‘One of my clients is going to be working away from home for six weeks. She has asked if we could have a couple of online sessions while she is away. She is concerned that she will lose the momentum to make changes if she has such a long gap in the middle of her sessions. My supervisor has asked me to think carefully about whether I should do this as I have not had any specific training in working online. However, if I think about putting my client first, I can see that, for her, it would be good to respond positively to her request. Are there any rules around working online with clients?’
Delivering therapeutic sessions online requires additional skills and a different set of competencies to working face-to-face. You can find the telephone and e-competences framework on the BACP website (see details below).
Whether you work face-to-face or online, the relationship is central to the work you do. Ideally, you would undertake some additional training. Some questions to think about are:
- what do you think the differences might be in working online?
- what kind of contract or agreement might you need for this kind of work?
- how are you going to maintain the boundaries of sessions?
- how are you going to maintain confidentiality? The available platforms for videoconferencing have very different privacy settings, and you will need to ensure the one you use is secure. In face-to-face work, you can ensure that the setting is private, and you need to be able to provide that same level of confidentiality when you are videoconferencing.
- what impact could working in this way have on your therapeutic relationship?
- how will you deal with any technological breakdown that might occur?
Your supervisor has expressed concern about you working in this way, and I think it might be beneficial to work through their concerns with them. You are facing an ethical dilemma – you can see the benefits for your client, but you are not sure that you are competent to work in this way. It may be helpful to work through this using an ethical decision-making tool such as the one on the Ethics Hub.
With regard to the Ethical Framework, ‘Putting the client first’ (Commitment 1) is a two-fold commitment:
a) Making clients our primary concern while we are working with them, and;
b) Providing an appropriate standard of service to our clients.
Sometimes, ‘putting the client first’ means explaining why you cannot do something they have asked of you. If you do not feel that you are competent to work in this way, then it is important to say so and to think through what else you could do to help your client maintain progress while she is away.
If you decide that, with support, you can offer her this service, it might be a good idea to have a practice videoconferencing session before she goes away, so that you can iron out any glitches and she can give you feedback on whether this is going to be helpful to her.
‘I am a student member and used my iPhone to record a client session for my coursework. My client gave permission for me to do this, provided the transcript and recording were only used anonymously within supervision and training. My supervisor thought it would be helpful for us to use the recording in our supervision session, but I accidentally sent the recording of my client to a friend who was in my address book and has the same name as my supervisor. She texted me to tell me that she had got it and had deleted it. Do I need to do anything else? I am worried about telling my course tutor, as I don’t want to lose my place on the course.’
In the past, recordings of client sessions were made on specialist recording devices, which made this kind of mistake almost impossible. Digital technology has made recording much easier, but it has also opened the door to these kinds of mistakes. Smartphones are usually secure in that they do have password security, whereas many digital recorders do not. However, if you are using your personal phone to record client material, it is easy to send information to the wrong person and the boundaries become blurred between personal and professional. You need to speak to your supervisor and agree a course of action to limit any harm to your client.
We are committed through the Ethical Framework to ‘ensure candour by being open and honest about anything going wrong and promptly inform our clients of anything in our work that places clients at risk of harm, or has caused them harm, whether or not the client(s) affected are aware of what has occurred, by:
a) taking immediate action to prevent or limit any harm;
b) repairing any harm caused, so far as possible;
c) offering an apology when this is appropriate;
d) notifying and discussing with our supervisor and/or manager what has occurred;
e) investigating and taking action to avoid whatever has gone wrong being repeated.’
(Good Practice, point 52.)
When things go wrong, we can learn from our mistakes and ensure these kinds of errors do not happen again. So it’s important to look carefully at what you might do differently in a similar situation.
Usually, when there has been a breach of confidentiality, your client will have the right to know, and to know what you have done about it. Your placement provider and your course provider both need to be informed. It will be much better if you tell them, and also tell them what you (with the support of your supervisor) have decided to do to limit harm, rather than them finding out through the client making a complaint. The placement provider may also have a duty to report the breach to the Information Commissioner’s Office (see www.ico.org.uk for more information).
You can find out more from the Good Practice in Action Legal Resource 014: Managing Confidentiality.
‘I sometimes see comments from BACP members on social media that might be construed as provocative, inflammatory or sometimes even abusive. I don’t feel confident to voice an opinion in case my words are misconstrued or I am the one that is picked on. Is there anything I can do if I am subject to abuse on social media sites?’
When abusive remarks are posted, it can be very painful and distressing. If the comments are posted within a group (such as a closed Facebook group), then you can contact the moderator of the group, who has the power to remove them. It is best to think carefully about whether to respond because there are some people who intentionally disrupt social media conversations (it’s called trolling), and any response you make is likely to be taken out of context. If you suspect someone is trolling you, then it is better not to respond at all.
It is also important to remember that some social media sites are not moderated, whereas others may be. Since there is no way of preventing people from copying and sharing content (sometimes out of context) from one platform to another, it is always important to think ahead about how your contributions might be shared on platforms where there is no moderation and no way of getting material taken down other than by appealing to the owners of the platform itself.
‘I googled my counsellor after we had been meeting for a few sessions. She always seemed so quiet and reserved and I wanted to find out a bit more about her. I discovered her professional website, but also a number of photos of her protesting at a political rally. I don’t actually agree with her stance on the issue she was protesting about, and now I feel deeply uncomfortable. Can I ask to see another counsellor?’
Your counsellor will have made a commitment to making you her primary concern while she is working with you. She is expected to respect your views and beliefs, even if she does not share them. If you are able to raise the matter with her, then you could perhaps tell her about the impact seeing the images has had on you, and then make a decision as to whether your relationship is strong enough for you to continue working together.
You do not say if the counsellor is in private practice or part of an organisation. If you are seeing her in an organisational setting, you should be able to ask the manager of the service to allocate you to another counsellor. If you are seeing her in her private practice, then you could look around for someone else in the area. There is usually no reason why you should not change counsellor or stop going, unless it is a condition of some other legal agreement. The initial agreement you made with your counsellor should include details of your right to cancel sessions.
Counsellors need to think very carefully about the information available online about them that can be seen by anyone. It is important to check the privacy settings on your social media updates to ensure private posts do not accidentally end up in public settings.
‘One of my clients sent me a friend request on Facebook. I have two accounts – one I use purely for my counselling work, to send information to prospective clients etc, and the other for my friends and family. I thought I had accepted her on my professional account, but I had actually accepted her on my personal Facebook. As a lot of her issues are around ‘not feeling wanted or valued’, I decided not to ‘de-friend’ her. However, she has now started commenting on my family posts. When I tried to raise the issue at our most recent session, she told me that being accepted as my friend has been a turning point in her life. My supervisor thinks I need to explain to her that it is not appropriate, but I feel this will really distress her. And surely I need to “put the client first”? Your advice please?’
As a member of BACP, you are committed to building an appropriate relationship where ‘reasonable care is taken to separate and maintain a distinction between our personal and professional presence on social media where this could result in harmful dual relationships with clients’ (Ethical Framework, Good Practice, point 33c). Unfortunately, a simple error has escalated into a difficult dilemma. Wisely, you are trying to limit the harm to your client. When faced with this kind of dilemma, you have a commitment to candour – being open and honest about anything that may cause harm to your client (Ethical Framework, Good Practice, point 52). It may also be helpful to use an ethical decision-making tool to work out what will do the least harm, and your supervisor can help you with this. You can find details of one of these models on the Ethics Hub (see below for details).
‘I am a member of BACP, and I recently saw a tweet by a therapist (who is also a BACP member) in which they quoted a small section of dialogue from a counselling session. They didn’t name the client and, when questioned, stated that the client had given permission. However, I feel that this does not demonstrate ethical behaviour. What if the client felt coerced into giving permission? And what message does it put across to the public in terms of how confidential sessions are?’
A fundamental commitment in our Ethical Framework is to show respect by ‘protecting client confidentiality and privacy’. If you want to share information relating to a client in other settings, you need to obtain their informed consent, and that means the client is aware of and has thought through the implications of material being shared in this way. Of course, for some clients, having a voice is important, and they would want to share their material. However, for others, the power differential between therapist and client may mean they agree in order to please you, or they have not thought through what may happen to their material if it is shared so widely. As noted above, once material has been shared, even on a private online forum, it can be copied elsewhere and could attract abuse.
Digital technology and social media enable us all to stay connected and network with others. However, these queries demonstrate some of the difficulties they also present specifically for counsellors. BACP is developing resources to support practitioners with their professional use of digital technology and social media. There is a new page on the website giving basic information and guidance. New Good Practice across the Counselling Professions e-learning on digital technology etiquette is also being developed for publication in 2020.
The dilemmas and responses are typical of those worked with by BACP’s Ethics Services. BACP members are entitled to access this consultation service free of charge. Appointments can be booked via the Ethics hub on the website.
Professional conduct
The Professional Conduct team regularly receives enquiries relating to social media and online advertising. The conduct procedure is often not applicable in dealing with a lot of the issues raised. However, here are some general hints and tips to help members in dealing appropriately with clients and colleagues in the digital world:
- Members sometimes share case studies on their website, forums or on social media. Removing the name of the client may protect their identity publicly, but think about whether the client (or their family and friends) may still be able to identify the subject of the case study, were they to see it.
- When posting comments on social media, consider how others may respond and whether you’re prepared to receive challenging or opposing views.
- Debate on social media can be healthy and informative. However, keep your comments professional and don’t make them personal. If a post or comment makes you angry, take some time and consider how best to respond (or not).
- When advertising your services, do so within your level of competence. Be clear when you state what you work with and the experience you have.
- If you use social media, remember that clients (past, present and future) may be able to access your posts and comments.
- If you advertise your services, make sure you regularly review advertising content – for example, are your advertised fees up to date? Are you still registered with the organisations/membership bodies listed on your website?
The Professional Conduct Notices can be found at www.bacp.co.uk/professional-conduct-notices