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UNIT 4

UNDERSTANDING BOUNDARIES IN COUNSELLING RELATIONSHIPS

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TABLE OF CONTENT

1. Boundaries in counselling relationships

2. Objectives of a new helping relationship

3. Strategies for ending relationships

4. The impact of a helping relationship ending

5. Conduct of the counsellor

6. Unit summary

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BOUNDARIES IN COUNSELLING RELATIONSHIPS

Boundaries are a vital aspect in any helping relationship as they help to define the relationship of everyone involved and ensure that all parties are protected from harm and that high ethical standards are adhered to. It is the responsibility of the counsellor as part of their ethical practice to ensure that boundaries are set and constantly applied throughout the counselling relationship.

Boundaries help individuals to feel comfortable in the counselling environment so that they are better able to talk about their experiences and feelings and therefore are more likely to be able to find their own resolutions to their issues.

There are many factors that need to be considered when boundaries are being drawn up as part of a therapy contract, which will apply regardless of the type of therapy that is being practiced, some of which include:

Confidentiality

Disclosure of information

Conduct of the counsellor

The relationship outside of the counselling environment

The counselling contracts

Data protection

The counselling environment

Referral

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Confidentiality

Within the counselling relationship, confidentiality is, arguably, the most important aspect because the client must feel as if they are in a safe environment. The subject of confidentiality might even be broached first by the client who may be fearful of revealing things in a relationship they don’t feel is bound by ethical guidelines. Before the first session begins, the counsellor should assure the client of confidentiality but also let them know that there are times that this agreement must be broken. The client knowing and understanding this will form part of the contract between the two parties.

Confidentiality also applies in situations where it might be necessary to discuss a client’s session, for example if the counsellor needs to seek advice from their mentor. In this situation the counsellor should never use the real name of the client, but instead use an alias. They should also be careful about what details they disclose as well because it is quite possible to identify someone by piecing together very few details, such as their age and where they work. Counsellors must never discuss any details about their clients in any other circumstances, for example at home with their partner. Breach of confidentiality, for some clients, is likely to be extremely distressing and could result in legal action being taken against the counsellor, and so it is paramount that guidelines are followed.

There are occasions where the client may want the counsellor to share information, perhaps with their GP or their employer so that they can gain some more details about how best to help. The client must, though, be very specific about what the counsellor can and cannot divulge.

Failure to adhere to regulations regarding confidentiality can result in issues, such as:

Facts being changed or exaggerated outside of the counselling setting

The client/counsellor relationship being compromised beyond its set

boundaries

The client will be less likely to open up if they feel that the information they give

will be discussed with others

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DISCLOSURE OF INFORMATION

All clients must be informed very early in the counselling relationship that absolute confidentiality, in some circumstances, can never be guaranteed. Guidelines for this are usually predetermined by the health care organisation or agency for which the counsellor works. However, these will apply as well for those counsellors who work in private practice. Clients should know that confidentiality will be broken if the following applies:

The client expresses suicidal tendencies

The client threatens harm to others

Abuse of children is suspected

It becomes apparent the client is seriously mentally ill

Drug trafficking is suspected – this must be reported under the Drug Trafficking

Offences Act 1986

There is a suspicion of terrorism – again, in this case, breaching confidentiality is

a legal, rather than an ethical, requirement

It is really important that counsellors are aware of these rules before any actual counselling takes place. This will ensure they are better equipped to deal with an emergency situation, should it arise.

Counsellors should also ensure that they are up to date with any kind of changes to rules of confidentiality, such as the one regarding terrorism, which became part of the Terrorism Act 2000. They can also refer any areas of confidentiality of which they are not sure to a supervisor who will be able to advise them – although, as stated earlier, clients should be made aware from the outset that aspects of their case may be discussed with a supervisor but be assured that information will be kept to an absolute minimum with their identity never being revealed.

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CONDUCT OF THE COUNSELLOR

The counsellor is obliged, as part of their code of conduct and duty of care towards their clients, to adhere to the core conditions that were discussed in the previous section. As well as this, counsellors should always ensure the following:

Being trustworthy: this means that the counsellor should honour the trust placed in them by the person attending counselling, who is likely to be vulnerable and in a state of distress.

Autonomy: this refers to the fact that the counsellor should allow their client to come to their own resolutions without direct advice.

Beneficence: by acting in this way, the counsellor will always have the client’s best interests at the heart of the counselling relationship.

Non-maleficence: this means avoiding any kind of harm coming to the client, for example financial or sexual or emotional exploitation, which links back to the fact that the client is likely to be vulnerable.

Justice: ensuring that all clients are treated fairly and impartially and all have the same access to adequate services.

Self-respect: the counsellor will ensure that their knowledge is up to date and that they will seek their own counselling for personal development when required.

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THE RELATIONSHIP OUTSIDE OF THE COUNSELLING ENVIRONMENT

As part of their basic ethical code of practice, all counsellors are aware that starting a romantic or sexual relationship with any client, past or present, is completely unacceptable. Additionally, the counsellor should not agree to work with friends or relatives, as this will affect their ability to remain impartial throughout sessions.

Some counsellors, however, will agree to telephone or Skype contact outside of the counselling environment if their client feels as though they are in crisis and in need of immediate help. The boundaries of these circumstances, however, must be strictly enforced so that the client does not become over-reliant on the therapist whenever they feel as though they are having problems dealing with an issue. Over-reliance on the counsellor will lead to a slower resolution of issues and less autonomy when the relationship has ended.

Key Term: ‘Autonomy’ – the ability of an individual to be independent

and make decisions for themselves.

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THE COUNSELLING CONTRACTS

The contract establishing the boundaries of the working relationship between client and counsellor must be worked out at the start of the first session. This way, the client is aware of exactly what they should expect; the following are amongst what should be established:

Financial details, such as the cost of a session and if the client is still liable to pay

for one if they should miss it

Issues of confidentiality and when this must be broken

Length of each session (including what happens if the client is late) and duration

of the contract

Overview of the counsellor’s qualifications and experience

Explanation of what happens if a session has to be supervised

Records and note keeping

The end of counselling

Complaints procedure

DATA PROTECTION

Protecting the individual’s data is very important because all details about clients must be held securely and accessed on a ‘need to know’ basis. Once the counselling relationship has ended, the records should be securely stored for a ‘reasonable’ amount of time before being destroyed in an appropriate manner. All information is covered by the Data Protection Act 1998, which guides counsellors about what kinds of information should be recorded and stored and details of the legal rights of people whose information is stored by another party, such as a counsellor.

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THE COUNSELLING ENVIRONMENT

This is usually a consideration for those counsellors who have their own private practice, and even more so for those who practice from their homes. Clients should not be expected to enter the house through the main door, nor should they be expected to navigate through the counsellor’s house to get to the dedicated room or the bathroom, as there could be members of the counsellor’s family present.

The dedicated counselling room should be decorated as neutrally as possible and no personal items should be on display. Also, the room should be free from clutter, as this can prove a distraction for clients. Ideally, it should be away from the main living space of the house, although this is not always possible. Furniture should be arranged neutrally so that the client in no way feels inferior to the counsellor. Finally, the counsellor should not answer a ringing telephone or respond to any text messages unless there is an emergency.

Having an appropriate environment ensures that the client feels comfortable and that the relationship between them and the counsellor remains strictly on a professional level.

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REFERRAL

Sometimes a client will present with an issue that is outside of the skill set of the counsellor, and when this happens, the counsellor must consider referring the client on to someone else who is better equipped to deal with the problem. However, a counsellor cannot simply refer a client on to another therapist without their permission, and this must be discussed before any kind of referral takes place or the client, who is already feeling vulnerable, may also feel rejected. A counsellor may be able to anticipate a referral, which is a much better situation for the client because they will then not be taken by complete surprise.

Reasons for referral include:

The level of the counsellor’s expertise is not enough to deal with the client’s

issue

The counsellor simply does not have time to fit them into their schedule

A positive relationship cannot be established with the client

Areas of expertise that are required might include a specific language spoken or a specialty in, for example, disability or recovery after illness. In these types of case, it is clear that the client would be much better off with someone who can better tailor their counselling to meet their particular need.

Occasionally, a client may specify that they wish to meet with a male or female counsellor, and this request should always be accommodated as it is usually for very good reason, such as physical abuse by someone of the opposite sex. Also, it is worth considering that some clients seek help for sexual issues and so they may be more comfortable disclosing information to a counsellor of the same sex.

The type of counselling that a client requires may also determine if a referral is required. For example, a counsellor may begin sessions confident that their person-centred approach will be beneficial for the client. However, it may emerge that the client’s issues are deeply embedded in childhood trauma and so they realise that an expert in psychoanalysis will be much better positioned to help the client.

A counsellor should keep a directory of other therapists in the local area and what their area of expertise is, so as to facilitate an easy referral if the client agrees to this.

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OBJECTIVES OF A NEW HELPING RELATIONSHIP

Objectives must be agreed with the client early on in the relationship and these should be referred back to regularly to check their progress. Many clients will find objective setting to be difficult, maybe because they fear the change that may come once the actions to achieve the objectives are initiated. However, regardless of what objectives are agreed to, counsellors will often use the SMART acronym to ensure that they are:

Specific – this ensures that objectives are not vague; such as saying, ‘I want to lose weight’. The client would specify precisely how much weight they want to lose.

Measurable – without some form of measure, it will be impossible to tell if the objectives are being met. With weight loss, this would mean that the client was encouraged to weigh themselves at regular intervals to check their own progress.

Achievable – objectives that are not achievable will likely result in a sense of failure, which could be a real setback for the client. Therefore, objectives must be in line with what the client is capable of.

Realistic – it would be unrealistic for someone who wants to lose weight to state that they want to lose 30lbs in one month. Being realistic helps objectives to be met much more successfully.

Time bound – a clear amount of time should be dedicated to objectives, otherwise motivation may be lost. Times that are set for achieving objectives should also be realistic so that clients do not become impatient and give up too easily.

Clients are encouraged to write their objectives down in slightly different terms:

What do I want? – This sets out clearly what the objectives for the client actually are, so they can see them and refer back to them.

How can I achieve it? – The counsellor will be involved in helping the client to formulate strategies in order for their objectives to be met.

Why should I do it? – This helps the client to focus on what has brought them to counselling, for example, in the weight loss scenario, this question might be answered by the client reminding themselves of the health benefits and of being a positive role model to their children.

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Objectives will be written into the initial contract that will be put together by both counsellor and client. But, before this can happen, it will be necessary for both parties to explore why the client has presented for counselling and therefore what they want to achieve from the sessions. For example, if someone is in a destructive relationship and they are struggling to find a way to cope within it, their ultimate goal might be to take themselves out of the relationship, but there will be steps that have to be put into place in order to do this because, clearly, the client does not feel as though this is something that they can currently achieve.

The counsellor will encourage the client to think for themselves about what their objectives might be and therefore may ask:

What kinds of objectives do you want to achieve?

What do you want from counselling?

What has brought you to counselling? (This is a general question but will

help to identify what the issues are and therefore how they can be

addressed.)

How do you think you will be able to achieve that?

Focusing on their issues should be what helps to formulate the objectives for clients who will then be able to work on strategies, which should ultimately help them to achieve their objectives. For some clients, this may be very daunting, and the full support of the counsellor will be necessary to identify any possible issues that might arise. Therefore, it is important that objectives are phrased in a positive way, as this will be much more motivating than those which imply some form of failure or self-criticism. For example:

Negative objective Positive objective

I don’t want to be so fat I want to be healthy and less heavy

I don’t want to freak out when I am

near water

I want to be able to be calm when I

am near water

I don’t want to sit at home all the

time because I am afraid of meeting people

I want to be able to go out without

feeling anxious

I don’t want to

because I feel stupid

fail my exams I want to study harder so that I will

pass my exams

I don’t want to sit and say nothing

because I’m scared what people will think

I want to have my opinion heard and

be less affected by the views of others

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These are examples of general objectives that the client might come up with in the first instance. They will then work with the counsellor to narrow them down and make them SMART, after which it will be decided what the priorities from the objectives are and therefore which ones will be attended to first.

Strategies and barriers to objectives will also need to be discussed so that the client has a realistic view of what they want to achieve. Let us continue to look at this in terms of a client who wants to lose weight:

Possible strategies Possible barriers

Attend sessions with a health trainer

– will book an appointment with GP to sort this out

Eating children’s leftovers – this is an

old habit proving difficult to break

Join the gym to attend fitness classes Partner does not want me to lose

weight

Ensure all meals are planned during

the week

Comfort eating in the house when

alone

Do not weigh self-more than once a

fortnight

Not finding time to go to gym classes

Buy a tape measure so the focus can

be on inch loss as well as weight loss

Becoming demotivated as the weight

has to come off slowly

Once the objectives are in place and as the sessions progress, the client should find that they are empowered to take control of their life and therefore their objectives, and these two factors are what will make the objectives achievable.

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STRATEGIES FOR ENDING RELATIONSHIPS

For many clients, the thought of their counselling sessions ending can be quite distressing before they have even started, so it is vital that when the sessions will end is discussed from the outset of the relationship. One of counselling’s main aims is to enable the client to become more autonomous – to be able to self-reflect and to work out resolutions for themselves. It also aims to bring empowerment to the client, and so the ending of sessions should provide the opportunity for the client to apply all that they have learnt during the sessions, and it can be quite liberating for some. Although the client must be aware that counselling has to have an ending, they should also be informed that they can return for maintenance programmes or the odd session for review.

It is important that the counsellor reminds their client that the relationship is only a temporary one so that the client’s sense of loss when they end is reduced. If the initial contract sets out exactly how many sessions there will be, the client will be aware of when it will end, and this can help them to maintain focus rather than concentrating on it as a negative.

Most people who leave a counselling relationship are in a far better place to work out their own solutions, with many ending the contract early because they have found the experience to be so empowering. However, counsellors must be understanding about the fact that many clients will not feel this way and may be genuinely afraid to leave the relationship.

There are several strategies that counsellors can employ in order to make the ending of the relationship as smooth and sensitive as possible for all involved. Firstly, it will help if the amount of sessions can be agreed to early on in the counselling relationship. If the client has been referred, for example by their GP, it is likely that they will have between six and ten sessions, however, privately paying clients do not have to stipulate the amount of sessions but this should be referred to by the counsellor as the sessions progress – the client must be aware that sessions are not infinite and must end at some point.

Having regular reviews of sessions will not only help to evaluate how effective the sessions are but it will also serve to show the client how many of them remain. It is during these reviews when clients will be encouraged to be open and honest about how they feel they are progressing and whether or not the strategies that they have put into place to achieve their objectives are working. Most clients will find that they are actively working towards their objectives and the amount of sessions that remain will be sufficient in helping their overall achievement.

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Discussing the end of the helping relationship will assist clients in preparing for how they will cope after the sessions have ended, and many counsellors will actively remind clients to remind themselves about how much progress they have made. Clients who have poor self-esteem may be reluctant to hear compliments from someone else, so getting them to write some things down about their progression can be very useful. They can use this to remind themselves that they can cope alone once their sessions have been completed.

Exploring other avenues of further support might be necessary for some clients who are happy to end their counselling sessions but still feel as though they need support from elsewhere or in the future. For example, if a client feels as though they have now got the skills to cope with their anxiety, they may wish to check on their independent progression by arranging some further sessions in a few months’ time. This may help them to maintain their current levels of control and also gives them reassurance that if they do find themselves reverting back to negative behaviours, they still have a support system in place to help them.

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Many clients will be enabled to see their progress by completing a questionnaire about their counselling sessions, much like they will have done about their issues at the outset. Questions that may be on a questionnaire include:

What feelings did you have throughout the counselling process?

What have you discovered about yourself and others whilst attending

counselling?

Do you feel as though you have achieved your objectives?

What coping strategies do you have for the future?

Do you have any unresolved issues and, if so, what will you do with them?

These questions will help clients to see their progress and identify any future issues that they can take control of now, rather than leaving them and possibly encountering future problems because of them.

A summary of the counselling relationship will also give the client the opportunity to look at how much they have achieved, and it will help to end the sessions by assisting the client in looking at where they were at the start of the sessions and where they are now upon ending them. Many clients will be surprised at how much they have achieved on their own and this can be very empowering to them, leading them to believe that they can cope on their own and that they no longer need assistance from others in order to live the life that they want to.

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THE IMPACT OF A HELPING RELATIONSHIP ENDING

The majority of counselling relationships will end smoothly, with clients empowered and enabled to take control over their own lives because the end of the relationship will have been well planned in order to minimise potential distress. However, sometimes issues can present themselves and they can impact the counsellor as well as the client, dependent on what the cause of the issue is.

Transference and counter-transference can cause an abrupt and unplanned ending to a counselling relationship because these two issues are not helpful in ensuring a successful counselling relationship. Transference refers to the client’s emotional response to the counsellor and is quite common within counselling. Some clients will, unconsciously, transfer positive or negative feelings onto the counsellor. These feelings will have come from past relationships or experiences, sometimes from childhood, and will not have any relevance at all to the current counsellor/client relationship. For example, if someone is seeking counselling because of distress from a broken relationship, they may transfer romantic feelings for the partner they have lost onto the counsellor, conversely, they may transfer feelings of anger onto them. A childhood example might be that they transfer feelings of idolisation onto the counsellor for a parent who left during a divorce and whom was never seen again.

Transference can be a difficult situation, as sometimes the client and counsellor can share experiences and so the client can see them as a friend or even an object of potential romance. If this should happen, the counsellor must seek advice from a supervisor because they are often unaware of its severity and it may end in the termination of the counselling relationship.

Counter-transference refers to the counsellor’s emotional response to the client, rather than the other way around. Counsellors are human and are capable of displacing their own feelings from the past into their current situation with a client. The ability to be wholly objective is questionable and so the counsellor must be aware of their own reactions and seek advice from a supervisor should this happen.

Counter-transference is more likely when the counsellor feels that their client is a victim and must be protected. It might also occur when the contents of a session reflect something currently happening in the counsellor’s life. For example, if the client is discussing a difficult relationship with their child, which is similar to one the counsellor is having with their own child, this can lead to difficulties. Remaining objective and not reacting in ways that reflect the way they would deal with their own child might prove testing, and so counsellors must be fully aware of their limitations.

Even when an ending is planned, many clients become dependent on the counsellor and they are the most likely to be distressed at the thought of the counselling relationship ending, even if this has been prepared and they know it is inevitable.

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Counsellors must ensure that they deal with this situation sensitively and acknowledge the feelings of the client throughout. If it is decided that the client will suffer as a result of counselling ending, then they should be signposted to further assistance elsewhere.

Many clients will not feel as though they can cope with the changes that they have implemented during their sessions once their sessions have ended. Again, the counsellor will need to be sensitive to this and remind the client of how far they have come and what they have achieved so far. The completion of a questionnaire may be able to alleviate some of the client’s fears.

Several ethical considerations become apparent at the end of a counselling relationship and these should be considered by the counsellor when the final session has taken place. For many clients, they will be very happy at the end of their sessions, and the counsellor should think carefully about any physical contact that might occur as a result of this. For example, it would not be appropriate to hug someone whose issues were because of physical abuse but if they offer their hand to shake, then this is perfectly acceptable.

Some clients will want to hug the counsellor when their sessions have ended to show a physical response of gratitude for their help and guidance. Again, counsellors should assess carefully the appropriateness of this on an individual basis.

Gift receiving can be an issue at the end of the counselling relationship because some clients will want to show their gratitude in this way. If the client works for an organisation, then they should adhere to their code of conduct in deciding whether or not it is appropriate for them to accept the gift. If the counsellor works independently it will be up to them to decide if they accept it, keeping in mind that to refuse the gift may be construed as offensive by the client.

Overall, the ending of the counselling relationship should be a positive one, reflecting all of the achievements that the client has made. Clients should leave the final session feeling empowered and reassured that they are now equipped with everything that they need to continue their life independently.

UNIT SUMMARY

In this unit we have looked at the cornerstones of counselling practice and the skills used in helping relationships. We have also looked at the boundaries that must be set in a helping relationship as well as strategies for ending the relationship with a service user.