Professional and Ethical issues in the Beginning and Ongoing Phases of Therapy in Schools.In...

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PART 4Professional Issues in Counsellingwith Children andAdolescents


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ELEVEN

Professional and Ethical Issues in the Beginning and OngoingPhases of Therapy in Schools

TraceyFuller

Introduction


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Ethical dilemmas in working in the openingstages of therapy with children are verycommon. The majority of these orbit theprofessional and legal tensions that exist inattempting to provide confidential space forchildren (McGinnis, 2008). According tothe BACP’s Ethical Framework ‘Working withyoung people requires specific ethicalawareness and competence’ (2010: 6). Much alsodepends on individual circumstances,developmental needs, levels of risk, andtherapeutic and other relationships (Bond,2010). What may be the best course of actionin one situation in one setting with oneclient may be wholly inappropriate inanother. Ways of working ethically alongsideteachers, other professionals and parents alsorequire active consideration.


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170 THERAPY WITH CHILDREN AND YOUNG PEOPLE

Dilemmas in working therapeutically withchildren and young people often result in apotential conflict between the principles ofauton- omy, fidelity (trust) and that ofbeneficence (Daniels and Jenkins, 2010). Thistension can also exist in adult work whererisk is involved, however with children itbecomes a major feature of the work: thisis because their younger developmental stageinevitably means that children are morepowerless and vulnerable to abuse andharm. Our requirement to protect and act inyoung people’s best interest can conflictwith children’s right to trusted confidentialspace and autonomy (McGinnis and Jenkins,2011). Child counsellors perhaps work uniquelyat the intersection of these rights. Theopening (and on-going) stages of therapeuticwork include assessment and review meetingsand initial contracting with young clients.The initial setting-up of the schoolcounselling service is also strongly implicatedhere, as this will often determine acounsellor’s level of success inmaintaining the therapeutic relationship, nomatter when an ethical dilemma arises.We would argue that three factors seem

important in maintaining helpful relationshipswith children through ethical challenges:

• Careful and explicit contracting with youngpeople, parents and the school, in terms ofconfidentiality and its limits in the faceof safeguarding concerns (McGinnis andJenkins, 2011).

• Appropriate and clear service levelagreements and protocols that underpin theschool counselling, combined with ongoingcommuni- cation about these in practice(Pattison et al., 2009).


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• Developing an approach that putstransparency at the forefront of therapeuticpractice with young people, in order thatinformation sharing is based routinely oninformed consent, wherever immediate safetyallows (McGinnis, 2008).

These elements, alongside the reflective useof regular supervision, form a helpful basis for ethical counselling practice in schools.In order to develop a justification for the

above approach to ethical dilemmas in theopening and ongoing stages of therapy, we willstart by briefly outlining some of thedebates, legal frameworks and dilemmas asregards confidentiality in schools. This willbe followed by a discussion of beneficialcommunication with teachers and children’snetworks, and some reflections on initiating acounselling service in a school. First sessionswith children and the setting-up oftransparent contracts will be explored, aswill managing assessment and review meetings.This will be followed by a case example of usinga transparency and reflective supervision tohelp face the ethical challenges pro- voked bya child protection disclosure. The chapter willconclude with some reflections on theimportance of school counsellor self-care.


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PROFESSIONAL AND ETHICAL ISSUES 171

Confidentiality and ethical dilemmas: balancing trust and safety

‘Confidentiality especially with regard tochildren and young people … perpetuallydemands thought and dialogue ... there is verylittle that is universally agreed, other thanit provokes strong feelings’ (McGinnis,2008: 126). McGinnis points to the depth of thedebate as regards confidentiality withchildren. The BACP Ethical Framework statesthat confidentiality is an ‘obligation arisingfrom the client’s trust’ (BACP,2010: 3), while Baginsky (2004) argues thatschool counsellors are in a paradoxicalposition: confidentiality is upheld as beingvital to children but counsellors equally havea role to ‘liaise with pastoral managementstaff, special needs co-ordinators, yeartutors, class teachers, governors, parents andsupport agencies’ (McGinnis and Jenkins, 2011:12). The Welsh Government’s School Counselling‘Toolkit’ suggests counsellors are required to‘work with, and alongside other services andagencies in a collegial manner, whilstmaintaining appropriate levels of confi-dentiality’ (Hill et al., 2011: 6), yet somestudies have highlighted that the culturewithin schools does not necessarily respectchildren’s right to a confidential space(Jenkins and Palmer, 2012).

Young people’s views onconfidentiality

There is much evidence that that anexpectation of confidentiality is a keyconsideration for young people in seekingtherapeutic help (LeSurf and Lynch, 1999;


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Boulton, 2007; Fox and Butler, 2007).Confidentiality is attractive to young peoplecontemplating using a school counsellingservice, whilst the fear that it may notreally be confidential may inhibit someothers (Burnison, 2003; Fox and Butler, 2007).This factor may have a developmental aspectwith older adolescents in particular having thegreatest concern about the confidentiality ofthe service they received.

Confidentiality: threeapproaches in law

A basic understanding of the three legalapproaches to children’s rights supported in lawprovides a supportive framework for schoolcounsellors in seeking to reflect on ethicaldilemmas in schools. This is a complex andcontinually evolving area that can seemed farremoved from the relationship with anindividual young person. (For a comprehensive


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172 THERAPY WITH CHILDREN AND YOUNGPEOPLE

exploration of confidentiality with childrenand children’s rights we would recommendBaginsky, 2007; Fox and Butler, 2007; Danielsand Jenkins, 2010; McGinnis and Jenkins, 2011;Jenkins and Palmer, 2012.) Three models ofchildren’s rights that are supported bydifferent legal statutes and case law arebriefly outlined in Figure 11.1.Despite this breadth of legally supported

positions to children’s rights, within schoolsthere is a tendency to over-emphasise thepri- macy of the welfare approach (Friel, 1998;Daniels and Jenkins, 2010).

Confidentiality: Three approaches in law

The ‘Welfare Model’: This pre-supposes that adults are best placed to make decisions affecting the welfare of children and young people. In terms of ethical values it prioritises beneficence over principles of autonomy. Pastoral systems in schools tend to be run according to this principle. Daniels and Jenkins suggest that this approach is essentially‘adult-centred’ and regards parents as the main consumer of education despite moves to the contrary in actual legislation such as The Children’s Act 2004 (2010).

Participatory Approach

This model suggests that children and young people have theright to be involved in decisions that affect their lives andwellbeing in accordance with their age and level of maturity.This principle is supported by a variety of legislation tovarying degrees,including Article 12 of the United Nations’ Convention on the Rights of the Child 1989 and the Children’s Act 1989. This model is often found to be acting in decisions about residence and parenting where the court will actively seek young people’sviews. In ethical terms this balances autonomy and other ethical principles such as beneficence

Independence Model: The ‘Gillick principle’

This is based on the ‘Gillick principle’ where children under the age of 16 can be provided with confidential treatment (including counselling) provided they demonstrate


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‘sufficient understanding’ of the nature of the issue (Gillick v West Norfolk Area Health Authority, 1985). The Children’s Legal Centre suggests that mature children/young people have a right to seekindependent advice and counselling without parental consent (Children’s Legal Centre, 1989: 12). The ‘Fraser guidelines’ further elucidated this area by setting out further criteria to justify such intervention, importantly that:

1. The young person had refused to have their parents informed2. The provision of counselling was seen as being in the young person’s best interest.

A helpful checklist of the application of Fraser guidelines to counselling situations canbe found in Daniels and Jenkins, 2010: 70.The concept of ‘Gillick competence’ has been applied to maturing adolescents, often over 14 and under 16, who are deemed of sufficient maturity to assent to counselling without parental consent.

Figure 11.1 Three models of children’s rights (adaptedfrom Daniels and

Jenkins,2010)


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A national survey found that 41% of schoolsrequired evidence of parental permission inorder for young people to gain access to schoolcounselling services (Jenkins and Polat,2006). In many secondary schools parents areinformed about the existence of the schoolcounselling service and are given anopportunity to ‘opt-out’ for their son ordaughter if they actively object (Jenkins,2010). The position in primary schools howeveris different as parental permission is nearlyalways required (Jenkins and Palmer, 2012). Themisrepresentation of the concept of in loco parentishas been criticised by some workers (McLaughlin,1996; Jenkins, 2010) as it has beenerroneously interpreted to suggest that schoolsmust exercise a ‘duty of care’ in substitutionfor a parent’s. This may then have been usedto over-ride the rights of children and denyaccess to counselling for some students who donot have parental consent.How confidentiality is practised by school

counsellors may vary greatly according to thenature of the agency that provides it (McGinnis,2008; Daniels and Jenkins, 2010). Counsellorsdirectly employed by schools in particular maybe subject to the same employment condi- tionsthat apply to teachers (i.e., to work under thereasonable direction of the head teacher; seeDaniels and Jenkins, 2010). Counsellors mayalso feel vulnerable to embedded tensionsbetween ethical practice and their employmentexpectations. This suggests that it may beeasier to practise ethically in schools withthe support of an external agency orcommissioning authority, where counsellors maybe more protected from sudden changes totheir contracts and are able to ensure agreater continuity of service for children(Harris, 2009).


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Having briefly explored some of the debatesabout confidentiality we will now investigateinformation sharing in schools, its evolutionas well as its potential benefits.

Schools andinformation sharing

Children’s networks greatly impact on theirwell-being and helpful communication withthat network can affect meaningful change andbe powerfully therapeutic (Hoffman, 1993;McGinnis and Jenkins, 2011). Teachers are theprofessionals who have the greatest dailycontact with children and as such they areoften very concerned for their wellbeing andwill seek to work together to support andprotect them (McGinnis,2008; McGinnis and Jenkins, 2011). Schools willroutinely share information formally andinformally in order to do this (McGinnisand Jenkins, 2011; Lamb, 2012). A counsellorarriving in a school, with a clinical modelabout the necessity of providing confidentialspace in


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order to create the therapeutic frame andmaintain the ethical principles of fidelity andtrust (BACP, 2010), may experience a professional‘culture clash’. They will have to adapt to anenvironment where the practice of sharinginformation is regarded as good practice (Lamb,2012).It is perhaps helpful for counsellors working

in schools to understand something of theevolution of school’s approaches to informationsharing.The Children’s Act 1989 set down that local

authorities have the responsibility to‘safeguard and promote the welfare’ of children(Part 3, Section 17). This act gave localauthorities the legal responsibility toinvestigate whether children are suffering orare likely to suffer ‘significant harm’(Section 47). In the wake of the LamingInquiry (2003) into the repeated failure ofprofessionals to protect Victoria Climbie,followed by the ‘Every Child Matters’ GreenPaper (DfES, 2003) and the resulting Children’sAct 2004, the culture of sharing information inorder to safeguard children has become deeplyembedded in cultural practice within andbetween statutory agencies, including schools(McGinnis and Jenkins, 2011; Jenkins andPalmer, 2012). There are complex arguments asto whether this ‘culture of mandatory reporting’of suspected child abuse is legally valid, andwhether it should extend to include counsellorsbased in schools, with perhaps those employeddirectly by schools having the greatestrequirement to disclose safe- guardinginformation (Brown, 2006; Daniels and Jenkins,2010; Jenkins,2010; Jenkins andPalmer, 2012).


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A further extension of the sharing ofinformation between professionals has beendeveloped by the coalition government (HMG,2010), despite some workers’ misgivings aboutevidence of a positive impact for the childrenthemselves (Baginsky, 2007; Daniels and Jenkins,2010; Jenkins, 2010). For children who areconsidered as perhaps not ‘at risk’ but ‘inneed’, multi-disciplinary CAF (Common AssessmentFramework) plans are implemented (Department ofHealth/Department of Education andEmployment/Home Office, 2000). CAFs require thesharing of much personal information aboutchildren, including their needs, behaviour,learning and family background, amongst a widevariety of professionals including teachers,social workers, CAMHs (Child and AdolescentMental Health Service) workers, educationalpsychologists, etc. CAF plans then become partof young people’s records in schools and otherstatutory settings (HMG, 2010). TAC (Teamaround the Child) and multi-professionalmeetings are also widely used in schools tosupport children (Bomber, 2009).The practice of sharing information about

children has been driven by the need toprevent further tragedies and failures insafeguarding as happened with VictoriaClimbie. It is within this professional,legal, political and socio-cultural context thata school counsellor will have to work. We havesympathy with Daniels and Jenkins’ powerful(2010)


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argument for the value of providing trulyconfidential space as a practice thatempowers young people and prevents a laterretraction of safeguarding disclosures.However, in practice this requires counsellorsto manage and assess high levels of risk,which may only be tenable and safe whereindividual counsellors’ work is supported (andheld as confidential) within multi-disciplinaryteams that include social workers. Schoolcounsellors often work as lone mental healthprofessionals amongst teams of educators.Undoubtedly, ethical and safe schoolcounselling work does require an understandingand active assessment of clients’ developmentallevel and degree of vulnerability. For exam-ple, it may be helpful for a 15 year oldto have more autonomy to determine the timingand manner of their disclosure about past sexualabuse by a non-resident adult in a way thatempowers them rather than increases theirexperience of powerlessness. In contrast, tokeep confidential concerns about an 8 yearwho has said that they are regularly hit witha belt would be dangerous and unethical. Howschool counsellors make such assessmentsand apply ethical principles in practicerequires much further research (Jenkins andPalmer, 2012). School counsellors need to workalongside their teaching colleagues in a waythat carefully balances young clients’ rightsto a trusted space with managing thetransparent flow of information to best supportand protect them. They also need to make aneffort to understand and respect theprofessional culture of education ofprofessionals working together.For these reasons we believe a polarised

position with regard to confidentiality isessentially unhelpful in schools. Learning topractise with transparency with young people


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is an appropriate and practical route throughthese perceived professional tensions. We arguethat a ‘specific competence with ethicalmatters’ as regards counselling students inschools requires a nuanced practice thatencompasses all of the following (BACP, 2010).

• Children have the right to trustedconfidential therapeutic relationships(where their immediate safety allows).

• Young people and children come attached toadults who will greatly affect theirwellbeing. School counsellors need tocommunicate with the people and systemsaround the child as they can be a powerfulresource and act to affect change.

• As young people’s developmental stageprogresses towards mid-late adolescencegreater individuation often results in adesire, and a greater capacity to, maketheir own decisions and to have ‘private-non-parental space’ (Frankel, 1998).

• ‘Informed consent’ (where their immediatesafety allows) and transparency should beat the heart of the sharing of informationfrom counselling sessions (McGinnis, 2008).


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• Information sharing by the counsellorshould be determined by the potentialbenefits for the child, their developmentalage/stage, and whether there are safetyissues at stake (McGinnis and Jenkins,2011).

We will go on to explore transparency andinformed consent in the following section andin the case example of Sophie later in thechapter.

Working transparently with children,young people and teachers

McGinnis (2008) argues for a transparentpractice that puts ‘informed consent’ by theyoung person at the heart of most informationsharing. Allowing young people to retain adegree of control over disclosures is crucial(McLaughlin, 1996; Dogra, 2005; Jenkins andPalmer, 2012). Much has been writtenelsewhere about what constitutes ‘informedconsent’ which is beyond the scope of thischapter to explore (see Pearce, 1994; BMAED,2004; NSPCC, 2009; Daniels and Jenkins, 2010),however in this context we are describingnegotiating consent with each young clientfor the sharing of material from theircounselling sessions with other named adults.In working alongside teachers it is also

helpful to understand their professionalexpertise and the pressures they experience.Children who are referred to counselling mayprovoke strong feelings in the adults aroundthem of powerlessness, rage, fear and hurting,and these can potentially lead to a cultureof blaming and psychological splitting(Heyno, 2009; Music, 2009). School counsellorscan helpfully disrupt this cycle by providing


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a more integrated position that offers hopeto the student and hence to their teachers(Music, 2009). Containing and listening toteachers’ anger and anxiety about clients canbe a key part of our daily role. Delaney (2009)describes the importance of reframingdiscussions with teachers about pupils tofocus on their underlying (often attachment)needs. Others emphasise the necessity of‘translat- ing’ pupil behaviour and theanxiety that often underpins it (Bomber,2009). There is a lack of reflective space forteachers and generally an absence ofprofessional supervision despite the supportthey may provide for students (Lloyd, 1999;Hanko, 2002; Geddes, 2006; Bomber,2009). It may be hard for a teacher totolerate a pupil who is causing them to feelpowerless, to be listened to when they are notsupported or listened to themselves.Counsellors need to avoid getting drawn intopsychological splitting themselves by blamingteachers. We strongly believe that workingethically in a school context requires empathyfor


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school staff as well as pupils.Acknowledging the difficulties and remainingnon-defensively curious are often helpfulresponses in con- versations with teachers. Suchdialogue also provides an opportunity to modeltransparent working with children and respectfor their right to make choices about thedecisions that affect them.

Service levelagreements

Establishing a therapeutic frame with oneindividual client is dependent on the outerstructures that support the overall schoolcounselling service. Issues such as rooms,referral routes and numbers, record keeping,understandings about confidentiality,timetabling and managing communications withstaff, all greatly impact upon a counsellor’sability to practise effectively andethically. Service level agreements betweenthe school and the counselling servicepotentially provide the most helpfulstructures in order to offer containment forthe counselling (Pattison et al., 2009).Developing a shared understanding about thenature of the counselling, matters ofconfidentiality and safeguarding isultimately the best foundation for ethicalpractice in schools (Cromarty and Richards,2009). These agreements also need to predateface-to-face work with children.School counselling has been widely found to

be beneficial to young people in schools(Cooper, 2004, 2006; Hill et al., 2011).However, many schools are unaware of theethical intricacies of setting up such aservice, and there are often unrealisticexpectations with regard to time and referral


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rates (Baginsky, 2004). McGinnis (2008) arguesthat counsellors should be able to presenttheir legal and ethical responsi- bilitiesclearly so that others understand that theyare not being ‘pre- cious’ or ‘secretive’.Equally, counsellors need to be aware ofschools’ and local authorities’ responsibilityto safeguard children and the pro- tocolsinvolved.Time spent making relationships with

teaching staff at school, and with externalagencies such as local CAMHs teams andchildren’s services and in jointly planning aservice, has been linked to positive out- comes(Cromarty and Richards, 2009). School inset andstaff meetings can be used to inform andeducate staff about the counselling service. Itis also equally vital to find ways of introducingthe role of the counsellor to the students suchas special assemblies and visits to classes.The role of a counselling service link person ina school may be vital in this process as isexplored by Eileen Armstrong in the followingchapter. Harris (2009) highlights theimportance of the attitude of the schoolleadership if counselling is to become anintegrated service in school.


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Rooms andtimetables

Finding a safe space to carry out counsellingcan be a sensitive issue in schoolenvironments, and especially in primaryschools where space is often at a premium.It is common for many spaces to have multipleand competing purposes: for example, a smallgroup room may also be a first aid room. It isvital to find a comfortable room that does nothave an association for children with‘being in trouble’. Further, as spaces areoften shared it is common practice for adultsand children to enter rooms unannounced. It isnecessary to consider the siting of such roomsin order to consider the privacy of young cli-ents attending counselling sessions both withintheir sessions and en route to and from them.Establishing the necessity of an uninterruptedsafe space and the concept of therapeuticboundaries requires discussion andinformation for staff. Matters of timetablingthe counselling appointments also demandforward discussion, with some schoolspreferring a rotation of counselling slots sothat students do not con- tinually miss thesame lesson.Recent reviews of school counselling services

such as Pattison et al. (2009) outline a numberof recognised key ingredients (as listed below),although further research is required toestablish shared understandings of themeaning of each of these factors.

Important recognised ingredients for a school counselling service


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• Sustainable funding.• Employing professionally qualifiedcounsellors with experience of working withchildren and young people who are inregular clinical supervision. (Counsellor’s should bemembers of professional bodies such as the BACP and UKCP whohave clear ethical frameworks.)

• Providing a safe and private space in schoolfor the counselling to take place.

• Service should be viewed as a non-stigmatisingand integrated part of school provision.

• Specialist evaluation and monitoring of the service should be in place.• The service should operate in a way thatmeets the requirements of current legislationand offers confidentiality within the limitsrequired by safeguarding.

• Counsellors must work in a way that isflexible and respects and values diversity.

Room ConfidentialityParents Resources Child protection

proceduresTeachers Timings

Referral appropriatenessPupils/students Timetables Referral routes

Supervision Waiting lists etc.Record keeping


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• Counsellors must work in a ‘collegial’ mannerwith other agencies and professionals whilstmaintaining appropriate confidentiality.

• The service must employ counsellors who areapproachable and have the personal qualitiesto create trusting therapeutic relationships(adapted from Pattison et al., 2009:170–72).

Meetings can be very difficult to arrange giventhe restraints of school counsellor workingcontracts and teacher workloads andpriorities. It can be difficult finding time toliaise with school staff when most coun- sellorsare employed on a part-time basis, with theirhours often being linked to numbers of studentsto be seen rather than the time to set up andmanage the service (Cromarty and Richards,2009; Harris, 2009). Ways of ensuringopportunities for such communication areperhaps a very pertinent focus forcommissioners of school counselling services(Cromarty and Richards, 2009).

Establishing a counsellor’s role

Practicalities

Shared understanding

Setting up the school counselling service

Referral and assessment

Numbers & routes Assessment information Referral forms

Managing communication


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Counselling Link workerSENCOChild Protection CoordinatorHead teacher

How will the service be evaluated?

Student feedback evaluation forms etc. Information on patterns of presenting issues for head and governors

Establishing links with external agencies

Children servicesCAMHSOther support agencies

Figure 11.2 Factors to consider in setting up a school counselling service


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Figure 11.2 shows a suggested network offactors that may require consideration whensetting up a school counselling service.We believe that developing a clearunderstanding and on-going dialogue around thefactors listed below is essential to supportthe school counsellor (and hence theirclients) when ethical dilemmas do emerge(McGinnis, 2008).

Encounters: initiating a transparent therapeutic contract

The first assessment session with a child oryoung person is a vital platform for ensuringfuture ethical practice (procedures forrunning assessment and review meetings thatinvolve parents/ staff are outlined later inthe chapter). Initiating a respectfulrelationship with a young client includesoutlining (in a developmentally appropriateway) the confidentiality of the sessions andits limits. This is not a ‘once and only’procedure as it is often helpful to return tothis contract and further discuss itsimplication, for example where a counsellorbelieves that a client is about to disclosesafeguarding information (NSPCC,2009; Jenkins and Palmer, 2012). In secondaryschools it can also help to have a simplywritten confidentiality statement displayedin the counselling space, such as can be seenin Figure 11.3.Counselling agencies will often have protocols

and assessment forms for evaluating a serviceand assessing risk, such as Goodman’s (1997)Strengths and Difficulties Questionnaire thatneed to be completed in first sessions.


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Counsellors have a duty to further assess forthemselves whether they are best placed tosupport a young person. Where there is a highlevel of risk, such as in the case of suicidalclients, or where the counsellor believesthere may be highly complex needs, or an

What you say to your counsellor is confidential. They will notshare what you tell them unless:

• You want them to because it would be helpful for somebody else to know.• You (or another young person) are in serious danger.

It can be helpful to encourage clients to ask questions and to test out hypothetical scenarios around this. With older clients it also important to discuss explicitly that this contract includes ‘seriously hurting’ themselves.

Figure 11.3 Example of a counsellingagreement


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underlying undiagnosed disorder or mentalillness, it may be best for the client to bereferred on to (or work in tandem with) aservice where they can be supported by amulti-professional team such as the localCAMHs. This is commensurate with the counsellorworking within the bounds of professionalcompetency and in the best interests of theclient (BACP, 2010; Bond, 2010). Young people(and parents) need to be included in theonward referral process. Clients’ consentshould be sought, and where age appropriate,young people can contribute and have accessto any written onward referral information(NSPCC, 2009). Offering such opportunities canwork against clients feeling disempow- ered orrejected by an onward referral. Pre-existingrelationships with local CAMHs teams can bevery helpful at this point in easing suchreferrals.

Engaging with the networkaround the child

We learn from systemic theory that children donot live in isolation and their relationshipsare a key part of how they learn aboutthemselves (Wilson, 1998). Boundaries areformed and tested against other people to helpchildren develop a sense of self and theirplace in the world. Meeting with the widernetwork, or ‘system of concern’, can enhancethe relationship with the child, and (withconsent) the wider system can be giveninformation about the therapy, increasing theopportuni- ties for understanding for everyone(McAdam and Lang, 1994). Communication withparents can offer the possibility ofsignificant therapeutic movement and affectchange for the child. This can also be a


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resource for the counsellor, providing storiesof hope and courage, different perspectives,new solutions and unexpected information thatcan enhance that counsellor’s thinking andpractice (White and Epston,1987; Hoffman,1993).

How to engage with thewider network

Initial assessment meetings often involveparents, especially in the primary phase.Later counselling review meetings usefully mayinvolve parents and other family members, andsometimes teachers. Maintaining the assumptionthat everyone in the child’s network wants thebest for that child contributes towards theco-creation of a respectful and qui- etlyoptimistic environment (Smart, 2012). Thecounsellor may take a position of curiosityand humility. The function of meeting thewider


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182 THERAPY WITH CHILDREN AND YOUNG PEOPLE

What do they think it would be helpful for their parents or teachers to know?

1. What are they happy to share?2. What material (if any) do they want to keep confidential?3. Who do they want to do the sharing? Some clients want to share their

experience of counselling themselves, while others prefer the counsellor to‘translate’ their feelings for them.

4. Do they want to be present? Some clients may fear criticism or embarrassment in such meetings.

Figure 11.4 Transparent preparation for a review meetings with a client

network is less about giving answers orguiding others to a pre- meditated point,and more about joining with others in acommon concern for the child, with a wish thattogether new communications and ways ofthinking might emerge (Smart, 2012). It is alsoa demon- stration to the young person thatthey are being held in mind by so manypeople, in a way that is orientated towardsan appreciation of their qualities andabilities (Bomber, 2009). Review andassessment meetings require preparation andreflection. Review meetings demand specificpreparation with the child, including askingthem who they feel it would be helpful to bepresent.Such preparation may include a

developmentally appropriate discussion withclients (see Figure 11.4).

Review and assessmentmeeting process

When meeting with a family or professionalteam, the counsellor is responsible forholding a safe enough space (Smart, 2012), soa clear description of the context of themeeting enables a contract to be negotiatedthat includes an exploration of concerns and


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a common purpose of mutually finding the bestway forward. Lang and McAdam (1994) use fourcontext markers for the counsellor to set thescene (see Figure 11.5).Confidentiality may also be outlined, included

a marker between the public and the privatedomains of a conversation. It is helpful for thecounsellor to connect with everyone in theroom, including absent members such as othersiblings (Smart, 2011). The counsellor mightsay, ‘I would like to start by asking each ofyou in turn what your concerns are aboutJane. What might her older sister say if wewere able to ask her?’ After spending timeon hearing people’s concerns, they may thenask about the strategies already tried orresources perceived.


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Definition of relationship (‘Hello, I am Jane’s school counsellor, and I have invitedyou all to this meeting today. I shall be leading this meeting.’)

Marking the time (‘We have about an hour… ’) Place (‘Thank you for coming to the school … ’)Content (‘I understand the goals of this meeting are to find a way forward for Jane, but perhaps you have some ideas about today’s meeting as well?’)

Figure 11.5 Ways of marking the context in assessment and review meetings

A counsellor’s preparation with a young clientwill support that person to feel confident toshare any communication that the client hasgiven consent for (such as ‘When I am very angryon the surface I often feel very worried insideand I don’t know what to do about it’). Thecounsellor may be able to give a positive re-framing to blaming or hope- less comments. Thereis also an opportunity to hear aboutresources and exceptions to the problem. Newstories may emerge that are free of theconcerns that contribute to a singleperspective of the child as a problem bearer(White and Epston, 1987).At the end of a meeting with the wider

network, it may be helpful to make time toreview the conversation, consider how it may ormay not have been helpful, and think togetherabout themes or ideas that people mightcarry forward. It is important to value thecommunication and the event of the meeting initself as a recognition of care for the youngperson, and to model this to all involved.

Working ethically with situations involving risk with young people


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There are many situations involving risk thatwill raise ethical dilemmas in the openingand ongoing stages of counselling. This isincreas- ingly the case perhaps as childrenmature towards adolescence, where risk takingis a feature of young people’s development(Cozolino, 2006). For example, underage sexualactivity can be a particular cause ofethical tension (Jenkins, 2010). Theintroduction of the Sexual Offences Act 2003and the Bichard Inquiry 2004 (Home Office,2004) recom- mended the routine reporting ofunderage sexual activity in order to protectyoung people from sexual exploitation, withall sexual activity under 13 to be regardedas ‘statutory rape’. This approach has beenrobustly criticised by the BMA as access tosexual health and family


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planning services is crucially dependent onoffering young people high degrees ofconfidentiality (Department of Health, 2004).Equally, working alongside young people who

are self-harming is ethically challenging forschool counsellors. Best (2005) highlights howschool pastoral systems routinely contactparents where self-harm is disclosed, arguingthat where abuse underlies the cause of theself- harm this may not be in the bestinterests of the young person. NSPCC (2009)guidelines for counsellors suggest working tode-stigmatise self- harm, explore itsunderlying feelings and causes, minimise risk,and negotiate onward referrals where possible.It is beyond the scope of this chapter to

review all the possible sources of dilemmas thatcounsellors will face in this area. The followingsection focuses on working with safeguardingconcerns as possibly the most common ethicaldilemma that characterises school counsellingwork.

Maintaining therapeutic alliances through child protection disclosures

The worry that our clients may be unsafe orbeing harmed necessitates us as counsellors toweigh three conflicting ethical principlesagainst each other: beneficence in the form ofthe child’s welfare; the fidelity and trustin the therapeutic relationship; and theirautonomy in their right to confidentiality. TheBACP Guidelines on Good Practice in Counsellingin Schools suggest that where a conflictexists between a child’s right toconfidentiality and their right to beprotected, the latter must take precedence


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(McGinnis and Jenkins, 2011). However the sim-plicity of this statement can belie theintricacy of working to maintain a therapeuticrelationship with a young person in the eventof child protection disclosures, designatedchild protection teacher involvement, chil- drenservices’ referrals, and policeinvestigations. As counsellors we need tokeeps the young person and their feelings inconstant focus. Opportunities need to bemaximised to maintain or repair trust in thera-peutic relationship, and simultaneouslyencourage a sense of personal agency, whilstworking with others, to promote a client’ssafety. The reality of traversing this territorywhere competing ethical principles are atvariance with a fearful, angry or traumatisedyoung client is stressful for schoolcounsellors. Regular, accessible and reflectivesupervision can give an opportunity forcounsellor anxiety to be managed in order toreflect on the demands of these competingethical principles, and find a way ofmaintaining a trusting and helpful relationshipwith clients.The case example below is used to describe

how supervision was utlised to reflect onthe risks Sophie faced, and thechallenge of


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assessing competing ethical principles. Due tothe sensitivity of this material this casestudy is a composite constructed from realclinical situations with several young people.

Working with Sophie: a commentary on a school counsellor’s ethical reflectionsSophie (aged 14) referred herself to counsellingby putting a note in my counselling post-box, andinitially did not want her parents to be in-formed. I outlined a contract with her that lether know that what she shared would beconfidential unless she was in danger. Sophie’sfather had split from her mum and she nowlived with her mum and step-dad. She also hasan older step-brother (aged 20) who was the sonof her step- dad. Towards the end of the initialassessment session she cried as she re- latedthat she didn’t like spending time with herstep-brother because she found him scary and he‘gave her the creeps’, especially if he had beendrinking which she said he did a lot. She said helooked at her in a ‘funny’ way but she wasunable to elaborate on this, although clearlyupset.

In supervision I reflected on my initialtentative concerns and ‘gut-suspi- cion’ thatSophie might be being sexually abused by her step-brother based on the fearful, shameful andpowerless counter-transference reaction I wasleft with when Sophie exited. I agreed that thebest course of action was to work on developingthe relationship but to continue discussing anyconcerns in supervision. We discussed how at thisstage I believed that it was in Sophie’s bestinterests to access counselling and that she


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was developmentally competent to make thatdecision (Gillick Competent), but that I wouldcontinue to discuss with her the possibility ofletting her mother know about the counsellingwhen it felt appropriate. We also agreed that Iwould ask the counselling link worker for anyknown information about the family and howSophie was managing at school.At this point, when the situation was

unclear, Sophie’s right to autonomy and needto develop trust (fidelity) in the relationshipwere taking precedence.

Sophie returned the following week agitated andflushed. Five minutes from the end of thesession she disclosed in fractured tears thather step- brother came into the bathroom drunkwhen her mum had been out and touched herbreasts and asked to have sex with her. She wasvery scared that he would do this again orworse.


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At this stage I believed that Sophie hadsuffered significant harm. Sophie clearly needed tobe protected and kept safe (beneficence) and Iwanted her to retain as much trust in thetherapeutic relationship as possible (fidelity). Ihoped that it would be possible to persuade herthat having taken the courageous step oftelling me she would consent to me shar- ingthis disclosure so she could be protected froma further assault. I also wanted to berespectful of my client’s right to autonomycommen- surate with her age and developmentalstage.

I reassured Sophie that she had done the rightthing in telling me. I also let her know thatI was very worried about her. I actively soughther permission to share the information so thatshe could be protected (informed consent).Initially Sophie was unhappy about anyone elsebeing told. She was worried about the impact ofthis disclosure on her mother and whether shewould believe her. She also feared that herstep-brother would ‘take it out on her’. Becauseof the timing of this disclosure at the end ofthe session, I asked Sophie to come back afterbreak so we could speak some more. I thenchecked with Sophie that she had somebody tosupport her over break-time.

Break-time gave me an opportunity to reflect andmake an ‘emergency’ phone call to mysupervisor. Together we shared our concernfor Sophie and her need to be protected fromfurther harm from the step- brother(beneficence). I discussed my anxiety that Sophiemight retract her disclosure if I shared theinformation without her consent. Mysupervisor further encouraged me to give Sophie


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as much autonomy as possible within thesituation and to be as transparent with heras possible in order to maintain trust inthe relationship or at least give a betteropportunity to repair the therapeutic alliancelater (fidelity).

When Sophie returned I reminded her of ourinitial contracting about limits ofconfidentiality. I let her know that I was tooworried about her safety and that othersneeded to be told so she could be protected. Ilis- tened to and acknowledged her angry andpanicky feelings about this. I asked her whatshe would want to happen if this were happeningto her best friend rather than her, whereuponSophie admitted that she would want the guystopped and her friend safe. This gave me someleverage to help her reflect on how others whocared about her would feel. Re- luctantly sheagreed that it might be the only way ofstopping him and she admitted that same hopehad made her come along to counselling in


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the first place. I let her know that initiallythe Designated Child Protec- tion Teacher, whowas the deputy head, would need to be told,and I asked her if she wanted me to tell her,or whether she wanted to tell her herself withmy support. I reassured Sophie that thematerial she had talked about that was not to dowith the assault could stay confidential. Idiscussed what was likely to happen next (i.e.,that a social worker might come and talk to herabout her experiences in school, and that atsome point they would go and talk to her mum andinterview her step-brother).

Sophie was given an opportunity to contributeto and see the content of the written referralthat was faxed off that afternoon to children’sser- vices. In the days that followed a socialworker came and spoke to Sophie at school andinterviewed her parents and step-brother athome. I kept in communication with theDesignated Child Protection Teacher and withchildren’s services so as to understand what washappening in the investigation for my client.Initially Sophie’s step-brother moved outpending further investigation, although he movedback in several weeks later with continuedchildren’s services involvement and monitoring.I was able to support Sophie throughout thisprocess and worked towards repair- ing thetrust in the therapeutic relationship. Thisinvolved re-contracting with her and making clearwhat could remain confidential. There was nopolice prosecution. Sophie, although fearful,upset and angry at various points, did feelgenerally believed and supported and ultimatelysafer and less isolated. She continued incounselling for a further ten months.

In the period of time that followed thisdisclosure I sought to prioritise transparentworking with Sophie. This helped her to feelmore included and powerful in the process and


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helped ultimately to restore trust and fidelity in thecounselling relationship.This brief case example concurs with what has

been initially explored in a recent study byJenkins and Palmer, that in reality ‘Schoolcounsel- lors, and others workingtherapeutically with young people, are likelyto be involved in a complex process ofbalancing confidentiality with maintaining thetherapeutic alliance and applying riskmanagement policies’ (2012: 557). As previouslystated, how counsellors in schools in generalwork through these situations involvingrisk, and how they manage the ethicaldilemmas involved, is a subject that requiresmuch further investigation. In these ethicallychallenging situations it is helpful to find aroute that is both transparent for theclient, and respects their stage of developmentand right to make choices, with their need tofeel protected (NSPCC, 2009). As previouslystated, in any ethical chal- lenge, theindividual context and circumstance are keydeterminates of eventual practice. However, thefollowing counsellor checklist is tenta- tivelysuggested as helpful. It is based onprofessional experience and a


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reading of literature in the field, includingthe NSPCC’s Procedures and Core Standards (2009),the BACP’s Ethical Framework (2010), McGinnis andJenkins (2011), Daniels and Jenkins (2010), andWorking Together to Safeguard Children (HMG, 2010).

Reassure the client that they have done the right thing in letting you know.

1. Tell the young person that you are concerned about them.2. Seek informed consent for the sharing of information (wherever safety allows).3. Where consent cannot be gained work in a transparent way

through the referral process. Seek to repair and maintain the therapeutic alliance.

4. Discuss who you are going to talk to and the likely consequences. This is most often the Designated Child Protection Teacher in the school.

5. Be mindful to limit the disclosure of counselling material to matters that affect the client’s safety.

6. Try to give the client options: listen to their feelings and opinions.7. If possible share with the client, or compose together,

any written communication about the situation (as is developmentally appropriate).

8. Continue to listen and acknowledge the client’s feelings throughout the process.9. Continue to seek the support of a supervisor.10. Try to discuss or repair any loss of trust in the counselling relationship. Re-contract.11. If unsure about the level of risk of ‘significant harm’

it can be helpful to contact the local children’s services and discuss anonymously your concerns.

Figure 11.6 Checklist for working with Safeguarding Disclosures with young people

Counsellorself-care

Working with risk and child protection concernscan be highly stressful for schoolcounsellors. Uniquely amongst otherprofessionals in schools, counsellors areseeking active contact with young people’spowerful feelings that may underpin the


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trauma of abuse for example. Equally uniquely,counsellors have theoretical frameworks andsupport structures such as supervision (andor personal therapy) that allow them toreflect on the emotional impact of this workon them. Taking seriously the BACP (2010)guidance on our responsibility as counsellors toensure that our work does not becomedetrimental to our health is vital. Werecommend the authentic use of supervisionboth to support us with our ethical dilemmasand explore the impact of this challenging workon our wellbeing. Ultimately, it can be verycomforting that, as children are embeddedwithin networks, we are usually not alone inseeking to support our clients.


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Conclusion

As cautioned in the final phrases ofthe BACP’s (2010) Ethical Framework, thereare no easy answers to meeting thechallenges of competing ethical principles inthe initial and ongoing phases of thera-peutic working in schools. We have outlined howa working knowledge of some of the legal basisfor children’s rights to confidentiality ishelp- ful, as is an understanding of thepotential resource of working together withparents, teachers and other professionals toaffect change, and support and protect youngpeople. We have highlighted the importance ofclear initial contracting with young clients,and the value of embed- ding schoolcounselling services within service agreementsthat support ethical practice. Throughexploring working with safeguarding concernswe have highlighted the value of workingtransparently with young people, keeping themin focus and negotiating onward referrals(wherever safety allows). We suggest that anethical approach in the initial stages ofcounselling needs to be mirrored by an ethicalunder- standing of teaching pressures, theemotional experience of working with youngpeople and education contexts, as well as theimpact on counsellors themselves. Howschools counsellors practically work throughsuch ethical dilemmas is a subject that stillrequires much research and we look forward tofurther developments in this area.

Notes


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I would like to thank Tanya Smart for hercontribution and support with this section.

Professional and Ethical issues in the Beginning and Ongoing Phases of Therapy in Schools.In...

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