The complaint against the above organisational member was heard at a Practice Review Hearing in line with the Professional Conduct Procedure.
The Complainant has complained about Highbury Counselling Centre, a BACP organisational member of the British Association for Counselling and Psychotherapy (BACP).
Investigation and Assessment Committee Summary and Allegations
The Complainant had an initial assessment at the Centre on 24 November Year 1. Her counselling sessions started on 15 January Year 2 and ended on 26 November Year 2. The Complainant’s communications with the Centre continued until January Year 3.
The Complainant stated that she was given no information from the Centre about the different therapies they offered and the way in which they could help her overcome her problems. The Complainant also advised she was given no information about her counsellor in relation to her qualifications or therapeutic approach.
The Complainant advised that she found sessions scary and difficult to express what she wanted to. She also found it difficult as she had no information about the counselling she was receiving and as the counsellor used lots of silences, she found this oppressive and overwhelming.
The Complainant advised that there was no discussion with the counsellor on how they would be working together, and she found it strange and frustrating that she was receiving little support or guidance. When the Complainant asked questions of her counsellor, she found that the answers were not transparent.
The Complainant advised that throughout the therapeutic relationship at the Centre there was no opportunity to offer feedback or raise concerns on the service she was receiving or an opportunity to review her progress.
The Complainant stated that during counselling sessions she became depressed and anxious and mentioned this in some of her sessions at the Centre. Her counsellor recommended that the Complainant [ . . . ]. The Complainant stated she felt it was negligent of the Centre not to carry out a mental health screening in her initial assessment or monitor her mental health during the ten months she had counselling.
The Complainant advised that as she was not happy with the service the Centre was providing and she called the Clinical Service Manager on 28 November Year 2. She was informed during this call that her counsellor was a trainee. She had not been made aware before that she was seeing a trainee counsellor.
On 29 November Year 2, the Clinical Services Manager telephoned the Complainant and told her that the counselling arrangement was being terminated. This was without any warning, leaving her with unanswered questions about the qualifications of her therapist and the way the therapist had worked and depriving her of any opportunity to have met with the counsellor to discuss and conclude their work together.
The Complainant saw the Clinical Services Manager for a review appointment on 5 December Year 2 to discuss her counselling sessions and suitable ways forward for a therapy referral. The Complainant complained that as the Centre had kept no records of her session, she had to explain the nature of her issues again.
The Complainant submitted a formal complaint to the Centre on 7 December Year 2. In summary the email stated that:
• she remained dissatisfied with the response she had received regarding the counselling she had received and the distress and illness this had caused her;
• her initial assessment did not consider her traumatic experiences;
• there was no explanation from her counsellor as to how they would be working together;
• the Counsellor did not answer the Complainant's questions about the therapeutic approach;
• she was upset and angry when she found out, 10 months later, that she had been doing relational therapy with her counsellor;
• her Counsellor did not answer questions relating to her training and qualifications honestly and was not concerned about her experience of therapy;
• she was not informed that her counsellor was a trainee
• she received no apology or acknowledgement that the processes of the Centre had caused her unnecessary upset and distress;
• she felt the situation could have been avoided if she had been informed she had been assigned to a trainee counsellor, which would have given her the choice whether to proceed or not as she did not feel comfortable with this and needed a more experienced practitioner;
• her views on how she was finding therapy were not sought at regular intervals; and
• no records were kept of sessions.
The Complainant received an acknowledgement of her complaint on 10 December Year 2 and a full response on 17 December Year 2. In summary the Centre’s response stated that:
• the Centre had reviewed its material and procedures and concluded that the training status of its therapists was accessible knowledge on their website and leaflets which are sent to all potential new clients;
• it would remind assessors to consistently notify new clients that counsellors may be trainees;
• the Centre had concluded that its regular team meetings, internal and external, and supervision for counsellors confirmed that there are robust procedures in place to monitor clients' wellbeing and the quality of counselling sessions;
• the Centre’s client records include the initial intake form, an assessment report, attendance record and closure form which the Centre concluded was accurate and appropriate for the counselling services offered;
• the Clinical Services Manager reiterated that she was sorry the Complainant had felt distress, stress and illness in the last year and reassured her that practices and procedures at the Centre would continue to be reviewed
• the Clinical Services Manager offered to meet with the Complainant to discuss her complaint further and provided details of how a stage 2 complaint could be made if the Complainant remained unhappy with the response.
The Complainant stated that as she wanted to discuss her complaint further, she met the Clinical Service Manager again on 19 December Year 2. She explained the distress she had felt during her sessions at the Centre and that she had at one point experienced [ . . . ] and the counsellor had offered no help or support. She was advised the counsellor had followed the correct procedures for protecting her wellbeing.
The Complainant explained to the Clinical Service Manager that there had been no opportunity in sessions for review and no monitoring of her wellbeing. She stated that the Clinical Service Manager replied saying these aspects were intertwined within the therapy, which made her feel hurt and distressed. She stated that she wasn’t treated with honesty and integrity as such aspects had not been addressed explicitly and openly, which would have allowed her to ask for any adjustments she needed.
The Complainant advised that after the meeting, the Clinical Service Manager sent her an email dated 20 December Year 3, with a more formal apology, acknowledging that failures had occurred in the context of the Complainant’s experience with the Centre and apologising that the counsellor had not made it clear that she was a trainee.
The Complainant sent her counsellor an email, on 20 December Year 2 to find out more about her qualifications and the way she worked. The counsellor responded on 21 December Year 2 explaining about her work and stated that she would not respond to any further emails as their sessions together had ended and goodbyes had been communicated in previous emails and that any further communication would be outside the boundaries of the counselling relationship.
On 6 January Year 3 the Complainant emailed both her former counsellor and the Clinical Service Manager to request some support sessions with her former counsellor as [ . . . ] had worsened and she felt overwhelmed and unsupported. She stated that her former counsellor had a good understanding of her situation.
The Clinical Service Manager replied on 7 January Year 3 and advised the Complainant this would not be possible as the therapy with the former counsellor had reached the stage where the Complainant had made a formal complaint about her experience at the Centre stating that she had found aspects of the sessions with the counsellor distressing and unhelpful. The Clinical Service Manager explained that this was why the counselling sessions had been ended early and that she did not feel further sessions with her former counsellor would be helpful. She offered to meet with the Complainant to discuss suitable options and possible referrals and encouraged her to contact her GP regarding her symptoms.
The Complainant responded on 7 January Year 3, requesting a meeting with her former counsellor to discuss the work they did together to help her gain clarity on where they had got up to and said she would be happy for someone else to also be present at the meeting.
The Clinical Service Manager responded on 9 January Year 3 to advise that it would be best not to re-enter a new arrangement with her former counsellor and offered to see the Complainant herself for some support sessions to assist in finding a new therapist and to review what she had found useful in therapy so far.
The Complainant submitted a complaint to BACP dated 12.4.19 which was disclosed to the Centre. The Centre provided an initial response which was considered in full by the Investigation and Assessment Committee (‘IAC’) together with all other information provided by the parties.
The IAC decided that a number of the Complainant’s points of complaint did not meet the requirements of the realistic prospect test. However, it found that, in relation to other points of complaint, there was evidence of a failure by the Centre to comply with the Professional Standards such that those other points of complaint did meet the realistic prospect test. It therefore put forward allegations as follows:
[Note: In allegations 1 – 5 below the IAC used the term ‘Organisation’ to refer to ‘the Centre’.]
1. On dates between 24 November Year 1 and 15 January Year 2, in contravention of Paragraph 31 in the Ethical Framework for the Counselling Professions 2016, the Organisation failed to provide the following information to the complainant, in advance, as follows:
a. the different types of therapies offered by the Centre and the way in which they could help the Complainant to overcome her problems;
b. that the Complainant was allocated to a trainee counsellor; and
c. that the Counsellor's modality of work with the Complainant was Relational Therapy
therefore, denying the Complainant the opportunity to make an informed decision about the services she wished to receive.
2. On dates between 1 July Year 2 and 26 November Year 2, in contravention of Paragraph 82(a) in the Ethical Framework for the Counselling Professions 2018, the Organisation failed to be open by ensuring:
a. that the counsellor who worked with the Complainant was informed that she was a trainee counsellor; and
[As a preliminary matter, the Practice Review Hearing Panel determined that this part of allegation 2 contained an obvious typographical error and, with the agreement of the parties, it was amended to read – ‘a. that the Complainant was informed that the counsellor who worked with her was a trainee counsellor’].
b. that the Organisation’s “Information and Guidelines for Counsellors” at paragraph 13(F) reflected the requirements of Paragraph 82 (a) which requires a counsellor to notify the client that they are a trainee.
3. In contravention of Paragraph 38 in the Ethical Framework for the Counselling Professions 2016, and Paragraph 32 in the Ethical Framework for the Counselling Professions 2018, the Organisation failed to ensure that the Complainant's views about the counselling work were sought and/or the client’s progress reviewed at appropriate periods throughout the therapeutic relationship.
4. In contravention of Paragraph 41 in the Ethical Framework for the Counselling Professions 2016, and Paragraph 45 in the Ethical Framework for the Counselling Professions 2018, the Organisation failed to ensure that the Complainant, having requested details of her counsellor’s qualifications, was provided with this information.
5. In contravention of Paragraph 12 in the Ethical Framework for the Counselling Professions 2018, the Organisation failed to protect the Complainant's trust by ending the counselling relationship abruptly without notice and with no opportunity to work towards an ending, which caused the Complainant genuine grief.
Practice Review Hearing
The matter was heard at a Practice Review Hearing and considered by a Professional Conduct Panel.
On balance, having fully considered the matter, the Panel made the following findings:
The only direct evidence of what happened in the assessment and therapy sessions was from the Complainant. The Panel found her evidence to be consistent and plausible and that she was open in the manner she gave her evidence. They found no reason not to consider her a credible witness.
1. In relation to allegation 1:
a. X provided evidence of the information provided on the Organisation’s website and in its leaflets. She accepted that this was not an exhaustive list of the modalities of therapy the Organisation offered and that the amount of information offered about each modality, without explanation, could be confusing to a potential client. The Panel noted that while there was a lot of information provided, it did not explain the ways in which different modalities would help a potential client, or the Complainant in particular, overcome their problems. X described what should have happened in the Complainant’s assessment session and therapy sessions and explained that she trusted the therapists that provided those sessions to have acted in this manner. The Complainant gave clear evidence that there was no discussion with her in the assessment or therapy sessions regarding the different types of therapies offered by the Centre and the way in which they could help the Complainant to overcome her problems. The Panel noted that it was not disputed that the Complainant continued to ask for information about the type of therapy she was receiving, and this was evidenced by emails in the papers. It concluded that if the Complainant had been given clear and comprehensive information during the assessment or therapy sessions, then she would not have continued to ask for that information. The facts of allegation 1(a) were found proved.
b. The Complainant said that during her assessment session she was told that she may be allocated to a trainee counsellor, but her allocated therapist did not inform her clearly and openly that she was a trainee counsellor. She said she first knew that her therapist was a trainee when she spoke to X on the phone in December Year 2. The Panel found that this was consistent with the Complainant’s repeated questioning of her therapist about the therapist’s qualifications. X stated that the Complainant would have been told by the trainee therapist but was not able to provide any record to demonstrate this was done in this case. The Panel noted that the counselling contract signed by the Complainant and her assessment record were silent on the matter. The Panel also noted the email the Complainant sent to X on 7 December Year 2 in which she stated that she was told in a telephone call by X that ‘without my knowledge or consent, [my therapist] is a trainee.’ Further, in her email to the Complainant dated 20 December Year 2, X had said that she was very sorry that the counsellor did not make it clear that she was a trainee. The facts of allegation 1(b) were found proved.
c. X stated that it was expected of the Centre’s therapists to explain their own modality to clients and she was confident that the Complainant’s therapist would have done this. The Complainant stated that her therapist did not inform her that her modality of work with the Complainant was Relational Therapy until towards the end of their year of working together and only after repeated requests by the Complainant. The Panel noted the Complainant’s email to her therapist dated 6 November Year 2 in which the Complainant asked ‘what exactly do you mean by relational therapy?’ and ‘what were your reasons or thinking behind letting me know about the relational psychotherapy at the time that you did?’ It also noted the Complainant’s original formal complaint to the Centre set out in an email dated 7 December Year 2 in which she stated that she was upset and angry at having only been told that she had been engaged in relational therapy ten months into the process. The Panel found this was consistent with the Complainant’s evidence of not having been given this information in advance. The facts of allegation 1(c) were found proved.
The Panel concluded that the Centre’s conduct, as found proved above, was in contravention of its obligations to the Complainant under paragraph 31 in the Ethical Framework for the Counselling Professions 2016. Allegation 1 was, therefore, upheld.
2. In relation to allegation 2 (as amended):
a. X accepted that the Complainant asked the Centre more than once whether her therapist was a trainee. The Complainant said she asked three times. The Panel found that on either account, it was clear that the Centre did not provide a clear and unambiguous answer when first asked and this was supported by the evidence in the Complainant’s formal complaint emailed to X dated 7 December Year 2. It also noted X’s email dated 20 December Year 2 in which she accepted that ‘sometimes inevitably things fail’ and apologised for the ‘failures that occurred with your experience’ and stated that ‘she was very sorry that [the] counsellor did not make it clear in your sessions that she was a trainee’. X explained in oral testimony that she was trying to avoid causing the Complainant further distress and that this was not an admission of failings on behalf of the Centre. The Panel did not accept that an experienced person such as X would put admissions like this in writing unless they were genuine, especially as X said in evidence that the email was written after speaking to the Complainant’s therapist and a supervisor. The Panel noted that the form relating to seeking consent for recording a session may have described the therapist as a trainee; (only an uncompleted example was available). However, it accepted the Complainant’s testimony that when asked about being recorded, she did not pick up the form or read it, she simply declined immediately. The facts of allegation 2(a) were found proved.
b. The Panel noted the contents of the Centre’s Information and Guidelines for Counsellors document. At paragraph 13(F) it states:
‘The counsellor should be transparent about whether or not he/she is a trainee, should this issue be raised during a session’.
The Panel noted paragraph 82(a) of the Ethical Framework for the Counselling Professions 2018 which states that in the interests of openness and honesty with clients:
‘trainees on a practitioner-qualifying course working with clients will inform clients (or ensure that clients have been informed) that they are trainees.
The Panel concluded that the Ethical Framework requires proactive openness and honesty, whereas the Centre’s Guidelines required only reactive disclosure. Consequently, the Centre’s Guidelines did not reflect the requirements of the Ethical Framework for the Counselling Professions 2018 in this respect and therefore the Panel found the facts of allegation 2(b) were proved.
The Panel concluded that in its conduct as found proved above, the Centre had failed to be open and honest as required by paragraph 82 of the Ethical Framework 2018. Allegation 2 was, therefore, upheld.
3. In relation to allegation 3:
X gave evidence that she spoke with the Complainant on the telephone on more than one occasion and met with her more than once also. X described the Centre’s process for reviewing clients’ progress in counselling, comprising regular supervision of counsellors and regular team meetings and the Panel found this was supported by the Organisation’s documents produced in evidence. The Complainant did not question these processes and had no personal knowledge or direct evidence of whether or not they were followed in her case because she had not been involved in such supervision or team meetings. X’s evidence was also that the Complainant’s counsellor consistently checked in with the Complainant regarding how she was feeling as part of the regular counselling sessions; although she accepted that the Centre did not organise formal review sessions (with clients) as such. The Complainant stated that she was not asked for her views of how her therapy was going until after she had ended over a year of therapy with the Centre. The Complainant confirmed that her therapist would ask ‘how are you?’ or words to that effect at the beginning and end of the sessions, but she did not feel she was asked to comment on how the therapy was progressing or given an opportunity to provide input or engage with any feedback process. X stated that therapists can gather information about how well therapy is working for a client by indirect methods. The Panel accepted this but also noted that the therapist was inexperienced and was dealing with a client with complex issues (the Complainant). The Panel found no direct evidence that the Complainant’s views were sought or gathered, overtly or otherwise, or that these were incorporated into any reviews of her therapy.
The Panel concluded that there was insufficient evidence to prove that the Centre failed to review the Complainant’s progress at appropriate periods throughout the therapeutic relationship; albeit without her input and not in her presence. However, it determined that the evidence showed the Centre failed to ensure that the Complainant's views about the counselling work were sought at any point throughout the period of counselling, and that it had been practicable to do so.
The Panel concluded that, to this extent, its conduct found proved above was in contravention of Paragraph 38 in the Ethical Framework for the Counselling Professions 2016, and Paragraph 32 in the Ethical Framework for the Counselling Professions 2018.
Allegation 3 was, therefore, upheld in part.
4. In relation to allegation 4:
The Complainant recalled asking for her therapist’s qualifications repeatedly during sessions, throughout the period of counselling, and then asking the Centre for this information. The Panel was satisfied, from X’s testimony and the email evidence, that X provided the information promptly when she was asked directly by the Complainant during a telephone conversation in November Year 2. The Panel also accepted that the Centre’s policy states that the therapist should have disclosed the information when asked. However, X did not provide any evidence of measures in place to ensure that therapists complied with this requirement generally; nor that the Complainant’s counsellor had done so specifically. Further, the Panel took into account X’s email of 20 December Year 2 in which she apologised for the counsellor’s failure to respond to questions about her qualifications when asked. The Panel therefore concluded that the Centre failed to ensure that the Complainant was provided with her therapist’s qualifications when she requested them in contravention of paragraph 41 in the Ethical Framework for the Counselling Professions 2016, and Paragraph 45 in the Ethical Framework for the Counselling Professions 2018.
Allegation 4 was, therefore, upheld.
5. In relation to allegation 5:
The evidence of the parties was consistent in describing an abrupt end to the therapeutic relationship. X was able to give direct evidence in relation to this allegation as she was involved in this aspect of the Centre’s dealings with the Complainant. X explained that she took the decision to stop the Complainant seeing her therapist in the best interests of the Complainant and after taking advice in supervision. She further explained the alternatives she offered the Complainant, including ‘holding’ sessions while the Complainant arranged a new therapist. The Complainant confirmed what X had explained and said that, by that point, she did not want to continue to be involved with the Centre and so declined the offers made. The Complainant also accepted that X’s decision to stop her seeing her therapist was probably the right decision at that time. The Panel concluded that X’s decision to terminate the counselling arrangement was based on reasonable clinical judgement and that she made appropriate offers to the Complainant to mitigate the impact of the abrupt ending after the event. However, the Panel noted that the Centre had unilaterally decided to end the counselling relationship immediately and that the Complainant had simply been notified of that decision by telephone. Further, in X’s numerous discussions with other professionals about what was in the Complainant’s best interests, there was no evidence of the Complainant being involved in the discussion or decision. The Complainant had been afforded no opportunity to work towards an ending. Therefore, the Panel determined that despite X’s efforts to mitigate the consequences of the Centre’s decision to terminate the counselling arrangements after the event, the Centre had not done ‘everything’ it could have done to develop and protect the Complainant’s trust as required by paragraph 12 of the Ethical Framework for the Counselling Professions 2018.
Allegation 5 was, therefore, upheld.
Accordingly, the Panel was unanimous in its decision that there had been a failure to comply with the Professional Standards. Specifically, that the Centre had acted contrary to:
• paragraphs 31, 38, 41 in the Ethical Framework for the Counselling Professions 2016, and
• paragraphs 12, 32, 45 and 82(a) in the Ethical Framework for the Counselling Professions 2018.
The Panel noted the submissions made by the Organisation dated 26 March 2020.
• Since September 2019, after the initial assessment appointment with a client, as part of finalising referrals for counselling, the clinical manager arranges telephone contact and discusses suitable referral options with each client, in consideration of each client’s wishes and the resources available at the Centre at the time.
• To ensure that the parameters of the counselling are proactively discussed, and that this conversation is an integral part of the counselling contract between counsellor and client, the Organisation has amended its contract to include:
‘In the initial appointment, your HCC counsellor will inform you about their professional status (in training or qualified), the therapeutic model they are trained in, and how the therapeutic modality will operate in sessions.’
• The progress of the therapeutic work will continue to be reviewed organically, with direct and indirect ways, during the therapeutic sessions, and on a case by case basis, and subsequently in clinical supervision and line management meetings. However, in addition, from May 2020, the Organisation will contact all clients by post or email twice a year with a brief questionnaire reviewing their counselling sessions. Responses will be seen by the client’s counsellor, the counsellor’s supervisor, and the clinical manager and will be included in the client’s files.
• The Organisation apologised for its decision not to follow the usual procedure on therapeutic endings in the Complainant’s case and said that going forward every effort will be made to avoid abrupt and distressing endings for any client.
• The Organisation provided copies of its new contract and the biannual client questionnaire.
In considering sanction, the Panel was mindful of public protection and raising and maintaining standards of practice.
The Panel considered the following sanction was fair and proportionate, given the allegations upheld in this case:
1. An apology - The Organisation has apologised to the Panel/BACP in its submissions and made an ambiguous and qualified apology in its emails to the Complainant.
The Panel requires the Organisation to send the Complainant a clear and unambiguous written apology.
2. Counsellors’ training status – The Organisation has made some improvements in this regard but had not fully addressed the concerns identified in the hearing.
The Panel requires the Organisation to ensure that:
a. After the assessment session but before the first counselling appointment, each client is to be informed in writing/by email that their allocated counsellor is or is not a trainee.
b. During the first counselling appointment with their allocated counsellor, each client is to be told:
i. whether their counsellor is in training or not;
ii. the counsellor’s qualifications;
iii. the modality(ies) of counselling that the counsellor will employ with the client.
c. Immediately after the first counselling appointment, the information specified in 2.b.i-iii is to be confirmed to the client in writing/by email.
3. Feedback – Whilst it is acknowledged that the Organisation has made progress in proposing a questionnaire in order to improve clients’ opportunities to provide feedback, it has not fully addressed the concerns identified in the hearing.
The Panel requires the Organisation to introduce demonstrable, practical measures that will not only ensure that the biannual questionnaire and ‘organic’ reviews provide clients with opportunities to give feedback about the service they receive, but will also ensure that such feedback is actively reviewed and discussed with clients.
4. Endings – The Organisation has stated an intention to ‘make every effort’ to avoid abrupt and distressing endings for future clients but has not demonstrated how this will be achieved.
The Panel requires the Organisation to:
a. develop a protocol demonstrating how it will ensure clients are given the opportunity to comment on proposed endings before termination of a therapeutic relationship (unless circumstances are such that it is not practicable to do so); and
b. incorporate this protocol into its processes and ensure that it is implemented effectively and fairly.
Within 4 months of the expiry of the 28-day appeal period, the Organisation is to submit evidence of compliance with all aspects of the above sanction to BACP.
The written submissions will be considered by a Sanction Panel.
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