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• Miguel has been in supervision with Karen for two years. They used to meet face-to-face before he moved and now they have supervision online. Miguel recently began working at a GP surgery and he wishes to discuss his new client, Paula.
  
  Miguel: Paula has been referred by the GP surgery. She’s in her late 60’s, has low mood and has recently retired. The doctor told me that she has become progressively deaf and uses a hearing aid. I checked with the doctor whether she needs a hearing loop for the session and was told, ‘it’s fine, we can usually communicate OK.’ But I’m not convinced about how appropriate this is for therapy.
  
  Karen sat and pondered for a moment on what Miguel had said. Her immediate reaction was, ‘never mind therapy, that’s not appropriate in any healthcare setting’, considering all public sector service providers have a responsibility to ensure services do not discriminate.
  
  Karen: I think you are right to be concerned. It sounds like the surgery does not provide a hearing loop? I would have thought that would have been available as a matter of routine from what I know about legislation relating to disability discrimination.
  
  Miguel: That’s my view too. They have a portable one but it’s broken and the doctor said that noone seems to miss not having it, so they haven’t bothered getting it repaired or replaced.
  
  Karen: And you are left in a position where there is an expectation that you can provide counselling to Paula, a deaf client who uses a hearing aid but really needs to use a hearing loop.
  
  Miguel: It seems she can hear without the loop but not as well as when her hearing aid is switched to pick up the loop signal. Clearly, the loop makes a difference to her. I know this because when I contacted her to arrange a first session she told me – her phone is adapted at home.
  
  Karen felt reassured that the conversation had taken place although it didn’t seem to have resolved anything.
  
  Karen: So, clearly communication between you will be much easier with a hearing loop. But what is the position now? Have you spoken to the doctor?
  
  Miguel: I informed the doctor of my concerns and said that I’d spoken to Paula. The doctor said that they’d look at fixing the loop, but it would probably be a while, and could I at least start the therapy sessions. Why they can’t just go out and buy a new one I don’t know.
  
  Karen sensed Miguel’s irritation and frustration, and voiced this in her response.
  
  Karen: Leave’s you feeling irritated and frustrated.
  
  Miguel: It does. I want to offer Paula counselling, I don’t want to disadvantage her, but would it be ethical to offer her sessions before the hearing loop is repaired, or whatever they end up doing about it?
  
  Karen thought either way, Paula would be disadvantaged. The surgery had got itself into a difficult position that could easily have been avoided. Karen wondered what Paula’s view was. Some people might be prepared to accept and make the best of the situation, but that wasn’t the point. Paula had a right to access the counselling service.
  
  Karen: What is Paula’s view?
  
  Miguel: She seemed to be accepting of the situation, she doesn’t want to cause trouble. She’s clearly got a good relationship with her doctor despite all of this. I think they’ve known each other a long time. I’m wondering whether to offer telephone counselling until the hearing loop is sorted, but I still feel this isn’t really what should happen. I just don’t feel comfortable with any of this.
  
  Karen: It’s leaving you feeling uncomfortable being put in the position of feeling you have to offer something that is not ideal…
  
  Miguel: And it feels discriminatory. I mean, OK, maybe the telephone counselling as a stopgap might be seen as a temporary reasonable adjustment in the circumstances, but, it still doesn’t feel right.

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  Points for reflection
  1.    What was your first reaction to the situation as it arose, and have your thoughts changed on reading the dialogue?

  2.    If Miguel was to provide telephone counselling as a stopgap, would this be a ‘reasonable adjustment’ or unethical practice colluding with disability discrimination?

  3.    What action should Karen specifically advise Miguel to take? 

  4.    In terms of your theoretical approach to counselling, are there particular considerations that you would need to take account of when working with a person for whom deafness has developed progressively like Paula?

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  Responses to points for reflection
  by Caro Bailey
  
  1. Angry!  Having read the dialogue, also outraged and disillusioned – this seems to be a situation which need not to have occurred if the GP practice had attended to its disability access issues.
  
  2.  I am inclined to think if Miguel did bow to the GP’s pressure and provide telephone counselling he would not only be colluding with the ongoing situation but likely perpetuating it.  Sadly Paula loses out, Miguel feels inadequate by being unable to provide a service for a needy client and Karen holds the pressure from all three sides, in the middle.
  
  3. As I see the situation now, if Miguel works with Paula in any way without a loop she may well be disadvantaged because of her hearing loss additionally, she might feel she does not deserve the help she has a right to and which the surgery has a duty to provide. I would encourage Miguel to inform the GP he is not prepared to work with Paula, because it is an unethical situation. I would also suggest he clarifies he is quite prepared to work with her as soon as a loop is provided. At the same time, I would advise that Miguel contact Paula to explain he will be working with her once the surgery has provided a loop, but there will be a bit of a wait until that can happen
  
  4. I always ask potential clients to come for an initial mutual assessment session during which we can discuss whether we want and can work together.  With a progressively deaf client, I would also want to check out the extent to which she can lip read and/or use writing aids to help her understanding. I would want to find out how able, resilient and supported she is about pursuing her rights as a woman with a hidden disability not only for herself, but perhaps in consideration of others in a similar situation.

• We are interested in your views. If you would like to respond to these points for reflection, or the responses email niki.lawrence@bacp.co.uk

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  Caro Bailey has been counselling, supervising and training for over 30 years and is a co-tutor on the CASCADE diploma in individual and group supervision

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  Richard Bryant-Jefferies has written a number of books on counselling and alcohol use themes, in particular using fictitious dialogue to allow the reader to engage with characters and processes within the counselling room. He has been a counsellor and supervisor working in the NHS and in private practice. Visit www.richardbj.co.uk

   

• References:
  

  BACP Information sheet Making therapy accessible to disabled people (G11)
  BACP Ethical Framework for Good Practice in Counselling & Psychotherapy