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• This month’s dilemma
  Cameron is nearing the end of his two-year counselling training. He has been having therapy for the entire two years, which was a required part of his course. Cameron has found the therapy very useful, both personally and as part of his professional development, and in the process has developed a good relationship with his therapist. The therapist has occasionally suggested books or articles for Cameron to read and has helped him to think about his client practice in the light of his personal history. Now Cameron is considering stopping therapy but wonders whether he might continue to work with his therapist in a new role as supervisor. After all, she knows Cameron so well and would be aware of possible pitfalls in his practice. What are the issues that Cameron should consider?
  
  Linda Aspey (counsellor/psychotherapist and executive coach)
  It’s not so surprising that Cameron might consider asking his therapist to be his supervisor. Trust in therapy is not easily built and, as he was in some ways a ‘sent client’, there may have been some additional concerns to overcome along the way. In two years he may have shared and learned a lot; it probably won’t all have been easy. The relationship is established, trust and safety may be high, and there is a level of understanding that wouldn’t be present in a new relationship. So why go through it all again with someone new?
  
  The BACP Ethical Framework cautions care around concurrent dual relationships, yet it does not specifically refer to role changes within the relationship. However this dilemma is not new. Teachers of therapy often meet students who were former clients, and therapists who have trained as coaches often wonder if they can take on former counselling clients for coaching and vice versa, or offer the two approaches within the one contract. Boundaries can and do shift, and sometimes re-negotiated relationships can grow into something different and positive for both parties. However, any changes have to be fully considered, with the wellbeing of the client at the heart of any decision, and here we have several clients – Cameron himself, and his future clients.
  
  As a newly qualified counsellor, this can be a very useful reflection and learning exercise for Cameron. First, what are the tasks of therapy and supervision? What are the differences and similarities? He could visit the BACP Ethical Framework and the BACP P4 Information sheet ‘Guidelines for ethical decision-making’ to begin to inform his reflective process.
  
  Whose problem is this – his or the supervisor’s? Has something passed between them that has led him to think that a change in their working alliance might be possible? Ideally he would raise this with his therapist before coming to any conclusions himself. He or they could consider this complex situation from a number of perspectives: that of counselling client, supervisee, therapist and supervisor, and those of his clients.
  
  As the client, why is Cameron considering stopping therapy now? Does the end of the course have to signify the end of therapy? Has he run out of money, achieved all he can or might there be defences at play – for example, to move the focus of the sessions onto a client, and away from him? Have he and his supervisor talked about working towards an ending, or is this sudden? And what if Cameron decided at some point in the future to resume therapy with the therapist – could and should they shift back to their earlier relationship?
  
  As a supervisee, would he be coming willingly to supervision or is there a parallel in being ‘sent’ again because it’s a requirement for professional practice? How does he think their relationship might change around, for example, power, status and knowledge? What might it feel like if the focus was not on him as the client but on his clients?
  
  If Cameron were the therapist here, what factors would he want to consider if a client asked him to change their contracted relationship? What has he learned in his training about the therapeutic dynamic and what may be at play here? Why does he want to continue to see her as his supervisor; is there any element of dependency or idealisation occurring?
  
  These questions – and more – need to be addressed. It is possible they could make it work well, but they both need to exercise extreme wisdom and be willing to say no if needed.
  
  Linda Barnsley (counsellor/supervisor)
  Reading this month’s dilemma, I felt a connection to Cameron’s situation that enables me to give a subjective reflection on the matter.
  
  As a trainee I found myself in a similar situation. Looking back, it was comfortable for me to stay for supervision with the same person who had previously been my counsellor, mentor and role model. She spoke to her own supervisor about the issue and, after a suitable break in the counselling relationship, we decided to proceed with her as my supervisor.
  
  The one pitfall was the change in the dynamics of the new relationship. With her as my counsellor, I had felt totally accepted, enabling me to feel safe and be congruent when bringing my issues to therapy. I was not prepared for the transference and countertransference that was evident when she became my supervisor, and with the element of teaching and monitoring that can be involved with trainee counsellors.
  
  There were times when I felt like a child with a strict and sometimes manipulative parent. This affected the way in which I felt able to bring my clients to supervision. I own the feelings that I had then, and realise that I was extremely vulnerable at this time. Cameron might consider such a situation. Change is never easy, but very often I find that it is what is needed at the time, and is crucial in our personal development if we are to move forward to become competent therapists.
  
  Carole Smith (senior lecturer at the University of Huddersfield)
  I wonder why Cameron is considering this at all. If he is two years into his training, he should know by now that there are important differences in the therapist and the supervisor role. I also wonder whether he has already discussed this with his therapist and whether she has given him any indication that this situation would be possible. I am suspicious about Cameron’s motives and would like to hear the therapist’s side of this, if there is one. Why has the training organisation failed to ensure he is aware of dual roles?
  
  If Cameron has been using therapy for his personal development, which he should have been as he is in training, he should understand the nature of keeping very clear professional boundaries and, at this stage, should be considering supervision as a professional challenge in his next stage of development and not as a continuation of his personal therapy. If his therapist has been ‘helping him to think about his client practice’, part of her role should be to separate out personal issues that need to be explored in therapy and personal/professional issues that need to be taken to supervision, which provides a more objective professional stance.
  
  On the other hand, I can see why Cameron would like his ex-therapist to be his new supervisor; after all, they have developed a good relationship where they are aware of each other’s strengths and weaknesses, which could be a great advantage to his development. They have also learned a shared communication style in their two years together, which must have been therapeutic for Cameron.
  
  Even though therapy and supervision have different goals, there are a number of commonalities to both types of relationship, such as the working alliance, respect for and sharing of knowledge and ideas, honesty, openness and support. If Cameron is not aware of the difference in roles, I can understand his motivation.
  
  However, I feel concerned if Cameron has no contract in place from his training organisation that states clearly what they expect from him in terms of supervision and supervisors. Often a training organisation will provide a list of accepted (in terms of accreditation, practice orientation, insurance etc) supervisors for the trainee to contact and the trainee should understand the requirements for supervision from the outset of training. I am surprised if Cameron is not fully aware of this from his trainers, and I would want to investigate their role.
  
  Cameron needs to consider how his therapist’s intimate knowledge of him might affect the goals of supervision if she continued in this role with him. If his therapist has so far been fully present in the role of supporting him, this would alter considerably in the role of supervisor, where the prime aim is to ensure Cameron’s clients’ wellbeing and safety, working within the boundaries of an ethical framework.
  
  If the therapist has considered being his supervisor, I would be alarmed and concerned about the power dynamic and the ethics in her practice. As a trainer I would want to discuss motives with both of them. If the therapist knows nothing of Cameron’s idea to continue with her as his supervisor, and her ultimate reply would be an ethical no, then it will be a valuable learning experience about boundaries, endings and ethics for Cameron. If they have a sound relationship, then it should be robust enough to survive her refusal with an explanation and an exploration of ethical boundaries.
  
  Margaret Akmakjian-Pitz (supervisor, counsellor and psychotherapist in private practice)
  At first glance this must have seemed ‘perfect’ for Cameron… but it’s not. The change of relationship would require both parties to alter quite radically how they relate to one another. Not impossible, but very hard, and not generally advisable for at least two years.
  
  The big issue is boundaries. I wonder if Cameron has actually discussed this with his counsellor. As presumably the more experienced of the two, I would expect her to ask some probing questions about what might be going on for Cameron, as well as discussing at length the possible pitfalls and problems.
  
  At the very least, the proposed arrangement would limit Cameron’s exposure to others’ ways of working. And, as an inexperienced counsellor, he would do well to have more variety of input, the better to broaden and strengthen his own world view. And always, the best interests of the client must be paramount. Supervision is said to be a relationship about a relationship, but in this case I can see the client easily getting lost as Cameron and his former counsellor grapple with what’s going on for him.
  
  One can anticipate that in the beginning, at least, Cameron – as the less experienced of the two – would experience some confusion about whether he’s talking to his supervisor or his counsellor. And now that he is no longer in active training, he wouldn’t have a third person (his tutor and/or his personal development group) as a possible balance to his experience with his ex-counsellor/now-supervisor.
  
  A further consideration might be the way in which his ex-counsellor works. As his counsellor during his training, she may very well have adapted herself to his programme requirements. As his supervisor, she may very well revert to her own, presumably preferred, way of working, which would be an additional confusion for Cameron. She may actually not have had any supervisor training, which could seduce the two of them into a continuing, but odd, counselling sort of relationship.
  
  All of the above is my logical response. My gut feeling is that Cameron isn’t ready to leave the current relationship yet, so is looking for a way to continue it. Maybe he should, and find a supervisor for his practice.
  
  Barbara Hales (counsellor and supervisor in private practice)
  My first reaction to this month’s dilemma was, ‘No way should Cameron continue to work with his current therapist in a new role as his supervisor.’ Then I did what I hope Cameron would do as he nears the end of his training – I looked at the BACP Ethical Framework for guidance in reaching a decision.
  
  The Ethical Framework recognises that dual relationships ‘can have a powerful beneficial or detrimental impact’, so Cameron might be wise to avoid the risk by finding a different supervisor. Cameron could look at the Ethical Framework with his therapist, who will herself be governed by it in her present role and as his potential supervisor. His decision may be influenced by such issues as dependency, loss, change and transference, which could be explored during his therapy.
  
  Cameron is nearing the end of his course, so he will be facing many changes. He will be losing the support network of fellow students and tutors, while increasing his client sessions. He might consider continuing as a client with his therapist during this transition time, working in the educative and self-reflective style they have developed. He could use future sessions to consider any client groups he might find especially challenging, and what he can learn about himself to minimise that. The Ethical Framework reminds us that self-care is an aspect of functioning efficiently as a counsellor, so Cameron might build up his life-enhancing activities and relationships outside counselling, to offset the loss of fellow students and tutors.
  
  The Ethical Framework requires practitioners to work within their limits ‘taking advantage of available professional support.’ The P4 BACP Information Sheet on ethical decision-making could offer Cameron useful guidance. He might ask his current therapist, and his course tutors, to suggest possible supervisors. A different supervisor will bring a new perspective and enable Cameron to develop and broaden his experience both professionally and personally.
  
  In a few years’ time, after a lengthy break from being a client and having experienced another supervisor, Cameron may choose to return to his present therapist for supervision.
  
  Lorraine Quinn (counsellor and psychotherapist in private practice)
  In my experience it is not unusual for practitioners to have a therapist who becomes their supervisor, and vice versa. In this case it sounds as if Cameron’s therapist has crossed the boundary and is already acting as a de facto supervisor, helping him to think about his client work and recommending books and articles to read. If so, then the question is why did both parties allow this to happen, and what is Cameron missing out on?
  
  It appears that they have not had even a basic discussion as to Cameron’s motivations in bringing client work to therapy when he first started to do so. This might have picked up on what his therapist offers Cameron that his supervisor does not. This could become part of their work together, bringing the focus back to their client/therapist relationship and providing a rich area for developing self-awareness for both. It looks, however, as if both Cameron and his therapist have not even noticed the shift or, if they have, do not regard it as a worthwhile topic for exploration. I think it is important for the two of them to look at what Cameron has been trying to avoid in therapy by turning it into supervision, and his therapist’s apparent collusion in the process. Once they are both clear about the current sub-conscious dynamics of their relationship, they can then reach an informed decision about changing their contract formally, if that is the route they decide to take.

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  Next month’s dilemma
  Rachel is a therapist who has been working with her client, Satya, for some time. During the course of therapy Satya has discussed difficulties with her partner, which were a large part of her reason for entering therapy. She feels that therapy has helped her to reach a good understanding of her issues. She now feels that it would be beneficial for her partner to attend a one-off session so she (the partner) can see for herself exactly what has been achieved. Satya is convinced that this would make a huge difference and help her to progress in her relationship. As it would be a one-off, Rachel is considering allowing Satya’s partner to attend. What issues should Rachel consider in making her decision?
  
  Please email your responses (500 words maximum) by 28 May to Heather Dale at hjdale@gmail.com. Outline how you would manage the dilemma and make your thinking as transparent as possible. A selection of answers will be published in Therapy Today, with others appearing online at TherapyToday.net. Readers are also welcome to send in their own ethical dilemmas for consideration for publication, but these will not be answered personally.