This week we were looking at Ethics in counselling. Our tutor gave us some “Counsellor’s Ethical Dilemmas” to unpick and suggested we use the BACP’s Ethical framework to aid us. That is what it is there for, after all.

The first ethical dilemma was that we had been working with a client for three sessions and we discover that our counselling supervisor is our client’s manager, and that our client’s main reason for attending the therapy is to discuss a future employment tribunal involving their manager (who is also our supervisor). I think in the first instance I should use immediacy and let the client know my relationship with their manager. I would assume, since my client’s manager is a counsellor that my client is also in the counselling realm, so they should understand why it is unethical for me to continue counselling them. If I was working for an agency then I would try to arrange another counsellor for them that has no connection to their manager. I would also take the matter to my line manager, who, in an ideal world, is not my supervisor – It is a conflict of interests for your line manager to be the person you go to supervision for. This situation could cause any manner of problems, from there being tension between my client, myself and their manager/my supervisor, to an element of distrust considering it took me three sessions to discover that my supervisor was my client’s line manager, and it could potentially disrupt the employment tribunal as well if the client felt that matters about it could have been discussed in supervision. The client could also refuse to work with another counsellor, given that we’d already completed three sessions.

In the second scenario a client turns up to their sixth and final session smelling of alcohol. How I managed this situation would depend on the strength of the smell, and whether I felt the client was intoxicated – After we had already had five sessions together I think I would be able to tell if the client was acting abnormally (drunk), or if they only smelt of alcohol. A smell of alcohol can persist even if only one drink has been recently consumed, but if it was a strong smell on their breath, clothes and hair, I might be less inclined to continue. If they arrived with a can in their hand and were slurring their speech, I would definitely not continue. With that being said, it would be my duty as counsellor to limit their harm – having a drunk person to deal with and look after is sometimes a problem all of its own. Depending on the organisation it could be possible to reschedule another appointment for the next week when the client was sober.

The third scenario involves our client telling us that they are going to commit suicide as they have been told that they are terminally ill and have only six weeks to live. I think in the first instance I would encourage the client to tackle the feelings they have about their terminal illness head on, reassuring them that this is a safe place for them to really express how they feel and explore what they think. By the end of the session we can see if they still feel the same – they may well not feel so bad after having got it out in the open. I would definitely contact their GP as well to let them know that they were feeling suicidal.

The most obvious problem that I envisage in this scenario is the client feeling suicidal. This could be disastrous if handled badly. Dismissing their feelings would be a bad move and would probably make them feel worse about themselves. I would imagine coming to terms with a terminal illness is not one of the easiest things to do, and being told you only have so long to live would make you feel quite dejected.

For scenario four, halfway through the session the client announces that they have taken an overdose and feel drowsy. The absolute first thing I would do is take what they are saying as the absolute truth and call an ambulance. Dismissing it as a lie, even if the client has form for lying, could result in death or serious damage to the client. When a counsellor is seeing a client, the client is under the counsellor’s duty of care and a counsellor is accountable – you absolutely have to put their safety first, even if there is any doubt. I would also break confidentiality and contact the clients GP to let them know what has happened. I think I could still carry on counselling the client after something like this, but it may cause problems from their perspective if they are embarrassed about continuing. I would definitely take it 100% seriously – it’s just too risky not to. If I didn’t believe the client and dismissed it as a lie, but then it turned out to be the truth and they had taken an overdose then there would be dire consequences for everyone involved.

In scenario five my client tells me that her husband has told her that his counsellor is my supervisor and therefore has more experience than me. First of all, I would remain calm. It is a bit of an inflammatory statement and when we were discussing it in the group it did raise the ire of a few of my peers, myself included if I’m being honest. I think I would explain how supervision works in a counselling situation, but even thinking about mentioning that my supervisor would not necessarily have more experience than me would be succumbing to my feelings of wanting to make it clear that I am a great counsellor, regardless of who is counselling her husband and who my supervisor is. I would tell her that it would be possible for her to see a more experienced counsellor in our agency if she would prefer, but that I am more than happy to continue myself.

I feel this would cause so many problems. They are both having counselling, but it is difficult to tell if it is marriage counselling or just individual counselling. If it is marriage counselling then they could be playing mind games with each other, I can imagine that. Why would the husband’s counsellor be telling him that they are my supervisor? That is an ethical no-no right there, and needless immediacy. I would not be able to talk about it with my supervisor, because my supervisor is involved in the situation. I would have to tell my line manager, get a second, impartial, opinion on the problem.

In addition to these, Pat also gave us some “Counselling Skills” dilemmas to explore, and these were based more on using helping skills in a more casual environment rather than in a professional capacity as a fully trained and licensed counsellor.

In the first scenario we were asked to imagine that we worked in a care home and regularly use our counselling skills to support the residents. An elderly man whom we have recently been supporting has told us that he shoplifts from the local shop. Firstly, I would not instantly report him to the police or to the care home management. I would carefully make sure he is clear about any repercussions that would come about if he got caught while building up trust to see if there are deeper underlying problems, such as kleptomania or dementia. He could also feel he doesn’t have enough of his own money to spend, which I could discuss with my line manager at the care home.

In the second scenario I work as a mentor at a secondary school. One of the students tells me that they self-harm. First and foremost, I would report it to my superior. Once I have been made aware of it and passed it on and it is on record, it won’t come out of nowhere as a surprise for everyone else later on. With them being 15 or younger, it is important to flag it as it is most definitely a symptom of something else going on elsewhere in their life that they maybe feel too ashamed to talk about. If, after admitting to it and it being reported and someone else coming in to investigate further the child doesn’t want the fuss, then they could say they were lying. That would also cause trust issues and they may not want to talk about it further.

Scenario three involves one of the elderly ladies in the care home where I work as a carer telling me that she is totally depressed and doesn’t want to continue living. I would tell my line manager as soon as possible, as it could be that she is stockpiling medication. Again, logging something like this is important as it highlights that this person has an issue and it makes other people aware of the issue, so more people can keep an eye open for any developments. I think a care home is the safest place for an elderly person that is feeling depressed and suicidal, as they have a great support network in place. I would also try to get her to tackle her feelings about not wanting to be alive, and she may feel differently after exploring those themes.

In scenario four I help at a local church bereavement “tea and chat” group as a volunteer supporter, and one of the recently bereaved individuals seems very disturbed. I don’t think I would push too hard on this one to be quite honest. I would gently probe, see if they are generally ok, but pushing too hard and trying to talk to someone that doesn’t want to talk usually just makes things awkward. I would make it clear that if they did want to talk, then I would be there for them. I would definitely bring it up with the leader of the group, just to make them aware that I’ve noticed something is off, maybe they would have noticed something too. It could be that it was a meaningful anniversary of birthday for the recently bereaved individual; maybe the group leader would have an idea if that were the case. There is not much worse than seeing an easy opportunity to help someone but not taking it. One problem here is that the person could leave early, not wanting to talk about it, before I let them know that I’m available to listen.

This week we also talked about Confidentiality, and we were asked to explore what we would personally find difficult to keep confidential and write about it. I’m not sure I would find anything particularly difficult to keep confidential, as in my role as a counsellor it would be my duty to put my client first. At first I thought of a few exceptions to this, such as if a client were planning to steal something, but I think that maybe unless it were serious organised crime, just asking them about what circumstances had lead them to this decision, if they thought it was the right thing to do, if they had alternatives that would be safer and more legal for everyone involved, that might change their minds, or at least make them think twice.

Another exception to this would be if someone were in danger, either the client or someone else. If the client said he was suicidal then I feel like I would have to tell someone so no harm came to him. Also, if a client said he was going to hurt someone else, then I feel I would have to tell someone. I think the main issues I would break confidentiality for would be violence against someone else, and sexual or domestic abuse. I don’t consider myself a gossip, so it’s not like I would divulge any juicy stories to other people just for my own enjoyment or to boost my popularity, I am very discrete.

Ethical dilemmas in relation to maintaining confidentiality is definitely a challenging area. I know that if I am ever unsure of what to do, supervision is great for getting feedback from an experienced counsellor, and for more urgent ethical problems, the BACP has an ethical helpline to support its members. What fascinates me is that there is no standard answer that solves all ethical quandaries. No two situations are ever the same, and what works for one person may not work for another. People are dynamic elements that interact with one another in chaotic ways. In all of the scenarios above, there are so many factors that could cause problems, or dynamic elements in those problems that could cause more problems on top of them, that no one answer would ever be enough to definitively answer the dilemma. In all cases, the counsellor should discuss it with their supervisor and get another perspective on it.

It does, for me, underline the main reason that a question beginning in “Why” can be so utterly useless. People can do things just because they want to. Any reason attached to that could be utterly arbitrary, or simply made up because it sounds convincing in their head. The real challenge when it comes to solving ethical dilemmas is getting to the root cause of a person’s desires and finding out what it is that they are trying to communicate by acting in a certain way. A counsellor can’t simply ask “Why”, because oft-times a client probably doesn’t know any further than it feels good to them and they want to do it – it’s an unconscious desire.

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