Alicia watches the screen of her computer and waits. Her supervisee, Gareth, has just finished discussing his private work and is about to move on to talk about his counselling work at an NHS trust that delivers mental health services. He is privately contracted to the trust to provide workforce counselling. He qualified as a counsellor three years ago.

Gareth: It has been busy; there seem to be more referrals coming in at the moment. So many changes and people being moved as part of the reorganisation that is taking place as well. There’s a lot of stress.

Alicia knows that there is a lot of change taking place across the NHS. It isn’t something she has direct experience of herself although she is currently counselling a nurse who works in an A&E department, which has given her some insights. She sets this aside as she responds to Gareth; she is more concerned with how he is handling the situation.

Alicia: So, more referrals and a lot of stress in evidence. How are you dealing with it?

Gareth: It’s not easy, you know. And you hear things that, well, I don’t know. It’s not easy.

Alicia: Can you say more about that?

There’s a pause and Alicia guesses that Gareth may be weighing up what to say.

Gareth: One of my clients, Jim, I‘ve talked about him before. He was involved in an incident recently. A violent attack by a patient aimed at one of the staff.  He stepped in and got assaulted himself. The guy hit him and broke his nose.  He had to go to A&E to get it fixed. He was off work for a couple of days, but when he went back he didn’t get much support.

Alicia: Is he OK now?

Gareth: He just seemed to accept it as normal. He said that it happens and you have to accept it. But it seems to be happening more and more. He tells me how the patients being admitted are more mentally unwell and it’s like everything is getting so intense, and yet the staff where he is working feel they are just being left to cope. He later said that he was quite shocked by what’s happening.

Alicia: Like there’s a culture of putting up with it, even though things are getting worse.

Gareth: Something like that. He feels like he wants to talk to someone senior about his experience, you know, but he’s not sure. His line manager seems too close to it. He’s stressed as well. I don’t know. I feel I want to talk to someone myself. I mean, I can, you know. I feel like I ought to talk to people in the Human Resources department, but I’m not sure if I should.

Alicia: Have you discussed it with Gareth as an option?

Gareth: Yes, but he doesn’t want to make a fuss, doesn’t want to be seen as a troublemaker. Feels he has to just get on with it.

Alicia: But you are really concerned?

Gareth: I am but what can I do? I can’t breach confidentiality, but I really do feel that things are getting more dangerous for people like Jim and his colleagues.

Alicia: And you assume that senior people are not aware and want to alert someone about it.

Gareth: I suppose, yes, I mean, I do wonder who knows what. I just don’t know. Jim’s face did look a mess when I saw him after it had happened. It’s healing up now, but I really felt for him. Still do. I feel I really need to do something.

Points for reflection
Richard: What are the thoughts that are immediately with you on reading this section of dialogue between Alicia and Gareth?
Caro: How complicated, how sad and what an indicator of the sort of society we now live in.  How haunting for the likes of Gareth confronted by situations like this and at the same time thoughts that examples of violence like this are symptoms of a malaise and not a cause...

Richard: How would you now respond to Gareth? What do you feel it is important to either get across to him or to explore with him?
Caro: Above all I would want to try to assure Gareth I am there for him to be able to talk to and will support him all the way. He sounds distressed and rather alone with this issue. I would also clarify that, while I may not agree with what he thinks or believes, as long as he can account for his thoughts and beliefs, he will have my unqualified support.  I am there to help him clarify what is going on and to make decisions that he can both live with and that accord with his ethical beliefs.

Richard: Supposing more incidents occur that are highlighted to Gareth in his work as a staff counsellor, with a similar lack of support from the organisation. If Gareth does raise concerns himself but he feels they are brushed aside, what are the implications for confidentiality and ethical practice if he decides to ‘whistleblow’?
Caro: I’m not at all sure exactly on whose behalf he would be whistleblowing.  I believe strongly that if, as far as we can judge, an individual is responsible for himself, we absolutely should not take this away by acting on his behalf – however laudable our motives might be.  To do this is to infantalise, diminish another’s autonomy and dignity and destroy the possibility of holding confidences in the future. As far as possible, I believe our job as counsellors is to encourage, enable and possibly inspire our clients to make their own decisions and therefore take their own courses of action – not to do this for them. 

However, I do think these are agonising sorts of situations to be in, causing much heartache and stress. But I believe we need to approach the situation another way. If I were Gareth I would be consulting the Healthcare division of BACP, to find out if they hold any information and advice on situations like these.  I would also be conferring with colleagues in similar situations; there is undoubtedly strength in numbers.  I would be building up a dossier of information about violence at work: we know this to be a not uncommon situation from statements on public transport for example – about staff having the right not to be attacked by the public.  Members of the NHS workforce will be members of trade unions; they too will have information and can possibly offer guidance. While I believe we cannot act on behalf of our clients and supervisees, if we feel strongly about a situation we can act on our own, independently.

Richard: Is there a point at which it might be appropriate for Alicia to make contact with the mental health trust?
Caro: No! All that I mention above applies I believe to the supervisor/ee relationship also. Why the urge to infantilise and rescue? Surely one of the most difficult aspects of being either a counsellor or a supervisor is to be able to hold and contain a wide variety of situations that we find difficult and would dearly like to resolve? And how do we ever learn to tackle issues that are important to us if we don’t experiment and explore them for ourselves? We cannot live another’s life and we do not have the right to. It is immensely hard to live with what might seem to be ‘inaction’ but we really do have to stay our hands – which is not to say we cannot take action on our own behalf.

This is the last in this series on online counselling.

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.



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