counselling – A Client First

Maria Albertsen – A True Great

I still can’t believe I am writing this. Since hearing the news of Maria’s death last week, I have been reflecting deeply on her life, her immense and unparalleled impact on our profession, and on our friendship. I am simply heartbroken for her lovely children – she was an incredibly dedicated parent and her untimely loss is an unimaginable tragedy for her family.

As a leading activist in the counselling profession, Maria achieved things that I didn’t think were possible. She gave a voice and courage to working class therapists and aspiring therapists. She taught us that we all have a place here, and that we do not have to accept the deep injustices that run throughout the profession. She taught us that we can make real, tangible change – she was the driving force behind campaigns which have altered the course of membership bodies’ policy decisions and advertising of unpaid work. She was the creator of Counsellors Together UK the largest activism group in the UK therapy world, and the founder of National Counsellors Day – a simply huge annual event for counsellors across the country. And she never stopped. She was always planning the next thing. She developed CPD, coaching, reflective spaces, developed funding for retreats for therapists on low incomes, and constantly, constantly, had her eye on professional politics. She had the ability to hold so much information in her head, and make connections that anybody else would miss. She would send me obscure documents with triumphant voice notes explaining how this document proved we were moving in the right direction. Her tenacity was surpassed only by her ingenuity and compassion. She was the perfect ally and the perfect friend.

Our backgrounds were similar in some ways. We’d share stories about growing up on northern, working class estates in the 80s and 90s. We shared a lot of values, especially when it came to the fight for marginalised people (and telling Tories to fuck off, of course). We laughed a lot. A lot, a lot. It is hard for me to imagine ever having as much fun in the therapy activism world without her to share the laugh with.

Back when I started talking about Harm in Therapy, CTUK was the only organisation who would platform me. My invite to National Counsellors’ Day was the first time anyone had been willing to put the topic front and centre of a therapy conference. Now, the conversation is growing exponentially. Most of the time, Maria is not credited for that, but she should be. Maria, like so often she did, went where others were unwilling to go. She was fearless.

She knew everything. About professional politics, the MBs, the activism world, all aspects of the profession. She was told things. And why? Because she was so immensely likeable. Everybody who actually knew her, liked her a lot. Her detractors never knew her, they distanced themselves from her because they feared her. And they feared her because her fight for the little guy did not align with the normative agendas that protect status and ringfence power for the elite. She dismantled those barriers because she knew they were phony. And she proved that they were. We mustn’t forget that lesson in her absence.

Her impact on this profession is immense and permanent. She has changed us. Not only those of us that knew her, but the profession as a whole, it is permanently altered by her contribution. Every social justice conference, every policy change, every conversation about poverty, unpaid work, wages and inequity had their way paved by the work of Maria Albertsen. Her legacy will impact future therapists who haven’t even thought of training yet. And clients who haven’t even thought of accessing therapy yet.

Earlier this year, Maria told me that her job was to get people talking. She said that she felt her role was to make space for these conversations about injustice and inequity to happen (because it is harder to ignore an issue that is conscious to us). She said to me: “In 2017, hardly anyone talked about unpaid work or the issues around it. And now it’s talked about all day, every day. Imagine if we can do the same about poor clients/poverty”. She wanted us to talk and keep talking. Not to let injustice be brushed under the carpet. She wanted us to make sure that membership bodies could not shy away from the inequity in access to therapy, or the impact of national politics on the wellbeing of clients. She spoke with courage about her own experiences with the DWP, and called for change. It is for us now to talk. It is for us to have conversations, with each other, with our membership bodies, with our supervisors, with politicians, and with the world. Maria wanted us to keep talking and we will.

Her influence will be with me throughout my career and my life. I shall never forget her, or her passion for change. Our profession must always carry her passion with us. Now and forever.

Why is it important to be a member of a professional body?

There is no mandatory regulation of counsellors and psychotherapists in the UK. Even as I write those words I find the situation difficult to comprehend. I imagine readers from other countries being baffled by the situation – No licensing? No minimum qualifications? No mandatory complaints procedure?

Luckily, the profession has become self-regulatory and a therapist has several options as to which professional body or bodies to join. Arguably, the two best-known in the UK are the BACP (British Association for Counselling and Psychotherapy) and UKCP (United Kingdom Council for Psychotherapy) while regional options exist for Scotland (COSCA) and Ireland (IACP) and other general and specialised options exist, many of which are accredited by the Professional Standards Association (See the counselling directory for a more comprehensive list: http://www.counselling-directory.org.uk/accreditation.html ). For the purposes of this article, membership refers to either individual or organisational membership.

So why should counsellors join a professional body? Is it enough to acknowledge and abide by their ethical frameworks, or is membership the only ethical way forward?

I’d like to look at this from the perspective of a first-time client. Our imaginary client feels they might benefit from some counselling and so types “counselling” and the name of their local town into Google. Up pops the name of a local therapist in private practice. Her website states she has 10 years’ experience, she specialises in the area of the client’s issues and is affordable. The client looks at the picture of the therapist and thinks it is somebody she might get along with, so she gets in touch and books an initial session. It has not crossed the client’s mind to check whether the therapist is a member of a professional body. The client is not aware that counselling is not a regulated profession, and assumes that the therapist is bound to a code of ethics.

The therapist might rationalise that she is ethical. That she follows the BACP ethical framework but simply does not like the bureaucracy of the professional bodies. She might surmise that she has been working effectively with clients so far in her career and membership to a professional body is simply an unnecessary expense. As far as she is concerned she is working ethically, and as far as the law is concerned, she is doing nothing wrong. She mentions nothing about her lack of membership in her contract.

The alarm going off in my mind as I imagine this scenario is screaming the word AUTONOMY!

The client has not properly been made aware of what service is being offered by the therapist. I would argue that the therapist’s actions amount to deception by omission. It seems vital to the integrity of and public trust in the profession that clients are fully aware of what they can expect from counselling, and this must include what options are available to them should they wish to make a complaint at any stage.

If our imaginary client were to investigate the possibility of making a complaint against her therapist and discover that there were no options available to her, this could feel like a terrible betrayal, potentially damaging not just trust in the therapist, but in the profession as a whole.

I am a strong supporter of mandatory regulation of the profession. I feel there are many benefits – which I will undoubtedly explore in the pages of this blog – and in my view those benefits outweigh any cost. But while we remain in a situation where membership is not mandatory, let us ensure that our clients are offered the security of professional body involvement should they need it, or at the very least be clear in the contract about what the implications of lack of professional body membership are for your practice and your clients’ rights, so that they are able to make an informed choice.

Power in Therapy

Person-centred therapy serves to help the client to develop an internal locus of evaluation – to convey a trust which the client can internalise and begin to trust themselves.

So, while counselling from this humanistic perspective aims to empower, it seems important to ask: What power imbalances inevitably exist within the counselling relationship? and: Are we adequately aware of how they present in the room?

As well as the client and therapist’s perception of their respective societal and professional statuses, their preconceptions about each other and the mandatory reporting responsibilities of the therapist – which are all likely to contribute to the therapist being perceived as holding a role of authority – it seems to me that there is a unique relational power dynamic which affects the relationship and the work in a number of ways. Here are what I feel are some of its contributing factors:

Trust in the therapist: Often a client enters therapy with no experience of counselling or knowledge of what to expect from the therapist. In the introductory session a client is usually given some information by the therapist. In person-centred counselling his might be as simple as “I am not the expert; in therapy we will explore what is troubling you together in order to facilitate the changes you are looking for.”. Whatever boundaries are suggested by the therapist are likely to be accepted by the inexperienced client. If the therapist decides it is okay for the session to run over by ten or fifteen minutes, a client may not object. If a therapist decides to copiously self-disclose, the client may have no frame of reference as to whether this is appropriate in the context of counselling. The therapist has the benefit of supervision to check whether the counselling being delivered is appropriate, however the client often has nobody with whom to check. Which leads me to…

Isolation: There are very few relationships in life which deliver such an intense level of intimacy in complete isolation from all other relationships. This means that no other person is witnessing the relationship, therefore there can be no objective view on its health and productivity. Even a supervisor is getting a picture of the relationship through the therapist’s filters. As I alluded to above, this means that a client has no sounding board and may not be able to independently ascertain whether the sessions are therapeutic or whether the relationship has become problematic. The BACP’s ‘Ask Kathleen’ service seeks to address this issue, however it is dependent on clients’ awareness that something may not be right and their willingness and ability to seek help. The intimacy of the relationship and the complete focus on the client may also contribute to intense feelings towards the therapist, which could potentially impact on the power dynamics…

Love and attachment: Love and attachment can form an important part of therapy. The therapeutic bond is a vessel for the work and I believe that immense healing can occur when working at relational depth. The emergence of attachment can be a large part of the therapeutic work and many modalities see the client’s attachment to the therapist as extremely valuable to the process.

Love and attachment do, of course, impact on the power dynamic in the room. Attachment towards a therapist often ties into very young feelings and can leave a client vulnerable and sensitive to perceived rejection or inconsistency. To call upon my earlier example of a therapist who allows time to run over regularly, imagine how a vulnerable client may feel if the therapist decides to book clients back-to-back one week and ushers the client out of the room right on time. From an adult perspective, the therapist is doing nothing wrong – last week they had time to go over, and this week they do not, but to a vulnerable inner child, the communication may be that the therapist has had enough of them, or they are no longer good enough or worthy of extra time. Equally with a therapist who habitually self-discloses, what if something occurs that they do not wish to disclose? Perhaps they need to miss a session due to a funeral, or an illness they do not wish to share details of. Of course a therapist does not have to disclose anything they do not wish to, but the disempowerment that a client might feel in such a scenario must not be ignored.

A client’s feelings of love or attachment to their therapist might also impact on their willingness to make a complaint or seek an opinion on the actions of the therapist. Here lies potential for grooming, gaslighting or abuse, whether conscious or not on the part of the therapist. Additionally, if a therapist were to lose objectivity due to their feelings towards a client, they may discourage the client to leave, thereby not properly respecting the client’s autonomy or even initiate dual relationships.

It is vitally important that we keep all of this in our awareness as practitioners and ensure that we are not using the unavoidable power differences which occur in the relationship in order to meet our own needs.

A Client First

This is my first foray into blog-writing and in a strange way I feel very at home already. I am in the final year of training to become a counsellor/psychotherapist and I suppose I am already beginning to wonder if the world of the qualified therapist provides the same space for discussion and exploration of ideas that I enjoy weekly at university. Perhaps I am scoping out new territory in which to…well, I’m not sure…express? explore? ignite debate? challenge my preconceptions? Maybe all of these. I tread lightly as I take my first steps into this uncharted terrain and bring with me an open mind and enthusiasm to learn and grow.

The title of this blog alludes to my introduction to psychotherapy, which was (and still is!) to experience therapy as a client. As I move into psychotherapy as a career, I am sometimes uncomfortable with what I describe as an ‘us and them’ attitude I have occasionally experienced from practitioners. At the beginning of my learning, I witnessed a tutor declare to the students “All clients lie!”. As inexperienced as I was at the time, I found this sentiment jarring and frustrating. As a client I felt a real sense of the inherent power imbalance, as though I were stood at the foot of a mountain, vying to be heard by those at its summit.

My experiences in psychotherapy have not always been positive. My first therapist displayed a disregard for therapeutic boundaries which was not only unhelpful, but actively harmful. When I subsequently sought consultation with an excellent therapist, I noticed that even he sometimes struggled to know how best to work with the fallout from my previous therapist. I have found that almost no literature or research exists on working with clients who have been harmed in therapy and meeting the unique needs of this client group. I hope to be able to contribute in this area; I want the profession to be able to confront this aspect of its shadow and not to shy away from the harm that we can do as practitioners. I want clients who are wary of reentering therapy know that therapists want to help them. That we are by their side, that we want to understand what is happening for them, and that we do not fear working with them. I feel that an open conversation in the profession is essential to achieve this.

So, that’s a little bit about me and my interests. In this blog you can expect my thoughts and comments on all things psychotherapy, a strong leaning towards the rights of clients and the ethical responsibilities of therapists, and probably some poetry here and there too!