Welcome to installment of the private practice business mini-series, where I will wrap up our commitments to clients’ mini-series.

Maintaining integrity, accountability and candour are major aspects of the counsellor’s commitment to their clients, to themselves and to the profession.

Counsellors should be as transparent about the work they do as possible.

This starts with a clear contract – and website – that lists all the boundaries and terms of the therapeutic relationship, such as:

  • Fees and how to pay them
  • Cancellation policies
  • Contact outside sessions
  • How the counsellor works
  • What to expect
  • And more…

If the therapist doesn’t feel they can work with a particular client, they should be clear about this within themselves and with their supervisor, and find the best way to communicate this to the client and refer them on to someone that can help them better.

It is then the therapist’s responsibility to update their knowledge so next time they can see clients with similar issues.

If a client is doing well in therapy and the counsellor doesn’t feel they need it anymore, it is their responsibility to explore this with the client – keeping someone in therapy because they are paying and not saying they want to end is not being ethical.

Some clients don’t realise that it’s their right to end therapy at any point – even when it’s stated in the contract and discussed in the first session – or some of their presenting issues might mean they are not able to voice the need to end.

They might be anxious about it or fear of letting the therapist down, for example.

It is the counsellor’s duty of care to explore all these issues and more with the client, to ensure that therapy is doing what it’s meant to do – to help and not to make hurt or worse.

I find that my blog, which I started back in 2017 really helps with being honest and presenting myself to clients and potential clients as transparently as possible.

They can read about how I work and what therapy will be and feel like with me.

Blogging opens so many doors for therapists, and as good as it is, we have to be aware of who is reading it and how they will be affected. Too much self-disclosure might be bad for our practice – there are places for us to work through our own issues.

That leads me to the next point – being honest with ourselves about our need to dip back into therapy is important, because it allows us to “top up” our emotional and psychological needs through our own therapy.

Clients are sometimes surprised that I tell them I have my own therapist, but they soon realise that apart from it benefiting me, it benefits them too, and it models that there is no shame in saying you’re attending therapy.

I also let them know about supervision and how that is also for the benefit of their therapy and therapist.

Being human has been something clients have benefited from.

I am not your stereotypical psychodynamic counsellor with a blank screen posture.

I talk a lot, I ask questions, I interact and challenge my clients in a gentle way so they can work through their issues.

I acknowledge to them I’m a bit tired or getting better from a cold, I might get a tear in my eye from listening to their story or get really angry on their behalf.

All of this helps the therapeutic process, and if it doesn’t help then clients are good at telling me.

Honesty goes both ways in therapy!

Being accountable means a lot of things.

The first thing that comes to my mind is supervision.

Supervision is a space where we can be accountable for the work we do with clients. Where we keep in check whether we are being objective or being drawn in by the client’s issues and maybe colluding a bit with them. It is where we regroup and find ways to be different with our clients so they get what they came for – support and positive change over time.

Discussing risk is another important aspect, and one that trainee and those starting off in private practice might find more difficult to address. More experienced counsellors might still struggle with it but find that it comes more naturally for them to ask the questions because of their duty of care and knowledge of how important it has been for past clients. It also safeguards the therapeutic relationship and the therapist’s practice, to say the least.

Asking about potential risks includes asking the client if they’re suicidal, have had any suicidal thoughts or made any plans to end their lives. The answer to this question will lead the therapist to make some ethical and moral choices – do I contact someone for this client so they are not left on their own? Can I keep the client in my office a bit longer if I don’t have another client and will that help or hinder the process? Do I just suggest Samaritans and A&E services if they find themselves struggling between sessions? Do I offer more sessions? What to do next?

These questions can all be asked in supervision and also directly with the client. What do they want to do about their predicament? This can be about suicide risk or other risk – domestic abuse, for example.

Have you got anything to add in regards to being honest and keeping accountable as a therapist and supervisee?

Leave a comment below!

Ethics and Professional Standards- Our Commitment to our clients (part 3)

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