in the past. 

6.    Ms Blissett allegedly failed to provide a good quality of care and lacked sensitivity and respect, by suggesting to the Complainant that she named the
child and asked its forgiveness by writing it a letter or sending off some balloons without first exploring that advice of this kind was wanted or needed.

7.    Ms Blissett allegedly failed to provide a good quality of care by allowing her personal and religious views to prejudice the relationship with the Complainant and by allegedly saying that the Complainant should feel guilt, that she had killed her child and believed that you reap what you sow and by asserting that you knew God forgave her for what she had done.

8.    Ms Blissett allegedly showed a lack of respect and undermined the Complainant's trust by allegedly questioning her inappropriately about whether she had faith or believed in a higher power.

9.    Ms Blissett's alleged emphasis on her own personal and religious beliefs caused the Complainant to assume that the counselling service was aimed specifically at those with faith and to question the accuracy of the advertising statements on the website, thereby undermining the Complainant's trust and sense of autonomy. 

10.  Ms Blissett allegedly breached confidentiality by discussing the Complainant's issues in depth with her sister on the phone without first checking with the Complainant the identity of the caller or that she had her consent to do so. 

11.  Ms Blissett's alleged behaviour, as experienced by the Complainant, suggests a lack of the personal moral qualities of empathy, respect, competence and wisdom to which practitioners are strongly encouraged to aspire, as outlined in the Ethical Framework for Good Practice in Counselling and Psychotherapy 2010, a contravention of paragraphs 1, 3, 11, 12, 13, 18, 20 and 60 and the ethical principles of being trustworthy, autonomy and non-maleficence.

Findings

On balance, having fully considered the above, the Panel made the following findings:  

1. There was agreement between the parties that Ms Blissett did enquire of the Complainant as to the issues she wished to discuss.  The Panel      found that Ms Blissett did not provide the Complainant with a choice as to whether she wished to discuss her issues or not at the time of the      telephone conversation, putting pressure on the Complainant to respond to her questions.  Ms Blissett admitted that she had not sought the Complainant's consent with regard to whether she wished to disclose to Ms Blissett detailed information about her issues and discuss them with her over the telephone.  The Panel was further satisfied that Ms Blissett did not provide adequate information to the Complainant as to why      she was asking questions about the Complainant's issues, or about her choice as to whether she answered those questions or about  her consent to the disclosure of sensitive and detailed information. The Panel thus found that Ms Blissett had not provided a good quality of care in this regard and upheld the allegation.
 

2. The Panel found that at the point of referring the Complainant to another counsellor called [ . . . ], Ms Blissett should have terminated the conversation with the Complainant.  The Panel found that instead of doing so, Ms Blissett continued to have the conversation with the client by asking probing questions and making comments which were inappropriate and left the Complainant feeling exposed and vulnerable.  The Panel further found that Ms Blissett, in so doing, failed to contain the conversation.  The Panel thus found that Ms Blissett had not provided a good quality of care in this regard and upheld the allegation.
 

3. Ms Blissett admitted that she may have "stepped over the line" in asking intrusive questions of a sensitive nature such as whether the Complainant knew what was the sex of the baby.  The Panel found that in asking such questions, Ms Blissett failed to provide the Complainant with a good quality of care and upheld the allegation.
 

4. The Panel, on the evidence, found that whilst Ms Blissett may have said "I feel you have feelings of guilt" or words to that effect, she did not say that the Complainant should have feelings of guilt.  As such, the Panel did not uphold this part of the allegation.  There was a sharp disagreement between the parties as to whether Ms Blissett said that there was no getting around the fact the Complainant had killed her child.  The Complainant was adamant that Ms Blissett had said those words and Ms Blissett strongly refuted having said those words.  On the balance of      probabilities, the Panel found that during the telephone conversation, in which Ms Blissett had referred to examples of other clients' issues, Ms     Blissett had likened termination to child killing and that the Complainant had reason to believe those remarks were aimed at her.  However, the Panel was not satisfied that it was proven that Ms Blissett had said that there was no getting around the fact that the Complainant had killed her child.  As such the Panel did not uphold the allegation. 

5. Ms Blissett recognised that her comments could have lacked wisdom and sensitivity and that in hindsight there were other ways of handling it.  The Panel found that Ms Blissett failed to provide a good quality of care and lacked wisdom and sensitivity by referring to the experience of other clients who had undergone terminations with knitting needles in the past, and therefore, this allegation is upheld. 

6.   Ms Blissett denied that she suggested the Complainant name the child but confirmed that she said that some women had done this and the various suggestions of letters etc were how some people said goodbye.  Ms Blissett further denied that she mentioned forgiveness.  The Panel was satisfied that Ms Blissett, during her conversation with the Complainant about her issues, had specifically referred to other clients' issues relating to terminations and how they dealt with those issues thus raising these matters in the Complainant's mind.  On balance, the Panel was satisfied that in raising these matters with the Complainant, Ms Blissett was in effect making suggestions to the Complainant on how she may deal with her own issues.  The Panel found that Ms Blissett should not have proceeded so far as to make suggestions without first checking whether her advice was sought and in so doing, Ms Blissett had failed to provide a good quality of care and lacked sensitivity and respect.  As such, the allegation is upheld. 

7.  The Panel, on the evidence, was not satisfied that Ms Blissett had said that the Complainant should feel guilt and that she had killed her child (refer to finding 4).  As such, the Panel did not uphold this part of the allegation.  The Panel was not satisfied that there was sufficient evidence to prove that Ms Blissett had asserted that she knew God forgave the Complainant for what she had done.  However, there was agreement between the parties that the phrase "you reap what you sow" was said by Ms Blissett.  The Panel did not accept Ms Blissett's assertion that the phrase was said by her prior to her learning of the Complainant's termination.  The Panel preferred the Complainant's evidence asserting that this was said after mention of the termination.  The Panel found that the phrase "you reap what you sow" in the context used was a judgemental statement demonstrating a lack of a good quality of care.  As such this allegation is partially upheld.

8.   Ms Blissett did not have the Complainant's consent to talk about deeper issues at the time of the telephone conversation.  The Panel found that Ms Blissett showed a lack of respect and undermined the Complainant's trust by questioning her inappropriately about whether she had faith or believed in a higher power.  This allegation is therefore, upheld. 

9.    The Panel was not satisfied on the evidence that it was proved that the advertising statements on the website were inaccurate.  The Panel was further not satisfied on the evidence that Ms Blissett had placed sufficient emphasis on her own personal and religious beliefs to suggest that the counselling service was aimed at Christians.  As such this allegation is not upheld.

10. Ms Blissett was contacted by the Complainant's sister.  The Complainant gave her sister consent to contact and speak with Ms Blissett.  The
Complainant accepted when questioned that it was likely that her sister may not have allowed Ms Blissett to "get a word in edgeways" when her sister spoke to Ms Blissett.  The Panel was not satisfied that there had been a breach of confidentiality and as such this allegation is not upheld.

11. In light of the above findings, the Panel was satisfied that paragraphs 1, 3, 11, 12 and 13 and the ethical principles of being trustworthy and autonomy of the Ethical Framework for Good Practice in Counselling and Psychotherapy 2010 had been breached but not paragraphs 18, 20 and 60 or the ethical principle of non-maleficence.  Ms Blissett also demonstrated a lack of the personal moral qualities of respect, competence and wisdom.  The Panel found that whilst Ms Blissett had intended to be empathic, the Complainant did not experience her in this way for much of the conversation and as such the Panel found that Ms Blissett lacked the personal moral quality of empathy.  

Decision

Accordingly, the Panel was unanimous in its decision that these findings amounted to Professional Malpractice on the grounds of incompetence and the provision of inadequate professional services.  The evidence further suggested that the member's standard of practice fell far below that expected of a reasonably competent practitioner, exercising reasonable care and skill. 

Mitigation

Ms Blissett made a number of apologies, including apologising with regard to "stepping over the line" and deeply apologising for any upset caused to the
Complainant.  She also accepted some responsibility for her actions.   

Sanction

Within one month from the date of the imposition of this sanction, which will run from the expiration of the Appeal deadline or the exhaustion of the BACP Appeal process, Ms Blissett is required to provide a written submission which evidences her immediate reflection on, learning from and understanding of, the issues raised in this complaint and what she would now do differently, in particular initial contact and the sensitive issues associated with a termination.  This submission must be between one and three thousand words. 

Ms Blissett is required to write and submit a second report within 6 months from the date of the imposition of this sanction.  Ms Blissett is required to
have this report countersigned by a supervisor outside of her current network.  In this report, Ms Blissett is required to address comprehensively the following areas:

Ø  Provide evidence that she has undertaken an extended case study with regard to this complaint, with a supervisor outside of her current network, examining in-depth how each of her comments may have had an impact on the client and also how, in retrospect, she may have ameliorated that within the conversation.                                                                                                            

Ø  Provide evidence that she has comprehensively examined how her attitudes to faith may have an impact on client material and demonstrate consideration of whether she can identify client groups with which she should not work.  

Ø  Detail her reflection and learning on the importance of the initial contacts by any client to a counselling service.

Ø  Provide evidence of her learning on how to contain, manage and facilitate the initial contact of a prospective client.

Ø  Detail her learning with regard to the disclosure of examples of clients' issues when speaking to a different client.  

Ø  Provide evidence, in conjunction with either a supervisor outside her current network or a consultant, that she has reviewed her assessment procedures as to fitness or purpose both in theory and practice and detail and show evidence of any revision to her assessment procedures. 

Ms Blissett will be required to attend an interview with a Sanction Panel within 8 months of the imposition of the sanction.  At this interview, Ms Blissett
will be required to demonstrate her further in-depth learning and understanding of the issues raised in this case.

These written submissions must be sent to the Deputy Registrar and Deputy Director of BACP Registers by the given deadlines, and will be independently considered by a Sanction Panel and at the interview. 

(Where ellipses [ . .  ]are displayed, they indicate an omission of text)

  

  

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March 2014: Paul McGinley, Reference No: 568810, Barking IG11


The complaint against the above individual member/registrant was taken to Adjudication in line with the Professional Conduct Procedure.

The complaint was heard under BACP Professional Conduct Procedure 2010 and the Panel considered the alleged breaches of the BACP Ethical Framework for Good Practice in Counselling and Psychotherapy.

The focus of the complaint, as summarised by the Pre-Hearing Assessment Panel, is that the complainant began individual counselling with Paul McGinley on 28 May 2008.  The counselling continued for nearly five years and ended on 25 March 2013.

Mr McGinley allegedly did not charge for the first session, which lasted 60 minutes, and it is alleged that all subsequent sessions lasted 60 minutes, although Mr McGinley's website stated that sessions would be 50 minutes long.  At various points in the counselling, the complainant alleges that she discussed ceasing therapy, but Mr McGinley allegedly offered to waive fees rather than explore with the complainant her reasons for wishing to finish counselling.

At an early stage in counselling, the complainant alleges that she asked for a hug at the end of the session as she was distressed.  Thereafter, the complainant alleges that hugs became routine at the conclusion of sessions. 

In 2011, having commenced a counselling skills course, the complainant alleges that she initiated conversations in her sessions about boundaries and about the power imbalance in the relationship.  Mr McGinley allegedly responded to this, stating that he does not keep notes and denied that there was a power imbalance.  He also allegedly mocked the idea of the "therapeutic intervention".

In April 2012, the complainant alleges that she discussed with Mr McGinley the fact that she needed a psychodynamic counsellor for her course requirements and he allegedly suggested that she could carry on seeing both therapists.  By this stage, the complainant alleges that she felt that she could not leave therapy without permission from Mr McGinley as she was so dependent on him. 

During the early part of counselling, Mr McGinley was allegedly critical of the fact that the complainant's entire social life was via an internet message board, saying he thought that the complainant should be seeking a social life outside the internet.  Despite this, he later allegedly encouraged the complainant to try dating websites, saying that the complainant needed to be nudged in the right direction.

When the complainant allegedly attempted to explore her sexuality with Mr McGinley, he allegedly did not help her explore these issues but merely stated that he did not believe that she had a problem with sex and that if she was with the right person it would all feel natural and right.  Further when the complainant told Mr McGinley that she may be bisexual, Mr McGinley allegedly responded that he was jealous.

When the complainant commented that the sessions were a place for her to talk about herself, Mr McGinley allegedly responded by saying, "I don't know about that", which confused the complainant and left her unsure as to what the sessions should be about.

In the session on 11 February 2013, Mr McGinley, having met the complainant's previous therapist at a conference, allegedly encouraged the complainant to make contact with the therapist, telling her that [ . . . ] (the previous therapist) had said that she would welcome this.  The complainant alleges that when she did contact [ . . . ] at a later date, it transpired that [ . . . ] had merely asked after her and had not suggested that the complainant contact her.

In the final session on 25 March 2013, Mr McGinley invited the complainant to sit on his knee for the remainder of the session.  The complainant alleges that Mr McGinley stroked her thigh, kissed her cheek and they both said that they loved the other at the end of the session.  On this occasion, the complainant alleges that Mr McGinley did accept payment.

The Pre-Hearing Assessment Panel, in accepting this complaint, was concerned with the allegations made within the complaint suggesting a contravention of the Ethical Framework for Good Practice in Counselling and Psychotherapy, and those in particular are as follows:

1.    Mr McGinley allegedly did not provide a good quality of care to the complainant in that he allegedly dismissed the sexual issues that the complainant raised in the counselling session, encouraged her to try internet dating and regularly suggested that the complainant needed to be "nudged" in the right direction.

2.    Mr McGinley allegedly failed to clarify and agree the rights and responsibilities of both he and the complainant, in that he allegedly:

a)    Charged for some sessions but provided numerous sessions to the complainant free of charge, when she said that she wished to terminate counselling as she could no longer afford  it.  This left the complainant feeling that she could not terminate therapy.

b)    Allowed the length of the sessions to run to 60 minutes when his website stated that all sessions would be 50 minutes,

c)    Failed to explain to the complainant how counselling could be terminated when she expressed her wish to terminate and instead allowed counselling to continue.

3.    Mr McGinley allegedly failed to keep appropriate records of his work with the complainant as he allegedly told her that he did not keep any written notes.

4.    Mr McGinley allegedly failed to provide the complainant with competently delivered services, which were periodically reviewed, in that no reviews were carried out during the 5 year counselling relationship.

5.    Mr McGinley allegedly failed to honour the complainant's trust by not having respect for her privacy and dignity in that he allegedly discussed the complainant with her former therapist without her permission and discussed other clients with the complainant, allegedly commenting that there were clients that he got bored listening to.

6.    Mr McGinley allegedly failed to deliver services on the basis of the complainant's explicit consent, in that he allowed therapy to continue when the complainant told him on more than one occasion that she wanted to terminate therapy.

7.    Mr McGinley allegedly abused the complainant's trust in order to gain sexual and emotional advantage, in that he allegedly:

a)    Hugged the complainant at the end of the sessions.

b)    Encouraged the complainant to contact her previous therapist stating that the therapist requested that the complainant contact her, when in fact she did not.

c)    Told the complainant that she was attractive

d)    Allowed the complainant to sit on his knee during the final session where he stroked her thigh and in response to the complainant telling him she loved him, told her that he thought that he loved her too.

8.    Mr McGinley allegedly failed to be clear about his commitment to be available to the complainant, in that he did not make it clear what contact was permitted outside of the  counselling session and allowed out of session contact with the complainant to develop.

9.    Mr McGinley allegedly failed to show resilience and ensure that his capacity to work with the complainant did not become personally diminished, in that in response to a comment made by the complainant, he allegedly said that he was still feeling bruised from a comment made by the complainant at the previous session.

10.  Mr McGinley allegedly was unfair in that he failed to use the consistent application of appropriate criteria to inform his decisions and actions in that he failed to ensure that he met the complainant's needs by allowing her to terminate counselling when she told him that she wanted to stop.

11.  Mr McGinley allegedly failed to act in the best interests of the complainant in that he caused the complainant to feel dependent on him as a result of the free sessions, the hugs and the out of session contact he permitted.

12. Mr McGinley's alleged actions and behaviour, as experienced by the complainant, suggests a contravention in particular of paragraphs 1, 3, 5, 13 and 18 of the Ethical Framework for Good Practice in Counselling and Psychotherapy 2007/2009 and paragraphs 1, 3, 5, 6, 11, 13, 17, 19 and 20 of Ethical Framework for Good Practice in Counselling and Therapy 2010/2013.  It also suggests a contravention of the ethical principles of fidelity in the 2007/2009 Ethical Framework and of being trustworthy, autonomy, beneficence, and non-maleficence in the 2010/2013 Ethical Framework, and showed a lack of the personal moral qualities of empathy, sincerity, integrity, resilience, respect, humility, competence fairness and wisdom to which counsellors and psychotherapists are strongly encouraged to aspire.

Findings

On balance, having fully considered the above, the Panel made the following findings: 

1. The Panel heard conflicting evidence from both parties with regard to this allegation.  The complainant stated that when she attempted to discuss her sexual issues she felt as though Mr McGinley dismissed them and would instead recommend internet dating.  Mr McGinley strongly disputed that he had dismissed the complainant's sexual issues.  Mr McGinley  provided evidence of a diagram that the complainant had produced for use within their therapy sessions to help her discuss her sexual issues, as the complainant found it easier to write things down that she could not say, and was more expressive in her emails.  Mr McGinley stated that they discussed this diagram within their sessions and the issue of the complainant's sexuality was always there.  There was insufficient evidence available to the Panel to establish that Mr McGinley had dismissed the sexual issues that the complainant presented.  The Panel found that in encouraging the complainant to try internet dating, Mr McGinley did not fail to provide the complainant with a good quality of care, particularly given that one of the issues that the complainant wanted help with was with relationships in general.  The Panel also did not find that in suggesting that the complainant needed to be nudged in the right direction, this amounted to a failure to provide a good quality of care.  This allegation is therefore, not upheld.

2.

a)  The complainant stated that at the time, Mr McGinley's website stated that he charged for all sessions.  Mr McGinley stated that it was his practice never to charge for the first session as he viewed this as an assessment.  He accepted that his website may not have accurately reflected this.  Mr McGinley also admitted that there were occasions when he did not charge the complainant for their therapy sessions but stated that he did this because the complainant had lost her job and was therefore unable to afford to pay for the sessions.  Mr McGinley stated that when the complainant stated that she did not want to continue therapy, his understanding was that this was because she was unable to afford to continue due to financial reasons and not because she wanted to cease therapy altogether.  Mr McGinley stated that he viewed himself as having a duty of care towards the complainant as she had lost her job and was in distress but stated that it was always agreed that the complainant would begin paying for the sessions again once she started working, which she subsequently did.  Mr McGinley stated that upon reflection he could see how not charging the complainant for some of the sessions could play out in her feeling special.  The Panel found that Mr McGinley failed to explore with the complainant whether there was any other reason for her wishing to cease therapy at that time and there was a lack of discussion and exploration around this issue.  This part of the allegation is therefore upheld.

b)   Mr McGinley accepted that his website stated that the sessions would last 50 minutes, however, he stated that he worked from 3 different locations and the length of the sessions would vary depending upon the location.  In the location where he worked with the complainant, he stated that the sessions would have lasted 60 minutes.  Mr McGinley stated that he would have made the complainant aware of the length of the sessions during their first assessment.  The Panel was therefore satisfied that the sessions were expected to be 60 minutes in duration and did not find that Mr McGinley had failed to clarify the rights and responsibilities of himself and the complainant in this regard.  This part of the allegation is therefore, not upheld.

c)   The complainant stated that there were numerous occasions when she told Mr McGinley that she wished to cease counselling. Mr McGinley disputed that the complainant had ever explicitly stated that she wished to terminate counselling, other than for financial reasons, which was when he offered the free sessions or because she was being forced to do so by the college, as she needed to have a therapist of a particular modality.  Mr McGinley stated that he took this request to supervision and his supervisor recommended that they have an ending session which he then discussed with the complainant.  Mr McGinley stated that the complainant subsequently had a falling out with the college which meant that she did not need to change therapists.  The Panel therefore, did not find that Mr McGinley had failed to explain to the complainant how therapy could be terminated or that he allowed counselling to continue against her wishes.  This part of the allegation is therefore not upheld.

3. Mr McGinley produced as evidence copies of the records that he kept of his sessions with the complainant.  The Panel accepted Mr McGinley's evidence that the purpose of the records was an aide memoire to assist him in remembering key matters discussed by the complainant.  Mr McGinley denied that he had ever told the complainant that he did not keep any records.  The Panel therefore, did not find that Mr McGinley failed to keep appropriate records of his work.  This allegation is therefore, not upheld.

4. Mr McGinley stated that it was his practice to carry out a review after the first six sessions and again after the twelfth session.  Mr McGinley stated that given his modality, reviews were an ongoing part of the therapeutic process, even if no specific time was set aside for a review.  The Panel accepted Mr McGinley's evidence that reviews were an ongoing part of the process of his therapeutic work with the complainant and therefore did not find that Mr McGinley failed to provide competently delivered services which were periodically reviewed.  This allegation is not upheld. 

5. Both parties accepted that Mr McGinley had permission from the complainant to discuss her with her former therapist at an alumni event that both he and the complainant's former therapist were due to attend.  With regard to discussing other clients, Mr McGinley admitted that he may have commented to the complainant, by way of example, that there are clients that he got bored listening to but denied that he had ever discussed any particular client with her.  Whilst the Panel found that such a comment was not wise, the Panel did not find that in making such a comment there was any evidence that Mr McGinley had discussed any particular client or disclosed confidential information relating to that client.  The Panel therefore, agreed that there was insufficient evidence to suggest that Mr McGinley had failed to honour the complainant's trust by not having respect for her privacy and dignity.  This allegation is therefore not upheld.

6. There was conflicting evidence in relation to this allegation.  Whilst the complainant stated that she had told Mr McGinley on more than one occasion that she wanted to terminate therapy, Mr McGinley denied that the complainant had ever explicitly stated that she wished to terminate therapy except by pre-facing it with her being unable to afford therapy because she had lost her job, and needing to change her therapist as a requirement of her course.  With regard to her financial difficulties, Mr McGinley stated that his understanding was that the complainant was not saying that she no longer wanted to see him, rather that she wanted to continue with therapy but could simply not afford to do so.  As a result, Mr McGinley stated that in accordance with what he perceived as his duty of care to the complainant, he offered to provide her with free sessions until such time as she found another job and started to earn some money.  Mr McGinley further stated that when the complainant indicated that she required another therapist for her course and would therefore have to terminate therapy, he took the matter to his supervisor who recommended that they have an ending session, which he subsequently discussed with the complainant, but the complainant no longer wished to cease therapy.  Mr McGinley stated that when therapy did ultimately come to an end, he supported the complainant's decision to try something different and stated that she could come back in the future if she wanted.  There was insufficient evidence available to the Panel to suggest that Mr McGinley failed to deliver services on the basis of the complainant's explicit consent. This allegation is therefore, not upheld.

7.

a)   Both parties agreed that at some point during the therapeutic relationship, hugs became a regular feature at the end of the sessions, following a request made by the complainant at the conclusion of a session.  Mr McGinley stated that he discussed the hugs in supervision and continued to raise with the complainant how she felt about the hugs.  Mr McGinley stated that given his modality, he saw no therapeutic benefit in refusing or withdrawing hugs from the complainant, particularly given that she had previously indicated that she liked the hugs.  The Panel accepted that the hugs were a legitimate part of Mr McGinley's therapeutic orientation and there was no evidence that in hugging the complainant, Mr McGinley abused the complainant's trust to gain sexual and emotional advantage.  This part of the allegation is therefore not upheld.

b)   The complainant in her evidence stated that Mr McGinley persistently encouraged her to contact her former therapist.  Mr McGinley denied that he was persistent in his  encouragement but stated that he did suggest to the complainant that it may be beneficial for her to contact her former therapist and did so to challenge the negative view that the complainant had of herself and of her ability to be of any significance to anyone.  The Panel accepted that in doing this there was no evidence to suggest that Mr McGinley abused the complainant's trust to gain sexual and emotional advantage.  This part of the allegation is not upheld.

c)    Mr McGinley admitted that he told the complainant that she was attractive and again did this, to challenge the negative view that the complainant held about herself.  The Panel accepted Mr McGinley's evidence that this comment was made to benefit the complainant and did not evidence an abuse of trust to gain emotional and sexual advantage.  This part of the allegation is therefore not upheld. 

d)    There was conflicting evidence provided by both parties with regard to this allegation.  The complainant recounted in detail what she stated had occurred during the final session, stating that she was invited to sit on Mr McGinley's lap where he stroked her thigh.  Mr McGinley strongly denied that the complainant had ever sat on his lap.  Mr McGinley stated that the complainant was upset at the beginning of the session and requested a hug and then asked if she could sit on his lap, a request which Mr McGinley stated that he denied.  Given the conflicting version of events provided, there was insufficient evidence available to it to make a finding.  This part of the allegation is therefore not upheld.

8. The complainant stated that no boundaries were set around email contact but she remained conscious about disturbing Mr McGinley and therefore checked regularly whether it was ok to continue emailing him, which he confirmed it was.  Mr McGinley stated that they had an agreement that the complainant could email him once a week if she was feeling distressed and he would provide a brief response to her in return.  The Panel noted that in some of the emails Mr McGinley made inappropriate disclosures of a personal nature and responded to some emails outside of what the Panel considered as working hours, with some emails being responded to after 10:00pm.  Mr McGinley stated that he did this because he did not want to forget to respond the following day.  Given that Mr McGinley was aware that the complainant had developed an attachment towards him and that the only secure attachment that the  complainant previously had was with her former therapist, the Panel agreed that Mr McGinley did not made it sufficiently clear to the complainant his commitment to being available to the her in permitting contact outside of the sessions to develop in the way which it had.  This allegation is therefore upheld.

9. Mr McGinley stated that he could not recall saying he felt bruised from a comment made by the complainant, but that if such a comment had been made, it would have been made as a way of suggesting that he would welcome the complainant expressing her anger or disappointment.  Mr McGinley also referred the Panel to the written evidence and in particular emails from the complainant where she did appear able to challenge Mr McGinley.  The Panel did not find that in making such a comment, Mr McGinley failed to show resilience and ensure that his capacity to work with the complainant did not become personally diminished, particularly given that Mr McGinley continued to work with the complainant.  This allegation is therefore, not upheld.

10. The Panel accepted Mr McGinley's evidence that when the complainant made it explicitly clear that she wanted to terminate therapy, he took the matter to supervision and it was recommended that they have a few ending sessions to bring the therapy to a conclusion.  Mr McGinley stated that he took this suggestion to the complainant but the complainant decided that she no longer wished to terminate therapy.  Mr McGinley said that when the complainant stated again that she wished to terminate therapy, a final session was agreed and therapy was terminated.  There was insufficient evidence available to the Panel to suggest that Mr McGinley had failed to use the consistent application of appropriate criteria to inform his decision and actions, given that he consulted his supervisor and therapy did come to a mutual conclusion, and this allegation is therefore, not upheld.

11. Mr McGinley stated that he was aware that the complainant had an attachment towards him and said that with the exception of the first session, which it is his practice never to charge for, the free sessions were offered to help the complainant through a difficult time and it was always understood that payment would be required again, when the complainant found a new job.  With regard to the hugs, Mr McGinley stated that he consulted his supervisor regarding these and provided them to challenge the view that the complainant held about herself.  Mr McGinley stated that he set boundaries around the email communication and whilst the Panel accepted that Mr McGinley was not sufficiently clear about his commitment to be available, there was insufficient evidence available to the Panel to suggest that either the hugs, the email contact or the free sessions in themselves, caused the complainant to feel dependent upon Mr McGinley.  The Panel therefore, did not find that Mr McGinley failed to act in the bests interests of the complainant and this allegation is not upheld.

12.In light of the above findings, the Panel was satisfied that paragraph 3 of the 2007/2009 Ethical Framework for Good Practice in Counselling and Psychotherapy had been breached but not paragraphs 1, 5, 13 and 18, and paragraphs 3 and 19 of the of the Ethical Framework for Good Practice in Counselling and Psychotherapy (2010/2013) had been breached but not paragraphs 1, 5, 6, 11, 13, 17 and 20, and the ethical principles of being trustworthy (fidelity in the 2007/2009 Ethical Framework For Good Practice In Counselling and  Psychotherapy), autonomy, beneficence and non-maleficence had been breached.  It also found a lack of the personal moral qualities of sincerity and wisdom but did not find a lack of the personal moral qualities of integrity, resilience, respect humility, respect and competence had been breached. 

Decision

Accordingly, the Panel was unanimous in its decision that these findings amounted to professional malpractice in the provision of inadequate services, as Mr McGinley's service fell below the standards that would reasonably be expected of a practitioner exercising reasonable care and skill.

Mitigation

Mr McGinley states that he now has a psychodynamic supervisor, which helps him to see things differently.  He further stated that he had changed his practice and now provides his clients with a written information sheet containing the terms and conditions of his service, a copy of which was contained within his written evidence.  Mr McGinley further stated that he was reviewing his process regarding note taking. 

Sanction

Within one month from the imposition of this sanction, which will run from the expiration of the appeal deadline, Mr McGinley is required to provide a written submission, which evidences his immediate reflection on, learning from and understanding of, the issues raised in this complaint.

Within 6 months of the date of the imposition of this sanction, Mr McGinley is required to provide a written report detailing his learning and understanding of the parts of the complaint that have been upheld, which should be countersigned by Mr McGinley's psychodynamic supervisor.  Further, Mr McGinley is required to evidence how his practice with regard to note taking has changed, given his written evidence that he is reviewing the way in which he takes notes. 

These written submissions must be sent to the Deputy Registrar and Deputy Director of BACP Registers by the given deadlines, and will be independently considered by a Sanction Panel.

 (Where ellipses [ . . . ]are displayed, they indicate an omission of text)


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November 2013: Susannah Lee, Reference No: 719337, Surrey KT12

The complaint against the above individual member was taken to Adjudication in line with the Professional Conduct Procedure.

The complaint was heard under BACP Professional Conduct Procedure 2010 and the Panel considered the alleged breaches of the BACP Ethical Framework for Good Practice in Counselling and Psychotherapy.

The focus of the complaint, as summarised by the Pre-Hearing Assessment Panel, is that the complainant had been having counselling/psychotherapy for five months with Ms Lee when on 23 August 2012 Ms Lee handed him a letter which included the suggestion that they end counselling. The complainant alleged that this came as a total shock to him as there had been no earlier hint of Ms Lee's intention to suggest this. The complainant alleged that Ms Lee gave her lack of experience as her reason for ending counselling with him, despite the fact that he had at that stage already had 19 sessions with her and that allegedly at no stage during those sessions had the process been reviewed with him, even though information on her website indicated that sessions would be reviewed every six weeks. The complainant alleged that Ms Lee had behaved inappropriately during their last session, commenting, for example, that he was manipulating the situation by crying, and suggesting that he sees a psychiatrist; acting in a condescending manner by suggesting that he need not worry as he would not have to pay for that final session; and showing no regret or sorrow for ending the counselling, declining even to shake his hand. The complainant alleged that by ending the counselling in this way, and contrary to information in the counselling contract signed by the client where she requested two weeks' notice from him should he wish to end counselling in order to "offer us both an opportunity to fully address the ending of our therapeutic relationship and any issues of support or further referrals", Ms Lee had acted unprofessionally. The complainant further alleged that Ms Lee had discussed his case with the complainant's GP without his knowledge or consent and had thereby breached his confidentiality. Finally the complainant alleged that his subsequent attempts to persuade Ms Lee to explain why she chose to end counselling with him went unanswered by her. In response to a request by the PHAP for copies of email and other correspondence with the complainant, and her notes for the three sessions prior to and including 23 August 2012, Ms Lee stated that the email box and notebook she used via her website had been cancelled and that she no longer had access to the emails from the complainant nor to her notes of the sessions with him.

The Pre-Hearing Assessment Panel (PHAP), in accepting this complaint, was concerned with the allegations made within the complaint suggesting a contravention of the Ethical Framework for Good Practice in Counselling and Psychotherapy, and those in particular are as follows:

1. Ms Lee allegedly failed to provide a good quality of service to the complainant in that she allegedly failed to manage the ending of the counselling relationship which ended abruptly, failing to meet the complainant's needs

2. Ms Lee allegedly failed to give careful consideration to her own competency limits, and failed to work within those limits, in that, after 19 sessions with the complainant, she allegedly concluded that she should end counselling with him because of her own lack of experience

3. Ms Lee allegedly failed to deliver a good service to the complainant in that allegedly she did not ensure that the rights and responsibilities of both herself and the complainant were clarified and agreed by them both so that the complainant could have a clear understanding of what he could reasonably expect from her in their counselling relationship

4. Ms Lee allegedly failed to keep appropriate records of her work with the complainant without a good or sufficient reason in that she allegedly cancelled her email box and notebook, which she had used via her website, resulting in her no longer having access to her notes of the sessions with the complainant

5. Ms Lee allegedly failed to deliver a competent service, which was periodically reviewed by her in consultation with the complainant, in that allegedly no such review was conducted at any stage during 19 sessions with him

6. Ms Lee allegedly failed to keep the trust of the complainant in that she allegedly failed to pay sufficient attention to the quality of listening and respect she offered to the complainant at and immediately after their final session

7. Ms Lee allegedly failed to respond to the complainant's request for information concerning her assessment, allegedly expressing to his GP, that he was becoming emotionally attached/dependent on her

8. Ms Lee allegedly failed to respect the complainant's right to privacy and confidentiality in that she allegedly discussed his case with his GP without notice to him and without his consent to do so

9. Ms Lee allegedly failed to respond promptly or at all to the complainant's request for information concerning the reason for her decision to terminate his counselling in that she allegedly failed to respond to a text message and two email messages from the complainant requesting such information and explaining its importance for him

10. Ms Lee allegedly failed to endeavour to remedy the harm allegedly caused to the complainant through her alleged failure to respond to his requests for information as to the reasons for her termination of counselling with him

11. Ms Lee's alleged behaviour as experienced by the complainant suggests a lack of the personal moral qualities of Integrity, Respect and Competence to which all practitioners are strongly urged to aspire; a contravention of paragraphs 1, 2, 3, 5, 6, 11, 16, 20, 41 and 42 of the Ethical Framework for Good Practice in Counselling and Psychotherapy (2010 edition); and the ethical principles of Being Trustworthy, Non-maleficence and Autonomy.

Findings

On balance, having fully considered the above, the Panel made the following findings:

1. There was a sharp difference of opinion between the parties in relation to this allegation.  The complainant stated that he was unaware before the final counselling session, that this was to be his last session.  Ms Lee however, stated both in her oral and written evidence that she gave notice to the complainant on 2 August, that 23 August 2012 would be their final session.  Whilst the Panel found that the quality of care provided to the complainant fell short of what was expected, given that Ms Lee was not appropriately supported by a supervisor, it was unclear whether or not the counselling had ended abruptly.  There was therefore, insufficient evidence for the Panel to make a determination in relation to this.  This allegation is not upheld.

2. Ms Lee, in her evidence stated that the complainant was her first client and admitted that at the time that she saw the complainant and throughout their counselling relationship, she did not have a supervisor in place.  The Panel found that given the complainant's medical condition and the fact that he had previously undergone counselling, for which he had fulfilled the quota of sessions that he could have with the previous organisation, it should have been apparent to Ms Lee that the counselling relationship would be a difficult one to manage.  The Panel agreed that Ms Lee was reckless in not having supervision in place, neither before she began her counselling work nor at any point during their counselling relationship.  Ms Lee admitted that she did not seek any guidance from an experienced practitioner before deciding that she could not work with the complainant and felt compelled to take the decision not to work with the complainant, as she thought it would be better for the complainant to work with a more experienced practitioner.  Ms Lee also admitted in evidence that she felt trapped and bullied by the complainant. The Panel therefore, found that Ms Lee did not give careful consideration to her competency limits and failed to work within those limits, and terminated counselling as a result of her own lack of experience.  This allegation is therefore, upheld.

3. The Panel questioned both parties in detail in relation to this allegation. Ms Lee's counselling contract with the complainant stated that she would discuss the complainant with her supervisor, when in fact she knew at the time that she entered into this contract, that she did not have a supervisor.  The complainant stated in his oral evidence that had he known that Ms Lee was working with him without supervision this would have caused him concern as he understood the importance of a counsellor having supervision.  Given that Ms Lee was a practicing counsellor and stated within her contract that she would discuss the complainant with her supervisor, the Panel found that the complainant could reasonably expect that Ms Lee would be supported by a supervisor, and at no point did Ms Lee clarify with the complainant that she was not in fact receiving supervision.  The Panel therefore, agreed that Ms Lee failed to provide a good quality of care to the complainant in that by failing to undergo the supervision she led the complainant to believe she was receiving, she failed to clarify the rights and responsibilities of both herself and the complainant, so that he could understand what he could expect from their counselling relationship.  This allegation is therefore, upheld.

4. Ms Lee admitted in her oral evidence that as a result of her closing down her website, she no longer had access to the complainant's records and did not have any back up records.  The Panel agreed that the explanation for the loss of the complainant's records was not good or sufficient, and Ms Lee had therefore, failed to keep appropriate records of her work with the complainant. The allegation is therefore upheld.

5. Ms Lee stated in her evidence that reviews with the complainant were carried out at sessions 6, 13 & 18.  Although Ms Lee did not have the complainant's notes to refer to, she relied upon the annotations that she had made upon the receipt stubs, which she denoted as "RV", to signify that a review had taken place.  The complainant admitted on questioning that a review did take place in session 6, but disagreed with Ms Lee's evidence that any further reviews had been carried out.  As both parties agreed that at least one review had been carried out, the Panel did not find that no review was conducted at any stage during the 19 sessions.  This allegation is therefore, not upheld.

6. The complainant in his evidence stated that he was shocked at the decision to end counselling and in the final session, asked Ms Lee to explain the reasons to him.  The complainant asserts that Ms Lee should have been more understanding of why he was upset at what he regarded as the sudden and abrupt ending of counselling.  The complainant stated at the end of the final session when he offered to shake Ms Lee's hand, she seemed reluctant to do so.  Ms Lee stated in her evidence that it is her practice to always wait for the client to offer their hand before she shakes it.  Ms Lee stated that she listened attentively to the complainant, notwithstanding her evidence that she felt intimidated and wanted the relationship to end.  Whilst the Panel accepted that Ms Lee was attentive to the quality of listening she offered to the complainant, it did not accept that Ms Lee was respectful to the complainant as she did not respond to the complainant's anxieties concerning his mental health needs, instead suggesting that he be referred to a psychiatrist.  Furthermore, the Panel considered it likely that the complainant picked up on the discomfort that Ms Lee was experiencing as a result of her feeling bullied.  The Panel therefore, found that the level of respect offered to the complainant fell below an acceptable level, and as a result Ms Lee failed to pay sufficient attention to the quality of respect offered to the complainant.  This part of the allegation is therefore upheld.  The Panel did not find that Ms Lee failed to pay attention to the quality of trust that she offered to the complainant.  This part of the allegation is therefore, not upheld.

7. In both her oral and written evidence, Ms Lee accepted that she did not respond to the complainant's request for further information regarding her assessment of him.  Ms Lee stated that at the last session the parties had agreed that there would be no further contact between them and stated that she thought that it may make matters worse to engage in correspondence with the complainant.  The Panel found that given that the complainant had indicated that he would be making a complaint to BACP and in view of her professional responsibility to the complainant, Ms Lee did fail to respond to the complainant's request for information regarding her assessment of him.  This allegation is therefore, upheld.

8. The complainant stated at the commencement of the hearing that he wished to withdraw this allegation, as he accepted that Ms Lee did have his consent to contact his GP.  It could therefore, not be said that Ms Lee failed to respect the complainant's privacy and confidentiality in this regard.  This allegation is therefore, not upheld.

9. Ms Lee stated in her oral evidence that she did not respond to the complainants request for information regarding her decision for terminating therapy.  Ms Lee stated that one of the requests made by the complainant was in relation to whether or not she had spoken to his GP.  Ms Lee stated that as this was a matter between her and the complainant's GP, she did not consider the need to discuss this with the complainant.  Further, Ms Lee stated that they had agreed at the last session not to have any contact with each other.  The Panel did not find the explanation given by Ms Lee satisfactory.  The Panel noted that Ms Lee's decision was made without any consultation with an experienced practitioner and no explanation was given by her to the complainant as to why she was not responding to his requests for information.  The Panel therefore, found that Ms Lee did fail to respond promptly or at all to the complainant's request for information.  This allegation is therefore, upheld.

10. Ms Lee admitted in evidence that she failed to respond to any correspondence from the complainant, from which it was clear that he was upset, seeking clarification from her as to the reason that she terminated therapy.  In failing to respond, the Panel found that it was clear that Ms Lee failed to remedy any harm caused to the complainant.  This allegation is therefore, upheld.

11. In light of the above findings, the Panel found that Ms Lee had breached the ethical principles of being trustworthy, non-maleficence and autonomy and paragraphs 1, 2, 3, 5, 11, 16, 41 and 42 of the Ethical Framework for Good Practice in Counselling and Psychotherapy 2010, and showed a lack of the personal moral qualities of integrity, respect and competence. The Panel found that paragraphs 6 & 20 of the Ethical Framework for Good Practice in Counselling and Psychotherapy 2010 had not been breached. 

Decision

Accordingly, the Panel was unanimous in its decision that these findings amounted to professional malpractice on the grounds that Ms Lee was incompetent, reckless, negligent and provided an inadequate professional service with this client which fell below the standard that would reasonably be expected of a practitioner exercising reasonable care and skill.

Mitigation

Ms Lee stated in her oral evidence that she accepted the need to have adequate supervision in place, and when she returned to private practice, she would ensure that she had a supervisor in place.

Ms Lee also stated that in the future she would ensure that she would record her notes in a book and keep the book in a locked cupboard.

Sanction

Within one month from the date of imposition of this sanction, which will run from the expiration of the Appeal deadline, Ms Lee is required to provide a written submission, which evidences her immediate reflection on, learning from and understanding of, the issues raised in this complaint.

Ms Lee is also required to undergo 6 sessions of supervision of a minimum of an hour and a half per session with a supervisor who is a BACP accredited member, or equivalent, and has at least 5 years' experience.  Ms Lee is required to provide proof of the supervisor's qualifications and experience.  Within these sessions Ms Lee should deal with the following:

  • Her in-depth understanding of how the quality of her interactions with the complainant and her lack of experience, led to the complaint.
  • Her new and increased understanding of what she has learnt about herself and her internal processes.

Ms Lee is required to provide a signed letter from her supervisor confirming that she has undertaken at least 6 sessions of supervision and that the above areas have been dealt with in supervision.  Such evidence is required to be provided in no less than 6 and no more than 18 months.

Ms Lee is also required to provide a further written report detailing her further in-depth learning and understanding as a result of the complaint and the supervision that she has undertaken above.  This report should be countersigned by Ms Lee's supervisor.  This report is due within no less than 6 months and no more than 18 months, and in any event after she has undergone the 6 sessions of supervision.

Ms Lee is further required to provide a written undertaking to BACP, at the same date as her first submission, i.e. within one month from the expiration of the appeal deadline, confirming that she will provide written notification to BACP of the date that she intends to re-commence work with clients, before she undertakes such work.  

Following the completion of the written part of the sanction, Ms Lee is required to attend an interview arranged by BACP, where she will be required to demonstrate a satisfactory and improved understanding of the importance of supervision for counsellors and psychotherapists.  

  

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July 2013: Sharareh (Sherry) Keyani, Reference No: 555782, Exeter EX2

The complaint against the above individual member was taken to Adjudication in line with the Professional Conduct Procedure.

The complaint was heard under BACP Professional Conduct Procedure 2010 and the Panel considered the alleged breaches of the BACP Ethical Framework for Good Practice in Counselling and Psychotherapy.

The focus of the complaint, as summarised by the Pre-Hearing Assessment Panel, is that the Complainant commenced counselling with Ms Keyani on 26 April 2010.  The Complainant ended the counselling relationship following the session on 13 Dec 2010.

The Complainant allegedly informed Ms Keyani in the first session that she had engaged with counselling on previous occasions, that she wanted help in overcoming unhelpful coping strategies;, that she had a preference for solution focused therapy and did not find it helpful to go over the past. 

The Complainant alleged that Ms Keyani took phone calls during her counselling sessions and that often the sessions started late, sometimes by as much as half an hour and on other occasions were allowed to overrun.  The Complainant further alleged that she was unclear about the number of sessions she was being offered after the first four assessment sessions, which then seemed to go from a fixed to an unfixed number, without an explanation.

The Complainant alleged that in the first session Ms Keyani raised an issue about the appropriateness of the Complainant being allocated to her for counselling, as she had allegedly told the Complainant that she normally dealt with complex cases rather than regular clients.  In the penultimate session on 6 December 2010, Ms Keyani allegedly expressed the view that the Complainant was "stage 4" in terms of counselling need and eligible for referral to a psychologist but intended to continue working with her.  The Complainant alleged that she found this very confusing.

The Complainant alleged that she made clear to Ms Keyani her requirements regarding confidentiality in the first session, because of a past negative experience which had affected her trust and that it was agreed that only the dates and times that she attended sessions would be recorded in her medical notes.  However, the Complainant alleged that she realised that this agreement had been breached when she saw her medical records covering the period that she was in counselling with Ms Keyani.  The medical records did include observations about the Complainant's mood and the content of some of the counselling work.

The Complainant alleged that Ms Keyani persisted in using a life line as a therapeutic tool, week after week, and did not seem interested in talking about the positive aspects of her life, which resulted in her having to keep going over difficult times in the past and not having space to explore her present issues.  The Complainant alleged that she was criticised for avoidance and resistance and Ms Keyani emphasised how long it would take to work through the past events.  When the Complainant talked about a painful memory, she alleged that Ms Keyani did not give her time to explore it satisfactorily by saying that they would come back to the issue and immediately asked what the next significant event was that she remembered, which she found distressing.

The Complainant alleged that on 6 December 2010, she told Ms Keyani that she had spoken to her GP about difficulty sleeping and a very low mood with thoughts of wanting her life to end that she was clear she would not act on.  Ms Keyani allegedly responded by emphasising the importance of getting on with the life line.

The Complainant alleged that during the course of therapy, Ms Keyani expressed personal opinions, which she found undermining and disempowering; that the Complainant should not do [ . . . ], work [ . . . ], which was the focus of the Complainant's work.

On 13 December 2010, the Complainant alleged that she told Ms Keyani that she had had a very hard week, but this was not acknowledged and that Ms Keyani stated that if the Complainant could not remember the details, it could not have been that bad.  The Complainant allegedly said that she did not want to use the life line but Ms Keyani stated that she wished her to complete it, so that the Complainant could see how she sabotaged counselling when she got close to something.  The session allegedly became increasingly difficult and exhausting for the Complainant and ran over by half an hour.

On 13 December 2010 the Complainant further alleged that Ms Keyani speculated that the Complainant had been involved in something she could not remember by repressing childhood memories about an issue concerning [ . . . ].  Ms Keyani allegedly asserted that the Complainant had admitted in a previous session, [ . . . ].  The Complainant stated that these accusations were false and alleged that she found the statements so grossly inaccurate and upsetting that she needed immediate support from her line manager at work, after the session ended.  The Complainant then terminated the counselling relationship.

The Pre-Hearing Assessment Panel, in accepting this complaint, was concerned with the allegations made within the complaint suggesting a contravention of the Ethical Framework for Good Practice in Counselling and Psychotherapy, and those in particular are as follows:

1. Ms Keyani allegedly failed to provide a good quality of care and competently delivered services by taking telephone calls without prior discussion with the Complainant, thereby interrupting her sessions, including taking routine calls such as being notified of the arrival of another client.

2. Ms Keyani allegedly failed to provide a good quality of care and competently delivered services by not adequately managing the time set aside for the Complainant's counselling sessions that sometimes started late or were allowed to overrun.

3. Ms Keyani allegedly failed to provide a good quality of care and competently delivered services by not being explicit about the number of sessions being offered or discussing this issue at appropriate stages as counselling progressed, with the result that the Complainant was unclear about whether the number of sessions was finite or not and any criteria that would influence this.

4. Ms Keyani allegedly failed to provide a good quality of care and competently delivered services by speculating about whether the Complainant's issues amounted to a complex case or not and whether she was the right person to work with her, thereby undermining the Complainant's trust and confidence.

5. Ms Keyani allegedly failed to provide a good quality of care and competently delivered services by deliberating about her competence to work with a 'level 4' client and suggesting the Complainant was entitled to a referral to a psychologist but nevertheless, choosing to continue to work with the Complainant.

6. Ms Keyani allegedly undermined the Complainant's trust and autonomy in failing to have an informed discussion with the Complainant about her options and giving her mixed messages about working with her.

7. Ms Keyani allegedly failed to provide a good quality of care and competently delivered services by paying insufficient attention to clarifying the Complainant's therapeutic goals and preference for working with present issues.

8. Ms Keyani allegedly failed to provide a good quality of care and competently delivered services by taking insufficient account of the Complainant's previous experiences of counselling and the Complainant's wish not to go over the past, which had influenced her choice of solution-focused therapy. Ms Keyani allegedly persisted with the use of the life line which involved looking at past issues, despite a reference to the Complainant's low mood and possible link to the life line exercise in the medical notes dated 29 Nov 2010.

9. Ms Keyani allegedly did not meet the client's needs or pay careful attention to the client's consent to her methodology, over-riding the Complainant's wishes and sense of autonomy in working with the Complainant using the life line, week after week, despite the Complainant's objections and criticising the Complainant for sabotaging the therapeutic work by not wanting to use the life line in the final session.

10. Ms Keyani allegedly failed to respect the Complainant's right to be self-directing by expressing personal opinions about her suitability for working in certain areas, which she found undermining and disempowering.

11. Ms Keyani allegedly failed to provide a good quality of care by stating that the Complainant was repressing childhood memories and by asserting that in the course of therapy, she had admitted [ . . . ].

12. Ms Keyani allegedly broke the confidentiality agreement that she made with the Complainant at the start of counselling, that only dates and times of sessions would be recorded in the medical notes, by making additional comments about the Complainant arising out of the content of the counselling sessions and observations about her generally, which were recorded.

13. Ms Keyani's alleged behaviour, as experienced by the Complainant, suggests a lack of the personal moral qualities of empathy, respect, competence and wisdom to which practitioners are strongly encouraged to aspire, as outlined in the Ethical Framework for Goof Practice in Counselling and Psychotherapy 2010, a contravention of paragraphs 1, 2, 3, 6, 11, 12, 13 and 20 and the ethical principles of being trustworthy, autonomy and beneficence.

Findings

On balance, having fully considered the above, the Panel made the following findings:

1. Ms Keyani's oral evidence was that she gave advance notice to her client that the phone in her office may ring. Ms Keyani said that her phone seldom rang but admitted on questioning that there were at least 2 occasions when it rang when the Complainant was present. Whilst the Panel accepted that Ms Keyani did discuss with her client the possibility that her phone may ring, it found no evidence that Ms Keyani considered the impact that this would have upon the Complainant. The Panel found in failing to consider this, Ms Keyani failed to provide the Complainant with a good quality of care and competently delivered services. This allegation is therefore, upheld.

2. Both parties accepted on questioning that sessions started late or overran. The Complainant in her evidence stated that she never knew when her sessions would start or finish. The Panel found that a competent therapist would ensure that sessions began and ended on time. Therefore, in not maintaining time boundaries within the counselling relationship, Ms Keyani did not provide a good quality of care and competently delivered services. This allegation is therefore, upheld.

3. The Panel found a sharp difference of opinion as to whether Ms Keyani had been explicit about the number of sessions that the Complainant would receive. On the balance of probabilities, the Panel found that Ms Keyani did confirm the number of counselling sessions that would be offered and had been explicit in this regard. This part of the allegation is therefore, not upheld. In Ms Keyani's written evidence however, the Panel found that there was only evidence of one review having been carried out. The Panel considered this to be insufficient, given that it had heard from both parties that Ms Keyani referred to the Complainant as a "complex case" and discussed a referral to a psychologist on more than one occasion. The Panel therefore, found that Ms Keyani did not discuss the number of sessions at regular intervals, and this part of the allegation is therefore, upheld.

4. In her oral evidence, the Complainant stated that the trust and confidence in the counselling relationship declined over time, that it was not the result of one particular incident, and that it finally reached an unacceptable level as a result of the incident that occurred in the penultimate and last sessions. The Panel also heard from the Complainant that Ms Keyani never speculated as to whether or not she was the right person to work with, as Ms Keyani was clear that she was the right person to work with her. The Panel therefore, did not find the Complainant's trust and confidence was undermined as a result of Ms Keyani stating that the Complainant was a complex case or whether she was the right person to work with her. This allegation is therefore, not upheld.

5. Ms Keyani admitted on questioning, that on more than one occasion she routinely told the Complainant that she could be referred to a psychologist. Ms Keyani stated that she gave the Complainant the option of being referred, but each time the Complainant chose to continue to work with her. The Panel accepted that Ms Keyani discussed the referral with her supervisor, who agreed that she could continue to work with the Complainant. Ms Keyani in her evidence stated that she was the only counsellor in the GP practice who was able to work at level 3/4 of the stepped care model and deal with clients with moderate, severe and psychotic disorders of depression. Whilst the Panel noted that the Complainant may not have appreciated the significance of being classified as a level 4, the Panel found that in this instance, Ms Keyani did not fail to provide a good quality of care and competently delivered services. This allegation is not upheld.

6. The Panel found that Ms Keyani failed to carry out a sufficient assessment with the Complainant to determine whether they were suitable to work together. During the assessment that did take place, the Panel found no evidence that the Complainant's goals for counselling had been set or discussed. This was particularly so, given Ms Keyani stating in her verbal evidence that the Complainant had been vague about her goal for counselling in the first session but at the second session, proceeding to set the Complainant the task of preparing a lifeline. In doing this without defining the Complainant's goals for counselling, the Panel found that Ms Keyani undermined the Complainant's trust and autonomy. This allegation is therefore, upheld.

7. The Panel found that in failing to carry out a sufficient assessment where the therapeutic goals were set and having regard to the Complainant's needs, which, based upon the Complainant's clear evidence, the Panel accepted were to deal with her present issues in therapy, Ms Keyani failed to provide a good quality of care and competently delivered services. This allegation is therefore, upheld.

8. The Panel accepted that whilst Ms Keyani did take into account the Complainant's previous experience of counselling, she admitted on questioning, that she had not known of these experiences in any depth. Ms Keyani stated that she was unaware that the Complainant had previously done a lifeline in her other counselling relationships and therefore, Ms Keyani did take insufficient account of the Complainant's previous counselling experience. Ms Keyani in her oral evidence stated that she had not agreed to do solution focused therapy, as this was not something that she did. The Panel found that the uncertainty between the type of therapy that was being offered and that which was provided had an impact on the quality of care and services delivered to the Complainant, which may have been discovered if sufficient account had been taken of the Complainant's previous experience of counselling. This part of the allegation is therefore, upheld. There was agreement between both parties that when the Complainant said that she did not want to work on the lifeline, Ms Keyani did not persist in her doing so. This part of the allegation is therefore, not upheld.

9. The Panel questioned Ms Keyani in detail about her methodology and found her lacking in her ability to explain her methodology. Given that Ms Keyani could not satisfactorily explain her methodology to the Panel, the Panel found that it was reasonable to accept that the Complainant was not in a position to consent to Ms Keyani's methodology and know what it would involve. The Panel heard evidence from Ms Keyani that the lifeline was introduced in the second session with no prior discussion or preparation of the client. This part of the allegation is therefore, upheld. Ms Keyani denied that she had criticised the Complainant for not wanting to do the lifeline, and on the balance of probabilities, the Panel found there was insufficient evidence to prove anything to the contrary. This part of the allegation is therefore, not upheld.

10. Ms Keyani stated in both her oral and written evidence that she suggested that the Complainant look at something other than [ . . . ] as a career. Ms Keyani stated that suggesting other occupations was something she routinely did with her other clients to encourage them to explore their options. However, the Panel found that the Complainant interpreted this encouragement as a judgment on her ability. Whilst the Panel accepted that Ms Keyani had the Complainant's best interests at heart, the way in which Ms Keyani had expressed this encouragement was open to interpretation. The Panel, however, concluded that there was insufficient evidence for it to find that Ms Keyani had failed to respect the Complainant's right to be self-directing. This allegation is therefore, not upheld.

11. Whilst there was a sharp difference of opinion between the parties as to the version of events of this session, the Complainant categorically denied that she had disclosed to Ms Keyani that [ . . . ]. The Panel explored this allegation at length, and the Complainant accepted that what she had actually said could have been misinterpreted by Ms Keyani, although the Complainant further stated that Ms Keyani should have sought to clarify the statement that was made. Ms Keyani, however, was adamant that she had not misheard or misinterpreted the Complainant's statement. The Panel, on questioning both parties, was not satisfied that Ms Keyani had checked with the Complainant her understanding of what was said during the session. The Panel preferred the evidence of the Complainant in this regard and on the balance of probability found the allegation to be upheld.

12. There was disagreement between the parties as to what had been agreed regarding confidentiality. Ms Keyani was clear in her evidence that she had advised the Complainant that she would record some information on her medical records to give an indication of the purpose of her visit, but would not disclose what Ms Keyani termed as anything of a personal incident. Whilst the Panel found that Ms Keyani had failed to check with the Complainant that she fully understood what would be recorded, the Panel did not find that Ms Keyani had breached confidentiality. This allegation is therefore, not upheld.

13. In not clarifying certain statements made by the Complainant, Ms Keyani failed to demonstrate the personal moral qualities of empathy and respect. The Panel found that in this case Ms Keyani failed to demonstrate the competence and wisdom expected of a qualified counsellor and member of BACP, in not clarifying and reviewing regularly with a client whom she deemed to be "complex".

14. In respect of the above findings, the Panel found that Ms Keyani had breached the ethical principles of being trustworthy, autonomy and beneficence and a breach of paragraphs 1, 2, 3, 6, 11, 12, 13 of the Ethical Framework for Good Practice in Counselling and Psychotherapy 2010. The Panel did not find paragraph 20 had been breached.

Decision

Accordingly, the Panel was unanimous in its decision that these findings amounted to professional malpractice in the provision of inadequate professional services and the member was incompetent, in that the service that she was responsible for fell below the standard that would reasonably be expected of a practitioner exercising reasonable care and skill.

Mitigation

Ms Keyani demonstrated some evidence of learning.  She stated that she now recognised the importance of having a written contract and the need to maintain boundaries regarding her time. 

Sanction

Within one month from the date of the imposition of this sanction, which will run from the expiration of the Appeal deadline, Ms Keyani is required to provide a written submission which evidences her immediate reflection on, learning from and understanding of, the issues raised in this complaint.

Further Ms Keyani is required to undergo work with a supervisor, outside of her current network, who is a senior accredited counsellor or psychotherapist, for a minimum of 1½ hours per month to cover the period of the sanction.  This should be a minimum of 6 sessions.  Details of this supervisor should be supplied at the same time as the first submission is submitted.

Ms Keyani is required to provide a written contract within three months from the date of the imposition of the sanction which should contain the following:

  • A clear statement of an acceptable form of limits on confidentiality
  • A clear statement of the length of the sessions
  • The extent of the notes that will be taken and who will and can have access to these
  • The particulars of any assessment that is offered, including what is involved in the assessment and approximate number of sessions that it will last for

This contract submission must be countersigned by the supervisor.

Ms Keyani is further required to submit a detailed and evidenced case study of no less than 3,000 words and no more than 5,000 words addressing the following:

  • Her methodology and core modality, which describes her rationale for her chosen method of working with clients and gives an in-depth knowledge of at least one theory and how she uses other theories.
  • A demonstration of her ability to make a clear contract.
  • Her ability to make clear goals for the clients and set clear reviews at regular intervals.
  • A demonstration of how she now manages her time boundaries in both her private practice and in an organisational setting.

The case study is to be submitted within no less than 6 months and no more than 12 months of the date of this report, and must also be countersigned by the supervisor.

Ms Keyani is required to provide a supervision log, detailing all of the above supervision sessions, signed by Ms Keyani and also countersigned by the supervisor.  This log should be submitted with her case study, within the timeframe above.

These written submissions must be sent to the Deputy Registrar and Deputy Director of BACP Registers by the given deadlines, and will be independently considered by a Sanction Panel.

 (Where ellipses [ . . . ]are displayed, they indicate an omission of text)

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July 2013: Francis Jacob, Reference No: 590709, Lichfield WS13  

The complaint against the above individual member was taken to Adjudication in line with the Professional Conduct Procedure.

The complaint was heard under BACP Professional Conduct Procedure 2010 and the Panel considered the alleged breaches of the BACP Ethical Framework for Good Practice in Counselling and Psychotherapy.

The focus of the complaint, as summarised by the Pre-Hearing Assessment Panel, is that the Complainant was referred to Mr Jacob for counselling by her GP and that counselling commenced on 3 June 2009.  The number of sessions to which the Complainant was entitled, was extended after the involvement of the Community Mental Health Team (CMHT).  The Complainant's counselling with Mr Jacob ended on 15 July 2010.

The Complainant alleges that Mr Jacob transgressed professional boundaries in relation to the counselling services he provided for her, including allowing sessions to overrun, escorting her from the building, giving her tea, biscuits and cake, discussing his own personal issues, including the implications for the Complainant if he set up a private practice and having coffee with her in a social setting and meeting in a pub. 

The Complainant alleges that Mr Jacob communicated with her by text using his personal phone and also by email, out of hours and at weekends and that she used these ways of communicating with him heavily, which allegedly increased her sense of dependence on him.

The Complainant alleges that Mr Jacob made fun of her and said abusive and insulting things and threatened to withdraw therapy.  The Complainant alleges that Mr Jacob made comments indicating that he was sexually attracted to her and he gave her a kiss on the cheek, after spending an afternoon with her.  At the next appointment, Mr Jacob allegedly behaved in a hostile and critical way towards the Complainant.  Allegedly when the Complainant challenged Mr Jacob about his behaviour via email, he threatened to withdraw therapy if she spoke of the matter again.

The Complainant alleges that Mr Jacob expressed his disagreement about the medical diagnosis made regarding her psychological problems, commenting that consultants only gave out medication.  The Complainant further alleges that she requested a referral to a Community Psychiatric Nurse but that Mr Jacob did not pursue her request despite her increasing mental instability but continued to take responsibility for her care and then went to Canada for 3 weeks leaving her unsupported.

The Complainant alleges that Mr Jacob refused to see her with her Care Co-ordinator for a closure meeting but subsequently sent her text messages which did not make sense or were incomplete.

The Pre-Hearing Assessment Panel, in accepting this complaint, was concerned with the allegations made within the complaint suggesting a contravention of the Ethical Framework for Good Practice in Counselling and Psychotherapy, and those in particular are as follows:

1. Mr Jacob allegedly failed to provide the Complainant with a good quality of care in that he: -

i. Often allowed the Complainant's counselling session, which was the last appointment in the evening, to overrun, which risked undermining any sense of containment for the Complainant.

ii. Escorted the Complainant from the building at the end of her session through the car park, which allegedly blurred boundaries.

iii. Provided cups of tea, cakes and biscuits during counselling sessions, which risked undermining the professional nature of the relationship.

iv. On 15 February 2010, went to a pub to discuss the Complainant's issues and thereafter spent the afternoon with her socially, risking undermining the therapeutic work and professional nature of the counselling relationship.

v. Talked to the Complainant during the meeting referred to above, about his own significant personal issues rather than the Complainant's, which allegedly emotionally affected the Complainant, altering the nature of the counselling relationship and the potential for the Complainant to focus on her own needs, which was to her detriment.

vi. On 1 July 2010, had a social meeting with the Complainant, lasting 2 hours, which covered issues linked to the Complainant's therapy as well as a discussion about significant events in Mr Jacobs personal life and his feelings towards the Complainant.  The content of this encounter allegedly undermined the professional counselling relationship and the potential for the Complainant to focus on her own needs during counselling, which was to her detriment.

vii. Discussed with the Complainant the threat to her if he set up in private practice and commented that she was getting a good deal in getting him on the NHS for nothing, which the Complainant allegedly found disturbing and threatening.

viii. Failed to explore with the Complainant the possible impact on the therapeutic work, the fact that Mr Jacob and the Complainant knew people mutually and that they talked about them during therapy, which allegedly caused the Complainant to feel confused.

ix. Used his personal phone for texting the Complainant and suggested the use of email for out of session contact, including weekends, which allegedly increased the Complainant's sense of dependency on Mr Jacob as she made extensive use of this facility.

x. Encouraged the Complainant to write a narrative, which was part of his work for a university, and for his own benefit, blurring boundaries and having the potential of being exploitative.

xi. Sent the Complainant two unexplained empty/incomplete text messages after counselling had ended, despite the fact that he had been instructed by his employer to have a separate work mobile and delete her details from his personal phone which resulted in the Complainant feeling very distressed. 

2. Mr Jacob allegedly failed to maintain competent practice in that he: -

i. Told the Complainant that he had not talked to his supervisor about whether he had crossed boundaries in his work with the Complainant, such as asking her to go for a coffee.

3. Mr Jacob allegedly failed to keep the Complainant's trust in that he: -

i. Showed a lack of respect and courtesy towards the Complainant in the way he spoke to her on occasions, making fun of her, saying that she paraded herself in front of men, interpreting her flushing when wearing a low summer top as an indication of a sexual attraction for him, allegedly called her a dirty bitch, and asking repeatedly what message she put across to guys.

ii. Abused the Complainant's trust to gain sexual and emotional advantage by:

  • a) Saying in February 2010, that therapy sessions felt like they were having an affair.
  • b) On 15 February 2010, saying to the Complainant after spending an afternoon with her, that he should kiss her on the cheek as they had met socially and then doing so when they parted company.
  • c) On the date referred to above, saying to the Complainant that he wanted her and if he was not married, he would "go for it".
  • d) On 1 July 2010, when he asked the Complainant to have coffee with him and they talked about the sexual attraction between them, using phrases such as "if he wanted to get his leg over" and saying that the connection between them could be "purely carnal".
  • e) On other occasions, saying to the Complainant that she had a special place in his heart, that he thought of her outside of therapy and that he would not forget her.

4. Mr Jacob allegedly failed to respond appropriately when things were going wrong in the counselling relationship, in that he: -

i. On 18 February 2010, blamed the Complainant for what had occurred on 15 February, mainly in relation to an incident in the pub, and was hostile towards her and threatened to end counselling.

ii. Failed to pursue a request made by the Complainant that she be referred to a Community Psychiatric Nurse despite her increasing mental instability but continued to take responsibility for her care.

iii. Went to Canada for 3 weeks without making any arrangements for the Complainant, despite his alleged agreement with the Mental Health Crisis Team to take responsibility for her care, with a care plan that included referral to a psychiatrist and speaking to the GP about her medication.

iv. Told the Complainant on his return from Canada when the Complainant checked what he had done in relation to the care plan, that "it was not what he had signed up for." 

v. Failed to take any responsibility for the breakdown of the counselling relationship with the Complainant.

vi.After counselling ended abruptly in July 2010, did not respond to requests for him to attend a meeting to try to achieve closure for the Complainant.

5. Mr Jacob allegedly failed to work in a respectful and collaborative way with colleagues to enhance the services available to the Complainant in that he:

i. Questioned the medical diagnosis that the Complainant had been given, criticised psychiatrists for prescribing medicines and the competence of other agencies involved in her care, thereby reducing her trust in other professionals who might have enhanced her care and increasing her dependence on him.

ii. Failed to work in a collaborative way with other agencies which might have assisted in the Complainant's care or worked in parallel with him and failed to refer the Complainant to a CPN and her Psychiatrist in a timely way, which was to her detriment.

6. Mr Jacob's alleged behaviour, as experienced by the Complainant, showed a lack of the personal moral qualities of integrity, sincerity, respect and competence to which practitioners are strongly encouraged to aspire, as outlined in the Ethical Framework for Good Practice in Counselling and Psychotherapy 2007/2009 & 2010.  It also suggests a contravention of the Ethical Framework for Good Practice in Counselling and Psychotherapy 2007/2009 and in particular paragraphs 1, 2, 7, 11, 18, 33, 34, 43 and 46 and the ethical principles of fidelity, autonomy, beneficence and non-maleficence and the Ethical Framework for Good Practice in Counselling and Psychotherapy 2010 and in particular, paragraphs 1, 2, 7, 11, 17, 41, 42, 51 and 54 and the ethical principles of being trustworthy, autonomy, beneficence and non-maleficence.

Findings

On balance, having fully considered the above, the Panel made the following findings:

1. In relation to the allegation that Mr Jacob failed to provide the Complainant with a good quality of care, the Panel made the following findings:-

i. Mr Jacob accepted in both his oral and written evidence that he allowed the counselling sessions with the Complainant to overrun because the Complainant was often in an emotionally unsatisfactory state, and it would take time to get her to a place where she was stable.  The Panel was of the opinion that Mr Jacob should not have let the pattern of overrunning form and should have sought to wind down the counselling session sooner, to deal with this issue.  This allegation is therefore upheld.

ii. The Panel accepted Mr Jacob's evidence that it was the practice within the GP practice that all clients had to be escorted out of the building.  The Panel accepted Mr Jacob's evidence that he did not walk the Complainant through the car park, and this part of the allegation is therefore not upheld.  Mr Jacob stated that there were three occasions when as he was walking to Tesco to collect his car, the Complainant walked with him.  This part of the allegation is therefore upheld.

iii. Mr Jacob admitted that there were occasions when he provided the Complainant with a cup of tea, but this was prior to the commencement of the counselling sessions, and not during.  Mr Jacob advised that he did this out of courtesy as he was making himself a cup of tea and had to walk past the Complainant in the waiting room to access the tea making facilities.  Both parties accepted that cake was offered to the Complainant on one occasion.  The Panel was not satisfied, on the evidence, that this had occurred during the session.  This allegation is therefore not upheld.

iv. Mr Jacob accepted that he went to the pub with the Complainant, but stated that when he did so, he was still in "therapeutic mode".  The Panel found that Mr Jacob was trying to rescue the Complainant from her distress and that by meeting the Complainant in this way, Mr Jacob risked undermining the therapeutic work and professional nature of the counselling relationship.  This allegation is therefore upheld.  

v. There was conflicting evidence from both parties in relation to the allegation that Mr Jacob had talked about his own personal issues rather than the Complainant's, to her detriment.  On balance the Panel was not satisfied that there was sufficient evidence for it to uphold the allegation and therefore this allegation is not upheld.  

vi. Mr Jacob accepted that a meeting took place with the Complainant on 1 July 2010 in a café in a shopping centre.  There was disagreement between the parties about the length of this meeting.  Mr Jacob accepted that it was a mistake to meet with the Complainant in a shopping centre.  Mr Jacob admitted that he did disclose personal information to the Complainant at this meeting, but this was of a limited nature, to add authenticity to the issue of abandonment that they were discussing.  Mr Jacob denied that this was a social meeting but an ad-hoc therapeutic session.  The Panel found that this type of setting was wholly inappropriate for a counselling session and that such a meeting had the effect of altering the context of the therapeutic relationship, to the Complainant's detriment.  The allegation is therefore upheld. 

vii. Although the parties agreed that there was some discussion about Mr Jacob setting up in private practice, there was a difference of opinion about what was discussed.  In particular, Mr Jacob denied that he had made any threat.  The Panel had insufficient evidence to make a determination, and this allegation is therefore not upheld.

viii. There was a difference of opinion between the parties as to who instigated a discussion in relation to people who were known to both parties. The Panel had insufficient evidence to make a determination. This allegation is therefore not upheld.

ix. Mr Jacob admitted that he used his personal phone for all of his clients at the practice, because he had not been provided with a business phone.  Both parties accepted that out of session contact took place by email and text message, and that Mr Jacob encouraged the Complainant's use of email.  The Panel was satisfied on the evidence that this had encouraged dependency and this allegation is therefore upheld.

x. Mr Jacob denied that he had encouraged the Complainant to write a narrative as part of his work for a University.  He stated that he provided the Complainant with a book on narrative psychology to assist her in providing more structure to her writing.  On balance this allegation is therefore not upheld.

xi. Mr Jacob accepted in his oral and written evidence that two empty text messages were sent by accident to the Complainant after counselling had ended but that this was a mistake.  Mr Jacob apologised for it and accepted that this would have caused the Complainant distress.  This allegation is therefore upheld.

2. In relation to the allegation that Mr Jacob failed to maintain competent practice, the Panel made the following findings:-

i. While Mr Jacob did not say that he would never discuss the issue of boundaries with his supervisor, he accepted that he did say to the Complainant that he would not speak to his supervisor at that time.  In this, Mr Jacob failed to maintain competent practice and this allegation is therefore upheld.

3. In relation to the allegation that Mr Jacob failed to keep the Complainant's trust, the Panel made the following findings:-

i. Whilst Mr Jacob accepted that he called the Complainant "a dirty bitch", he stated that he did so in a joking way with no intention of disrespect towards the Complainant.  Mr Jacob accepted that it was inappropriate to use language such as this.  This part of the allegation is upheld.  Mr Jacob denied that he had said that the Complainant paraded herself in front of men, or interpreted her flushing as sexual attraction towards him.  Further, he stated that he only asked the Complainant in one session what message she thought she was putting across to guys, and did not do this repeatedly.  He further provided the context in which he had made the statement indicating that it was not intended in a disrespectful way.  This part of the allegation is therefore not upheld.

ii. With regard to allegations 3 ii a-c, there was insufficient evidence to support those allegations and they are therefore not upheld.

With regard to allegations 3 ii d) and e), the Panel made the following findings:-

d) Mr Jacob stated that he did discuss the Complainant's sexual attraction to him at this meeting and admitted that he used the term "get his leg over", but stated that he did this in an attempt to convey to the Complainant that they were not involved in a personal relationship. Mr Jacob wholly accepted that he should not have used this terminology and that it was inappropriate. This part of the allegation is therefore upheld. There was no evidence that Mr Jacob had said that the connection between them was carnal. This part of the allegation is therefore not upheld.

e)    Mr Jacob gave evidence that he told the Complainant that he thought about all of his clients outside of therapy, and that in general there were clients that he would never forget.  This allegation is therefore partially upheld.

4. In relation to the allegation that Mr Jacob failed to respond appropriately when things were going wrong in the counselling relationship, the Panel made the following findings:-

i. Mr Jacob denied that he was hostile or blamed the Complainant for the incident in the pub.  Mr Jacob stated in his evidence that he apologised to the Complainant for this incident.  The Panel accepted Mr Jacob's evidence that he advised the Complainant that counselling could not continue if boundaries were not maintained.  Mr Jacob however denied that he made any threat to end counselling.  This allegation is therefore not upheld.

ii. The Panel found that Mr Jacob did not support the Complainant, in his absence, by ensuring that there were adequate resources in place to support her in relation to her mental instability.  The Panel also found that Mr Jacob did not interact with the Mental Health Team and instead suggested that the Complainant contact her GP for a referral to a Community Psychiatric Nurse.  Mr Jacob in his evidence said that he did not know of the range of services that may have been available to the Complainant, and had his clinical line manager, who was on long term sick leave, been available he would have made enquiries about the range of services on offer.  The Panel found that Mr Jacob had responsibility for the Complainant and that he failed to respond appropriately to ensure sufficient cover was put in place.  In the absence of his clinical manager, Mr Jacob should have sought guidance elsewhere.  The Panel were therefore of the view that Mr Jacob had a duty of care to the Complainant, which he failed to honour.  This allegation is therefore upheld.

iii. Mr Jacob admitted on questioning, that the Mental Health Crisis Team "handed" the Complainant back to him, after she had sought their services.  Mr Jacob in his evidence stated that he did not know what this meant but, before he went away to Canada he gave the Complainant a card with the contact details of the Mental Health Crisis Team.  In failing to check with either the Mental Health Crisis Team or the GP what this meant, the Panel found that Mr Jacob failed to make adequate arrangements for the Complainant.  This part of the allegation is therefore upheld.  The Panel found no evidence that there was any agreement between Mr Jacob and the Mental Health Crisis Team.  This part of the allegation is therefore not upheld.

iv. The Panel found insufficient evidence to support the allegation that Mr Jacob had told the Complainant that he had not signed up to a care plan, and this allegation is therefore not upheld.

v. Mr Jacob stated that counselling with the Complainant was terminated by the Mental Health Team, and not by himself, after the Complainant became ill.  There was insufficient evidence to support the allegation and it is therefore not upheld.

vi. Mr Jacob stated in evidence that in compliance with instructions from the GP practice not to contact the Complainant, he agreed not to do so to comply with the policy and procedures of the practice.  Furthermore, Mr Jacob stated that the Complainant was still contacting him after the termination of counselling and he therefore did not consider it appropriate to attend a meeting with the Complainant.  This allegation is therefore not upheld.

5. In relation to the allegation that Mr Jacob allegedly failed to work in a respectful and collaborative way with colleagues to enhance the services available to the Complainant, the Panel made the following findings:-

i. Mr Jacob stated in his evidence that he accepted the diagnosis that the Complainant had been given, but drew to the Complainant's attention the problems that could be caused when people are labelled.  Mr Jacob denied that he had criticised other agents and psychiatrists or the competence of their care.  This allegation is therefore not upheld.

ii. The Panel accepted the Complainant's evidence that she had asked Mr Jacob to make a referral to a Community Psychiatric Nurse, and Mr Jacob failed to do this.  The Panel found that Mr Jacob was unaware of the work that the other agencies were doing with the Complainant and failed to refer the Complainant back to the Mental Health Team, which might have assisted the Complainant.  Mr Jacob stated that he was not aware of, or involved in any meetings relating to the care of the Complainant and was not party to her care plan.  This allegation is therefore upheld.

6. In respect of the above findings, the Panel found that Mr Jacob showed a lack of the personal moral qualities of integrity, sincerity, respect and competence to which all practitioners are strongly encouraged to aspire. The Panel also found that Mr Jacob had breached the ethical principles of fidelity, beneficence and non-maleficence as set out within the Ethical Framework for Good Practice in Counselling and Psychotherapy 2007/2009, and paragraphs 1, 2, 11 and 43. The Panel found that the ethical principle of autonomy and paragraphs 18, 33, 34, and 46 had not been breached.

In relation to the 2010 Ethical Framework for Good Practice in Counselling and Psychotherapy the Panel found that Mr Jacob had breached the ethical principles of being trustworthy, beneficence and non-maleficence and paragraphs 1, 2, 11, 42 and 51, but the ethical principle of autonomy and paragraphs 7, 17, 41 and 54 had not been breached.

Decision

Accordingly, the Panel was unanimous in its decision that these findings amounted to professional malpractice in the provision of inadequate services and incompetence.  

Mitigation

The Panel were of the opinion that there were systemic failings within Mr Jacob's working environment, namely that the Complainant was not matched to Mr Jacob's competence and was not appropriately assessed before being transferred to him.

The Panel noted Mr Jacob's line manager was absent during an important stage within the counselling relationship.

Mr Jacob seemed to be unaware as to whom he was accountable and the Panel accepted that there appeared to be confusion regarding to whom Mr Jacob was accountable within the Primary Care setting.

Mr Jacob accepted that he acted outside of his level of competence and accepted that he should have dealt with the issue of boundaries in a more robust way.  Further Mr Jacob accepted that on occasion the choice of words that he used with the Complainant was not appropriate and that he should have been more open and explicit with his supervisor when discussing the boundary issues with her.  

Sanction

Within one month from the date of imposition of this sanction, which will run from the expiration of the Appeal deadline, Mr Jacob is required to provide a written submission, which evidences his immediate reflection on, learning from and understanding of, the issues raised in this complaint.

Within 12 months from the date of imposition of this sanction, Mr Jacob is required to attend courses covering the topics below, each course of 6 hours duration, and provide evidence of completion of the same:

  • Training in mental health issues in counselling
  • Transference and erotic transference
  • Maintenance of boundaries in counselling relationships

Within 12 months from the date of imposition of this sanction, Mr Jacob is also required to provide a written report, of no less than 2,000 words demonstrating his in depth learning and understanding of the following:

Ø Erotic transference and its impact and management in the counselling relationship,

Ø The maintenance of boundaries and their importance in counselling relationships,

Ø The cultivation of dependency in counselling relationships and the impact and consequences for clients.

Upon completion of the above, and in no less than 12 months and no more than 18 months, Mr Jacob will be required to appear for interview, before a Sanction Panel, to give verbal evidence of sufficient learning from and understanding of, the issues raised in this complaint.

These written submissions must be sent to the Deputy Registrar and Deputy Director of BACP Registers by the given deadlines, and will be independently considered by a Sanction Panel and at the interview.

   

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August 2012: Darren Simpson, Reference No: 521894, Leicestershire LE10

The complaint against the above individual member was taken to Adjudication in line with the Professional Conduct Procedure.

The complaint was heard under BACP Professional Conduct Procedure 2010 and the Panel considered the alleged breaches of the BACP Ethical Framework for Good Practice in Counselling and Psychotherapy.

The focus of the complaint, as summarised by the Pre-Hearing Assessment Panel, is that the complainant saw Mr Simpson for counselling, provided by her employer, beginning in March 2010.  Following the six allocated sessions, the complainant then saw Mr Simpson for private counselling at his home from September to December 2010.  The complainant alleges that there was no contract provided for the private sessions.  The complainant alleges that Mr Simpson joked in one session about having an affair with her.  She alleges that during the penultimate session in December 2010, Mr Simpson stroked her hand and told her of his fantasy of kissing her, adding that he would not do that since he was her therapist.  The complainant alleges that at their final session, Mr Simpson kissed her, felt under her underwear, and exposed himself to her.  The complainant alleges that this caused her great distress, so much so that she went home and told her husband what had happened that day, and briefly contemplated suicide.  The complainant  alleges that despite having made an agreement with Mr Simpson that there would be no further contact between them, Mr Simpson texted her a few days later, and consequently there was an alleged exchange of texts and telephone calls which went on to the following February.  She alleges that some of the texts confirm that Mr Simpson acknowledged that something inappropriate had taken place. 

In the complainant's attempt to resolve the matter, she made a complaint to her employer and the authority that had employed Mr Simpson for her initial counselling.  In her complaint to her employer, the complainant alleged that Mr Simpson also failed to keep adequate notes of their sessions, that he falsified some of the written evidence that he submitted to the hearing, that he was disrespectful of her in some of his statements and that he stated that he had discussed with his supervisor the possibility of her having a borderline personality disorder.  Following her attempts at resolution through her employer, she was not satisfied that the issues had been resolved, and therefore submitted a complaint to BACP. 

GROUNDS IN FAVOUR OF ACCEPTING THIS COMPLAINT:

The Panel, in accepting this complaint, was concerned with the allegations made within the complaint suggesting contravention of the Ethical Framework for Good Practice in Counselling and Psychotherapy, and those in particular as follows:

  • Mr Simpson allegedly failed to re-contract and clarify the terms under which the counselling was to take place with the complainant, when the counselling changed from her workplace to his private practice.
  • Mr Simpson allegedly made an inappropriate and ambiguous remark inviting an affair with the complainant.
  • Mr Simpson allegedly abused the complainant's trust and engaged in sexual activity with her.
  • Mr Simpson allegedly failed to deal appropriately with what he allegedly described as a ‘issues of transference' (erotic feelings towards the therapist) towards him on the complainant's part.
  • Mr Simpson allegedly engaged in an exchange of texts and telephone calls for a further two months after the last session, having allegedly agreed to terminate the therapeutic relationship.
  • Mr Simpson allegedly admitted to the investigating officer employed by the complainant's employer that he failed to keep notes after every counselling session with the complainant.
  • Mr Simpson allegedly created fictitious notes about the private counselling with the complainant and then disclosed those notes to her employer without her consent and allegedly without giving her sight of them.
  • Mr Simpson was allegedly dishonest in his account of the counselling when responding to the complainant's complaint to her employer.
  • Mr Simpson allegedly made disrespectful remarks about the complainant in response to the complaint to her employer, and allegedly suggested a potentially disrespectful diagnosis of the complainant in his evidence.
  • Mr Simpson's alleged behaviour, as experienced by the complainant , suggests a contravention in particular of paragraphs 3, 5, 11, 12, 17, 20, 41,and 42 of the principles of being trustworthy, autonomy, beneficence and non-maleficence, and the moral qualities of integrity and competence in the Ethical Framework for Good Practice in Counselling & Psychotherapy (2010).

Findings

On balance, having fully considered the above, the Panel made the following findings:

  • I. There was a contract, signed by the complainant, which acknowledged her wish to enter private therapy with Mr Simpson following the end of her workplace counselling. However, the Panel found that this contract did not clarify the terms under which the counselling was to take place when the counselling changed from the workplace setting to Mr Simpson's private practice. Neither was the Panel satisfied that Mr Simpson had made the change from workplace to private counselling sufficiently clear to the complainant in a verbal contract. This allegation is therefore upheld in part.
  • II. In evidence, there were conflicting accounts from both parties with regard to whether Mr Simpson had made an inappropriate remark and inviting an affair with the complainant. On balance, the Panel found that there was insufficient evidence to uphold the allegation.
  • III. Again there were conflicting accounts from both parties, as to whether Mr Simpson had abused the complainant's trust and engaged in sexual activity with her. On balance, the Panel found that there was insufficient evidence to uphold this allegation.
  • IV. Mr Simpson had submitted evidence that the issue of client transference had been discussed, at length, in supervision on 8 November 2010 in relation to the complainant. However, on questioning, Mr Simpson admitted that he had "not enough understanding" of the issue of transference and in this respect the Panel found that he was not adequately prepared for any issues of transference that transpired in the counselling session on 10 December 2010. The Panel was not satisfied that Mr Simpson dealt appropriately with the issues of transference in subsequent sessions, or in texts and telephone conversations following the last face to face session on 10 December 2010 and therefore this allegation is upheld.
  • V. There was evidence that Mr Simpson and the complainant had engaged in an exchange of texts and telephone calls between 11 December 2010 and 3 February 2011. On questioning, Mr Simpson stated that he believed he was continuing to work psychotherapeutically in engaging in this exchange. However, there were conflicting accounts as to whether there had been an agreement to terminate the therapeutic relationship after the last session. Therefore, whilst there was an exchange of texts and telephone calls for a further two months after the last session, the Panel was not satisfied that there was sufficient evidence to prove that there had been agreement to terminate the counselling relationship. On balance, the Panel did not uphold this allegation.
  • VI. The Panel found no evidence that Mr Simpson had admitted to the investigating Officer of the complainant's employer that he had failed to keep notes after every counselling session with the complainant. On questioning, it was acknowledged by both parties that Mr Simpson had consulted his case notes during the original investigation by the complainant's employer. This allegation is therefore not upheld.
  • VII. The Panel found no evidence that Mr Simpson had created fictitious notes about the private counselling with the complainant and that he had disclosed these without her consent and without giving her sight of them. This allegation is therefore not upheld.
  • VIII. The Panel found no evidence of dishonesty in Mr Simpson's account of the counselling when responding to the complainant's complaint to her employer and therefore did not uphold this allegation.
  • IX. The Panel found no evidence that Mr Simpson had made disrespectful remarks about the complainant in his response to the complaint to her employer. Mr Simpson had discussed a possible diagnosis relating to the complainant with his supervisor. Following the complaint made to the complainant's employer, Mr Simpson conveyed information regarding the possible diagnosis to the investigators, to indicate the complexities of working with clients showing sudden and dramatic changes in their presentation of themselves. The Panel found that this was not intended to be disrespectful, but was submitted by him in defence of a complaint made against him. Therefore the Panel did not uphold this allegation.
  • X. In light of the above findings, the Panel was satisfied that paragraphs 3 and 12 of the Ethical Framework for Good Practice in Counselling and Psychotherapy 2010, the ethical principles of Autonomy and Beneficence and the personal moral quality of competence had been breached. The Panel was not satisfied that paragraphs 5, 11, 17, 20, 41 & 42, the ethical principles of being trustworthy and non-maleficence nor the personal moral quality of integrity had been breached.

Decision

Accordingly, the Panel was unanimous in its decision that these findings amounted to professional malpractice in that Mr Simpson's practice fell below the standards expected of a practitioner exercising reasonable care and skill.  In particular, he provided the complainant with an inadequate professional service.

Sanction

Within one month from the date of imposition of this sanction, which will run from the expiration of the Appeal deadline, Mr Simpson is required to provide a written submission which evidences his immediate reflection on, learning from and understanding of, the issues raised in this complaint.

In addition, Mr Simpson is required to have monthly supervision for at least one year with a BACP psychodynamic supervisor, other than and in addition to his usual supervisor, to address the specific issues raised in this complaint.  In particular, Mr Simpson, in the light of the Ethical Framework for Good Practice in Counselling and Psychotherapy, is required to address the issues of:

  • transference and counter transference in psychotherapeutic relationships and especially the issue of erotic transference,
  • the responsibilities of working in private practice,
  • contracting,
  • the use of supervision

Mr Simpson is required to begin this monthly supervision within 3 months from the date of imposition of this sanction, and both inform BACP when this starts and provide details of this supervisor. 

Within 3 months of completion of this year's supervision, Mr Simpson is to provide a comprehensive written submission, which demonstrates and evidences his detailed learning from the complaint.  This report should include evidence of having addressed the bullet pointed issues as above.  The report should also include all the dates of the monthly supervision sessions and should be countersigned by the supervisor.

Mr Simpson is also required to provide evidence of formal training, which must be no less than a minimum of 6 hours that addresses the responsibilities and requirements of a lone practitioner working in private practice.  This evidence should be submitted to BACP and should include confirmation of Mr Simpson's attendance from the training provider, within 18 months from the date of imposition of this sanction.

These written submissions must be sent to the Head of Professional Conduct, by the given deadlines, and will be independently considered by a Sanction Panel.