What exactly is professional abuse? Everyone has their own opinions about what is and what is not acceptable behaviour. To keep matters simple it is probably best to begin with professional codes of ethics. For example how familiar are you with your own professional organisations code? If you are a member of more than one professional body are the different codes compatible? Does one organisation allow certain behaviour while another might prohibit it? Not important you think? Well, think again! 

By voluntarily becoming a member of a professional body, you are also agreeing to abide by its code of ethics. By joining another you are in addition agreeing to abide by this second code as well, and so on. I have personally known several therapists who have been members of different organisations not realising or seeming to care that the different codes that they had agreed to abide by were contradictory. In one case membership of one organisation prohibited certain activities, which their member engaged in on a regular basis as a member of another.

Imagine a worst-case scenario – someone brings a complaint against a multimember therapist which is ultimately found to have no basis. But, because the complaint was filed with several organisations, and they all investigated it, several problems arise because the therapist was found to have been in breach of one organisations code of ethics by engaging in activities promoted by another. Ultimately the multimember therapist might be forced to surrender one membership – only to find that this fact is reportable to other organisations (most organisations make it a condition of membership that any disciplinary action against a member be reported at the earliest opportunity) – in turn triggering further investigations and possible actions. So without actually having acted contrary to the best interests of a client it is still possible to find oneself being sanctioned.

There was a time when certain organisations ‘threw together’ a code of ethics because everyone else had them. Today ethical codes are no longer something which are just ‘thrown together’ (there are still one or two exceptions). A reputable committee might spend months labouring over them in the search for a code that will promote best practice among its members and offer a good measure of protection and redress where necessary to members of the public.

This brings us to the next point that needs to be examined – best practice.

When a client, often made vulnerable through stress, distress or illness, seeks assistance from a therapist, they are in effect placing their trust in them. This then places the entire onus for ensuring that this trust is not abused with the therapist. Client's have every right to expect that their chosen therapist will act professionally and objectively. Abuse in the real sense of the word happens the very moment that a therapist takes advantage of the trust placed in them. The moment that this happens the therapist is no longer acting in the best interests of the client. The moment that a therapist crosses this line they breach professional boundaries and exceed the normal limits of the professional relationship. Go back to your codes of ethics for a moment – it would be rare, I hope impossible, to find one that did not require a therapist to act in the best interests of a client. 

There are six main areas where abuse can occur and statistics show that the majority of offenders are male. These areas are sexual, sexual orientation, racial, emotional, physical and financial.

Sexual abuse is not confined to sexual acts, it can also involve inappropriate questioning that is not relevant to the course of treatment, which the therapist indulges in out of personal curiosity (as opposed to professional necessity) or for personal gratification. I’m not sure that the two can be separated; both are an abuse of trust.

A person’s sexual orientation may be causing them confusion and this may be one reason for them to enter therapy in order to resolve some issues. This is far different from a gay client attending for smoking cessation therapy only to find the therapist becoming more focused on their sexual orientation and making an issue of it.

Racial abuse can be both direct and indirect, and can also be surprisingly discrete. A number of years ago a relationship between a supervisor and the therapist under supervision deteriorated when the supervisor learned that their supervisee was involved in a long term and stable inter-racial relationship. Nothing was ever said but a lot was communicated in other ways. Racism is not always a colour issue either – prejudices are frequently pervasive and often ill defined.

Emotional abuse comes in many guises. Avoidable breaches of confidentiality are an abuse. Sometimes confidentiality must be breached in the best interests of a client. If there is evidence that a client intends to harm themselves or someone else then it is unlikely that you would be acting against their best interests by involving appropriate outside agencies. However there is no excuse for discussing client’s private details outside of the therapeutic relationship unless as part of a supervised session where rules of confidentiality still apply. At a conference years ago, shortly after I had completed my first training course, I discovered the therapist I was undergoing a training analysis with pointing me out to a group of their friends and telling them that I was currently a client. Even inexperienced as I was at the time, the fact that someone, especially a practising therapist, could be so ignorant of the rules of confidentiality quite frankly stunned me. Being dominating or intimidating, critical of clients, manipulating clients into extending a course of treatment or with-holding treatment as ‘punishment’ are also behaviours which should be considered a breach of professional boundaries, and thus abuse.

Obviously striking, pushing or restraining a client are the most obvious forms of physical abuse. Clients are also physically abused when restrictions are placed on their movements, i.e. being prevented from leaving a session. No contact need necessarily take place – simply standing between the client and the door is enough. Shouting, raising your voice and gesticulating as a means of intimidation or coercion also count as physical abuse in that it can make a client fearful of assault and/or for their safety.  

Clients can be taken advantage of financially in several ways. Deliberately delaying progress in sessions so that clients will have to attend additional sessions is one of the most blatant. It is also the most difficult to prove. Withdrawing therapy if a client can no longer afford to attend is seen by some as abuse. Equally I have spoken to many therapists who would disagree. Personally I would not withdraw support under these circumstances but others point out that they are professionals and have a right to expect to be paid for their efforts. This is a hard one indeed. At the very least the client should be referred on and an appropriate means of support should be found. The client should definitely not just be ‘dropped.’ On the other hand some therapists have agreed to provide therapy free of charge or at a reduced rate only to see their client driving away in a brand new sports car and show up at the next session wearing a Rolex and a fortune in jewellery. I would suggest though that this is rare – it has only happened to me once.

Lets not forget that organisations themselves can contribute to professional abuse. By failing to enforce their codes of ethics, not responding promptly to complaints and attempting to ignore or delay investigating complaints some organisations have caused as much if not more distress than the original incident or incidents in question. There have also been cases where promises have been given about the time that it will take to bring a complaint to resolution which, without explanation, have not been honoured.

The most damaging aspect of professional abuse of course are the affects on the client and those close to them. One bad experience can prevent clients from seeking further assistance and from benefiting from what could potentially be a life enhancing process. Not surprisingly clients emerging from an abusive professional relationship can do so with more problems than they had before seeking assistance.

As a therapist if you find yourself in any doubt about any aspect of your relationship with a client, consult your code of ethics initially and seek advise from your ethics officer or a member of the committee of your professional association as soon as possible. If in supervision discuss it with your supervisor as soon as possible. Be honest with them and listen to what thy have to say. It is acting in clients’ best interests to refer them on to another therapist if your interest in them becomes less than professional.

Resources:

Prevention of Professional Abuse Network (POPAN)  - 1 Wyvil Court, Wyvil Road, London SW8 2TG - 020 7622 6334 - www.popan.org.uk  - info@popan.org.uk

POPAN provides help for people who have been abused by health or social care professionals. They also produce clear and user friendly literature on professional abuse, what to expect when a complaint is made (client), suggested reading lists, a guide to what to look for when going into therapy and a newsletter.

Women’s Support Project - 31Stockwell Street, Glasgow G1 4RZ - 0141 552 2221

Women’s Aid Federation England - PO Box 391, Bristol BS99 7WS - 0117 944 4411 or 0345 023468

Recommended Reading

1. Boundaries – by Anne Katherine. Defines and explains what healthy boundaries are, how to recognise if personal boundaries are being violated and how to protect against this
2. Out of Bounds, Sexual exploitation in Counselling and Therapy – by Janice Russell. Overview of the issue of sexual exploitation in counselling and therapy – includes research
3. At Personal Risk – by Marilyn Peterson. Examines boundary violations in professional/client relationships. Examples from law, medicine, religion, education and psychotherapy
4. Patients as Victims, sexual abuse in Psychotherapy and Counselling – Editor Derek Jehu. A collection of articles and research reports including information on ethics
5. Complaints and Grievances in Psychotherapy – by Fiona Palmer Barnes. Billed as a handbook of professional practice, covers confidentiality, complaints procedures, errors and malpractice, examples of ethical codes and sample letters
6. Sex in the Forbidden Zone, when men in power abuse women’s trust – Peter Rutter. Explains what is meant by the ‘Forbidden Zone’, explores the extent of the problem, why men abuse power and much more – highly recommended
7. Folie a Deux, an experience of one to one therapy – by Rosie Alexander. When things ‘go wrong’ in therapy, from the client’s point of view.

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Michael O'Sullivan - Director of Studies
College of Integrated Therapies
www.health-concern.com
info@health-concern.com