learning journal 10

Safeguarding

So I thought this was going to be quite a boring one, safeguarding. How wrong I was. My previous experience of safeguarding training has been mixed with some great stuff by Devon and Torbay councils but not always the case with other providers. I guess the beauty of our training is that we get to discuss our opinions and feeling around issues and what this raises. However, this can also raise other issues to reflect on.

Today I became quite angry inside over an issue when the group was feeding back around how they would/wouldn’t have acted upon a case study example. For me it was quite black and white. The issue itself was over a suggested example of a 15 year old girl whom we could or could intervene in order to protect given what we are aware of, in this case a paedophile uncle actively attempting to re-engage with her. The discussion became quite heated when as I felt some members of the group had gone 100% person centred at the expense of the safety of an individual, and would not have acted in any way beyond supporting the person in the session to try to find her own best strategy.

While that is a laudable example of the purist person centred approach and one I would agree with on the whole, the age of the client, 15 and the potential harmful consequences immediately removed any shadow of doubt that I would have broken confidentiality with the person knowledge as her safety and well-being were my responsibility now as an aware citizen. That there can be any confusion in the case of a minor is worrying for me. Yes there is a process of evaluation so as not to act in haste, but we had had that as the counsellors to be had had a lengthy discussion about it. What followed was an alarming justification not to act as the client’s confidentiality took precedence. I saw quite a clear case to act given a school girl rape victim was currently threatened by the perpetrator and was in immediate and current risk of distress if not worse.

Looking within at how I felt around this was more interesting. I felt angry. It was a feeling borne of frustration I think. I know I was on a short fuse and have been for sometime with moving house stresses and getting ill so often lately which I think is due to lack of sleep. But, why am I frustrated with others in such an unproductive way. Frequently I don’t understand things the first time. This is happening a lot to me at work also over the last few days. I have been getting frustrated with people at work for not pulling their weight or doing things in what I feel is a wrong way, and this is not at all helpful to one of the biggest things you need in a workplace environment, to get along.

What I’ve noticed is that I am highly critical, of everyone, including myself, which is a character trait I could do without, quite frankly. Also this seems to be accompanied by an urge to be right, in discussions with co-workers. Its over-riding sometimes and takes over what I know to be better for me in the long run when for example I speak in a team meeting. Its not whether or not I am right that matters in the long run. People always come round to the better option but like in counselling, the better outcome I guess is for them to need to feel its their decision and I cant make it for them.

This is a factor in all my interactions particularly when I’m tired or under siege from feeling overwhelmed by tasks. Right now I feel this very much and wonder if doing the course was the right move this year. If I take this feeling of being overwhelmed in to my work place with clients then I will become less tolerant of them, irritable. I would lose the person centered approach and not be with them in their experience. Further in my role on Saturdays as a counsellor in training I would struggle to be present in the moment if I start to apply a judgementalness to my listening skills. This would totally detract from the experience of being there in their shoes for everything that they are saying. I recognise this in myself. So far I am confident I do keep it out of my one to one work with clients, but I have started to see it leak out in group work in my job role with particularly difficult boundary pushing behaviour working with addicts in the community.

An example would be yesterday in stage 1 drugs group, which is a group I co-run with another person. We had devised a group looking at self-awareness and denial, but during it clients began to get food out and roll cigarettes. When I asked them to stop doing this I noticed my reactions were short and irritated. In that moment my impatience and judgementalism came through and I could see it in the responses I got from some of the clients. The fact that I was less tolerant than usual over the boundary pushing and that it was apparent clearly could have a negative impact on my client work.

I recognise that stress is playing an important role in my ability to humanistic with clients, my ability to not be cynical and my overall feelings towards my client group on the whole of late. I am recognising after the event a lot of times yesterday that I was not tolerant of clients in their boundary pushing, which is only part of who they are in this process perhaps. I am quite shocked by even how a rise in stress levels has had abeit a small change in my reactions to clients. Partly I think that it is a rise in congruence when boundaries are being pushed which is no bad thing, and I feel that by and large that is the impact is has had on clients but also the emotional responses of anger behind my intolerance has been what I have been left contemplating. Clients will have noticed that shift. In one to one sessions client will notice that shift should it come about and then the impact would be really poor to the therapeutic alliance. All this leaves me feeling this week that I have been more emotional and I recognise the need for self-care. I look forward to therapy when it comes. I look forward to the house move being over in December also as this is probably the stressor that’s proving too much for me at the moment.

Gong back to my placement now I saw two clients this week in Truro. One was a man who presented with no issues at all. Quite an interesting session we had exploring positivity and moving forward. S was at first quite a tricky client in so much as he was seemingly quite reluctant. However I embraced this in a light-hearted way and worked more on building a connection between us so that he would feel comfortable in sharing. Sure enough this then brought out a lot of exploration in the past and present that I feel was an hour well spent.

The second person was completely the opposite, as they really wanted to unload. J presented overwhelming grief for recent losses of both parents and the upheaval that losing home, job and health in the past 18 months had made on her life. It crossed my mind that a counsellor in training may not be best suited to such an intense amount of emotion. However, I just stayed with the client, used all the basic listening and focussing skills and had no agenda to fix at all. I feel we accomplished a huge amount. It was emotional for the client and it was quite a draining experience being with such emotion for so long and I felt exhausted afterwards.

With both clients I clarified the level of confidentiality. I am really getting to grips with this as a fundamental aspect of introducing what it is we are able to do. It clearly sets the boundaries and truly informs the person what they can expect. I stated that what they discuss is confidential, although if they let me know that they will harm themselves or another or I believe them to be at risk of harm, I am duty bound to break that confidentiality. However, I will do this with their knowledge if at all possible. Also I was very clear about me keeping brief notes and relaying concerns to the team which I am part of. The other factor given that this is part of a service within a rehabilitation service for alcohol and drugs clients in recovery, is that I obviously make them aware of the provision to break confidentiality if they reveal that they plan to or have used mind altering substances. This is due to the risk they may pose themselves or the dangers that this could have on other vulnerable members of the houses. Some of this I read from a contract, but I always make it part of a wider discussion if the person intimates that they want further clarification. I feel that I am very comfortable with expanding on this and know the value of dealing with these issues right at the start of the relationship, as it makes that person feel boundaried and safe I feel, knowing what are the confidentiality limits.

I did speak to the engagement worker immediately after and only them, as it was necessary to hand over some of the essence of what had gone on, with a view to managing risk. The clients are bringing up very emotional things for them and leaving themselves vulnerable. This particular client group can use mind altering substances as a coping strategy for difficult emotions and so to let others in the team know that this has happened is really important.

I handed over to Sheeana the engagement worker for about ten minutes after the sessions. This was a very important part of sharing the process that the clients had been through so that we could ensure their care and safety, but also part of integrating the team as a wider and unified cohesive unit. It is really important for us all to feel that we are all aware of what is going on for the client group and that we are all aware of what is going on. This enables us to be more alert to risk, managing risk but also to build our working relationships to enable a strong bond between us as a team.

In line with the basic principles of the Data Protection Act 1998 (http://www.legislation.gov.uk/ukpga/1998/29/contents), the information I have is only to be used fairly and for limited specific purposes so that Sheeana and I share for a specific reason, the protection and support of our clients. We shared information in a specific and relevant way and in a safe and secure manner. In order for this to happen we shared client information behind a closed door in the team office so that clients could not hear us. Had there been any alarming risks or need to alert others, there is duty on call worker to bring in and we are very aware of how to do this should there be any need to involve them. This could be for very immediate risk of clients breaking rules in the house or for example clients’ fighting as happened on Monday just gone. At all times the mood in the house and the relationships between clients has to be monitored, after all these are people regaining emotions and living on top of each other in quite life changing circumstances. Had I felt that there were any such risks I would have called the on-call worker in addition to liaising with the engagement team. Further to all of this I wrote an anonymysed email to the team leader afterwards detailing who attended, any concerns or otherwise. This is a soft copy of my anonymous notes, which are very brief after each session and go in a folder, which is then locked away in the team leaders cabinet in a locked team office. This enables the team leader to check who is making use of the service and gaining from it, which in turn highlights risky attitudes possibly if they are not. Also it makes very clear any concerns or risks I feel that there are for the team leader to be aware of over the coming week, as he will be privy to their visits and general calendar events. Should these create any further raised levels we are sharing as a team to best prepare for the client to be supported.

Learning Journal 8

Confidentiality

I was unable to attend this week so made some readings of my own on the topic and also referenced my own personal experiences given that confidentiality is a massive part of working with clients in my particular field of alcohol and substance misuse work.

Essentially confidentiality is the rule or promise that certain information will be held with restricted or limited access. What this means is that we make it known to a client that what they share with us is treated with respect and privacy, although we elaborate on the lack of absolutes. In the counselling field the BACP explains respecting privacy and confidentiality more thoroughly as “a fundamental requirement of keeping trust and respecting a clients’ autonomy” (BACP Ethical Framework). What this means to me is that we as practitioners need to be clear with our clients about what confidentiality actually is, how we will ensure that we maintain it but also what the limits to that confidentiality are.

I am always open and clear about confidentiality in both my group and 1-1 settings with clients. Certainly when I first meet with them I am very thorough about what it means to have what they tell me treated confidentially. I am also very clear that I store records on a database and that I work in a team, which means others may have access to these notes. I justify this as being necessary for us to provide a thorough and professional service, as my team may need access to what has been discussed in my absence or days off. I get them to sign a form with any names or organisations or agencies they would be ok with us sharing information with, such as a relative, GP or social services for example. Usually this is only level 2 data that we will share unless the client specifies we can share further. Level 2 data being simply acknowledging that the person attends the service and also how frequently they attend/miss sessions and also some surface acknowledgement of how they have engaged.

By ensuring the client is aware of these boundaries to confidentiality we can make it known to them how safe their disclosures are. The client can then trust the process in so much as they can feel what they disclose can only travel within certain limits and wont be shared unnecessarily with other people or agencies. Even if this were to happen the client would know that they are made aware of this sharing of information wherever possible. This is how we treat people with respect and dignity, which is all part of delivering both a professional service. Also this professional service being ethically sound and respecting the client’s autonomy as we ensure that they are fully informed of the process, its limitations and how their disclosures will be treated.

For me its very important that I am clear with clients about the limits to confidentiality but also that we work in a confidential way. They must be informed and give their consent. It gives them a feeling that they can open up and trust us as a service. Without any confidentiality how could they being to do any work or disclose anything at all? This all comes from being very clear about the boundaries to confidentiality in my opening contracting with clients when I do their full assessment after they have been allocated to me as a recovery worker. Additionally I get clients to sign a confidentiality waver so that we can with their consent contact the GP, store data and disclose certain information to others that they have specified. If I am open and clear about things like expectations of engagement or confidentiality and its boundaries at the outset, it means they client is given respect and autonomy and is informed to choose whether this is the service for them.

If ever I needed to break confidentiality I would seek the supervision of my line manager whenever possible. I would also involve the client whenever possible. It would really depend on the reasons for breaking confidentiality and what has been disclosed but essentiality my concerns would be around learning that any individual was at preventable risk of harm, or that a serious crime was or had taken place.

Last week a client’s brother called the service wanting to speak to me and encourage me to call the client. I could hear his desperation and that he had real concerns. I did my best to be polite and explain very clearly that I was unable to disclose client’s engagement in a respectful manner. I could also tell that this caller was likely to be legitimate and was very probably a concerned family member, however I did not have signed consent to speak to him about the client. What I did was suggest that he ask the client to call me and at least pass on verbal consent to speak to this person. While not ideal it would give me chance to confirm verbally in the mean time that should I receive a call from this individual I could at least acknowledge the client was known to us as a service.

This was a potential incident that was avoided by not disclosing. However on the other hand, had I gotten consent from the client before hand to speak to the family member, I would have been able to confirm the client was engaging with our service and that he was attending appointments, which may have left them feeling less anxious. Concerned relatives frequently call our service.

What this episode confirms to the client is that he can talk safely and openly with our service. We do not disclose information to third parties in these sorts of circumstances and that we treat his engagement in our service with respect. It left me feeling reassured despite the pull of a concerned brother being on the line at one point. No matter how much they want to know their brother is alive or trying to beat heroin, its not ok to share that information without the client’s consent. On this occasion I didn’t feel it presented an ethical dilemma as while I did have some feelings of wanting to help the distressed family member on the phone, this was overridden by my knowing the boundaries to confidentiality and why they are in place. At no point was I close to breaking the clients trust in us as a service.

Learning Journal 4

Diversity has a lot to do with empathy I believe. That is, the ability to really understand how it feels to walk in that persons shoes. That alone takes a real letting go of preconceptions, leaving thoughts at the door and being prepared to open a new page on whatever that person brings. They are not a book you have already read. For me it means being prepared to work on my tendency to feel like I already understand someone, rather than maintain the desire to keep trying to hear how they experience their world and not adjust it to my own objective realities. When it comes to how that person has experienced their own challenges by way of prejudice or inequality, it must be incredibly important to believe that persons recount of their experiences of diversity.

Crucially to the client that shared experience of their understanding of how they have been stereotyped or discriminated against can only come if we as workers allow ourselves to do 2 things. Both to truly experience their reality but then to convey our understanding of that reality also. Then the counselor will be able to know how that person experiences their uniqueness or sub culture/micro-culture, but in a therapeutic offer, be able to share that understanding with the other person. That would then be a communication between the two people that may form a connection and so be supportive and beneficial to the client.

Diversity is going to work on so many different levels in counseling as the therapist surely benefits from being both aware of the 100% individuality of their client, that the client may or may not know their own uniqueness within their world and also that the therapist needs to aware of their own biases and prejudices and self-held beliefs that may impact the work they can offer a client. By communicating a shared understanding of the clients individual experiences to the client from the therapist by being known, the client can have their experience validated and whatever issues they have brought they can now look upon with a degree of validation and greater self-interest.

To raise self-interest and greater self-respect is key to a lot of my current in the drug and alcohol field. Although I do not counsel clients I still support them and play I feel a potentially important role in facilitating them to access their own resources for positive change. That requires the core conditions for me and pertinently, an appreciation of their experience of diversity issues given them often come with marginalizing compounding issues beyond the drug/alcohol ones, often being the pre-cursor.

I experience a strange reaction to clients in the drug and alcohol field, that I meet sometimes that I can only describe as empathy then a building prejudice. It really is rather strange. A very recent and very illustrative example would be this week. I interviewed a client transferring from Plymouth to our region and who wanted prescribing methadone. I spent about 40 minutes being right there with him in his anxiety, difficulty to attend groups, inability to use public transport, in and out of prisons, struggle to feed 4 kids, no job, partner caring fro him as too anxious to leave house on his own. Then his exacerbation at the cost of getting to our service meant effectively he had to pay for his methadone. It was that last statement that all of a sudden bothered me. “I have to pay for my methadone” – by proxy as we do not refund public transport. Right then and there he lost me. It really bothered me that he had so much for free, then had the check to complain he may be inconvenienced to access his free class A drugs. This is big for me. It goes to my very core. I think I want a society that is supportive and inclusive and doesn’t let anyone fall through the net as it were, but at the same time I cant stand laziness, something for nothing culture and expectations of others to provide when you yourself offer society nothing. Where does that come from? Is there a something for nothing culture? If by developing a feeling of entitlement would I not simply be enabled by a lack of support and inadequate life chances?

Its only when feelings like this really jar with me that I can notice my attitudes and prejudices. Where do they come from? Maybe my parents drumming into me the contempt for laziness from an early age or the culture of working as many hours as possible to be ‘successful’. Possibly a search for validation from others that may come from being a member of a team/society and precisely not the member of a team/society that needs to be carried. I am not sure, but I do know how it feels to be carried. The trap that it is, the cycle of being tied to a ball and chain that is a dependency and with it the inability to value yourself, to be physically or mentally able to set goals let alone achieve them. Couple with that the lowered self-esteem that comes with attending services, having to claim benefits and not being able to hold down a job. Yet, even having been there in my own position of feeling trapped, I still have to actively challenge the negative feelings that can be raised in me when it comes to hearing stories about people in this situation. Are they products of environments? Was I? Do I not still feel that ultimately I had choices, no matter how limited? Therefore can I blame myself for making poor choices, still? Do I still blame myself for making poor choices and carry a burden of this blame? If this is the case, how much are these ideals still going to be present when I work with a client base that largely is dependent and may well have made poor choices? Can I realistically maintain the conflict? Its interesting that when I am working with people on a one to one basis, this has never before cropped up, only when that one comment was made and pushed buttons. All times previous I have not struggled with core conditions but I recognize in me when that service and role comes under threat.

It actually feels quite a lot of relief has passed over me by getting this on paper. By expelling these thoughts I feel lighter. By going through this process I can be aware and know that this could come up for me with clients and to be mindful of it and how I express myself in these situations, but also that I need to be aware of my buttons and what pushes them, then I can be a lighter and less burdened practioner.

Over-identification is definitely something I need to be mindful of as a worker with clients who present with drug and alcohol issues. The marginalization, the prejudices and the stigma attached can feel all too familiar, yet is it? Is it familiar to me at all? My family were particularly exhausted and frustrated but my years of addiction, yet that does not mean I can relate to another persons family problems or the lack of work, or the being in a bed-sit. I can recall multiple issues being in a fog of chemical dependence yet it doesn’t endow me with insight in to another’s world. Not one bit. Not if I to offer them true empathy.

Learning Journal 3

Learning Journal 3

Boundaries

What are mine? How do we use them in therapy? Why do we need them in a therapeutic relationship?

This session we did a role play which very much put the focus on boundary making and maintaining. Boy did I have a challenge in Shawn who was relentless in trying to get me as the counselor to feed into his need for affirmation and play onto the childlike state he presented. I began well enough with a brief and slightly rusty nod to the confidentiality and time boundaries of the session with a mention of my level of training. I know there are many other items to mention in a contract/boundary giving section, and now I really wish that I had gone through other things. With hindsight it would have been really pertinent to have mentioned the fact that the session is about the client and not about me. That I am there for the client and that it is not a tijme to focus on myself as a counselor.

The session went well and I felt that I used skills that enabled Shawn to be heard and want to speak. I used minimal encouragers and summarized well. All the basic reflections that help a client to stay on track with their own thoughts. This I feel I am doing quite naturally now so this feels good to have become ok at this. Reflecting and eye contact and minimal encouragers take very little thought for me, theyt just happen now (famous last words). Like changing gear in a car, they just happen. Now I can start to look where the car is going.

The real challenge came for me when I had to start to try to sustain the boundaries as Shawn tried to get me as the counselor to tell him he was ok. “You think I’m ok don’t you?” – which to be fair to myself I must have had to try to absorb over 20 times. I used reflection a few times and simply put that question back to Shawn. I also made an enquiry about why Shawn felt he needed my affirmation? I then spread that net wider and tried to get Shawn to question why he may have needed it from his father, but it kept coming back. I feel that in a real situation I would have changed the tack of the session more dramatically and perhaps even brought the session to a close as it simply would not be safe to have a question put to you so rigidly and so repeatedly and be left feeling the person was mentally stable. I would explore that as an option in supervision anyway.

If I had had a firmer foundation I could have refereed to it. I would have benefitted from talking about the boundaries and my level of involvement and my role as I could have referred to it at any stage. I lacked that reference point and so was left feeling slightly flounder for much of the session. This had an impact on me as the counselor as I became distracted and off-balance around this constant boundary push. It must surely be best to put this to bed as quickly as possible in a situation so that no harm to egos is done and nobody feels hurt or in any way unable to continue and open up. The boundary push had made me feel unsafe and uneasy so it must have the potential to be this way for the client also.

Learning Journal 7

Ethical & Legal Requirements

This week we discussed and explored the ethical and legal requirements around practicing as a counsellor and brought into my consciousness the elements of values, morals, principles and professional boundaries that will guide me, I hope, as a practitioner. The importance of this is highlighted by the fact that the very first criteria for the course, 1.1.1 is working within an ethical framework. We also attempted to work within our professional and ethical boundaries when faced with clients that wanted to push these boundaries, exceeding those that are safe to operate in as counsellors in role-plays.

An ethical framework is a basis from which to know how we should practice as therapists. It pulls together a sense of what is good and safe practice by covering aspects of what our values will be as members adhering to this governance. Values are what we hold dear to our core. They are the foundation of all we are. It is universal that people hold values however values themselves are not universal. What a document such as the BACP ethical guidelines seeks to achieve I feel is a bringing together of what we hold as irrefutable core values as professionals seeking to provide a helping service.

Further to core values of respect, protection of rights and alleviating stress and suffering to name but a few, the guidelines pursue the administration of such value driven practice through principles of practice. The principles of practice open out a discussion for us all to be overtly aware of how our good practice, ideals and values can be conceptualised in terms of operating with a client group. That we should do no harm, be trustworthy and promote autonomy are but some of these ethical principles and by stating them clearly they are there for all to read, be clear about and debate and refine. That is what good practice is all about to me.

The reasons for working within an ethical framework are for me so that it unifies the best standard of practice and also provides a reference point for us all as practitioners to go back to. Ethical dilemmas will come up given that working in a helping role is challenging and we will encounter times when we feel there are different pulls on what we may wish to do as practitioners. But by having a best practice code of conduct it is an open document for all to know how we as a profession feel all decisions should be underpinned. Perhaps we all operate within our own set of values but are these in line with what is held by the majority involved with this profession to be most suitable for working with clients? By having this document it can bring together but also filter out who may or may not be suitable for working in a helping way, as determined by such an organisational code.

For me it’s incredibly important to have this ethical code as it serves as reference point, a guide and a clarification of what may not have been brought to my consciousness. I may think or feel like I operate in a ‘good’ way and that I’m ok for this reason. But when pushed to make challenging decisions or simply having a discussion with myself about what my values are this document unpacks them and explores them. I can then see if my values match or mismatch and what that then means for example. It is in the very nature of a helping profession that this foundation of practice is there, and also for it to be there to discuss and to make overtly accessible for all.

I did a role-play scenario as the counsellor, which went rather poorly in terms of holding the ethical boundary. I was there to counsel a lady who unable to pay her way for sessions; as a private practitioner I may face this dilemma and so it was a good one. What unfolded was me being tested in terms of would I allow this person to negotiate not paying and I was unable to parry somewhat of a barrage as I didn’t really have a clear picture in my mind of how to be safe and boundaried. On reflection I wasn’t well grounded and perhaps its just as well this did go badly from a learning perspective as I felt that I can take more away from it this way.

When the lady began intimating that she was unable to afford the sessions I felt like I wanted to accommodate this. I wanted to budge on the costing and allow her this movement. What I felt inside was discomfort and desire to allow this change to the arrangement. I wanted to give in, to be nice, to help. This is a curious feeling as why would I want to do something for free? Also what does it say about my self-respect as a practitioner if I can effectively be unpaid? What does it say about my confidence in my own worth or ability?

I dithered and didn’t handle this matter well at all. I did not weigh up the ramifications of allowing the clients desire to get free sessions. I moved more with a gut desire to ease the unpleasantness of being pushed to allow this to happen. It tells me a good deal about myself. Firstly I lack confidence in my own ability, which is probably not such a bad thing given my level of training. Secondly, I must be clear with boundaries. They are there for the clients and my safety. Once one boundary is eroded, the rest can be pressured and the whole sense of a safe and secure environment has begun to ebb away. This cannot then be a safe place to practice and although its simple, my default position when I’m not focussed needs to change. This is a matter that I would like to be more mindful of in every walk of life, boundaries. Thirdly, it’s probably better to go second or last in a role-play so I can sense the rules of the game. Going second or third just may have been a fraction easier as I could have learned by others imperfections and sensed what it was exactly I was supposed to achieve. That being said, on this occasion I am very glad I went first and made a hash of it as I can take the learning very seriously. Its good to see how bad it can get so I know what needs to happen.

On one hand it is not being just in my treatment of all clients as I am offering one client a different service. Even if she had no means of accessing counselling any other way, it is disrespectful to the process and other clients to treat clients differently. If I could act differently with one client, then I could shift other boundaries for others perhaps.

This was a very important session for me. I floundered in the role-play and felt out of my comfort zone, out of my depth and unsafe to practice. Because of this I have I feel taken a very good look at myself and what it means to be ethical and boundaried and very much what it is to be ‘safe’ to practice. I hope that by seeing this necessity to be so boundaried I can move forward and be in a more solid place to practice in future. I was not really disheartened, more conscious of incompetence and reflective on what it will mean to be doing this role. I feel I have an understanding of what I need to become.