The complaint against the above individual 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 as follows:
This complaint is brought by Organisation X, [ . . . ]. The Member worked as a counsellor with Organisation X in an employed capacity from 15 January Year 1 to 30 April Year 4 and then in a self-employed capacity from 1 May Year 4 to 20 January Year 8. Her self-employment was governed by the Self-Employed Counsellors Handbook which outlines the respective responsibilities of the counsellor and Organisation X including adherence to the BACP Code of Practice and the need to disclose concerns about clients to the Counselling Services Team Leader.
The Member commenced counselling the client (X1) on 18 March Year 7. This relationship ended on 18 November Year 7.
The Member disclosed her concerns about client risk to [ . . . ], the Counselling Services Team Leader, on 12 November Year 7. The Member discussed the points of concern with X1 at their next session and agreed what would be passed to Organisation Y. A report was prepared for these purposes and emailed to Organisation Y and posted to X1.
On receipt of the report X1 contacted the Counselling Services Team Leader and raised concerns regarding the exaggerated content and it was proposed that a meeting would be arranged with X1 and the Member to discuss this. The Counselling Services Team Leader spoke with X1 and became aware of boundary issues between the Member and X1. The Member allegedly sent text messages to X1 to wish her Happy Birthday and would allegedly cry in sessions when hearing X1’s story.
The Counselling Services Team Leader met with the Member on 1 December Year 7 to discuss boundary issues and resilience in relation to the work, including the non-retention of client telephone numbers by counsellors and appointment cancellation procedure which was to remain as and administrative process handled by Organisation X.
A meeting was arranged between the Member and the clinical supervisor on 8 December Year 7 to discuss boundary issues. X1 disclosed further information relating to the Member’s boundaries on the telephone in advance of a face to face meeting arranged between X1 and the Counselling Services Team Leader. X1 disclosed her concerns about the Member’s behaviour [ . . . ].
The Organisation X Complaints Procedure was invoked. X1 was dissatisfied with the procedure and a complaint was then lodged with BACP.
In accepting this complaint, the Pre-Hearing Assessment Panel was concerned with the following areas, and in particular these are:
1. It is alleged that Ms Stewart failed to keep the client’s trust in that, she was not attentive to the quality of listening and respect offered to her client, in submitting a report to the Counselling Team Leader detailing the safeguarding concerns to be raised with Organisation Y, which did not accurately reflect her discussions with the client.
2. It is alleged that Ms Stewart in submitting the inaccurate report did not provide a good quality of care that was respectful to the client’s capacity for self-determination and her trust.
3. It is alleged that Ms Stewart failed to provide a good quality of care and competently delivered services which met the Client’s needs, in that; Ms Stewart blurred the professional boundaries for the client giving rise to the client thinking that Ms Stewart was her friend by:
(a) On occasion sending the client texts with XX at the end of the text;
(b) Wishing the client happy birthday by text;
(c) Sending a text to the client which said “missing you”;
(d) Complimenting the client on her personal appearance;
(e) Engaging in out of session contact with the client which was of a personal nature.
4. It is alleged that Ms Stewart failed to provide a good quality of care and competently delivered services which met the Client’s needs in that Ms Stewart made an inappropriate disclosure to the client within the counselling setting about her own personal experience of relationship and her attitude to sexual experience.
5. It is alleged that Ms Stewart failed to provide a good quality of care and competently delivered services which met the Client’s needs in that Ms Stewart cried on two occasions whilst counselling the client, leaving the client feeling responsible for that behaviour.
6. It is alleged that Ms Stewart failed to provide a good quality of care and competently delivered services which met the client’s needs in that Ms Stewart inappropriately met with her client and the [ . . . ] to discuss the content of a safeguarding report that had been sent to Organisation Y [ . . . ].
7. Ms Stewart’s alleged behaviour, as described by the complainant and as identified in the numbered paragraphs referred to above, suggests a contravention in particular of paragraphs 11, 14, and 1 and the Ethical Principles of Being Trustworthy, Autonomy and Beneficence of the Ethical Framework for Good Practice in Counselling & Psychotherapy (2013), and showed a lack of the personal moral qualities of Integrity, Resilience, Respect, Competence and Wisdom to which counsellors are strongly encouraged to aspire.
The Chair reminded the parties that this complaint was brought by Organisation X, on behalf of a client whom the Member complained against had seen for counselling.
1. The Panel heard evidence from the former member complained against (the MCA) that over a number of sessions she had growing concerns as to her client’s safety and that of [ . . . ]. With her client’s consent, the MCA took these concerns to her Counselling Services Team Leader (TL). The MCA and her TL agreed that a report should be made to Organisation Y and that the MCA would discuss this with her client and agree together the points to be reported to Organisation Y. The MCA stated that, in a session with her client, the points to be contained in the safeguarding report were discussed and agreed. However, the Panel noted from the client's written evidence that she stated that the report was inaccurate. When questioned further, the MCA stated that the report prepared was an accurate reflection of their discussion and that she had taken notes in the session. She noted what she had heard from her client and at that time the client had agreed with the points she would be reporting on. The MCA stated that in submitting the report, she considered that she was making an accurate representation of the client’s concerns. Having considered the verbal and written evidence, the Panel, on balance, accepted the MCA’s evidence and found that the MCA did not fail to keep the client’s trust. This allegation was therefore not upheld.
2. The Panel referred to its findings in allegation 1 above and as such found that the MCA did not fail to provide a good quality of care that was respectful to the client’s capacity for self-determination and her trust. This allegation was therefore not upheld.
3. Before considering whether the MCA had blurred the professional boundaries for the client, the Panel made the following findings of fact;
(a) The MCA admitted sending her client texts with ‘xx’ at the end, the MCA stated in both her written and oral evidence that she regretted doing this and that it was a mistake, she also apologised for her action in this regard.
(b) The MCA admitted wishing her client ‘happy birthday’ and explained that this was in the context of receiving a text from her client stating that she would not be attending her scheduled counselling session because it was her birthday. The MCA stated that she was reaching out in a warm and courteous way. In her written evidence the MCA acknowledged that this was confusing for the client and had apologised.
(c) The MCA admitted sending a text to the client in which she said ‘missing you’. In both her written and verbal evidence the MCA explained that the client had missed a number of appointments already due to [ . . .], and that when she cancelled again she texted her in the terms alleged. The MCA stated that she was reaching out in a caring and sensitive way in order to maintain consistency in the relationship. She stated that the relationship was often not consistent because of the client’s [ . . . ] issues and that this inconsistency was distressing for her client.
(d) The MCA admitted complimenting the client on her personal appearance. She stated that the client would present herself as feeling [ . . . ]. She stated on one occasion she responded, saying to her client that it was not what she (the MCA) saw and she also commented on her strength and ability in the face of her [ . . . ]. The MCA stated that she was acknowledging her client’s thoughts of herself from a congruent and warm place by complimenting her.
(e) The Panel noted, the written and verbal evidence from the MCA, that her client would always introduce her to [ . . . ] when she attended her appointments. The MCA stated that on one occasion, when she had bumped into her outside of her workplace, she was drawn in by her client who wanted to introduce the MCA to [ . . . ] she was with. The MCA stated that she dealt with these situations by being polite and leaving as soon as she could. The Panel considered that as these encounters were not pre-arranged they could not be said to constitute ‘engaging’ in out of session contact, and therefore did not find, as a matter of fact, this occurred as alleged.
The Panel questioned the Member carefully regarding the above. In her response to the Panel, the MCA conceded that it was not best practice to place xx (kisses) in a text to a client and that it could create a misunderstanding regarding the relationship. The MCA was also aware of the extent of this client’s vulnerability and had alluded to this a number of times in both her written and verbal evidence. When questioned by the Panel regarding the client’s written evidence in which the client has stated that she considered that she and the MCA were friends, the MCA stated that she understood that the client might have thought this, but that she had never encouraged it. The Panel, having considered all the evidence before it took the view, that taken together the actions in (a) to (d) above did indeed blur the professional boundaries for the client, and found that on balance the MCA had failed to provide a good quality of care and competently delivered services which met the client’s needs. This allegation was therefore upheld.
4. The MCA accepted that she did talk about her own personal [ . . . ] experience and her attitude to sex. She stated, in her written evidence that this was in response to the client’s apparent lack of understanding of [ . . . ]. In her oral evidence, the MCA stated that she considered that the client was not clear that she had a right to say yes or no, so felt it was an important matter to discuss. The MCA stated that she gave personal examples about herself which she considered were not specific. She stated that she was giving basic psycho- education in relation to sex. The Panel heard the MCA’s evidence with regard to the examples she gave to the client. When asked whether she had accounted for the client’s vulnerability, the MCA conceded that she could see from the client’s evidence that she had not heard what had been said, and that it was her responsibility to have checked this out given the [ . . . ]. The Panel was of the view, that whilst personal disclosures may sometimes be appropriate in therapeutic sessions, given the circumstances of this client, the disclosures given by the MCA were inappropriate. The Panel found, on balance, that the MCA had failed to provide a good quality of care and competently delivered services which met the client’s needs. This allegation was therefore upheld.
5. The Panel questioned the MCA carefully on what she considered ‘crying’ meant. The MCA described this as tears running down the face and therefore denied that she had cried, but rather that she had wet eyes. She admitted that she had been tearful on two occasions in front of the client. She also stated that she wiped her eyes. When questioned as to whether it would be noticeable to someone in her presence, that she was upset, the MCA replied ‘yes’. She further explained in evidence, that she did reassure the client that she should not worry. When asked why she would have given an explanation to the client, the MCA stated that she might see and misinterpret it and blame herself. The Panel directed the MCA to the client’s written evidence where she had stated that the MCA apologised and said ‘it’s OK it’s not your fault’. The MCA agreed that she did this. The MCA also stated that she was not aware that the client felt concerned for her. The Panel concluded that on balance, the client had felt responsible and concerned for the MCA, and the Panel considered that the MCA should have been more able to maintain a professional detachment which would have assured the client that she need not take responsibility for the MCA. The Panel therefore found that the MCA had failed to provide a good quality of care and competently delivered services which met the client’s needs. This allegation was therefore upheld.
6. The Panel noted, both from the MCA's written and oral evidence, that the she had suggested speaking with [ . . . ] as the client had said, in session, that she felt frightened to tell [ . . . ] that an email had been sent to Organisation Y, which mainly related to [ . . . ] and potential risks to the client and [ . . . ]. The letter had been sent without the MCA having had sight of the contents. The MCA stated that she felt responsible for the letter and that she had been left to sort out the mess. The MCA stated that she was concerned for her client’s safety and was working ‘off the top of her head”. She therefore suggested inviting [ . . . ] into the room to discuss the letter, and the client agreed to this. In evidence the MCA stated that she was not thinking clearly; that she understood it was not a great decision; that she was not supported by anyone at Organisation X but that she felt that she did the best she could at that time. Whilst the Panel accepted that the client had agreed to the suggestion, it was concerned about the appropriateness of the suggestion given the content of the letter and considered that the MCA could not have anticipated [ . . . ]'s reaction to being told about it. The Panel considered this to be a poor exercise of judgment by the MCA and therefore found that the MCA had failed to provide a good quality of care and competently delivered services which met the client’s needs. This allegation was therefore upheld.
In light of the findings above, the Panel was satisfied that paragraph 1 and the Ethical Principle of Beneficence 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 Resilience, Competence and Wisdom, to which counsellors are strongly encouraged to aspire.
The Panel did not find a contravention of paragraphs 11 or 14 of the Ethical Framework nor did it find that the Member had contravened the Ethical Principles of Being Trustworthy or Autonomy. Further the Panel did not find that the Member had shown a lack of the Personal Moral Qualities of Integrity or Respect.
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.
The Panel noted that the MCA has considered her work practice over the period since the counselling ended, very deeply and has received extra supervision and personal counselling. She had also expressed that she was truly sorry for the client.
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.
Ms Stewart is no longer a member of BACP, having not renewed her membership prior to this Hearing. However, had Ms Stewart been a member of BACP, the Panel would have recommended the following sanction be completed:
That Ms Stewart provides BACP with a comprehensive and insightful written report evidencing her reflections, understanding and learning in relation to the areas of the complaint that were upheld, and addressing the following points:
• Evidence of an increased understanding of, and explanation of the need to maintain clear boundaries, particularly regarding out of session contact such as texting, e-mailing and phone calls; and should include reflections on what steps she would take to support herself when finding herself in a vulnerable position and/or when working with vulnerable clients.
The Panel recommended that any future application by Ms Stewart for BACP membership should be considered under the Article 12.3 Procedure, so that her suitability for membership can be properly considered by an appropriate Panel.
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