The suggestion that I contribute to the LDPRT blog reminded me that it was time I re-read the COSRT Codes of Ethics and Practice – one for General and Accredited members and one for Supervisors, the latter in my anecdotal experience being generally less familiar to COSRT members. I try to do this regularly as changes frequently occur and it is of course ethical to keep up to date – I prefer this explanation to the one most favoured by my partner, which is that my memory is getting worse and I might not retain all that I need to remember.
Also, I was encouraged to be more my real self by a lot of laughter at home at the very idea that someone as befuddled by technology as I am would presume to blog. This sort of response keeps my feet on the ground. It is a welcome reminder of the ethical need to have a life outside of our profession, supporting emotional competence and preparedness to undertake a stressful occupation. Without it, I am easier prey to counter transference influenced by my own back story.
Re-reading the Code for General and Accredited Members, I notice it’s application to any activity of Members professionally or personally which may affect their professional practice, a useful reminder of what I agreed to when joining. Membership is a contract that binds me to adherence to the Code. I cannot split off certain types of therapy from the strictly psychosexual and couple work, perhaps thereby mirroring splits in clients. I wonder how many colleagues appreciate that membership of a professional body is a binding contract to adhere to a Code of Ethics and check for any conflicts or differences if they belong to more than one organisation?
The Code encapsulates the minimum standards for safe practice in five ethical principles: trustworthiness (including professional competence), respect for the autonomy of clients, beneficence (the desire to do good), non-maleficence (the desire not to do harm), and commitment to anti discrimination practice. The Codes cover achieving this through professional competence, for example CPD, and crucially, by the use of supervision. They also raise the important concept of emotional fitness to practice and self awareness.
I often find a number of things occur at about the same time, causing an issue to foreground itself in my thinking. Recently, speaking to a non COSRT counsellor at a CPD event, we were musing in the morning coffee break on the current state of our counselling/psychotherapy profession. She asked me about the COSRT Codes – did they meet any need not covered by the BACP Ethical Framework or the UKCP Code of Ethics? There not being enough time to discuss this, I suggested that she could, if interested, read Daniel Watters’s paper Ethics and Sex Therapy: a Neglected Dimension (printed as Chapter 6 in New Directions in Sex Therapy, edited by Peggy Kleinplatz, published by Routledge, 2012). This traces the history of sex therapy ethical thinking and demonstrates why the psychosexual codes include provisions different to other psychotherapy codes. Masters and other early pioneers viewed the specialism as requiring a specific focus and ongoing attention to ethics because the work is of so private a nature. It is thus potentially influenced by our own, the client’s and society’s values, and morals. Increasingly nowadays, it is impacted by legal structures and philosophies, adding an extra layer of complexity. I see a link to couple work as well, as it too involves very personal dynamics, even when sex is not discussed directly in the counselling room. This can create a heady mix when discussing sexual matters and emotional relating and this is taken into account in the COSRT Code by the strict injunction against any romantic/sexual relationship, not just with current clients, but with past clients too, regardless how long ago the client relationship ended. This contrasts with BACP and general UKCP practice. I have found it sometimes puzzles others not working in the way COSRT members do and can be controversial.
Our work takes us to areas where other therapists often fear to tread. We hear about porn, sex addiction (or compulsion, as some prefer), diverse sexual practices, trauma, sexual abuse and rape – often of children – and other issues. This can challenge our well being if we are not careful. Working with such material often gives rise to a range of ethical problems. I rarely come across therapists who want to harm clients (although sadly there are some), but other aspects of COSRT’s ethical principles are often in the frame.
There is real potential for a clashing intersection of our own moral position/values and those of the client, plus the added factor of legal complexity in areas such as safeguarding/breaking confidentiality and adoption counselling, as just two examples. I am not saying that these do not exist in other counselling, but the nature of topics often brought to COSRT members makes it a strong likelihood that these will arise frequently and introduce dilemmas. By the way, dilemmas for me are not the result of a mistake, but are part of our profession, being decisions arising from the intersection of alternatives with an absence of a clear way forward, of how to define what is “right”. Of course, the role of supervision cannot be underestimated here, although it is only as good as our use of it.
However well intentioned, we all (including me) bring our own moral and personal histories with us and these can be particularly challenged in the work of sex therapy. I think that Masters was right to see the need for specific, ongoing reflection on the ethics of our work. Beneficence is what we all want for clients, but what this means is often influenced by our own views and philosophies, unless we are aware. We have to bear in mind also the ethical principle of respect for client autonomy and this is often in my clinical experience as a therapist and a supervisor where many dissonances with beneficence may arise. Additionally, the increasing number of laws applying to the work of therapy in my view sometimes increase the complexity of dilemmas and can be unhelpful in considering the best interests of the client. Consequently, I see fitness to practice as encompassing not just in theoretical and CPD competence concepts, but includes as a priority, our own well being and self awareness as crucial to safe, ethical practice.
Without this, I experience less alertness to where my personal moral values and personal views can interfere and promote an unhelpful countertransferential response, especially around beneficence and respect for client autonomy. Good examples of value laden topics are monogamy, what “couple” means, heteronormativity/binary gender thinking, my own past “morals” parental teaching, and all sorts of past baggage unhelpfully in my professional room if I am not self aware.
Real life at home, and well planned and carefully paced breaks are important ethical practice, and I sometimes wonder how much attention therapists, especially in training, give to this. However, this itself may give rise to a dilemma in settling on a balance between my needs and the client’s. Seeing these sometimes competing needs as of equal importance, I must make the best choices I can. My old script of self blame could complicate this, clouding my judgement if I get tired or overloaded.
I place the need for a life outside therapy very high on the ethical agenda, reminding me that therapists are people first and then therapists, consequently having the human frailties and weaknesses of our clients and fellow human beings. Interactions with colleagues have helped me be aware that others also have frailties thus encouraging me to strive for continuing awareness of my emotional fitness to practice as right and ethical, without my old script of shame about my own needs.
Faculty member LDPRT