Controversy on record keeping

Can we ask clients for testimonials?

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Dilemmas

This month's dilemma Sherifa completed her counselling qualifications three years ago. However, she has been

unable to find paid employment as a counsellor. Although she has continued to work in a voluntary capacity in order

to maintain her practice, she has become increasingly frustrated and has decided to set herself up in private practice.

As a first step, she enrolled on and completed a business start-up course, where she was advised to set up a website

and to include testimonials from her current clients at her placement. However Sherifa has just seen a conversation

on a social networking site where some members have suggested that this is not wise. What are the ethical issues

involved and what should Sherifa do? Opinions expressed in these responses are those of the writers alone and not

necessarily those of the column editor or of BACP.

Andrea Sheehy

Marriage and couple counsellor, website design and development I can understand why Sherifa's business start-up course has recommended that she use client testimonials. They can

be powerfully persuasive in a marketing package that includes a professional-looking website, high quality

photographs and verifiable details.

However, the essence of this dilemma is to be found in the conflict of interest between the benefits for the therapist

of obtaining a testimonial and ensuring the integrity of the relationship for the client.

The BACP Ethical Framework suggests that a resolution of this conflict should be biased heavily in the best

interests of the client. Therefore Sherifa should discuss the soliciting of testimonials with her placement manager

and supervisor before proceeding. For example, I can see a conflict of interest if testimonials from placement clients

are used to promote Sherifa's private practice.

In addition, supposing Sherifa were to solicit her clients for testimonials. I wonder how many would feel free to

express reservations or refuse. Sherifa would need to satisfy herself (and her placement manager) that she was

ensuring the integrity of the relationship, and this may be difficult to do. Wouldn't it be anti-therapeutic for a client who is being treated with dignity and respect possibly for the first time in their life to be asked this? Aren't they

going to feel obliged to help the person who has helped them?

Arguably the soliciting of a testimonial creates a dual relationship. The Ethical Framework says: 'The existence of a

dual relationship with a client is seldom neutral and can have a powerful… impact… For these reasons practitioners

are required to… avoid entering into relationships that are likely to be detrimental…'

A problem with testimonials is that they can imply that a benefit that one client has experienced from therapy will be

universally available to all potential clients. This is not the nature of such a diverse practice as therapy and such

testimonials could be interpreted as a misrepresentation of the work of the therapeutic community. While it is true

that some therapists produce consistently better outcomes for their clients than others, arguably what these therapists

are good at is motivating the client to engage in the work that they themselves need to do for therapy to be effective.

Testimonials can be anti-therapeutic because they collude with the client who seeks to project the responsibility for effecting change onto the therapist. It could also be argued that the client who writes a glowing testimonial is

discounting the work that they have put in and their courage in facing their demons.

Monitoring our services through feedback is vital and positive feedback is always gratifying but there are many

sound ethical reasons not to make them public. Satisfied clients often do become our best sources of future referrals

and there are plenty of ways that Sherifa's clients can make their voices heard effectively without involving her

directly.

Rob Hammond

Personal consultant, integrative coach-therapist

Sherifa should first consider the ethical guidelines of her professional body. There maybe nothing specific about

testimonials in the guidelines but they will make clear that the individual practitioner is accountable for her actions

and needs to be able to justify them if she is challenged.

Ultimately those of us in private practice are running a business and 'social proof in the form of client testimonials is a powerful advertising tool. But before requesting client testimonials Sherifa must consider the ability of each client

to be objective about her request. Therapy should work towards a client being self-directing in their life. However,

given the in-built power imbalance within the therapeutic relationship, extreme care must be taken that a client

doesn't feel under an obligation to provide a testimonial. Equally, Sherifa needs to be sure that her client isn't

investing her with undue responsibility for their wellbeing, thereby negating their own part in their progress.

On the other hand, to deny a client the opportunity to publicly state their successful outcome from therapy, in the

interest of future clients, would seem unfair.

Sadly there is still a certain amount of social stigma around receiving therapy. Client testimonials help to reduce the stigma of therapy and reinforce the notion that it is natural and acceptable. If a potential client is feeling nervous

about starting therapy, or is unsure of what to expect, feedback from previous clients can be a useful way to make

them feel more at ease.

There are numerous ways for Sherifa to gather testimonials. She could give clients a satisfaction questionnaire, with

a box to tick to give permission to use their comments and a stamped, addressed envelope for them to post it back to

her when they are ready. She could send clients a follow-up email once therapy has ended asking if they would

consider supplying a testimonial.

Sherifa should always explain how their feedback will be used (eg on her website), whether it will be anonymised,

how long will it be on view etc, and obtain the client's permission for this.

If the option of testimonials is openly discussed and the client is fully able to be objective about the request and to

make an informed decision, then I don't see that there is any problem.

Helen Cooke Volunteer MBACP (Accred) counsellor

The pages of Therapy Today are heavy with references to the lack of paid work in our profession and Sherifa's

dilemma reflects this difficult issue. Her situation has left me wondering what drives her counselling career and

about the nature of her professional relationships.

For example, what do we understand by having 'completed' our qualifications? Counselling training is not a finite

process and is often described as a journey, but Sherifa talks of 'maintaining' her practice rather than developing it

(and herself). Perhaps her motives are purely strategic, so frustration at being unable to take the next step to

employment is completely understandable. Will she devote energy to processing these feelings before she risks

carrying them forward into the work with her private practice clients?

Sherifa's entrepreneurial flair is to be encouraged. However, she has chosen what sounds like a generic business

course where the unique aspects of our profession are unlikely to be catered for. The BACP Ethical Framework encourages us to be open to and conscientious in considering feedback from colleagues, and we can benefit

enormously from their guidance and advice. Have Shefira's peers fallen by the wayside in her quest for progression?

Similarly, the question of whether or not to publish client testimonials on her website has arisen vicariously, through

coming across online postings between other people. Her dilemma centres on client confidentiality, which is a

hugely significant and precious element, yet she seems so isolated professionally.

Her intention to acquire testimonials from placement clients sounds very worrying. Trustworthiness, the BACP

Ethical Framework tells us, requires us to 'restrict any disclosure of confidential information about clients to

furthering the purposes for which it was originally disclosed', so client feedback provided to the agency cannot be

'lifted' for secondary uses. There are also Data Protection Act implications. For Sherifa to seek feedback separately

and overtly for her own promotional purposes, even with the knowledge and blessing of the agency, leaves me

struggling to imagine how this could be safely managed. Crucially, what are the implications for the therapeutic

relationship of this potential 'gift' from the client, or for clients who refuse the request? Sherifa needs to discuss all her plans with her placement supervisor without delay to ensure there are no current or

potential boundary breaches. Here they might explore ways to help her connect and flourish, including exploration

of the wealth of resources that BACP membership confers (eg relevant CPD workshops, the BACP Private Practice

division, regional networking days, local network groups, perhaps even setting one up in her area).

Sherifa might also take time to reflect on the personal moral qualities of humility and integrity while assessing her

priorities as a practitioner. She may decide to slow down her business-minded drive for the time being if it risks

overtaking the application of good ethical practice. Glowing testimonials are of no value if the method of acquisition

sends her crashing headlong into the sanctions pages of Therapy Today.

December's dilemma Ken and Rob both work for a telephone counselling organisation and chat via Skype once or

twice a month, often about clients.

One day Rob confides that he is not qualified; he completed a four-year psychotherapy training but did not take the final examinations. His CV states that he is a trained psychotherapist and he was not asked to produce documents

before being appointed. Ken is rather shocked but decides to do nothing as Rob has not actually lied about his lack

of qualifications.

However, Rob is now under investigation as a former client has complained that he was not qualified or competent

to deal with her needs and terminated therapy with him abruptly. Rob has asked Ken to write a letter of support, in

particular saying that he is familiar with his work and that he is competent to deal with complex issues.

What are Ken's options and what should he do? Email your responses (500 words maximum) to Heather Dale at

hjdale@gmail.com by 26 November 2014. Readers are welcome to send in suggestions for dilemmas to be considered for publication, but these will not be answered personally.

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