This month’s dilemma
Augustus is about to complete his counselling diploma. His counselling placement has been in a voluntary organisation where counsellors offer their services free, or for very little pay once they are qualified (clients pay a small fee to the service). The counsellors in the organisation are expected to undertake supervision in their own time and at their own expense.

However, some of them have told Augustus that they cannot afford supervision and do not undertake this element of their professional practice. Augustus is himself experiencing financial hardship and is considering ending his own supervision, while carrying on working in the organisation when his course ends.

Please note that the views expressed in these responses are not necessarily those of BACP.

John Daniel (psychosynthesis counsellor; editor of Private Practice, the journal of the BACP Private Practice division)
BACP states that the baseline recommendation for supervision for accredited practitioners must be not less than one hour’s presenting time to eight hours’ client work, subject to an overall minimum of 1.5 hours per month. Obviously this baseline will need to be extended for those with less experience. It is clear, therefore, that Augustus would be failing to maintain the baseline requirement, and consequently falling short of his duty of care to his clients, if he continues to work clinically at the organisation having obtained his diploma without arranging independent supervision.

The principle of beneficence necessitates a commitment to acting in the best interests of the client, which requires ‘an obligation to use regular and on-going supervision to enhance the quality of the services provided’. The principle of self-respect stipulates that there is an ‘ethical responsibility to use supervision for appropriate personal and professional support and development’. Should Augustus aspire to provide a safe, ethical, competent and professional service for his clients, it is imperative that he makes a commitment to attend regular supervision.

The second dilemma Augustus faces concerns his knowledge of his peers’ unsupervised practice. As Augustus is party to information that could potentially indicate risk of incompetence or malpractice that could cause harm to the client, he needs to consider the principle of non-maleficence here. This principle states that practitioners have a ‘personal and professional responsibility to challenge, where appropriate, the incompetence or malpractice of others’. To that end I would suggest that Augustus has a moral obligation to raise his concern with his peers, and explain clearly his reasons for doing so. If they don’t resume supervision, he would be advised to speak to the placement manager, having first let his colleagues know that he intends to do so.

This dilemma raises a wider question about the responsibility of placement agencies that offer voluntary placements to trainees on the basis that they arrange and pay for their own, independent supervision. In this case, the organisation for which Augustus works ought, at the very least, to be regularly monitoring and ensuring that its volunteer counsellors are in supervision. There is a suggestion here that this agency is failing to do so.

It may not be ideal that a newly qualified counsellor offering his services to a voluntary agency for free should be expected to meet the expense of his own supervision. However Augustus agreed to the terms and conditions of the placement when he began to work there, and will be in serious breach of those conditions should he decide to practise unsupervised.

Margaret Birrell (NHS psychological therapist and supervisor in private practice)
Although the therapeutic alliance is between the counsellor and the client, there is a complex mix of others in the picture of care. The voluntary organisation holds direct clinical responsibility and clinical liability for the clients they accept into their service, and for all outcomes. It has a duty of care to ensure safe and ethical practice for the client group, and to oversee the client work – even if, as in this case, they have declared they will not pay for supervision for the voluntary counsellors.

If they are unable to afford to provide supervision, they should at least monitor and ensure the counsellors have all made their own arrangements, and who the supervisors are, and maintain up-to-date records of which clients are allocated to each counsellor, in order to manage counsellors’ caseloads, levels of experience, areas of expertise etc). A reputable agency will hold membership of a regulatory body and be bound by its Code of Ethics and safe practice.

If the training establishment were aware of the poor standards in the voluntary organisation, I wonder if they would continue to encourage or allow their students to do their placements there?

The task of the training establishment is to ‘train’ new counsellors in the skills and knowledge of ethical practice and standards to ensure client safety. This includes providing students with a clear understanding of why regular supervision is important, what to expect from supervision and how to use supervision to their best advantage.

My recommendation to Augustus is to talk this through with his current supervisor, and consider the implications for his client(s) of stopping supervision. He may need to think about how he will factor the costs of supervision into his business overheads as a necessity rather than a disposable commodity in his future private practice. He would also be advised to talk this through with his training establishment, to update them fully on the current situation at the voluntary organisation. He should also advise the voluntary organisation of his intention to stop supervision, so that they are aware of the implications for their clients.

If Augustus is not currently attending personal therapy, my recommendation is that he should arrange this, to more fully develop his awareness of his ‘self’, ‘the client’ and why supervision of the therapeutic relationship is vital to client safety.

Finally, if Augustus wishes to develop his private practice after qualifying, I would recommend he researches now, before it is too late, what a reputable, safe practice should offer to attract referrals from reputable care organisations.

Kevin Ryan (volunteer and supervisor for Cruse Bereavement Care)
Exploitation is the word that comes to mind while reading this dilemma. Exploitation of counselling trainees seems to be a common experience in counselling. As more training courses are available, and all demand work experience as part of the qualification, there is a bigger pool of potential interns for charities and counselling organisations to call on.

A counselling organisation or charity has a duty of care to their volunteers. Augustus is offering his time for free, probably between five to eight hours a week, and over an extended time period, maybe even years. He is doing this in order to gain hours towards his qualification, but the placement organisation cannot view this as a free gift. In order for anyone to grow within a profession, they need support and nurturing. To get the best out of your volunteers you need to invest in them. The more grounded, confident and supported the volunteer feels, the better they will be able to work with their clients.

Placement has its responsibilities. Supervision is vital, especially for inexperienced trainees who are juggling academic theory with complicated reality. They cannot be expected to deal with complex client issues if the organisation does not offer them support. Counselling can be a very lonely experience for an inexperienced counsellor, as they shoulder the weight of the client’s problems and deal with experiences outside their comfort zones. Furthermore, supervision guards the client’s interests against a novice counsellor’s well meaning, but sometimes inappropriate or damaging, actions.

To me this counselling placement sounds dangerous. The management values supervision so little that it has pushed the costs in time and money onto its unpaid volunteers. They also seem unaware or do not care if the volunteers are arranging their own supervision.

A culture has developed where supervision is not central to the process; it’s an afterthought. This poses a danger to the volunteer, client and organisation. Moreover, it is transmitting shockingly poor professional values around supervision and client care that are being absorbed by their trainee counsellors.

Worryingly, for a listening profession, this organisation does not seem to be listening to its volunteers, who are suffering financial hardship because of its demands. The trainees, in their turn, feel they are unable to communicate their financial hardship to their management, and are instead being devious about their supervision commitment. This is a serious breakdown in communication and trust. The low value placed on these volunteers seemingly reflects an attitude in the organisation that there are plenty more eager college trainees out there, so why bother.

My advice to Augustus is to leave and give your time to an organisation that will value, support and protect you. You deserve better. My advice to the placement organisation is to look closely at your professional values.

Next month’s dilemma
Robert is an experienced counsellor in private practice. A new client, Antonia, comes to see him. She comes from a country which, 10 years ago, experienced violent upheavals, but the issues she brings have to do with problems in her marriage. Her husband is a drinker and serial adulterer.

At the end of her fourth session Antonia mentions almost in passing that she was involved in the fighting in her country and that she was captured and tortured. She adds: ‘I did well in the war; I killed a lot of people, so it’s OK.’

After Antonia has left, Robert finds himself reeling, to the point where he can barely think straight. It is clear to Robert that Antonia’s war experiences cannot be swept to one side and that he will find it well nigh impossible to work with her. Above all, Robert recognises that he is completely out of his depth, and does not want to see Antonia again.

What are the issues inherent in this dilemma and what should Robert do?

Email your responses (500 words max) to Heather Dale at hjdale@gmail.com before 27 February 2013. Readers are welcome to send in their dilemmas to be considered for publication, although these will not be answered personally.