http://www.nepenthe.org.uk/ethics/
The second in our series of posts on BACP’s proposed changes to its Ethical Framework. We share the concern of many therapists about the nature and direction of these changes (and BACP’s political ambitions). We do not think this serves client interests. We believe it to be harmful to the profession, and part of a profoundly unhelpful cultural blind alley, which serves no-one and down which much of the therapeutic world appears to be sleep-walking.
Our first post linked to Arthur Musgrave’s 2014 paper at the UPCA Conference: The Emergence of State-endorsed Therapy?:-
Both our posts are drawn from the helpful information included with Matthew Bowes’ petition opposing the changes in their current form – here is the link if you would like to sign the petition:-
This second post is two letters from Els van Ooijen to Tim Bond. Whilst we would approach some of the issues she raises from a somewhat different perspective, especially in the second letter on supervision, we have a strong resonance with much of the main thrust of her argument. We agree that a move from a principle-based ethic to a duty-based ethic is both needless and retrograde. We see no evidence whatsoever to suggest this would have any effect in preventing unethical or abusive behaviour by therapists (sadly, our own experience is that enthusiastic championing of increased regulation can go hand in hand with eye-wateringly toxic and unethical behaviour).
BACP has in part sought to justify these changes by reference to recent health scandals. Els refers to Ballett and Campling:-
‘Scandals within the NHS have multiple causes, such as a ‘chronic under resourcing’ (Ballett and Campling, 2011) and the pressure to do ever more with less, all of which lead to pressurised, overworked staff who themselves feel unvalued and uncared for. Ballett and Campling (2011:3) point out that what is needed here is a change in the culture to include a sense of ‘kinship and compassionate relationship between the skilled physician and the patient’. They stress that the people working within health and social care themselves need to feel that they are treated with compassion and kindness, so that they in turn can treat those in their care similarly.’
This seems a far more useful and productive approach than a drift in the profession or push by BACP towards more rules and more policing.
We strongly agree with her statement about the adoption of the current version of the Ethical Framework:-
‘……the shift from a ‘rule-based’ to a ‘principles-based’ ethic was a positive development. It signalled that counselling and psychotherapy were maturing professions that no longer treated their members as subjects, but as mature professionals, capable of making decisions based on ethical reflection and taking responsibility for their own conduct. I fear that a return to a different ethic may stop ethical thinking and reflection and result in practitioners simply doing as they are told. I know that this is not your intention, but I fear that it is a likely consequence.’
It has long seemed to us that:-
- increased rule-based thinking;
- deference to external locus reference points; and
- ‘accountability’ in terms of regulation, crime and punishment,
leads to correspondingly ever more blame of others, and less acceptance of personal responsibility – a vicious, retrograde spiral visible throughout our current cultural models.
As Els says in the context of her second letter:-
‘I fear that this focus on ‘duties’ and ‘division of ethical responsibilities’ will shift attention away from the ethical responsibilities we all have – as enshrined in the current framework. People may become concerned with ‘am I doing everything according to what the BACP wants’, rather than reflecting on ‘what is best’ in ‘this’ situation for ‘this client’.’
We think this mindset is already clearly visible in therapists, for example in any workshop or on the internet. Sadly, for good reason. BACP’s punitive professional conduct process provides a hefty incentive for any therapist to base decisions on BACP approval, rather than client interests.
Like Els, we would see it as ‘…a category mistake to see ethics as a set of duties. After all, where do duties come from if they are not based on certain agreed principles, either implicitly or explicitly?’
If we cannot trust therapists to develop and exercise their own inward ethical compass (and the principles and values to inform this), how can we possibly trust them in the complex and subtle relational dance of therapy?
We have considerable resonance with Els’ ‘Relational Ethic of Care’ in our person-centered context. Perhaps unsurprisingly, given her humanistic and holistic background, her overarching idea sounds close to our own service preference for a flexible, context-responsive approach, deferring to this moment, this relationship, these circumstances:-
‘A relational ethic implies that work with clients should always be seen in context. Therefore an attempt to set down specific duties (or rules by another name) that apply to everyone is problematic, as people and their contexts will differ. As Pauls and James (2005:36) state, ‘…with relational ethics, from the perspective of mutual respect, we focus on who we are rather than what we do, that is a way of being rather than a mode of decision making’.
Clearly this (‘a way of being’) aligns with person-centered ideas about the therapeutic process – and, if this is what works to support a human being’s growth and well-being in a therapeutic context, it seems bizarrely illogical to imagine that as therapists we will benefit from the reverse approach in our own infrastructure.
Our own approach to capturing how we work, since we made the decision to leave BACP in October 2013, resides not in the Ethical Framework – although we have no issue with the current version – but in our two published ethos statements, supported by our internal supervision structure (a person-centered peer-peer collaborative exploration of therapist process and client work, described by BACP as ‘good). Both ethos statements are couched in terms informed by a relational ethic:-
https://palacegatecounsellingservice.wordpress.com/our-ethos/
https://palacegatecounsellingservice.wordpress.com/our-ethos-statement-for-our-therapists/
We think Els van Ooijen captures the essence of what we are seeking to create, in her phrase ‘a relational and caring ethic’ – especially that word ‘caring’. This is at its heart a loving ethic. From a person-centered perspective, therapy (and indeed supervision) is about empathic, caring relationship – because it is in an environment of relational presence, and the core conditions of congruence, empathy and love, that we as beings are able to heal, integrate, and expand our consciousness.
Our own 18 years or so of providing counselling supervision leads us to the same conclusion as she voices at the beginning of her second letter:-
‘…in my twenty-odd years of providing supervision I have found that a considered reflection on the ethical principles, within a relational and caring ethic is sufficient to help supervisor and supervisee to come to a decision that puts the wellbeing of the client first.’
What serves one, serves all. She comments, accurately in our view:-
‘Reflection on practice requires supervisees to feel safe and supported so that they can be honest about all aspects of their work. A shift from a principles-based to ‘duties-based’ ethic may reduce ethical thinking to rules following and checking instead of careful ethical reflection. The role of the supervisor is likely to be perceived (by both supervisor and supervisee) as one of ‘policing’; as a result the supervisory relationship, as well as the quality of supervision, will suffer – with possible detrimental effects on clients.’
We would in fact replace ‘possible’ in the final line with ‘inevitable’ – one of the issues we sometimes have with new therapists entering this service is that they arrive with limitations on their capacity to offer a more effective therapeutic presence and relational depth, because they are frozen with fear about ‘getting it right’ and what the rules are (sadly not helped by some counselling training providers). It takes time to develop a sensitive and resilient internal locus, from that starting point.
We agree with Els that responsibility for client work must lie first and foremost with the practitioner, with support within supervision, from the relevant service/agency and from others. There is an extent to which the responsibility is jointly held, depending on the circumstances – yet in the end, only therapist and client are in the therapy room, and any meaningful consideration of the question of who is responsible for the quality of the therapy must take us back to the therapist:-
‘As a supervisor I am responsible to the supervisee for the quality of the supervision, I am not responsibility for the quality of the therapy, how can I be when I am not the one delivering it? Clinical supervision is a collaborative activity where supervisor and supervisee reflect deeply on the supervisee’s work, to enable them to be the best practitioner they can be.’
We also think that the existing ethical framework already covers the issues which BACP purports to be serving in the proposed changes – in the far more useful terms of values and principles.
She concludes:-
‘….the proposed changes give an impression of an unacknowledged agenda of managerialism, confusion between line management and clinical supervision, and a wish to turn clinical supervision into something not unlike quality assurance. All appear to be due to a regrettable lack of trust in counsellors and therapists as professional people, who want to be the best practitioners they can be to the benefit of their clients. I see this proposal as a retrograde step that is likely to damage the professions of counselling and psychotherapy.’
Yes. We think so too.
Palace Gate Counselling Service, Exeter
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