The role play I did
allowed me to work as a counsellor with a client from our class. I began a
little nervously as I had an audience but actually I was fine after about 30
seconds. However, the issue with working with trained clients is that they can
be a bit ‘professional’ and list things that I may have missed. Such as
confidentiality. I’m quite confident that I do attend to this normally, but it
doesn’t hurt to be reminded.
L brought a very deep and
personal subject, which was her inability to connect with male members of our
group. This was something that she clearly wanted to explore and I was
confident and measured in allowing her to focus on this, but again using
‘professional clients’ brings the issue of them being trained to focus on an
issue themselves. I don’t know for sure. I felt ok about the first period of
the session. I felt that I provided an environment whereby L could bring
anything she wanted without the fear of being judged. I felt that I was
attentive and hearing her. I wanted to know more, I am naturally a nosey and
curious person and I do a lot of the active listening skills as second nature
now as they feel right. I made L feel she could be heard and I was aware of
that after the event and perhaps during because she opened up. I do the core
conditions. I must do. There is no judgement I am aware of and I want this
person opposite me to flourish.
Anyway, the conversation
moved through the aspects of her struggles with the men in our teaching group.
It felt that there was something missing and that L wanted to connect with
others in the group but was held back and this bothered her. It had a negative
impact from what she was describing. L went on to say that she had thought a
lot about this and felt that it was due to incidences of rape and being
attacked by men in her earlier life. That she felt able to express this in
front of me was touching and brought us close for a brief spell I felt in so
much as there was a trust and honesty there which I hoped to respect.
How I handled this disclosure
was not perfect on reflection. I began to offer L the opportunity to explore
whether she wanted to take this further however I didn’t get that point across
clearly. I think that I was trying to be gentle in that moment. I needed to be
firmer as it was a matter of real importance, but at the same time I felt it
was a sensitive issue, no doubt. Of course there is doubt. For all I know L may
have dealt with the matter in many respects to the point whereby she is done
with the approach of whether or not she wants to involve others I don’t
actually know how she feels.
It’s obviously a fundamental
part of the relationship between counsellor and client that there is trust. The
person must feel that you will respect their privacy and maintain
confidentiality. This is also a part of the ethical framework.
What does remain with me
though is that it was a confidentiality issue as I now had a duty of care to others
should they be in danger. I realise that now but perhaps didn’t clearly see
that at the time. I did offer to L whether she wanted to ‘take this further’
but that was not clear and I think that L mistook the meaning slightly, I cant
be sure. However we did not look into it from a matter of others safety. This
affected me enough to take this to supervision and I discussed it there.
Supervision
When I spoke about the
issue of what to take further when hearing disclosures in a counselling setting
I found my supervisor really helpful. We talked about how its good to stop
someone and remind them of your responsibility if they were to let you know
certain details or things that led me to believe there could be others at risk
of harm. I had this knowledge from other roles, but to hear it in a counselling
session would be the same should perhaps have been more obvious than it was.
Saying something like “If you name that person and I think that they are still
a risk to children, then I will have a duty to report it.” However, it’s really
about also caring for the person in front of you as they may have been through
a great deal. It will involve keeping it quite loose and not making them feel
under pressure, more that we can look together at preventing others from being
in danger. It’s about supporting that person and making it all achievable in
their own way. This is where the matter of client’s autonomy comes into it.
They should I feel be able to be in control of any process, but that you are
there as a supporting guide and a supporting companion through any process, be
it just a counselling session or in this instance, taking information outside
the realms of the room as a disclosure could have meant that you as a pair, a
unit, need to now let others know that someone is a danger to others. For this
reason, as in the ethical code laid out by the BACP, it is really seen as
preferred that the client’s consent is obtained and all part of how the
confidentiality breach should be handled. However, in certain circumstances it
can be that confidentiality is necessary to be broken if it is to protect the
client from serious harm to themselves or others. That is now quite a heavy thing
to have to contemplate. Obviously its completely separate from the practice
session I had with L, but I have tried to imagine how that would look if I felt
that to include the client would endanger someone or them, so I would have to
act in their/another’s best interests by informing my supervisor for guidance,
an authority figure such as a social worker or the police in an emergency.
In order to satisfy
criteria for my diploma I have looked at the relevant legislation, such as the
duty of care act, concerning adults.
The Care Act: safeguarding adults
The Care Act 2014 sets out a clear legal framework for
how local authorities and other parts of the system should protect adults at
risk of abuse or neglect.
Local authorities have new safeguarding duties. They
must:
·
lead a multi-agency local adult
safeguarding system that seeks to prevent abuse and neglect
and stop it quickly when it happens
·
make enquiries, or request others to make
them, when they think an adult with care and support needs
may be at risk of abuse or neglect and they need to find out what action may be
needed
·
establish Safeguarding Adults Boards,
including the local authority, NHS and police, which will develop, share and
implement a joint safeguarding strategy
·
carry out Safeguarding Adults Reviews when
someone with care and support needs dies as a result of neglect or abuse and
there is a concern that the local authority or its partners could have done
more to protect them
·
arrange for an independent advocate to
represent and support a person who is the subject of a safeguarding enquiry or
review, if required.
It is crucial to know the definition
of a vulnerable adult. Essentially what I feel this act ensures will happen is
that once I act and inform the relevant authorities that I am concerned about a
client who may be in danger, or who may be at risk of neglect (social services,
or the police in an emergency) the local authority have a duty to make
enquiries. The act also elaborates on questions a practitioner who is on the
front line may seek to answer such as is self-neglect a safeguarding issue.
Here as a counselor who has a BACP ethical framework that encourages the
client’s autonomy this must be balanced with the decision that the counselor
must make about how able that person is to make decisions (given
distress/emotions/grief/drugs or alcohol etc) and how much capacity they have.
What is very clear to me is the need to chew decisions over with your
supervisor and hopefully other colleagues if part of an agency, which I hope to
be.
Physical abuse, sexual abuse
emotional abuse and financial abuse are all types of safeguarding concerns that
I could have in the future for an adult. Domestic abuse is sadly another area
of the legislation I feel will come up at some point if I pursue a career in
counseling. Again, the act encourages the wishes of the person to be at the
forefront of any decisions, however to also be aware that coercion and fear may
limit the clients ability to share things or that they may reverse a decision.
I think that I would be able to talk
to another adult in the team upon learning of any form of abuse, or obviously
failing that go to my supervisor, or even ring the bacp for guidance. In work
also I know that you can ring a MASH team for guidance into if that person
seems like they fit critieria, so I could sound them out also. Where I would
want to be very clear is from the outset with the client about the importance
of the limits of my confidentiality. That I was bound by a duty of care and
that they wouldn’t want it any other way, one would hope. Also that I would
want that person to be aware and involved wherever p[ossible of the potential
need to involve another agency and how could we workj together in partnership
to achieve the safe resolution of this matter, now they have brought it to the
session.
Anyway, with regard to the role play
we had I feel that I was on the right lines to ask the client how she felt
about looking into this matter further, but I did not follow that through. I
lacked the conviciotn and confidence. I think that being more mindful of the
gravity of even a classroom role play will stand me in good stead to take these
matters in to a professional arena.
This week on placement
saw me meet another client for the first time, S. S was quite nervous but that
didn’t harm the session I thought. I reflected the opposite in speed of speech
and was calmer to make him calm as well. It really seemed to work a little.
Strangely I found this quite reassuring. That he would be more nervous than I.
Am I beginning to exude some form of assuredness? Does that mean that I'm
becoming comfortable in this role, albeit in its infancy?
Anyway, the fact that it
was our first session and that I wanted to be very mindful of how crucial it is
to get the early this gave me an opportunity to be very clear and open about
the process, my ability, my level, my approach and the limits to counselling.
Its not just knowing how important the start is, but once you've begun listening
to a client after a couple of sessions and you realise that there are things
you could of said more clearly or thoroughly early on, it really has taught me
the need for a strong introduction to the process. Its about being professional
and considerate for the client. They will benefit and be part of the process
more if they feel held, secure and trusting that you have respect and
boundaries for this process. This explanation, or contracting process was
made really easy and open because S was actually one of the first people, if
not the first person to actually ask me what it was that counselling actually
did. So I explained to him about being a person centred therapist and what it
meant. I explained it meant that I was accepting and not judgmental, that I
would not try to work him out or diagnose. This would likely be quite different
from the support he had been receiving from his workers in the house as they
have a different agenda and obviously have a slightly different role. I was
sure to make it clear about the limits of confidentiality also as I need that
client to know that if they disclose using or drinking to me, I am duty bound
to take that to the team. They understand this and I think respect the process
more for that reason.
I really do take contracting
seriously after realising quite why it is important for confidentiality reasons
and for boundary reasons and for trust reasons and for reasons of the client
feeling held, safe and secure in your approach to be professional and caring
and on the ball.
What I recognise is that
there was in me today someone who wanted to be liked. I wanted to leave all
three clients that I saw with something positive. I didn’t initially want this
I don’t think except I have been receiving complimentary comments from them in
conversation and all of a sudden I had something I like that I want to keep.
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