|"Satya feels she has really benefited from therapy. Now she wants her partner to come to a therapy session. But perhaps the key question for her therapist is not whether but why?" |
|"Cameron gets on well with his therapist. They have developed a quasi-supervisory relationship during his counselling training. Now he needs to find a supervisor, and thinks she might be ideal" |
|"Janet recommends her own supervisor to a friend looking for a therapist. Then they fall out. And suddenly Janet’s relationship with her supervisor becomes a potentially unsafe space"|
Ben wants to work as a counsellor in the agency where he is already employed as the receptionist. His manager feels under pressure to support his career development, but would this dual role be ethical?
Dilemmas: When two roles are too many
This month’s dilemma
Aafreen is the manager of a busy voluntary counselling service. The receptionist, Ben, has been working there for several months. His work has been good, although Aafreen has found Ben’s manner with some of the clients to be rather abrupt.
Ben has recently qualified as a counsellor, although on a course that demanded very little client contact. He has now suggested to the management committee that he could provide counselling one day a week while continuing to work as a receptionist. If he cannot do that, he is anxious that his (counselling) career may be held back. What are the ethical issues involved?
Sharon Bond (consultant systemic and family psychotherapist)
I am a systemic psychotherapist, so my approach to analysing situations is influenced by Gregory Bateson’s edict, ‘Without context there is no meaning’. When I read Aafreen’s dilemma I was aware that much of the context was not explicit: for instance, Ben and Aafreen’s age, class and ethnicity are not given. I wondered about the different cultural contexts in which they may each be embedded and how these contexts might inform how they position themselves and each other in their interactions.
Ben is currently employed as a receptionist; was there a conversation about the possibility of progressing into a counselling role when he first joined the organisation? If so, who with, and did the conversation identify the process needed to support such a progression?
Ben’s manner with some clients is described as ‘abrupt’. I wondered how to understand ‘some clients’. Was the ‘abruptness’ related to the client’s gender, class, ethnicity or something else? Is Ben aware of this concern? How was Aafreen informed about it and what impact does it have on the service offered? Might some clients choose not to use the service because of this? It sounds as though Ben is competent at other aspects of his role as receptionist; what more does Aafreen think has to be done to help him manage the client relationship aspect in his current role?
I was struck by the fact that Ben made his suggestion to the management committee. I wondered, had he first discussed this with Aafreen and what was her response? Does his going to the management committee suggest a difference of opinion between them or did she suggest it?
I wondered how Aafreen saw the development aspect of her own role: whether there was a precedence for promotion from within the organisation; what the structure was and how transparent. I wondered how the wider issue of confidentiality was understood in this context.
I hope that, by inviting Aafreen to explore her thinking about some of these areas, she might arrive at some decisions about her options for action.
Jayne Godward (senior lecturer, person-centred counsellor and supervisor)
My first reaction was that it would not be advisable for Ben to counsel in his current workplace because of the need for boundaries around the counselling role. Before I settled on this answer, I decided to explore the different angles to check if there was any way that Ben could say, ‘Today I am your counsellor’ and on other days, ‘Today I am your receptionist’.
The trouble is Ben is Ben and if one of his clients happens to ring up or call in to change an appointment on his non-counselling day, he will be acting as the receptionist. He may even be seen chatting to clients or staff at his desk. As a client, would I feel able to trust that he is a proper counsellor who will keep my issues confidential and will be competent to work with them? How would any of us feel if we went to the doctor and the receptionist came into the consulting room and started treating us?
In terms of Ben’s self-care, will other staff members be able to maintain the boundary and resist asking him about his receptionist work on his counselling days, when he needs to be taking proper breaks between clients? If desperate for client hours, possibly towards his accreditation, might Ben be tempted to fill his vacant slots before allocating clients to other colleagues and end up working beyond his competence and overloading himself?
How would his volunteer colleagues feel about the person who has knowledge about their clients and perhaps organises them in his administrative role being a peer at group supervision, which is often offered at such organisations?
Could Ben just do counselling for a while and stop doing receptionist work? How would that be for a client who was returning to the service in crisis and in need of further counselling? If you walked into the counselling room and discovered that the counsellor was the rather curt receptionist with whom you had a slight argument last time – would you stay or would you go?
Whichever angle I took, it does not seem in anybody’s interest for Ben to work as a counsellor in the same agency. There is a high chance of perceived role confusion and conflict that could cause stress for Ben or others and may lead to unethical practice. I wonder if Ben has discussed this idea with his supervisor?
Two other issues of concern here are Ben’s abrupt manner, which seems inappropriate for a receptionist in a counselling organisation – the role requires sensitivity to handle people asking for support – and his apparent lack of adequate training. Aafreen has a responsibility to the organisation’s service users to raise any concerns with the management committee, who may be feeling under pressure to give Ben the counselling work. This would help prevent maleficence to clients and would be in the interests of the organisation.
William Johnston (person-centred counsellor in private practice)
It seems to me that there are two separate issues here. The first concerns the possibility of Ben having a dual role of receptionist and counsellor. I am not convinced that this is either practical or desirable. If the organisation could guarantee that he would not meet any of his clients when working as a receptionist, then this might be possible. The problem is that they cannot. If one of his clients should walk into the building for some reason not connected with sessions – a lost umbrella, for instance? – then Ben will be seeing his client (and the client, more importantly, will see Ben) in a quite different light.
Clients are entitled to choose exactly what they bring to their counsellor. I remember how upset I was, as a client, when I realised that receptionists were discussing with my counsellor my behaviour in the waiting room. I appreciate that this was a case of peculiarly poor boundaries, but it does highlight the sort of information to which receptionists have access and how important it is, from the perspective of the client, that there should be no possibility of cross-contamination between the two roles.
The other issue concerns Aafreen’s doubts about Ben’s suitability as a counsellor. She has noticed aspects of his manner with clients, she has doubts about his training course and there is a hint that he may be operating some form of moral blackmail by suggesting that his career will be held back if they don’t employ him as a counsellor. Bearing in mind also the first issue concerning boundaries around a dual role, then any hint that he has poor boundaries must become doubly important.
Either Ben is good enough to get a counselling placement with another organisation, or he is not good enough to get a placement with any organisation. The decision seems to be fairly simple.
Duncan Lawrence (freelance trainer/diversity advisor)
Appraisals/related CPD programmes are considered an integral part of modern employment practice. This would include receptionists, who are often considered ‘the face of the organisation’ and hold a very valuable customer–service interface role, as clients/service users go through them to receive counselling. I therefore wonder if Ben’s abrupt manner has been picked up and taken further within the organisation.
If Ben has had an appraisal, was counselling training formally identified as an area for professional development for him or for the counselling service? If so, were issues about the dual role within the service considered? It is unusual for staff to hold a variety of different roles (switching from greeting someone at reception to being their counsellor), so some consideration should be given to the challenges raised if a member of staff holds visibly dual roles in relation to service users.
The management committee in most voluntary organisations is, legally, the employer and thus meant to ensure the smooth running of the organisation and provide staff development/CPD support and guidance. It would be their responsibility to work this through to a win-win outcome.
If Ben is not subject to any staff warnings, he can expect to be given permission by the management committee to start seeing clients. If this is so, a development plan needs to be drawn up between Ben and the management committee.
If these steps are not completed, Ben may be left feeling confused and/or upset with the organisation, which could lead to loss of motivation, complaints about discrimination, complaints to BACP, complaints to an Industrial Tribunal, Ben leaving the voluntary organisation, etc. Finally, if these steps were not taken, Aafreen and/or the management committee need to arrange to receive development consultancy and training in these areas.
Ian Horton (supervisor in private practice)
A receptionist has a critical front-of-house role so, perhaps before anything else, the manager needs to address Ben’s manner with ‘some’ of the clients.
I understand how difficult it is for trainees or newly qualified counsellors to get client work experience, so I do sympathise with Ben. However, I guess he may not see that his dual role might create ethical issues.
Clearly Aafreen and the management committee need to address a number of issues. They are responsible for the quality of the service and need to consider whether completing a course that requires little client contact actually constitutes qualification as a counsellor. There are resource implications too. Surely Ben can’t carry out the two roles on the same day in a busy agency? There’s the practical issue of who covers reception on the days he is counselling. But, more importantly, who will provide management supervision and be accountable to the agency? If there is someone from the agency who can provide appropriate management supervision, then Ben will also need an external independent supervisor. However, if he is supervised only by an external supervisor, the agency will need to approve the supervisor and be part of a three-way contract to ensure adequate monitoring of his work.
Another issue may be whether Ben is able to separate his two roles and not try to act as counsellor when he is the receptionist. These are issues for the manager or the management committee.
Others’ views may need to be considered. It is possible that Ben’s clients may find it difficult to relate to him as receptionist and this dual role needs to be managed carefully. If Ben’s clients have a problem with him as a counsellor, to whom can they complain? It may also be important to consider the perspective of the clients being seen by other counsellors. How will they feel when they learn that he is also working as a counsellor? What is clear is that Ben’s clients should be informed that he is newly qualified, or at least not an experienced counsellor, so they can choose whether to be seen by him or not.
Without knowing the agency policy on client records and who has access to them, it is difficult to comment on the issues Ben’s dual role might raise for collective confidentiality within the agency. Similarly, without knowing the agency procedure, I imagine that new clients are simply referred to the next volunteer counsellor available; so who will be responsible for referring appropriate clients to Ben?
Helen Gifford (student counsellor)
An individual working in two roles in a counselling service presents a challenge. The individual has to be able to separate mentally between the two roles and also be able to reflect that separation to clients by, for example, not engaging in ‘session work’ during a call to arrange an appointment or other receptionist/administrative issue. I would expect that most practitioners would be able to make this distinction and would manage to juggle these roles effectively, as many private counsellors handle both these roles themselves.
In this case, however, Aafreen appears to have concerns about Ben’s interactions with clients in a receptionist role; she may be concerned about how he would manage a therapeutic relationship. My instinct is that he is applying some pressure to be allowed to practise within the service, implying that they will hinder his career if they do not agree to this. However, both these concerns – his ability to work with clients and his feelings about control – are subjective. Aafreen does have responsibility as manager of the service to ‘maintain and enhance good practice by practitioners and to protect clients from poor practice’ as stated in the BACP Ethical Framework.
My suggestion to Aafreen would be that she interviews Ben for the post, as she would any other applicant for the role. This would involve a written application, interview and references from his course tutor, previous counselling manager (if there has been one) and his supervisor. The fact that his counselling training involved little client work gives cause for concern. Aafreen needs to check that he is ‘qualified’ to practise as he may not have enough supervised client hours. She can then, with the committee, decide if he has the ability and experience to work as a counsellor within the organisation. If he doesn’t fulfil the requirements then they can always give him time to find another place to gain experience. In this way she can assess his ability fairly and give him the feedback he needs to continue his counselling career.
Mandy Pitts (trainee counsellor)
There are two issues raised here. The first is that of dual relationships if Ben sees clients in a counselling capacity. While he is working as the receptionist he may well encounter his own clients, should they contact the centre between appointments. In the one day a week when he is working as a counsellor, his relationship with his colleagues may also shift, potentially causing complications.
It also needs to be determined exactly what training Ben has received, because his lack of experience working with clients may be a concern. He has stated his own concerns about his career being held back, but many counsellors, especially those with little experience, can find it difficult to find placements, and that in itself should not be a reason for this organisation to agree to his suggestion that he see clients there.
It may be more appropriate for Ben to work with clients elsewhere to build up his experience and, perhaps, also undertake further training and CPD. Then, when he has developed his practice further, he could consider applying to become a counsellor at Aafreen’s organisation, but after ending his role as receptionist.
Next month’s dilemma
Janine works in private practice as a counsellor and a supervisor. One of her supervisees, Tiffany, who is nearing the end of the second year of her training, is discussing a client. Janine gradually becomes aware that the client must be the same person with whom another of her supervisees, Michael, an experienced counsellor who works in a voluntary organisation, is also working. The client is vulnerable with suicidal ideation.
What should Janine’s role and responsibilities be in this situation?
Please email your responses (500 words maximum) by 24 August to Heather Dale at email@example.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 on this website. Readers are also welcome to send in their own ethical dilemmas for consideration for publication, but these will not be answered personally.