1 Professional ethics: Building trust in counselling practice and research Professor Tim Bond University of Bristol
2 Why trust matters? Deeply embedded in our conscious and subconscious awareness Directs attention to our relational and professional responsibilities as counsellors Fills the gaps in dominant ethical principles or provides the foundations upon which professional ethics can be founded? What do clients want?
3 What do clients want? Safety Competence Compassion Respect Explicitly and sufficiently boundaried and agreed expectations of each other (?!?) Humility
4 Above all what do clients want? Someone to trust with what troubles them
5 What does trust mean? Interviewed clients What follows is informed by what clients tell me The difficulty of really understanding the client s experience Become the client in strange and troubling circumstances Will draw on an example of receiving counselling in such circumstances
6 Counselling in an unfamiliar culture Issue Method Outcome New insights Did it matter that there were some unresolved issues?
7 Two dimensions of trust Existential sufficient competence to address the risk and uncertainty that is emotionally and cognitively troubling me to make my existence unacceptably painful Relational the ability to construct a relationship of sufficient resilience and quality to support the counselling and withstand the challenges of difference and inequality
8 A provisional definition of trust a relationship of sufficient strength and quality to withstand the existential challenges of : Risk, and Uncertainty And relational challenges of: Difference, and Inequality
9 What does this mean in practice? Sufficient good enough for its purpose marginal to the full life of the client a catalyst to changes beyond counselling Strength resilient and sustainable capable of being maintained throughout counselling supported by commitment from the counsellor s vocation and professional boundaries
10 What does this mean in practice? Quality enough respect and rapport to provide the emotional foundations and sense of reward to withstand the discomfort of the client s self generated challenges and the challenges from the counsellor. Walking the tightrope between being supportive and collusive. No can be therapeutic. Insights from neurology relationship reward and plasticity
11 Existential challenges The starting point: the prompt of psychological pain to seek counselling and the desire for relief and problem solving Risk and uncertainty to be approached from these expectations Occupational hazard losing appreciation of client s hopes and purpose.
12 Client s experience of risk Risking loss of face and self respect threshold partially crossed in the act of seeking help Facing the experience of pain more intensely as everyday psychological defences are dropped Being left in a worse state than when counselling started due to incompetent or unethical practice Sense of hopelessness reinforced Becoming caught up in the counsellor s dysfunctionality
13 Counsellor s experience of risk Being taken to areas of own pain and trauma in order to work with client s issues Becoming stuck and/or deskilled and losing credibility in own or others opinions Becoming overwhelmed with the demands of the client neediness breaks boundaries irrationality distorts what has been established stalking and worse Therapeutic risk taking v professional misconduct
14 Client s experience of uncertainty Client s assessment of the counsellor How helpful will you be to me and my concerns? What will be demanded of me? Will the benefits outweigh the demands? What if I start to feel worse? Typical questions with therapeutic potential Am I the only person who is struggling with this? Am I uniquely alone in my failure and pain? Is my situation as hopeless as it feels?
15 Counsellor s experience of uncertainty How to respond to the client s explicit and implicit questions in ways that increase the likelihood of a positive outcome from the counselling? Uncertainty is the prompt for attentive listening All therapeutic theory is to be treated with pinch of doubt so that it does not become a barrier to careful listening to the client Good theory aids listening rather than predetermines our responses
16 Counsellor s experience of uncertainty Counsellor's uncertainties resolved in dialogue with client in different ways: Explicitly with client Internal reflection by counsellor Professionally boundaried consultations with supervisor and colleagues with relevant expertise Uncertainty can be disabling in excess but in moderation is the prompt for good and therapy responsive to the client
17 Relational challenges Difference Inequality
18 Client s experience of difference Will the counsellor reach out and strive to understand me in ways that I can recognise myself? Will the counsellor regard any differences between me and other clients as deficiencies or failures? Will I be judged and blamed? Will my counsellor understand the importance of my values and culture to me?
19 Counsellor s experience of difference Making the imaginative leap into another person s experience as the platform for therapy Difficulty of perceiving difference when too similar to client Difficulty of understanding when too different Gender, relationship and sexuality, age, social position, work, sense of self, faith, culture etc Balancing professional humility in face of difference with sense of purpose and direction towards healing
20 Client s experience of inequality Dependency of being the help seeker relative powerlessness may vary considerably watchful trust (+ve) or blind trust ( ve) projections on counsellor as wholly healed and therapeutically powerful Unrealistic expectations and over dependency Prior conditions and contractual terms to receiving therapy v terms based on negotiation
21 Counsellor s experience of inequality Excessive and inappropriate claiming of power to meet personal psychological needs often the start of boundary erosion/abuse Appropriate self knowledge about responses to powerlessness and powerfulness Using the counsellor s power to create security, safety, and therapeutic direction Dangers failing to use power abuse from powerlessness
22 Trust in research ethics Risk Uncertainty Difference Inequality
23 How does trust fit with principles? Being trustworthy Autonomy* Beneficence* Non maleficence* Justice* Self respect * Key principles of bioethics adopted by NICE (2008)
24 What trust for clients is NOT Nostalgia for the for revival of the respect for professionals because of their social standing and education no going back A concern to put the counsellor at the centre of all that is good and beneficial in the counselling experience de centring the counsellor is essential to understanding the therapeutic alliance or partnership and the counsellor in the context of the client s life
25 What an ethic of trust offers? Insight into the relational ethic required of counsellors and researchers in counselling Greater understanding of the varied and reciprocal nature of ethical context of the therapeutic relationship Offers insight into the ethical basis of challenges faced by both clients and counsellors
26 References Bond, T. (2007) Ethics and psychotherapy: an issue of trust. In R. E. Ashcroft, A. Dawson, H. Draper and J. R. McMillan (Eds.) Principles of Health Care Ethics. Chichester: John Wiley. pp National Institute for Clinical Excellence (2008) Social Value Judgements: Principles for the development of NICE guidance (2 nd edition). London : NICE
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