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Hearing Findings, Decision & Sanction

         

October 2014: Maria Louise Thorndyke, Reference, No: 564523, New Zealand

  

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. 

The focus of the complaint, as summarised by the Pre-Hearing Assessment Panel, is that the complainant attended five counselling sessions with Ms Thorndyke in 2009.   

In 2011, the complainant asked Ms Thorndyke if she could see her husband and was surprised that Ms Thorndyke said she could.  The complainant was invited to attend one session with her husband, where she felt attacked by Ms Thorndyke, believing that Ms Thorndyke was paying more attention to her husband's account than her own and allegedly being biased in favour of the complainant's husband.  Allegedly there had been domestic violence, and the complainant believed that this should have been reported by Ms Thorndyke to the authorities, as
allegedly required in New Zealand, particularly since Ms Thorndyke had allegedly reported that the complainant's husband was safe to have unsupervised access to their baby.   

In 2012, the complainant rang Ms Thorndyke to ask for the name of a counsellor she could herself see and allegedly Ms Thorndyke then told the complainant's husband that the complainant had contacted her, reporting their conversation.  Ms Thorndyke also allegedly gave her opinion on matters involved in the divorce proceedings, which caused difficulties.  The complainant further alleges that Ms Thorndyke broke confidentiality, in that she divulged private information about the complainant to her husband; and passed notes on the joint counselling session to her husband's doctor, including passing judgment on the complainant's personality on the basis of little or no evidence.

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 Thorndyke allegedly failed to avoid and to later manage the conflict of interest created by having seen the complainant as a client in 2009, followed by seeing her husband as a client in 2011, and then seeing the complainant in a session with her husband.   

2.    Ms Thorndyke allegedly failed to honour and keep trust with the complainant during the joint session by not being attentive to the quality of listening offered to the complainant and by not treating her with respect. 

3.    Ms Thorndyke allegedly failed to provide the complainant with a good quality of care in conducting the joint session where the complainant experienced the session as biased and not impartial and attacking, resulting in her being distressed.  

4.    Ms Thorndyke allegedly failed to be aware of, understand and manage a legal requirement to report domestic violence where the couple have a child, to the relevant authority. 

5.    Ms Thorndyke allegedly failed to respect the complainant's privacy and confidentiality in disclosing the complainant's personal and confidential information to her husband, to a doctor and to a psychologist, without the complainant's consent. 

6.    Ms Thorndyke's alleged behaviour, as experienced by the complainant, suggests a contravention in particular of paragraphs 1, 11, 10, 20, and 63 and the ethical principles of Being Trustworthy, Beneficence, Non-Maleficence and Justice of the Ethical Framework for Good Practice in Counselling & Psychotherapy (2010/2013), and showed a lack of the personal moral qualities of Respect, Competence, Wisdom, Sincerity and Integrity to which counsellors are strongly encouraged to aspire. 

A typographical error was identified with the numbered paragraphs of the Ethical Framework which were alleged to have been breached by Ms Thorndyke. It was identified that the PHAP report incorrectly referred to paragraph 13 of the Ethical Framework as having been allegedly breached when it should have referred to paragraph 10, which relates directly to allegation number 4 of the Pre-Hearing Assessment Panel's allegations.  The parties were notified accordingly of this typographical error and paragraph 13 of the Ethical Framework has now been deleted and replaced with paragraph 10. 

The Complainant was unable to participate in the hearing.  In view of the Complainant's inability to participate in the hearing, the matter was referred for consideration under paragraph 4.9 of the Professional Conduct Procedure which states: 

Where a Complainant or Member/Registrant Complained Against fails or refuses to attend a Professional Conduct Hearing, the Registrar has the power to decide to either: 

a) proceed with the Hearing in the absence of one or both of the parties; or 

b) adjourn the Hearing to a date not less than 28 days in advance; or 

c) terminate the proceedings; or  

d) refer the matter for consideration under Article 12.6 of the Memorandum & Articles of Association 

The options were carefully considered by the Registrar and a decision was made to proceed with the hearing in the absence of the Complainant, in accordance with paragraph 4.9a).  Both the Complainant and the Member Complained Against were made aware that the hearing would be proceeding in the absence of the Complainant, prior to the commencement of the hearing. 

Findings 

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

1. The Panel listened to the verbal evidence given by Ms Thorndyke in relation to this allegation and considered the written evidence provided by both parties.  The Panel heard that prior to seeing the Complainant in 2011, Ms Thorndyke had previously provided the Complainant with three individual sessions of therapy, two of which were funded under the Primary Lifestyle Options and the remaining session, funded privately by the Complainant.  Ms Thorndyke stated that during these three sessions the Complainant did not refer to     any difficulties with her husband. Ms Thorndyke stated that she was contacted by the Complainant in 2011 with a request that Ms Thorndyke provide counselling to the Complainant's husband.  Ms Thorndyke stated that she commenced therapy with the Complainant's husband and during the second session it became apparent that there were marital issues between the Complainant and her husband.  Ms Thorndyke therefore suggested to the Complainant's husband, that they may benefit from couples counselling and      gave the Complainant's husband the option of them seeing an alternative therapist or for Ms Thorndyke herself to provide couples therapy.  Ms Thorndyke subsequently provided two sessions of couples therapy to the Complainant and her husband and sometime following the cessation of these sessions, agreed to see the Complainant's husband individually again.  The Panel found that Ms Thorndyke failed to foresee the potential conflict of interest that could arise, and did subsequently arise, as a result of her agreeing to see the Complainant and her husband jointly after already having seen both the Complainant and her husband individually and then again seeing the husband individually.  The Panel also found that there was no evidence to demonstrate that Ms Thorndyke had addressed with the Complainant and her husband at the commencement of the joint session, the potential conflict of interest which could arise from her seeing them jointly, or discuss the potential implications of the conflict of interest.  The Panel was also not satisfied from the written and oral evidence provided that Ms Thorndyke had herself sufficiently considered the potential conflict of interest that could arise as a result of her previous relationships with the Complainant and her husband, prior to agreeing to see both parties jointly.  The Panel found that as a result of this, the quality of service provided to the Complainant and her husband was compromised.  The Panel     therefore found that Ms Thorndyke failed to avoid and manage the conflict of interest that was created and this allegation is therefore upheld.  

2. On questioning, Ms Thorndyke stated that she considered that she had managed the joint sessions fairly and had given the Complainant ample opportunity to speak during the session.  In the absence of any further verbal evidence from the Complainant, there was    insufficient evidence to suggest that Ms Thorndyke failed to honour and keep trust with the Complainant during the joint session by not being attentive to the quality of listening offered and not treating the Complainant with respect.  This allegation is therefore not upheld.
 

3. Ms Thorndyke stated in her evidence that she was attempting to manage the time during the session so that both the Complainant and her husband had equal time to discuss the issues that were affecting them.  here was insufficient evidence to demonstrate that in attempting to manage this time, Ms Thorndyke was biased, not impartial and attacked the Complainant.  Further the Panel did not have the opportunity to question the Complainant about the alleged distress that she suffered.  There was therefore insufficient evidence for the Panel to find that Ms Thorndyke failed to provide the Complainant with a good quality of care in this regard.  This allegation is      therefore not upheld.   
  

4. Ms Thorndyke explained that she was aware of her duty to immediately report any issue of domestic violence where children were involved.  The Panel was therefore satisfied that Ms Thorndyke was aware of and understood her obligations to report domestic violence where a child is involved to the proper authorities.  Further the Panel accepted Ms Thorndyke's evidence that there was no disclosure of domestic violence made during the joint session, which would have necessitated a referral.  The Panel therefore did not find that Ms Thorndyke failed to be aware of, understand and manage her requirement to report domestic violence.  This allegation is therefore not upheld.
 

5. The Panel accepted the verbal evidence provided by Ms Thorndyke and the written evidence provided by the Complainant's husband and psychologist in support of Ms Thorndyke's case, that Ms Thorndyke did not disclose to them confidential and personal information concerning the Complainant.  This part of the allegation is not upheld.  The Panel however noted that in a written report provided to the GP concerning the Complainant's husband, Ms Thorndyke made reference to the Complainant and gave opinions, for which she did not have the Complainant's consent.  Although Ms Thorndyke explained to the Panel the procedure for submitting reports to Doctors where the client had been referred under the Primary Lifestyle Option, the Panel noted that it was the Complainant's husband who had been referred to Ms Thorndyke and not the Complainant.  As such, the Panel found that the consent section of the Complainant's referral form, which she completed in respect of the individual sessions she received from Ms Thorndyke in 2010, was not evidence of the Complainant's consent to reveal information about her to her husband's Doctor in 2011.  The Panel noted that the Complainant's      husband had a separate and later referral in relation to his own counselling sessions.  The Panel further found that in submitting a report in 2011, which referenced the Complainant, Ms Thorndyke created a conflict of interest given that she had not obtained consent from the Complainant to refer to her in this way.  The Panel found that Ms Thorndyke referred to information about the Complainant without her  permission or a contract that sufficiently dealt with the issue of confidentiality.  The Panel therefore found that Ms Thorndyke failed to respect the Complainant's privacy and confidentiality in disclosing information to a Doctor without the Complainant's consent.  This      allegation is therefore upheld.  

6. In light of the above findings, the Panel was satisfied that paragraphs 20 & 63 of the Ethical Framework for Good Practice in Counselling and Psychotherapy (2010/2013 edition) and the ethical principles of Being Trustworthy and Beneficence had been breached.  It also found that Ms Thorndyke lacked the personal moral qualities of Competence and Wisdom to which all practitioners are strongly  encouraged to aspire.  The Panel did not find that Ms Thorndyke had breached paragraphs 1, 10 and 11 and the ethical principles of      Non-Maleficence and Justice and did not find that Ms Thorndyke lacked the personal moral qualities of Respect, Sincerity and Integrity.  

Decision

Accordingly, the Panel was unanimous in its decision that these findings amounted to Professional Malpractice in that the service that Ms Thorndyke provided to the Complainant fell below the standards that would reasonably be expected of a practitioner exercising reasonable care and skill.  The Panel found that Ms Thorndyke's actions amounted to recklessness, incompetence and the provision of inadequate professional services.  

Mitigation

When Ms Thorndyke first became aware of the complaint, she gave the Complainant the opportunity to meet with her supervisor to discuss the issues.

Sanction

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

In addition, within 7 months from the date of imposition of this sanction, Ms Thorndyke is required to provide a report that evidences the following: 

  • That Ms Thorndyke has fully thought through all issues relating to conflicts of interests including a working definition of how these can be managed within her work situation;
     
  • How Ms Thorndyke has used supervision to reflect on her learning around conflict of interest and how to recognise and manage conflicts and how to explain potential conflicts of interests to clients and check their understanding of the issues before commencing work. 
  • Ms Thorndyke's developed understanding of her obligation to maintain confidentiality, and to explain the limits of that, particularly in relation to the writing of reports that will be seen by outside agencies 

The above report is to be counter signed by a supervisor outside of Ms Thorndyke's current network, who Ms Thorndyke must have worked with over a period of 6 months, and have received at least 4 sessions of not less than an hour and half supervision per session.  The report must
confirm the number and dates of the supervision sessions.  The supervisor must confirm that the report and the issues raised in the complaint have been discussed in supervision and verify the number and length of sessions that have taken place.
 

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

                                                              

  

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July 2014: Fiona Legh-Ellis, Reference No: 505641, Worthing BN11


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.

The focus of the complaint, as summarised by the Pre-Hearing Assessment Panel, is that on 9 November 2012, the complainant attended an appointment with Ms Legh-Ellis, who was working predominantly with her daughter, but also saw the complainant, her husband and son on occasion.  The complainant alleges that she was disturbed to see her husband's car there, which made her feel very distressed.  The complainant alleges that Ms Legh-Ellis escorted her to a room she had not been in before, left her there, and then returned with some people she did not know.  The complainant alleges she was very frightened and tried to leave the room but was forcibly detained.

The complainant alleges that she remained very frightened and distressed but was detained in the room with a policeman and a lady from social services.  The complainant alleges that she was eventually able to calm down but was concerned that she was being arrested.  The policeman and representative from social services allegedly assured her they were not there to arrest her, but there to help her and to talk.  After approximately one hour the complainant alleges that they left her to talk to her husband and daughter who were in another room at the same premises.

The complainant alleges that Ms Legh-Ellis then returned to the room, but that she was very angry with Ms Legh-Ellis and left the building feeling betrayed and broken.

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:

1.        Ms Legh-Ellis allegedly failed to provide the complainant with a good quality of care, by failing to notify her that the Police and Social Services would be arriving to speak to her during a pre-arranged counselling session, instead taking her into a room in which she had never been before, causing the complainant to feel trapped and scared.

2.        Ms Legh-Ellis allegedly failed to give consideration to the limitations of her training in that it appeared that she had no experience of dealing with child protection issues. 

3.        Ms Legh-Ellis allegedly failed to clarify the rights and responsibilities of both the practitioner and client, with the complainant, in that she did not discuss with the complainant that the Police and Social Services would be attending during her counselling session.

4.        Ms Legh-Ellis allegedly failed to ensure that her records were kept securely and were adequately protected from unauthorised disclosure, by keeping information relating to the complainant in her kitchen.

5.         Ms Legh-Ellis allegedly failed to ensure that she communicated with the complainant in a way which was courteous and clear, in that she failed to notify the complainant, either before or at the time of her visit, that the Police and Social Services would be attending.

6.        Ms Legh-Ellis allegedly failed to ensure that her services were delivered on the basis of the complainant's explicit consent, by not seeking the complainant's consent as to whether or not she wished to talk to the Police and Social Services.

7.        Ms Legh-Ellis allegedly failed to respect the complainant's privacy and confidentiality in that she informed the complainant's husband of her appointment and allegedly failed to ensure that the complainant's personally identifiable information was securely stored.

8.        Ms Legh-Ellis allegedly failed to remedy the harm she may have caused to the complainant in that she did not apologise to the complainant following the visit from the Police and Social Services.

9.        Ms Legh-Ellis allegedly failed to foresee and manage the conflict of interest which could arise as a result of her providing counselling/psychotherapy related services to the complainant, her husband and their daughter.

10.      Ms Legh-Ellis' alleged behaviour, as experienced by the complainant, suggests a contravention in particular of paragraphs 1, 2, 3, 5, 11, 13, 20, 42 and 63, and of the ethical principles of Being Trustworthy, Autonomy, Beneficence and Non-maleficence of the Ethical Framework for Good Practice in Counselling & Psychotherapy (2013), and showed a lack of the personal moral qualities of Integrity, Humility, Competence and Wisdom to which counsellors are strongly encouraged to aspire.

Findings

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

1)        The Panel found that Ms Legh-Ellis was not aware until the Police and Social Services arrived that they wished to speak to the complainant, and accepted her evidence that she had been told by the complainant's then husband that they were there to see him and his daughter.  It could therefore not be said that Ms Legh-Ellis failed to notify the complainant that the Police and Social Services would be arriving to speak to her.  The Panel therefore, did not find that Ms Legh-Ellis failed to provide a good quality of care to the complainant in this regard. 

This part of the allegation is therefore not upheld.

The Panel heard evidence from both parties that the complainant was taken into a room in which she had never been before but accepted that this was because other rooms in the house were occupied.  The complainant stated that she had not felt trapped or scared by being taken into
the room. It was being confronted by representatives of the Police and Social Services entering the room with the purpose of speaking to her which made her feel trapped and scared. 

This part of the allegation is therefore not upheld.

2)        The Panel accepted the evidence of Ms Legh-Ellis that she had experience of child protection issues and that in her practice she had dealt with such issues on three or four occasions.  The complainant accepted that Ms Leigh Ellis had experience in this area.

The Panel therefore, did not find that Ms Legh-Ellis failed to give consideration to the limitations of her training in this instance.

This allegation is therefore not upheld.

3)        The Panel found that Ms Legh-Ellis did clarify the rights and responsibilities of both herself and the client with the complainant and that she provided her with a leaflet setting out those rights and responsibilities at the commencement of their contractual relationship.  Further
the Panel, having heard the evidence of Ms Legh-Ellis, accepted that she did not know that the Police and Social Services were coming to her house until shortly before the complainant had arrived at the house for her appointment and at the time of her arrival there was not an appropriate time or sufficient opportunity for Ms Legh-Ellis to advise her of the arrival of the representatives of the Police and Social Services.

This allegation is therefore not upheld.

4)        The Panel heard from Ms Legh-Ellis evidence as to how she kept her records.  Ms Legh-Ellis in her evidence stated that the only records that were kept in her kitchen were address cards, which contained the contact details of her personal and professional contacts, including clients.  She confirmed in evidence to the Panel that no confidential and personal information had been lost or subject to any unauthorised disclosure and that it would not be possible to determine from the address cards which of them were her clients.  Further, the complainant in her evidence stated that she was satisfied that her personal information had not been subjected to unauthorised disclosure.

This allegation is therefore not upheld.

5)        The Panel found that there was no evidence available that Ms Legh-Ellis failed to communicate with the complainant in a way that was courteous and clear.  Further, as in Allegation 3, and having heard the evidence, the Panel concluded that Ms Legh-Ellis did not know when the
representatives of the Police and Social Services were coming to her house until shortly before the complainant had arrived at the house for her
appointment and that there was not an appropriate time or sufficient opportunity for Ms Legh-Ellis to advise her of the arrival of the representatives of the Police and Social Services. 

This allegation is therefore not upheld.

6)        The Panel heard evidence that Ms Legh-Ellis was initially not aware that the representatives of the Police and Social Services wanted to speak to the complainant.  It was only when she went downstairs to let the representatives of the Police and Social Services into the house that she became aware that they wanted to speak to the complainant.  The representative from the Police said that they would go upstairs and  introduce themselves to the complainant.  However, the Panel found that, given that it was Ms Legh-Ellis' house and that the complainant was there to see her, that she should have gone upstairs alone and advised the complainant that the Police and Social Services wanted to speak to her and find out from the complainant if she was prepared to meet with them.

Therefore Ms Legh-Ellis failed to ensure that her services were delivered on the basis of the complainant's explicit consent and therefore, this allegation is upheld.

7)        The Panel found that due to the nature of the counselling services provided by Ms Legh-Ellis to the complainant and her family, the work provided was not covered by a confidentiality agreement and no explicit instructions had been given by the complainant to Ms Legh-Ellis that she could not talk to her then husband about her appointment times.  In the circumstances, Ms Legh-Ellis was entitled to inform the complainant's then husband of her appointment.

This part of the allegation is therefore not upheld.

Further the Panel found that personal information relating to the complainant was not kept in an unsecure way.  The Panel heard that the
complainant's name and contact details were kept on an index card, which was stored in a box in her kitchen and her records were kept in a locked filing cabinet.  The Panel further heard that although the index cards had got mixed up, they had not been lost.

This part of the allegation is therefore not upheld.

8)        The Panel found that Ms Legh-Ellis did not apologise to the complainant following the visit of the representatives of the Police and Social Services.  Although Ms Legh-Ellis was not aware that the Police and Social Services would arrive at the same time as the complainant, nevertheless it was her house, and she may reasonably have been expected to contain the situation, or to acknowledge the distress caused subsequently. Therefore, the Panel found that given all the circumstances of the visit to the house by the representatives of the Police and Social Services, Ms Legh-Ellis should have apologised to the complainant.  Further the Panel considered that Ms Legh-Ellis could have apologised to the complainant during the course of the Professional Conduct Hearing, which the Panel noted she did not do despite spending a considerable period of time during the Professional Conduct Hearing in the same room as the complainant with more than adequate opportunity to do so.

This allegation is therefore upheld.

9)        The Panel found from the evidence that there was a conflict of interest.  The Panel found that a counsellor should not work with a person "making a disclosure" and the party about whom "that disclosure is made", as had occurred in this case.  The Panel further found from the evidence that Ms Legh-Ellis failed to foresee that such a conflict could arise in her working relationship with the complainant's family.  The Panel found that if Ms Legh-Ellis had trained as a family therapist she would have learnt to deal with these matters.  Although the Panel accepted
that Ms Legh-Ellis was not offering family therapy, but support, she accepted in her oral evidence that the distinction was unclear and that these incidents involving the complainant and her family were such that she was acting outside her sphere of competence.  The Panel found that she
should have acted earlier to cancel her appointment with the complainant in the knowledge of the report that was going to be made by the complainant's then husband to the Police and Social Services. 

This allegation is therefore upheld. 

10)     In light of the above findings the Panel was satisfied that there was a contravention of paragraphs 13, 42 and 63 and the ethical principles of Autonomy, Beneficence and Non-maleficence of the Ethical Framework for Good Practice in Counselling & Psychotherapy (2013).  The Panel also found that Ms Legh-Ellis showed a lack of the personal moral qualities of Humility, Competence and Wisdom to which all counsellors are strongly encouraged to aspire.

However, the Panel was satisfied that there was no contravention of paragraphs 1, 2, 3, 5, 11, and 20 or the ethical principle of Being Trustworthy of the Ethical Framework for Good Practice in Counselling & Psychotherapy (2013).  The Panel also found that Ms Legh-Ellis did
not show a lack of the personal moral quality of Integrity.

Decision

In light of these findings and the allegations that were upheld, the Panel was unanimous in its decision that these amounted to professional malpractice on the grounds of inadequate professional services.

Mitigation

The Panel accepted the evidence of Ms Legh-Ellis that she no longer provided family support services and in particular that Ms Legh-Ellis no longer worked with complex families.

Ms Legh-Ellis stated that she had changed her record keeping and had further changed her procedures.

The Panel further accepted that on the day in question, which founded the basis of these allegations, it was a complex situation and Ms Legh-Ellis was overwhelmed by events.

Ms Legh-Ellis stated that there were things that she could have done better with the benefit of hindsight and she had acknowledged that she should have done things differently.

Sanction

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

Within six months from the date of imposition, Ms Legh-Ellis should provide a statement setting out her overall understanding of the events, and in particular her increased understanding of the significance of the need to remedy harm and apologise to clients who allege harm. 

Within the above statement Ms Legh-Ellis is required to confirm that she has discussed in supervision these issues with her supervisor and her supervisor is required to countersign the statement confirming such discussions did take place. 

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.

  

  

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June 2014: Linda Henderson, Reference No: 522038, London SE3 

The complaint against the above individual member/registrant 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. 

The focus of the complaint, as summarised by the Pre-Hearing Assessment Panel, is that the complainant sought counselling with Ms Henderson on 29 November 2012.  Ms Henderson agreed to see her on Monday 3 December but pointed out to her that she was shortly to go on a  retreat and that as a consequence after this first session there might have to be a break for 3 weeks.  At this first and only session, the complainant alleged that Ms Henderson responded to her inappropriately, did not give her the opportunity to divulge information as she wanted, fired questions at her that she did not allow her to answer, and "upset her greatly".  By the end of the session, the complainant stated that she felt "very low indeed; that she was in tears and that she felt like stepping out in front of cars in the dark and rain."  In particular, the complainant
alleged that Ms Henderson failed to address the vulnerable state she was in, having been told by the complainant that she wanted her cancer to return and take her life.   

In accepting this complaint, the Pre-Hearing Assessment Panel was concerned with the following areas, and in particular these are: 

1.   Ms Henderson allegedly failed to provide a good quality of care in that the service she delivered to the complainant during this first session, and in particular the alleged challenging approach she adopted at that early stage of counselling, did not sufficiently address the complainant's needs arising from her vulnerability at that time. 

2.   Ms Henderson allegedly failed to adequately assess and manage the risk the complainant posed to herself in that she failed to appropriately address the manifest distress exhibited by the complainant during that session, which she recorded in her notes as "Death wish", and failed to question whether she was in a sufficiently fit state of mind to leave the session without some follow up action on her part. 

3.   Ms Henderson's alleged behaviour as experienced by the complainant suggests a lack of the personal moral qualities of Empathy and Wisdom to which all practitioners are strongly urged to aspire; a contravention of paragraphs 1 and 14 of the Ethical Framework for Good Practice in Counselling and Psychotherapy (2010 edition); and the ethical principle of Beneficence. 

Neither the complainant nor Ms Henderson attended the Hearing. 

The matter was referred for consideration under paragraph 4.9 of the Professional Conduct Procedure, which states: 

"Where a Complainant or Member Complained Against fails or refuses to attend a Professional Conduct Hearing the Head of Professional Conduct (the Registrar) has the power to decide to either 

(a)        proceed with the hearing in the absence of one or both of the parties or

(b)        adjourn the hearing to a date not less than 28 days in advance or 

(c)       terminate the proceedings or  

(d)        refer the matter for consideration under article 4.6 (now known as 12.6) of the Memorandum and Articles of Association 

The options were carefully considered and in light of the circumstances, a decision was made to proceed with the adjudication hearing in the absence of both parties. 

It would have been of assistance to the Panel to have the benefit of questioning both parties in relation to their evidence to assist it in making a
determination in respect of the findings.  However, in the absence of both parties, the Panel had to base their decision solely on the written evidence provided by both parties.      

Findings  

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

1. On the basis of the notes provided by the Ms Henderson, there was no evidence to suggest to the Panel that an assessment of the needs of the complainant had been carried out, that any explanation had been given to the complainant about the process that would be followed during the counselling session and there was no evidence that a contract was discussed.  The Panel found that there was evidence within the notes submitted that Ms Henderson had adopted a challenging approach to the complainant and had made an immediate assessment of her, which did not sufficiently address the complainant's needs.  This was particularly so given the complainant's vulnerable state, which was recorded within the notes, and the fact that this was the complainant's first session with Ms Henderson.  The Panel noted the references within the notes to the complainant "finding it difficult to connect to her real feelings" and the complainant "feeling happy at the thought of dying of cancer".  The Panel found that Ms Henderson failed to address the needs of the complainant that arose during the single counselling session in that she did not pursue either the opportunity of referral or provide any offer of further support following the disclosures made by the complainant, other than a book that she had ‘dipped in to'.  The Panel agreed that this offered a wholly inadequate service to the complainant which did not sufficiently address her needs and therefore, found that Ms Henderson failed to provide a good quality of care to the complainant.   

This allegation is therefore upheld.  

2.   There appeared to the Panel to be a lack of a thorough and rigorous assessment and management of the risk the complainant posed to herself, in that there was nothing within the written evidence provided by Ms Henderson to suggest that she appropriately addressed the manifest distress exhibited by the complainant, and evidenced within her notes.  The written response provided by Ms Henderson registered her shock regarding the points described within the complainant's written complaint in which the complainant described her emotional state both within and following the single counselling session.  The Panel was concerned that within the notes submitted by Ms Henderson, there was evidence to suggest that she had failed to recognise and act upon the degree of distress that was being displayed by the complainant and failed to ensure that the complainant was in a sufficiently fit state of mind to leave the counselling session.  Further there was nothing within the written
evidence provided to suggest that Ms Henderson offered the complainant any further support or offered other ways in which she could obtain help, particularly in light of the fact that Ms Henderson was leaving to go on a 3 week retreat.  The Panel found that these elements all contributed to an inadequate assessment and management of the complainant's concerns.                                                                         

This allegation is therefore upheld.                                                                             

3.   In light of the above findings, the Panel was satisfied that paragraphs 1 and 14 of the Ethical Framework for Good Practice in Counselling and Psychotherapy (2010 edition) and the ethical principle of beneficence had been breached.  It also found a lack of the personal moral qualities of empathy and wisdom to which all practitioners are strongly urged to aspire.   

Mitigation 

The Panel found that there was no mitigation, in that Ms Henderson was not in attendance and did not provide any evidence within her written response that reflected any mitigation given that there was a complete denial of the allegations. 

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. 

Sanction 

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

At the same time as submitting her immediate reflections, Ms Henderson is required to provide details of her supervisor to BACP, to include name, qualifications and how long the supervisor has been supervising Ms Henderson. 

Within six months from the date of imposition of this sanction, Ms Henderson shall provide a reflective diary that she has kept of not less than 2000 words dealing with the issues raised in this complaint.  This diary must be counter signed by the Ms Henderson's supervisor to confirm having read its content. 

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.

                        

  

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June 2014: Kerry North, Reference No: 585063, Doncaster DN7

  

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.

The focus of the complaint, as summarised by the Pre-Hearing Assessment Panel, is that the complainant began individual counselling with Miss North in May 2011 and continued on a regular basis, (usually weekly) until 6 November 2012. 

The complainant alleges that he felt a strong connection with Miss North from an early stage in the counselling relationship, which felt more like a friendship than a counselling relationship, in part due to their alleged informal discussions around spirituality, her alleged self- disclosure about her life and her informal approach.

The complainant alleges that on 13 June 2012, Miss North sent him a series of unsolicited texts of a personal nature.  The complainant was aware that this breached ethical boundaries and felt that their relationship had moved to one of friendship.  The complainant alleges that as the relationship developed he felt more loved and wanted than he had ever previously felt in his life.

During the period between 13 June 2012 and the last session in November 2012, the complainant alleges that each session ended with a hug and during this period the complainant alleges that the venue of the meetings moved to his home, with the agreement of his wife, or on occasion the home of Miss North.  The complainant alleges that he paid extra for their sessions to reflect the additional travel time and petrol costs, as Miss North was allegedly experiencing financial difficulties.  The complainant also alleges that during this latter period, text messaging became a feature of their relationship, in which a fun rapport developed, and subsequently the complainant alleges that he was able to declare his love for Miss North, which was allegedly reciprocated by text by Miss North.

Towards the end of their relationship in November 2012, the complainant alleges that Miss North started to withdraw from the friendship and steer the relationship back to a more professional stance.  The complainant alleges that he challenged this change in focus and was left devastated when the sessions ended on 6 November 2012, in an unplanned manner.  The complainant alleges Miss North offered to refer him on but that he did not want to start the process over again.

Following the last session, the complainant alleges that he wrote a number of letters to Miss North to ask for an explanation of her behaviour, which culminated in a further two and half hour meeting at her home on 15 March 2013, in which Miss North allegedly offered the complainant the opportunity to revisit her after a few months.

Following the meeting on 15 March 2013, the complainant alleges that later on the same day and again the following day, Miss North texted him with an opportunity to work together in a spiritual group with one of her friends.  The complainant alleges that he was pleased by this response and contacted her friend.  The complainant alleges that Miss North was displeased by his contact with her friend and disengaged from her  original suggestion.

Following this period of counselling the complainant alleges that he was left feeling rejected, taken advantage of, used and discarded.

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:

1.    Ms North allegedly failed to provide the complainant with a good quality of care in that she abruptly terminated therapy, leaving the complainant feeling unsafe.

2.    Ms North allegedly failed to provide the complainant with a good quality of care and maintain appropriate boundaries in the counselling relationship by engaging in extensive out of session text and telephone contact and contacting the complainant, in distress and seeking his guidance, causing the complainant to believe that she had feelings for him and that he was special.

3.    Ms North allegedly failed to provide the complainant with a good quality of care in that she failed to manage appropriately or at all, the
issue of transference/counter-transference when the complainant declared his love for her and instead allegedly confirmed via text that his love for her was reciprocated and then allegedly subsequently told the complainant that she was projecting her feelings for her ex-husband onto him.

4.    Ms North allegedly failed to clarify and agree the rights and responsibilities of both her and the complainant in that she allegedly:

a)    did not make the complainant aware of the circumstances in which therapy would end;

b)    was not clear where therapy would take place, some of the sessions occurring at Ms North's house and others at the complainant's;

c)    failed to be clear about what charge would be made for these sessions, resulting in the complainant paying over and above the agreed rate on occasion;

d)    did not carry out any reviews in relation to the progress the complainant was making with regard to the therapy;

e)    did not discuss the issue of confidentiality and the circumstances in which information relating to him would be disclosed.

5. Ms North allegedly entered into a dual relationship with the complainant as a friend and counsellor through engaging in regular out of session text messages and telephone calls, sharing personal details, inviting the complainant to form a spiritual group with her, referring to the  complainant as "big bro" in her text messages, concluding her text messages with an x, denoting a kiss, and through allegedly meeting the complainant regularly on a social basis. 

6. Ms North allegedly failed to honour the trust of the complainant by discussing him with others, thereby failing to respect his privacy and confidentiality.

7. Ms North allegedly failed to respond to the complainant's request for information, in that she did not respond to his request for access to his notes and the details of her supervisor.

8. Ms North allegedly abused the complainant's trust in order to gain emotional and financial advantage by; hugging him at the end of      sessions, suggesting that they set up a spiritual group, taking money from the complainant which was not in respect of the counselling work they were doing and entering into a personal relationship with the complainant, which led him to feel loved and subsequently misled emotionally when the relationship ended.  

9. Ms North allegedly did not exercise caution before entering into a personal relationship with the complainant.

10. Ms North allegedly failed to maintain her fitness to practise in that she contacted the complainant in distress and spent some of the      counselling sessions discussing her own personal issues.

11. Ms North allegedly failed to notify the complainant of the existence of the Professional Conduct Procedure when she became aware that he was dissatisfied with the counselling.

12. Ms North was allegedly not honest, straightforward and accountable to the complainant in respect of all financial matters, in that she allegedly took money from the complainant for a meeting which was in the guise of a counselling session, accepted money which was for her personal benefit and not in respect of counselling, and accepted additional money for the therapy sessions over and above the usual fee.

13. Ms North allegedly failed to ensure that the way that she undertook her work was as safe as possible and that she sought professional support when needed, in that she allegedly contacted the complainant in distress and used the therapy sessions and their social meetings to discuss her own personal problems.

14.  Ms North's alleged behaviour, as experienced by the complainant, suggests a contravention in particular of paragraphs 1, 3, 4, 11, 16, 17, 40, 46, 62 and 64 and the ethical principles of Being Trustworthy, Autonomy, Beneficence, Non-Maleficence and Justice of the Ethical Framework for Good Practice in Counselling & Psychotherapy (2013), and showed a lack of the personal moral qualities of Sincerity, Integrity, Humility, Competence and Wisdom to which counsellors are strongly encouraged to aspire.

Findings

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

1. The Panel found on the basis of the evidence that Miss North did not provide the complainant with a good quality of care in that she abruptly terminated therapy in or about 11 November 2012 following an incident where the complainant had hugged and kissed her at the end of the session. Miss North, in her verbal evidence to the Panel said that she had been shocked by the incident and had made an excuse, telling the complainant that she would not be able to continue the counselling sessions at his home, stating that she did not want to drive in the dark and had family demands. The Panel therefore found that Miss North had left the session abruptly and that this abrupt exit had left the complainant feeling unsafe.

This allegation is therefore upheld.

2.   Miss North accepted that she exchanged frequent text messages with the complainant, had telephone contact with him and contacted the complainant when she was in a distressed condition seeking his guidance.  The Panel further found that as a result of this contact the complainant believed that Miss North had feelings for him and that he was special.  On the basis of this evidence the Panel found that Miss North had failed to provide the complainant with a good quality of care and maintain appropriate boundaries.

This allegation is therefore upheld.

3.   The Panel found that on the basis of the evidence Miss North had failed to manage the issue of transference/counter transference in that following text messages and emails from the complainant where he declared his love for her, Miss North confirmed by text to the complainant that his love for her was reciprocated. The Panel found that this amounted to a failure to provide a good quality of care in that Miss North had failed to maintain appropriate boundaries in the counselling relationship.

The Panel further found that Miss North had told the complainant, in a phonecall on 13 November 2012, that she had projected her feelings about her ex-husband onto the complainant.

The allegation is therefore upheld.

4.   The  Panel made the following findings.

a)  It was conceded in evidence by the complainant that he was told at the commencement of the counselling contract of the circumstances in
which counselling would come to an end.  This part of the allegation is therefore not upheld.

b)  It was conceded by the complainant that some sessions took place at Miss North's home and others at the complainant's home.  The
complainant conceded that he was content with this arrangement.  This part of the allegation is therefore not upheld.

c)  The Panel found that there was agreement between Miss North and the complainant that payment had been discussed and made clear and that Miss North had accepted additional payment for sessions from the complainant. The complainant stated that he had been happy to pay over and above the agreed rate on occasion to help Miss North who he knew to be in strained financial circumstances. This part of the allegation is therefore not upheld.

d)  The Panel further found that on the basis of the evidence reviews were carried out by Miss North regarding the progress the complainant was making with therapy.  This part of the allegation is therefore not upheld.

e)  The Panel found, having heard the evidence, that Miss North did discuss issues of confidentiality, and the circumstances in which information relating to him would be disclosed with the complainant at the beginning of their counselling relationship.  This part of the allegation is therefore not upheld.

In view of the above findings, this allegation is not upheld.

5.   The Panel found that Miss North did enter into a dual relationship with the complainant as a counsellor and a friend through engaging in regular out of session texting, phonecalls and emails and the sharing of personal details.  This dual relationship was evidenced by the text and email communications that passed between the complainant and Miss North outside counselling sessions where she referred to the complainant as "big bro" and ended texts with an x denoting a kiss. Miss North admitted in her written evidence that she had a social relationship with the complainant and that she had used him as a support friend when distressed. In addition the Panel found that in her written and verbal evidence Miss North admitted that she had invited the complainant to form a spiritual group with her.

The allegation is therefore upheld.

6.   The Panel found that Miss North did discuss the complainant in supervision and that this was normal practice, and accepted that Miss North did not disclose his name. The Panel therefore found that Miss North had not failed to respect the complainant's privacy and confidentiality. The Panel further found that Miss North did not discuss the complainant with any other person. The Panel found that it was the complainant himself who had spoken to Miss North's friend [ . . . ] to introduce himself to her.

This allegation is therefore not upheld.

7.  Following Miss North's admission that she had not sent the complainant his records or the details of her supervisor as requested by him, the Panel did accept her evidence that she had not done so as she had taken advice and had been told that she was not obliged to do so.

The Panel were however concerned that Miss North had not sufficiently taken into account her responsibilities and her client's rights under the data protection legislation.

This allegation is therefore upheld.

8.   The Panel found that Miss North by entering into a dual relationship and by accepting money for sessions which focussed on her issues rather than on the complainant's needs did gain emotional and financial advantage.  The Panel found that Miss North hugged the complainant at the end of counselling sessions and entered into a personal relationship with him which led him to feel special.

The Panel found that Miss North suggested setting up a spiritual group in March 2013 in an attempt to temporarily provide support for the  complainant. The  Panel found that this was more for Miss North's immediate benefit than the complainant's.

The Panel found that there was no evidence to suggest that Miss North had imposed any boundaries upon the counselling relationship and that in fostering a personal relationship had emotionally misled the complainant to believe he was loved.

The allegation is therefore upheld.

9.    The Panel found that Miss North had phoned the complainant in distress in June 2012 when her personal life was in crisis and that this contact led the complainant to believe that she was seeking his help as a friend. The Panel found that this contact indicated the start of the personal relationship between Miss North and the complainant and that by phoning the complainant under such circumstances evidenced that Miss North did not exercise caution before entering into a personal relationship with the complainant.

This allegation is therefore upheld. 

10. The Panel found on the basis of the evidence that Miss North had contacted the complainant in distress following an argument with her partner in or about June 2012 and that time had been spent in counselling sessions discussing her personal issues rather than those of the complainant.   As such the Panel found that Miss North had failed to monitor and maintain her fitness to practise. 

This allegation is therefore upheld.

11.  The Panel found that Miss North did notify the complainant in June 2012 of the Professional Conduct Procedures. The complainant in evidence stated that he could not remember whether this had occurred or not. 

The Panel accepted the evidence given by the Member Complained Against and as such this allegation is therefore not upheld.

12. The Panel found, on the basis of Miss North's written and verbal  evidence that monies were paid by the complainant to Miss North which were not in payment of counselling sessions for the complainant but which were for her own personal benefit and that she had accepted money in addition to the normal counselling fee.  Therefore the Panel found that Miss North was not honest, straight forward and accountable to the complainant in respect of all financial matters.

This allegation is therefore upheld.

13.  The Panel found that Miss North had contacted the complainant in distress, had used his therapy sessions and social meetings for her
personal problems and that she had failed to seek professional support for these issues. Miss North admitted in evidence to the Panel that she had had regular supervision but that she had not used it appropriately because she believed her supervisor was stressed. Miss North admitted that she had undertaken the supervision knowing it was inadequate and did not meet her needs in respect of her work with the complainant and that she had failed to ensure that the work she undertook with the complainant was safe. 

This allegation is therefore upheld.

In the light of the above findings the Panel was satisfied that there was a contravention of paragraphs 1, 3, 4, 16, 17, 40, 62 and 64 of the Ethical Framework for Good Practice in Counselling & Psychotherapy (2013). 

The Panel found that there was no breach of paragraphs 11 and 46 of the Ethical Framework for Good Practice in Counselling & Psychotherapy (2013). 

The Panel found that the ethical principles of Being Trustworthy, Beneficence and Non-maleficence had been breached.  The Panel found that the ethical principles of Autonomy and Justice contained in the Ethical Framework for Good Practice in Counselling & Psychotherapy (2013) had not been breached. 

Further the Panel found that Miss North showed a lack of the personal moral qualities of Sincerity, Integrity, Humility, Competence and Wisdom to which counsellors are strongly encouraged to aspire.

Decision

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

Mitigation

The Panel considered in mitigation the fact that Miss North had apologised unreservedly both through her barrister at the hearing and also personally to the complainant. 

The Panel also took into consideration that Miss North had taken no new private clients from Christmas 2012 and had undergone a brief 2 hour training on boundaries. 

The Panel further took into consideration the fact that Miss North was having personal therapy and in the light of the matters forming these
allegations she had changed her supervisor. 

The Panel also took account of her statement that she recognised the breaches as being serious and had sought assistance from the Panel during the hearing as to how she could remedy those breaches. 

The Panel also took account of Miss North's declaration that she would not work again in private practice without undertaking a substantial amount of further training.

The Panel also took cognisance of the testimonials that had been filed with the other documentation for the purposes of the hearing.

Sanction

The Panel decided on the following sanctions:

  • Within one month from the date of the imposition of this sanction, which will run from the expiration of the Appeal deadline and in the
    event of an appeal on exhaustion of the appeals process. Miss North is required to provide a written submission of no less than 2000 words, which evidences her immediate reflection on, learning from and understanding of, the issues raised in this complaint.
  • Within 12 months from the date of the imposition of this sanction, Miss North is required to attend training courses covering the topics listed below, each course of 6 hours duration and provide evidence of completion of same:-
  • The principles, practicalities and ethics of working in private practice.
  • The maintenance of boundaries and their importance in counselling relationships.
  • Transference, counter-transference and erotic transference in counselling relationships

Miss North will be required to demonstrate her learning from the above trainings in a written submission of no less than 2000 words. This submission to be made within 3 months of the completion of the training.

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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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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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: 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.