I have written a number of times on the need for better regulation of counselling and psychotherapy in the UK. Given our position, where anyone, regardless of qualifications can call themselves a coach, counsellor or psychotherapist, information is vital to allow clients to protect themselves. At a bare minimum clients need to know that a potential therapist is qualified, insured, and a member of a regulatory body. For me there is almost a protective desire to try to empower clients. I am reminded of how Carl Rogers (one of the founding giants of counselling) described the difference in power between therapist and client; A client enters into the counselling relationship vulnerable and incongurent, and meets with the therapist, who is authentic and congruent. That vulnerability is a part of the process, but also easy for the unscrupulous to exploit.
It is with this in mind that the idea of a “red flag checklist” has been occurred to me. Yes, clients should check the credentials of someone they are working with. Yes, they should interview their therapist, check their listings, look to see if there are any complaints about them. However should is a word that I try to avoid. Should assumes a number of spoons, time, energy, knowledge and lack of vulnerability which the very fact of being in counselling means might not be present. It is also my experience that many clients knew something was not right in a previous situation, but they did not have the words to turn a gut feeling into anything concrete. Only when they are in an ethical therapeutic relationship do they have something to compare with, and realise the failings of the past.
It is also sadly the case that some of the most abusive in the talking therapy world use these red flags against a client. They can suggest concerns mean they are not engaging properly, that the fault lies with the client.
The following “red flags” are not an exhaustive list. If there is something you think should be added, please say. Instead I hope it might be a starting point, for people concerned that their counsellor or coach or therapist may not be working in their best interests. In order to help with this I shall be splitting the discussion over two posts, which will I hope give readers time to reflect and consider the redflags. I will use the term therapist for simplicity, but this applies to counsellors, life coaches, psychotherapists, anyone who might enter into a working therapeutic relationship.
Good boundaries are vital in any kind of therapeutic relationship. Policing them is up to the therapist. It is not uncommon to hear questions such as; Can I give my therapist a gift? Is it OK to email between sessions? Can I invite my therapist to an important life event? It is never the job of the client to determine if this is OK or not, although of course common courtesies and good manners still apply. Instead it is the job of the therapist to enforce, and model good boundaries.
To give an example; I have been contacted by twitter DM by potential clients. It is perfectly fine, and I always respond the same way, by giving them my email and phone number so the conversation can take place in a professional boundaried space. This is part of my job, from the very first contact to show what good boundaries look like, and keep to them. So potential red flags might be:
- Your therapist adding you as a Facebook friend
- Between session contact initiated by the therapist just to chat. Contact should be minimal and about practical or admin issues (although of course there may be exceptions)
- Intrusion onto private spaces. The private/public split may be difficult to navigate in our interconnected world. However, liking family pictures on Instagram, commenting on your tumblr blog, intervening in twitter threads, may all be a sign of poor boundaries.
- Dual relationships. This is a slightly jargony term for having more than one role in a clients life. A therapist cannot also be a friend, employer/employee, or indeed, lover, sub/dom/me paramour or metamour.
- Referrals and recommendations they benefit from. Sometimes we have to make a referral, but it should not be for our benefit, but the clients. If they refer you to someone who pays them, or from which they in some way gain financial benefits, it’s a huge red flag.
- Relationships with significant others. A therapist cannot usually, ethically see members of the same family, or partners in a relationship. There are exceptions, such as family systems therapy, however, in a normal, one on one relationship, they should not also be separately working with your partner(s) parents or children.
It might seem obvious that sexual relationships between client and therapist are abusive, but other relationships must also be avoided. It is not just “Facebook friends” but a lack of respect for the importance of good boundaries. If you have that gut feeling that something is wrong around boundaries, look over the examples again, think about how you and your therapist interact. Are there any red flags? Remember this is not an exhaustive list but instead suggestions of areas in which boundaries need to be kept to be ethical and non harmful to a client, and therapist.
Again, some things we would expect in every therapeutic relationship. One of these is confidentiality. Confidentiality means you can expect the coach/counsellor/psychotherapist not to share anything you tell them, unless there is good cause. An ethical therapist will discuss in the first session what the circumstances around breaking confidentiality might be. They are, largely, common sense, if you, or another person, is in danger of harm we cannot turn a blind eye. The exact limits of confidentiality might change according to setting, but you should always be informed of this in your very first session. Periodic reminders of the limits of confidentiality are considered good practice, especially if a therapist believes a client may be about to disclose something which may need to be referred to outside agencies.
If someone you are working with as a therapist breaks confidentiality it is treated as a serious offence, assuming they are a member of a reputable governing body. It may even be a criminal offence under Data Protection laws. Again, some possible red flags to look for (especially on social media) are
- Discussing clients, even anonymously, on social media
- Writing in an identifiable way about clients
- Disclosing other client details when working with you. Now hearing “previous clients have found this useful” can be very reassuring, and is fine. It is very different to discuss another clients issues, or problems.
- Identifying clients to you, for example using their names
- Leaving notes or other identifiable materials where you can see them
- Discussing you with your friends and family
If a therapist is lax about other people’s confidentiality, it would be foolish to expect them to respect yours. Even whether you are seeing someone should be confidential. If, for example, a family member contacted me wanting to know if someone was having counselling, I would refuse to either confirm or deny it, since either would be breaking confidentiality. You should feel the same level of absolute reliance that your confidentiality will be respected whoever you are working with.
If upon reading this you feel that you recognise any of the red flags there are a number of possible courses of action. Assuming you feel safe to do so, bring the issue to therapy. A good ethical therapist will never feel threatened by a discussion of boundaries and confidentiality. It may be that they never use Facebook, and had forgotten you were facebook friends, or that the client you overheard them discussing was a hypothetical case study for a conference. I am not saying every situation will be so easily explained, but there may be an explanation.
If you feel unable to discuss it, or if the therapist refuses to, then you can take it to their professional body. Again this highlights the importance of only working with people who are members of regulatory bodies. As a member of the BACP clients have the assurance of knowing there is a robust complaints procedure in place. There is also the Ask Kathleen service, where you can check out any worries you may have. Other organisations such as the National Counselling Society, UKCP and CORST have their own procedures in place. Above all remember that if things have gone wrong, it is not your fault, nor should you feel guilt or blame, therapists are trained professionals whose job it is to ensure they keep to the highest standards at all times.