Relational Ethics in Practice

Narratives from Counselling and Psychotherapy

Lynne Gabriel, Roger Casemore, Lynne Gabriel, Roger Casemore

• Publisher: Routledge
• Year: 2009
• Print ISBN: 9780415425919
• eBook ISBN: 9781134093410
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Relational Ethics in Practice presents a new collection of narratives on ethics in day-to-day therapeutic practice. Highly experienced professionals from a range of roles in the therapeutic professions explore ways of developing ethical and effective relationships. The contributors provide the reader with engaging and informative narratives that indicate how ethics can inform and influence practice in a variety of clinical contexts across the helping professions. These personal and professional narratives will encourage people to think more proactively about ethics and the impact that they have on both therapeutic practice, and life in general.

Throughout this book, Lynne Gabriel, Roger Casemore and their contributors emphasise that the consideration of the ethical dimension is of paramount importance to successful processes and outcomes in every therapeutic relationship. Chapters cover a number of topics including:

• how theoretical approaches can inform ethical decision making and practice
• practical difficulties and ethical challenges
• innovative and unconventional approaches
• informed consent across various contexts
• pointers for good practice
• the notion of the 'wounded healer'.

Relational Ethics in Practice: Narratives from Counselling and Psychotherapy will appeal to a wide range of readers involved in the helping professions including counsellors, psychotherapists, researchers, supervisors and trainees.

Chapter 1
Introduction

Lynne Gabriel and Roger Casemore

Relational ethics in practice

A selection of narratives on ethical and unethical relationships from counselling, psychotherapy, psychology, psychiatry, training, research and supervision

The ethical dimensions of helping relationships are receiving increasing focus in the social and healthcare professions, not least because of the continuing rise in complaints against therapists and increasing interest in the nature of the client–practitioner relationship. Within the counselling and psychotherapy field, there is a recognition (both implicit and research-based) that the ethics of this relationship are of paramount importance to successful processes and outcomes. The quality of the client–practitioner encounter and practitioners’ ways of being in the lived reality of the therapeutic relationship is difficult to access. Hence this text, which invites experienced practitioners from diverse theoretical and practice positions to share their thoughts on and experiences of forming relational ethics in various relationship types and contexts.

Prior to outlining the chapter contents, it is important to offer a definition of what is meant here by relational ethic. The Oxford Reference Dictionary (1986) defines ‘ethic’ as ‘a set of moral principles’ and ‘relation’ as ‘narration, a narrative’. In the context of a helping relationship we can construe relational ethic as a co-constructed ethical and moral encounter, with associated relationship experiences and processes, that both influences and in turn is influenced by the complex multidimensional context in which the relationship occurs. The term relational ethic represents the complex medium through which decisions and interactions associated with the processes and progress of a relationship are mindfully and ethically engaged with (Gabriel, 2001a, 2002, 2005).

The process of translating philosophical theory and ethical thinking into practical application can feel far removed from the lived experience of intra-and interpersonal relating. Devising our own approach to relationship ethics can be challenging, despite the existence of ethical frameworks or codes of ethics. As the day-to-day reality of therapy practice can feel conflicted and chaotic at times, so there is significant value in hearing from the different chapter authors – each of whom provides an accessible narrative that can inform ethical thinking about and being in relationships. Some of the chapter authors offer theoretical context and concepts, while others draw more on personal and practice experiences. This rich variety serves to provide readers with a host of different approaches to relational ethics and we present a collection of works that illuminate and inform relational ethics in helping practice. The chapters cover a range of topics including:

• exploration of how a practitioner’s theoretical approach informs their ethical decision making and practice in helping work and relationships
• examples of practical difficulties and ethical challenges, along with pointers for good practice
• examples from practice and some innovative or unconventional attitudes and approaches
• informed consent across a range of approaches and contexts
• the notion of the ‘wounded healer’ and practitioner self-care
• examples from personal and professional experience.

This book makes an unusual and special contribution to the developing body of knowledge on practice ethics. It covers a wide spectrum of helping approaches and explores topics that reflect the diversity of theory and practice in the field including: counselling, psychotherapy, forensic psychology, psychology, psychiatry, supervision, training and research. We do not claim to offer an exhaustive approach to ethical thinking and practice – that is impossible in the world of applied ethics. What we do provide is a thoughtful and engaging collection, invaluable to today’s practitioners across the psychological therapies.

Underpinning the authors’ work are several ethics codes and guidelines, including: the British Association for Counselling and Psychotherapy’s (BACP) Ethical Framework, the United Kingdom Council for Psychotherapy’s (UKCP) Code of Ethics; those who work in psychology or psychiatry draw upon other guiding frameworks, including the British Psychological Society’s (BPS) Code of Ethics.

In Chapter 2, Lynne Gabriel explores the therapeutic relationship, with a focus on the intriguing concept of the role of the practitioner as a boundary rider, process sentinel and ethics warrior. She sets out a model through which practitioners can develop a personal–professional relational ethic for their therapeutic relationships with clients. Her work is based on qualitative inquiry into complex dual and multiple role relationships and draws on keynotes, papers and workshops at UK and international conferences. Gabriel explores findings from research into clients’ and practitioners’ experiences of overlapping role relationships. She proposes a model for relational ethics that facilitates a multidimensional perspective covering: relational context; intentionality; assessment; relational capacity and skills; relational responsibility, role fluency and spatial capacity – all of which are situated within the context of a collaborative client–practitioner narrative. Gabriel highlights the importance of understanding the link between therapist intentionality and relational integrity, showing how a therapist’s intent in a dual or multiple role relationship becomes central to its process and progress and influences whether the relationship or overlapping roles are beneficial or detrimental.

In Chapter 3, Roger Casemore offers a view that practitioners should be more concerned with developing ethics as a way of being which permeates their whole life, rather than a set of rules which govern their working practices. He suggests that our ethical values and principles should form part of our way of being that informs how we are and what we do in all aspects of our lives, rather than being a set of rules which we put into operation in the counselling room. Casemore explores the ways in which the relational work of therapy should be firmly contained within a commitment to relational ethics. He draws a parallel with the person-centred approach as ‘a way of being’ based on the integration of the three central conditions for therapeutic growth–congruence, positive regard and a non-judgemental stance – as deeply held aspects of the self of the therapist, rather than a set of techniques to be used with clients. He strongly questions whether it is possible to be an ethical practitioner in relationships with clients, if one is unethical in everyday life. Integrity in relationships with self and others is central to Casemore’s premise.

Aaron Balick, in Chapter 4, investigates relational ethics when working with lesbian, gay, bisexual and transgendered individuals. He explores how meanings of sexual identity are made within a complicated dialectic of difference, where gender and sexual identity are experienced in ways that are both multiple and relational, rather than from a perspective of conventional binary thinking. Balick focuses on the implicit conditions that create an ethical relational space and challenges therapists to be in touch with the multiple and relational aspects of their own gender and sexuality and risk engaging directly in relational dynamics that are likely to provoke uncomfortable aspects of their own sexuality.

In Chapter 5, Val Wosket draws on her personal-professional experience of relational ethics in supervision to explore the notion that the supervisory relationship is central to the process of effective supervision and that the full and effective exploration of ethical issues in supervision is always rooted in the quality of the relationship between supervisor and supervisee. She bravely uses examples from her own practice where she made mistakes by using her own ethical agenda as a supervisor, in order to emphasise the important learning that can come from mistakes and omissions. She also reminds us of how we may be wounded healers, offering us a challenge to consider the ways in which each of us brings experiences from past relationships into present relating and experiencing. With her supervisee’s consent, Wosket uses a case-work example from her supervision practice that demonstrates how ethical concerns that are out of conscious awareness can surface and become available for exploration in supervision. She also explores issues of supervisor power and authority and shows how relational ethics in supervision are largely about using the relationship with supervisees to mediate and work with issues of uniqueness and difference. At the end of her chapter, Wosket echoes a view held by most of the writers in this book, that relational ethics at its best can and must allow for creative, spontaneous and even unorthodox practice that privileges the needs of individual clients and supervisees over the limits and constraints of externally imposed professional protocols. Unorthodox does not mean unethical and the relational ethic espoused here denounces personal or professional abuse.

Kim Etherington, in Chapter 6, explores the ethical requirements for those involved in undertaking narrative, reflexive research. A reflexive relational ethic is central to her research thinking and practice. She suggests that in such research it is important to make transparent the researcher’s values and beliefs as these almost certainly influence the research process and its outcomes. Etherington shows how interactions in the relationship between researcher and researched give rise to ethical, moral and methodological issues. Illuminating this by using case material from research involving gathering life stories from past drug users, she advocates developing the research relationship as one of consultancy and collaboration and identifies the ethical issues arising from the various ways in which power issues permeate every aspect of research relationships. Etherington also strongly challenges the continuing influence of psychodynamic research which discourages practitioners from any form of self-disclosure and suggests the need for researchers to be more transparent and more present in their writing.

In Chapter 7, Nic Neath writes from a personal perspective, as a graduate from a diploma in counselling course, describing her experiences of relational ethics as a student, exploring her views on relational ethics in training, post training and the early stages of her counselling practice. She describes how, as a student, the landscape of her training seemed littered with a range of ethical dilemmas, each with potentiality for perilous adventure or shortfall in relational engagement, largely as a result of ‘not knowing what she did not know’. She explores some of the questions she had after training ended and identifies some of the philosophical, theoretical and relational issues that may not be given enough time in training. The chapter raises questions about whether we can ever be fully informed as trainees, when consenting to training or therapeutic processes. Her work also causes us to question the use of visualisation techniques that generate potent psychological and emotional material. It generates questions about consent and reminds us that it is a process that unfolds over time.

In Chapter 8, Subodh Dave, a consultant psychiatrist, explores relational ethics in psychiatric settings, sharing the richness of his learning from the experience of the transition from working in India, his country of origin, to working here in the UK. He strongly advocates a relational approach in psychiatry, particularly in developing relational ethics to inform processes of assessment and the formulation of treatment plans. He describes how his shared experience and relationships with patients helped him to adapt to working in a foreign land. Using case material he underlines the importance of taking account of the patient’s values and preferences and criticises the lack of guidance on relating to patients who fail to engage or on the ethical or moral imperatives of the clinician in such a common clinical scenario. He suggests that relational ethics is an action-oriented approach based on nurturing positive and healing relationships, in direct contrast to a competing rights perspective, which seems to prevail in the NHS. Dave challenges strongly with his individual view that evidence based medicine alone does not lead to improved patient outcomes but needs the addition of relational, value based medicine. He concludes with a strongly held view of the need for training for psychiatrists to create a new wave of ethical governance – a framework of learning and working that will enable individuals and organisations to achieve and maintain highly ethical practice; a framework which will facilitate and encourage diverse individuals and organisations to work in partnership and respectful relationships, with mutual respect for each other as diverse moral beings.

Chapter 9 brings legal issues into counselling and therapy’s relational domains. Peter Jenkins writes about key legal aspects of the relationship between practitioner and client. This includes legal definitions of the boundaries of safe practice and the legal responses to perceived breaches of such boundaries. He explores the theme of ‘therapy as evidence’, with personal reflections on his approach to ethical practice in his work as a counsellor trainer. Jenkins offers legal perspectives on the relationship between therapist and client and how therapy is not only a helping relationship and a therapeutic activity, but also one which is framed by powerful ethical considerations and, ultimately, one which is constrained by the law. He offers a personal dimension, describing the growth of his own personal-professional ethical stance, and clearly outlines the ethical and legal responsibilities of therapists and trainers and how these can often be in conflict.

In Chapter 10, Alan Dunnett writes about the role of practitioner self-care, stating clearly his view that counsellors should ensure that they do not use their work with clients to meet their own emotional and psychological needs. A practitioner’s capacity for self-care is central to their ability to provide an appropriate relational and ethical environment for their clients. Dunnett explores the power of the impact of a client’s stories on the therapist and the role of the organisation in increasing or ameliorating this impact. He questions the validity of the current promotion of the cognitive behavioural therapies which suits the philosophy and talents of some practitioners far better than others. He suggests that counsellors required to retrain in these approaches to therapy should question the ethics of working with clients from a theoretical position about which they have serious misgivings. He questions whether such individuals are likely to practise effectively if they experience psychological dissonance between their value system and the values of the organisation. Crucially, he states the nature of the counsellor’s relationship with himself or herself and with the organisation that the counsellor works in represents as much an ethical concern as the management of direct interaction with the client.

In Chapter 11, William West writes provocatively, drawing on his experiences and the experiences of others as counselling trainers, describing some of the ethical relationship challenges he has faced. He explores the notion that therapist training is based on faith in the chosen modality, rather than research on its efficacy, and that this might help us to understand the dynamics of training, the training team and the professional bodies. He uses a case study to highlight potential relational and ethical problems within therapy training teams. He acknowledges that therapist training is difficult and demanding and needs proper resourcing to be carried out effectively and comments on the existence of ‘self-exploitation’ of staff involved arising from their personal commitment to deliver quality training with inadequate resources. West advocates the need for a more robust scheme of accreditation of trainers and comments that if there are concerns about the quality of practice by therapists then the issue of the quality and delivery of training becomes even more important. With statutory regulation of counselling and psychotherapy imminent, this is a key issue for practitioner educators.

In Chapter 12, Roger Casemore identifies how his ethical stance on the strict application of some aspects of the British Association for Counselling and Psychotherapy’s Ethical Framework for Good Practice in relation to dual and multiple relationships has changed over recent years, as a result of his work in remote rural communities and small organisations. Casemore draws on case material and personal and professional experiences to show that there are significant differences in the ways that ethical principles need to be applied to relationships in different geographical and organisational contexts. From his own experience of inadvertent breaches of confidentiality, he declares the need to be clear and explicit and to seek agreement about the ways in which boundaries, relationships and aspects of confidentiality need to be varied within different cultural and organisational relational contexts. He emphasises the importance of living with the spirit and the ethos of the Ethical Framework in relational ethics, rather than being hidebound by the rules.

In Chapter 13, Lynne Gabriel considers the researcher–contributor research alliance. Gabriel draws on the concept of the working alliance to explore the significance of developing an ethical relationship which closely parallels the therapeutic alliance between therapist and client, which she describes as the research alliance. She examines role and relationship conflict and ethical dilemmas that can arise for counselling practitioners when taking up the role of researcher. Gabriel identifies from her own experience as a researcher how conflict and stress arising from researcher–practitioner role duality can be made more manageable by careful ethical thought and action. Gabriel argues that qualitative research interviewing demands a great deal of the researcher’s knowledge, skills, abilities and ethical literacy. Hence the need to develop conceptual and practical ‘tools’ that are researcher, contributor and context specific and offer a practical model for developing ethical research alliances.

In Chapter 14, Jeremy Tudway writes as a clinical forensic psychologist and draws on cognitive behavioural therapy (CBT) and rational emotive behavioural therapy (REBT) to consider ethics from a relational perspective, which is essentially intuitive in nature, rather than rule bound. He identifies a number of relationship dilemmas for the CBT and REBT therapist and illuminates these with examples from his work with high-risk clients. He explores some aspects of the power of the therapist and the importance of establishing an ethical relationship in which this power is not abusive. He makes some helpful suggestions for working ethically and lawfully with clients who present with highly challenging beliefs and behaviours.

In Chapter 15, Moira Walker offers an in-depth narrative on developing an ethically safe relationship when working with adult survivors of abuse. She explores feminist therapy and considers this in the context of psychodynamic models and its significance in working with adult survivors. Drawing on her practitioner experience, she powerfully explores the complexities and challenges of her work. She argues that in the client–therapist relationship the practitioner must offer genuine responses to carefully considered therapeutic needs, not dangerous knee-jerk responses to unrecognised or unprocessed countertransferences. Walker’s work provides invaluable theoretical concepts for those who work with adult survivors of abuse.

In Chapter 16, Lynne Gabriel offers a moving account of how the experience of personal trauma can impact on one’s capacity for ethical relations with oneself and with others. She describes how her experience of significant loss ...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Contributors
• Acknowledgements
• 1 Introduction
• 2 Relational ethics, boundary riders and process sentinels: allies for ethical practice
• 3 Relational ethics as a way of being
• 4 Relational ethics beyond the sex and gender binary: an integrative relational approach
• 5 Relational ethics in supervision
• 6 Ethical research in reflexive relationships: a dialogical process
• 7 Relational ethics: a perspective after the essays and marking
• 8 Relational ethics in psychiatric settings
• 9 Therapy as evidence: legal perspectives on the relationship between therapist and client
• 10 The role of practitioner self-care in practitioner–client relationship ethics
• 11 Training matters: on the way in
• 12 Relational ethics in small communities and organisations
• 13 Exploring the researcher–contributor research alliance
• 14 Relational ethics from a cognitive behavioural perspective
• 15 Counselling survivors of abuse: feminism, psychodynamic psychotherapy and ethics
• 16 Experiencing the edge: ethical and unethical relationships with self and others in times of intense or enduring trauma
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