Managing ethical issues in private practice during COVID-19

UKCP psychotherapist and Ethics Committee member Sharon Rooke offers guidance on managing ethical issues and critical decision-making processes for UKCP members working in private practice.

For many of us, working in private practice offers relative freedom, flexibility and autonomy. We can make decisions regarding our practice and ways of working that support self-care, life circumstances and our clients. However, COVID-19 has led to widespread uncertainty and confusion.

How have the restrictions and lockdown affected your practice?

How are you working currently? Are you seeing clients in person? Are you seeing clients online? What policies and procedures have you introduced or adapted?

Remote working via video call or telephone raises ethical issues such as confidentiality and client safety. Contracting with clients, regarding the content or themes that are discussed in the session can maintain the therapeutic alliance and also prevent sensitive material ‘contaminating’ or ‘evading’ the client’s space. What guidance do you offer remote clients to ensure an appropriate therapeutic environment is created for their sessions?

You’re welcome to share your experiences in the comments below. Take care not to include any details about a client from which they could be identified or could identify themselves.

Returning to in-person sessions

Some practitioners have started to arrange in-person sessions with some clients. These may be prioritised for clients who are in crisis or fall into the ‘at risk’ category.

New systems for seeing clients face to face will include the ‘journey’ of the client to maintain social distancing and minimise risk and potential exposure to the the virus.

In preparation, you should communicate your procedure to your client before their session, advising on the process and new working practices. New systems may include: who will open the door; how the room will be presented; if they need to bring tissues and water; whether they will be able to use any cloakrooms; if windows and doors will be open; how the room will be cleaned before and after their session.

As part of this decision making, you will need to determine the length of time between clients, making sure there is adequate time for you to clean and disinfect the chairs, door handles, balustrade, toilet etc in addition to your usual rituals and note-taking procedures.

Our Code of Ethics as a decision-making structure

The UKCP Code of Ethics and Professional Practice headings provide a helpful structure to support decision making and ethical practice.

Best interests of clients

• Act in your client’s best interests.
• Maintain social distancing.
• Respect your client’s autonomy; they may decline in-person sessions.

Professionalism

• Be aware that the new procedures and restrictions may trigger a power imbalance between the practitioner and client.
• Recognise any behaviours outside your professional life that may affect your relationship with clients.

Communication and consent

• Do not make any claims that you cannot substantiate, with regards COVID-19.
• Confirm each client’s consent to the specifics of the service you will offer.
• Be clear about any contract or disclaimer that you are using, as part of your risk assessment process.

Records and confidentiality

• Notify clients of the legal and ethical limits to confidentiality.
• Notify clients of the procedure for any ‘track and trace’ system that you are adopting.

Professional knowledge, skills and experience

• Have arrangements in place for informing clients and, where appropriate, providing them with support in the event of your illness or death.
• Understand the limits of your competence, and ability to work within extraordinary circumstances.
• Practice self-care and seek supervision as appropriate.

Social responsibility

• Actively consider issues of diversity and equalities, and acknowledge the need for a continuing process of self-enquiry and professional development.
• Avoid behaviour that is against government guidance.

Trust and confidence

• Ensure your professional work is adequately covered by appropriate indemnity insurance.
• Maintain boundaries.
• Safeguard children and vulnerable adults, taking appropriate action should you consider there is a risk of harm to self or others.