Professional conduct notice | Elizabeth Ann Farrow

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, was as follows:

The Complainant had an assessment session with Ms Farrow, on 21 November 2015, which she found helpful. She then contracted for 6 further sessions, which she paid for in advance.

When the Complainant arrived for the first session on 4 December 2015, she got no answer, despite having texted, emailed and finally putting a note through the door. Ms Farrow called her back later and alleged that she had texted previously to postpone the session. The Complainant accepted the apology and they rescheduled.

At the rescheduled session some days later, Ms Farrow was unwell and had to leave the room on more than one occasion, in order to get throat sweets and drinks. In addition, she sometimes coughed uncontrollably, which meant that the focus of the session was often on her rather than the Complainant.

Due to Ms Farrow being ill, the second session was delayed for some weeks. When it was re-arranged, the Complainant requested a double session. When the Complainant arrived at the allotted time, Ms Farrow was not ready for her, telling the Complainant that her keys were missing. She rang [ . . . ] whilst the Complainant waited, and then completed a form before she was ready to begin the session, which consequently started late. The Complainant, already distressed, was shocked by this behaviour.

A fourth session, via telephone was arranged, but Ms Farrow again changed the time. The Complainant understood that this would be a review and therefore used it to express her discomfort about the alleged lack of care or due diligence around administrative issues. Allegedly, Ms Farrow implied that the issue was with the Complainant rather than with her, and refused to acknowledge or discuss the concerns raised. The Complainant decided that trust was broken and requested a refund for the remaining sessions. Whilst Ms Farrow did respond to the request, she refused the refund on the grounds that if her sessional rates were applied to work she had undertaken such as further assessment of the Complainant's needs, and a search for a counsellor in the Complainant's area, that would equal the amount paid.

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

1. Ms Farrow allegedly failed to provide a good quality of care and competently delivered service that met the Complainant's needs, in that: Ms Farrow was not ready for the Complainant when she (the Complainant) arrived punctually for her session scheduled for 4 January 2016, leaving the Complainant to wait for her session to begin whilst Ms Farrow attended to her personal matters; Ms Farrow in the session of 4 January 2016 made a personal call in front of the Complainant and disclosed personal issues to her; Ms Farrow did not ensure that the Complainant was made aware that she had postponed their first session particularly when Ms Farrow was aware that she had problems with her own mobile phone.

2. Ms Farrow allegedly was not clear about her commitments to be available to the Complainant and honour her commitments to the Complainant in that; Ms Farrow changed the appointment time set for 18 January 2016, at very short notice, telling the Complainant that it was because of a safeguarding issue; Ms Farrow did not begin her appointment with the Complainant on time for the session of 4 January 2016.

3. Ms Farrow allegedly did not monitor and maintain her fitness to practise at a level that enabled her to provide an effective service, in that she held a session with the Complainant on 7 December 2015, when her fitness to practise had been impaired, Ms Farrow being unwell, sometimes coughing uncontrollably and leaving the room on more than one occasion to attend to herself.

4. Ms Farrow allegedly failed to respond appropriately to the complaint from the Complainant in that when the Complainant raised concerns with Ms Farrow in the fourth session, Ms Farrow did not respond appropriately to her concerns.

5. Ms Farrow allegedly failed to endeavour to remedy any harm that she may have caused to the Complainant and to prevent further harm to her in that; Ms Farrow did not offer the Complainant a fuller discussion of the Complainant's concerns; Ms Farrow did not offer an apology to the Complainant.

6. Ms Farrow allegedly did not clarify the terms on which she offered the complainant her services in advance of the Complainant incurring any financial obligation, in that; Ms Farrow claimed that she had discounted the fees when the Complainant had not been made aware of that from the outset; Ms Farrow claimed that she was charging for additional services carried out with respect to the Complainant when the Complainant had not been made aware from the outset.

7. Ms Farrow's alleged behaviour, as experienced by the Complainant, and as identified in the numbered paragraphs referred to above suggests a contravention in particular of paragraphs 1, 19, 40, 41, 42 and 59 and the ethical principles of Being Trustworthy, Autonomy, Beneficence, Non-Maleficence and Self-Respect of the Ethical Framework for Good Practice in Counselling & Psychotherapy (2013), and showed a lack of the personal moral qualities of Empathy, Sincerity, Integrity, Respect, Competence and Wisdom to which counsellors are strongly encouraged to aspire.

Application for new evidence

An application was made, by the Complainant, to submit late evidence under the protocol on New Evidence. In considering the reasons given by the Complainant, the Professional Conduct Panel decided to accept the new evidence on the basis that there was good and sufficient reason for the late production. The application was therefore accepted and the late evidence was included in the written materials.

An application was made, by the Member, to submit late evidence under the protocol on New Evidence. In considering the reasons given by the Member's legal representative, the Professional Conduct Panel decided to accept the new evidence on the basis that there was good and sufficient reason for the late production. The application was therefore accepted and the late evidence was included in the written materials.

Preliminary finding

In considering the evidence, the Panel had regard to the handwritten and typed notes provided by the Member, which were relied upon by her to counter the allegations made and therefore went to the probity of the evidence given by the member throughout the Hearing. The Panel firstly sought to establish the purpose and the timing of the handwritten and typed up notes. The Member explained that she would make handwritten process notes in the session, as well as clinical notes for supervision. She would then type up her session notes based on her memory and the handwritten process notes, as presented in her written evidence.

The Panel questioned the Member carefully about the typed notes, which she stated had been made from her contemporaneous notes taken during sessions. When asked whether her notes were typed up at the end of the day, the Member indicated positively that this was the case. She indicated that it was her preferred way of working and that they provided an audit trail as well as being used for her own personal supervision. When asked directly as to whether they were sometimes typed up at a later date, specifically in response to this complaint, the Member indicated that they were done on a day to day basis. But she also stated that if a phone call or email was made these would be added to the notes, although only if the information was relevant. The Panel pursued the line of questioning and in particular whether she had updated the notes once she was aware the complaint had been made as the notes appeared to conflict with the handwritten notes on some points and also with other information provided to the Panel. As a part of this, the Panel pointed to a sentence in the typed up notes that referred to an email which post-dated that particular session and so could not have been known at the time the notes were typed if they were typed on that day. In response the Member stated she had not updated the notes following the complaint although with regard to the specific example of the postdated email, the Member responded that she may have typed up the notes at the end of that week, rather than on the day.

The Panel having heard the responses by the Member regarding when the notes were made and noting some of the conflicts between the handwritten and typed notes, as well as the verbal evidence on the day, could not be satisfied as to the accuracy of the typed notes or whether they were contemporaneous and did not find they were a reliable source of evidence.

Findings

1. The Panel dealt with allegation 1 in two parts as follows;

(a) The Panel questioned both parties very carefully as to whether the Complainant had arrived punctually for her session on 4 January 2016. The Complainant stated that her [ . . . ] has driven her to her appointment and she sat in the car with her [ . . . ] until about a minute before the appointment. She stated that she watched the clock. She also stated, that she was well aware of the issues of boundaries and would not have attended early, as the counselling took place at the Member's home, and she would not want to cross with another of the Member's clients. The Complainant explained in detail that when she arrived she was taken to the therapy room and that the Member told her she had lost her keys, the Member then made a call to [ . . . ], she then tended to a parcel which she labeled and left at the front door. The Complainant stated that she had to wait for the Member to tend to these issues and so her session did not begin on time. The Member, when questioned, denied that she talked about lost keys, nor that she made a call to [ . . . ], she stated that she did not know what this was about. She also stated that she did not tend to a parcel, and as her [ . . . ] was working from home he would have done this. The Member stated that the Complainant arrived early and she let her in and took her to the therapy room, got her a drink, tended to security and switched on her answer machine. When questioned about how early the Complainant arrived the Member clarified this to be a few minutes and stated that the session began on time. The Panel also took note of the statement made by the Complainant's [ . . . ], in particular her evidence that on 4 January 2016 she took her [ . . . ] to the appointment at the agreed time. The Panel noted the conflict of evidence between the parties, however having carefully considered the evidence before it the Panel preferred the account of the Complainant which it found to be detailed, very clear and consistent throughout. The Panel found, on balance, that the Member was not ready for the Complainant when she arrived punctually for her session on 4 January 2016 and attended to personal matters
before starting the session such that the session started late and therefore the Member had failed to failed to provide a good quality of care and competently delivered services that met the Complainant's needs.

(b) The Panel questioned both parties regarding the postponement of their first session. The Panel heard evidence from the Complainant, in which she explained that on arrival for the scheduled appointment the Member did not answer the door. She stated that she called the Member three times and did not receive an answer and that she left a voicemail. She also posted a note, through the Member's door as she was concerned. The Complainant was adamant that she did not receive any missed calls or messages from the Member. The Member did eventually call her to apologise and the session was re-scheduled. Whilst the Complainant, at that time suggested that it might be her, the Complainants, phone that was an issue, she clarified on questioning that this was an assumption she had made and that there was no issue with her phone. The Panel questioned the Member, who stated that the Complainant had not confirmed the session and that her diary had changed in the meantime. The Panel pointed the Member to an email dated 28 November 2015, in which she confirmed with the Complainant the first appointment. The Panel noted that payment for the 6 arranged sessions had been paid in full. The Panel also made reference to the handwritten notes of the Member, which in the Panel's view was a clear note of what happened with regard to the first session on 4 December 2015. The note made reference to circumstances outside of the Member's control, which caused her to cancel all afternoon appointments, due to sudden illness, the Member had also made reference in the notes to her phone behaving badly, and that it was due for an upgrade. When questioned about her handwritten note, the Member stated that the note was not dated, and that she could not read it, she also denied that she had been sick that day. She also stated that, notwithstanding the statement to the contrary in her own notes, there was no problem with her mobile phone. The Panel considered that the Member's evidence was inconsistent. The Panel however, found that the Complainant's evidence was consistent and clear and preferred the evidence of the Complainant. The Panel therefore found that the Member did not ensure that the Complainant was made aware that she had postponed their first session particularly when the Member knew she had problems with her own mobile phone, and could have taken adequate steps by other means to ensure the Complainant was aware the session had been postponed.

Allegation 1 is therefore upheld in its entirety.

2. The Panel questioned the Member with regard to the appointment scheduled on 18 January, which was moved from the agreed time. The Member accepted that she had changed her appointment with the Complainant only an hour or so before it was due to take place citing a safeguarding issue as the reason for the change. The Panel asked the Member whether she had explained to the Complainant that safeguarding issues would take priority. In response the Member made reference to a term in the Contract which stated that ‘safeguarding and child protection are of paramount importance and information would be shared in this regard'. The Panel pointed out that this did not state that safeguarding issues would take priority and that in any event this clause related only to questions of maintaining confidentiality. The Member stated that she would have explained this to the Complainant when going through the Contract with the Complainant. When questioned, the Complainant was adamant that she was not given such an information at the outset. In addition the Member stated in evidence that she was trying to accommodate the appointment with the Complainant which was initially a Skype appointment, but because the Complainant was unable to set up Skype, she changed it to a telephone appointment to be flexible. However, this conflicted with the Complainant's evidence, in that she stated that the appointment was always intended to take place by telephone, as she knew she was unable to get Skype in her home area. This was supported by an email arranging this particular appointment from which it seemed clear that the appointment was to be by telephone, not by Skype. With reference to the session on 4 January 2016, the Panel referred to its findings in allegation 1 (a) above. In conclusion the Panel, noted that on both occasions the Member did not begin sessions on time and found that the Member was insufficiently attentive to her commitment to be available to the Complainant.

The Panel therefore upheld this allegation.

3. The Panel listened carefully to the evidence given by both parties. The Panel accepted that the Member did have at least one coughing fit during a session, but considered that this of itself was not an indication of her failure to monitor her fitness to practice. The Panel noted that the Member did subsequently become ill and took time off from practice at this stage. The Panel therefore did not find that the Member had failed to monitor and maintain her fitness to practise at a level that enabled her to provide an effective service to the Complainant at the session on 7 December 2015.

This allegation is therefore not upheld.

4. The Member accepted that a phone call was received from the Complainant in which she stated that ‘as this was not working for her and that she did not want to continue with sessions', the Member also accepted that the Complainant sounded angry. The Member stated that she was taken aback by this and by the request for a refund for remaining sessions and told the Complainant that she should write to her. The Complainant then hung up on the Member. The Complainant in her evidence stated that she was angry, she expected the Member to listen to her and to have a detailed discussion about her complaints, however she felt dismissed by the Member and ended the call. Accepting that the call had been ended abruptly by the Complainant, and that this did not necessarily allow the Member to respond immediately, the Panel considered carefully the appropriateness of her actions given that it was accepted that she knew the Complainant was not happy. On balance, the Panel concluded that the responsibility remained with the Member to follow up the Complainants concerns shortly after this call, in order to acknowledge the Complainants dissatisfaction and to create a basis for taking any necessary actions. The evident ‘inaction' by the Member, established both through written and verbal evidence, was therefore assessed by the Panel to be an inappropriate response to the Complainants concerns.

The Panel therefore upheld the allegation that the Member failed to respond appropriately to the Complainant's concerns.

5. The Panel referred to the evidence it heard in relation to allegation 4 above. It also considered that as the Member was aware that the Complainant was unhappy with the service, the Member had a duty to follow the complaint up and to give the Complainant the opportunity to discuss her issues. The Member stated that she did not subsequently contact the Complainant, because she felt it would be better for the Complainant to retain her autonomy with regard to the complaint and allow her to reflect on it. The Panel also noted that the Member has asked her administrative assistant to contact the Complainant on three occasions, but that this was to deal with the request for the refund. The Panel found that it was the Member's responsibility to endeavour to deal with the complaint and prevent further harm and did not accept the Member's explanation.

The Panel therefore upheld this allegation.

6. The Panel questioned the Member extensively in respect of her charging rates and fees. There was a sharp conflict of evidence between the parties with respect to the Contract in that the Complainant stated that she was never given a copy of the Contract nor had she been told that the 6 sessions which she paid for were discounted. The Member stated that she had talked through the Contract at the assessment session and had given the client a copy to read and sign. The Member had also stated, throughout her evidence, that the Contract was a ‘working document' and pointed to the handwritten annotations she had made, which she contended were notes of discussions she had in sessions with the Complainant. In particular, the Member referred to the note regarding the rates to be charged for researching on behalf of the Complainant. Notwithstanding, whether or not the Complainant had been given a copy of the Contract, the Panel, did not agree that a Contract could be a working document unless both parties agreed the amendments and in this case the annotations had not been signed by both parties to constitute a variation of the agreement. In considering whether the Member had at the outset, explained to the Complainant her charging rate, how monies paid would be applied and indeed whether the Complainant was aware that she had been offered a discounted rate, and whether amendments made to the Contract had been communicated to the Complainant, the Panel found that it was fair to say that there appeared to be a lack of clarity. However, given the diametrically opposed evidence of the parties the Panel could not make a finding that the Member had failed to clarify clearly the terms on which she offered the Complainant her services in advance of the Complainant incurring any financial obligation.

The Panel therefore did not uphold this allegation.

7. In light of the above findings, the Panel was satisfied that paragraphs 1, 19, 41, 42 and the Ethical Principles of Being Trustworthy, Autonomy, and Non-Maleficence of the Ethical Framework for Good Practice in Counselling & Psychotherapy (2013) had been breached. It also found that the Member demonstrated a lack of the Personal Moral Qualities of Empathy and Sincerity, to which counsellors are strongly encouraged to aspire.

The Panel did not find a contravention of paragraphs 40, or 59 of the Ethical Framework nor did it find that the Member had contravened the Ethical Principles of Beneficence and Self-Respect. The Panel did not find that the Member had shown a lack of the Personal Moral Qualities of Integrity, Respect, Competence or Wisdom.

Decision

Accordingly, the Panel was unanimous in its decision that the findings amounted to professional malpractice, in that the services for which the Member was responsible fell below the standards that would be reasonably expected of a practitioner exercising reasonable care and skill.

Mitigation

The Panel took into account the mitigation put forward on behalf of the Member by her representative. The Panel noted that the Member had taken time to reflect on events and share these with her Supervisor in the form of a ‘Reflective Journal' and that the Member has made changes to her practice in relation to the process and content of Contracting. The Panel also noted the testimonials submitted testifying to the quality of the Member's work as a Practitioner.

Sanction

One of the aims of the Professional Conduct Procedure is to protect members of the public. The Panel, in considering what sanction may be appropriate in the circumstances of this case, has taken into account the interests of public protection.

1. Within two months from the date of imposition of this sanction, which will run from the expiration of the appeal deadline, Ms Farrow is required to provide a written submission, which evidences her immediate reflection on, learning from and understanding of, the allegations upheld in this complaint, with particular regard to:

The significance of being ‘available' to her clients
Effective and professional contracting, including the clarity of financial arrangements
Professional and appropriate management of concerns / complaints raised by clients

2. Within 8 months of the completion of Part 1, the Member is required to submit a written report detailing the specific changes that have been made, both to her professional practice and their related administrative processes that demonstrates the improvements she has made in these areas and the extent to which these have become integrated.

Both parts 1 and Part 2 are to be reviewed and countersigned by the Member's Supervisor.

These written submissions must be sent to the Registrar, by the given deadline, and will be independently considered by a Sanction Panel.

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