Clinical Placement and Contextual Issues in Counselling - Essay Example

? Clinical Placement and Contextual Issues in Counselling Introduction Counselling agency and service goes beyond theroutine therapeutical sessions but also maintaining high standards of service delivery (Rennie, 1998). Ideal physical condition of the therapy room and entire environment plays an important role in an individual’s wholesome recovery. Hence the entire context of counselling includes the emotional atmosphere of the room and the functional physical components added to create a favourable mood. The relations existing between the agency and its clientele is also core to ensuring that there is cultural connection between the agency and its clients to create an atmosphere of tolerance (Ulrich et al, 2008). These are the factors that have been ignored in traditional counselling theories, practice and academic research but are increasingly gaining recognition from contemporary scholars. This paper takes a holistic view of counselling agency by delving into above listed and other contextual issues outlined in subsequent sections. This is done by first outligning experiences at a counselling project raising personal safety and risk management issues at the facility. The second section outlines the contextual issues arising from the practice like cultural diversity, sexual relations and the legal context. This is done with an aim of focusing attention to these important issues. Health and safety issues observed at a counselling program The main door leading into the facility has a buzzer intercom that is reinforced with a camera to identify the person coming in. It is a three storeyed building acting as the main office and a smaller one by its side. It has a sizeable reception area with the attendant protected behind a glass screen with a large hole in the middle to enable communication between the two parties. I noticed the receptionists being very friendly and ever smiling when attending to a client while seated in front of a desktop computer with a telephone. Arrangements for meeting the counseling program coordinator can be made through phonecalls, e-mail or physical visit to the project during office hours. They work all days of the week except on holidays and give round the clock support to clients. For ease of identification, all the workers at the facility had identification cards pinned on their shirts and have enough workforce other than counselors to attend to various aspects of client support. In terms of personal security, there is a fire escape on each floor enabling ease of movement incase of an outbreak and the entire area is generally secure. There are two separate buildings a large four story building and a smaller building but are very close. The small newer building allows access using only coded key entry; entry of unknown persons is thus limited. The counselling and supervisory room were large with comfortable seats. The rooms were clearly visible as clear glass was used to do the partitioning. The rooms are well lit from the entry point; the coded entry system makes supervision easy and very efficient. This is very vital for checking client behaviour incase of any unrests for instance hostilities from a rebellious client (Padesky, 1996). This transparency and open plan structure creates a warm, welcoming environment. In protecting matters of personal health, there is a no smoking policy throught the program within the premises. There are instructions to switch off lights before leaving the counselling room and close and lock windows. Further instructions are visibly outlined for a participant to familiarise oneself with all fire exists and note fire extinguishers’ positions in the hallway. There is an accessible first aid kit that provides preliminary treatment services incase of an accident. There are also phones at the reception to call the emergency services when the situation cannot be handled by the staff. The program has a strict diversity policy that is followed by all staff and clients alike; I was taken through a half day training on diversity and personal differences. Diversity issues are limited as the project employs people from all ethnic backgrounds only basing appointments and promotions on competence. The workforce is made up of a multi-ethnic group which is reflective of its client group and geographic scope served by the agency.A participant is only awarded a placement if he or she swears to adhere to principles of diversity and equal opportunity. There are however some deficiencies in this building; there is no wheel chair access to the larger building and there is no lift to help in moving physically disabled persons. The only fire assembly point is across the road from the main building; this makes it difficult to access incase of fire outbreak emergencies. Despite the fact that the main office is situated in the top floor, it is relatively spacious compared to other rooms with a nice friendly work force. There are accessibility issues with the toilets as there is no labelling at the entrance to the male washrooms to direct the patrons. The male toilet was small in size going by an average toilet size and also considering the age of those using these facilities. Contextual issues which apply to a counselling agency or service Diversity, equality and equity: counselors at Tower Hamlets are expected to visibly display competence when going about their duties at a counseling facility. They should not lose their objective approach to client issues or being influenced by personal biases developed over time. The biggest therapy problem is getting absorbed in prejudice or partiality which might make them respond in the wrong way unintentionally to diverse clients. Laszloffy and Hardy (2000) articulated that prior to a counsellor taking measures against cultural prejudice and bias, they must first expand their own cultural understanding and sensitivity. Part of this is an understanding that the minorities have fewer privileges than others in a particular society. For instance, Dovidio et al (2002) articulated that in a country like the UK, the white majority are more likely to be focussed on during an emergency and are more favoured in employment recommendations. Our diverse range of clients include groups and individuals who are subjected to prejudice mainly on the basis of culture, religion, sexual orientation and physical state. Other biases are based on a participant’s class in the society and age. We focus on equality despite the gender and sexual orientations among out clientele. Immediately a child is born and identified as male or female, their behavoiurs and placement is defined by socially constructed roles and attitudes (McColl-Kennedy and Anderson, 2002). Despite recent improvements in attaining workplace gender equality, it has always been biased against women; their conduct and behavior will thus be promoted and assessed with reference to the label. Is it accurate to state that these stereotypes, age and gender biases eventually fade away as a therapist take on the role of counselor? Wilson (2003) argues that in an effort to maintain professionalism, most counselors get into the client’s world as each case has unique characteristics thereby making the task interesting. But what are the effects of basing understanding on formed opinions and stereotypes? Our counselling agency, like other organizations has to state its stand on the issue of sexual orientation. This is because counseling is aimed at promoting tolerance; our agency favours counseling sessions that enhances coping mechanisms with changing sexual orientation. Most of counseling agencies are run by the church and these are traditionally known to be sensitive to sexual orientation issues. Looking into disability issues, it is evident from the case presented in the preceding section that the facility has no wheel chair access for disabled persons. Miwa and Hanyu (2006), stresses the significance of responses to discordant and contentious issues in psychotherapy. Disability counseling is not an easy task as the expert brings gives hope to disabled people or those not satisfied with their bodies. These are people living in a society ridden with socially constructed attitudes and bigotries behind changing body image. Our agency at Tower Hamlets will ensure that our facility has wheelchair paths to allow ease of movement. Our agency also counselling services become ineffective when the therapist is prejudiced based on physical disabilities. They will be trained on being open about issues of prejudices as this is the first step in dealing with it. We will be creative in the way clients are treated as treating clients equally doesn’t necessarily mean using a similar style. The facility’s physical condition: there are many dangerous situations and accidents that may arise within the agency’s premises. Fire exits will be present for ease of movements incase of an emergency; this is in addition to first aid kits for providing simple healthcare to affected persons. Well spaced counselling room and emergency button placed close to the counselor and pressed when he or she is attacked by the client. Continuing Proffessional Development (CPD) is conducted to equip employees with work and client management approaches making them efficiently use the physical space (Leather et al, 2003). Legal context: according to BACP (2007), confidentiality is one of the key ethical considerations that must be adhered to by therapists. Legal context in counselling agency mainly touches on issues dealing with client information confidentiality. However there are certain circumstances a counselor be legally authorized to breach confidentiality provisions. In matters relating to crime for instance, a court may give a directive to a counselor to issue out some information or present himself to a witness stand whenever there is a case involving the client. In following a principle of rationality and good faith, it is justifiable go against client confidentiality agreement to help in revealing a harmful act before it occurs (DH 2003; DH 2006; General Medical Council 2004). Some of those coming for counseling have mental issues that makes harm some people or even themselves. Reeve and Seber (2007), states that in case a counselor notes that someone has suicidal tendencies, he can breach the law and inform loved ones and authorities about the same to avoid life termination. It is paramount however for the counselor to weigh these issues, getting input from his peers and sometimes obtain legal advice on how to go about these infringements. This is done to avoid lawsuits to the agency which have huge financial and reputational ramifications. The supervisors monitoring the sessions will go by BACP standards that gives counselors at least 1 hour of supervision for every 8 hours of counselling or other therapeutic activities with the client and an overall minimum of 1.5 hours supervision monthly. A supervised period of personal development averaging 30 hours a month should also be mandatory. This may involve taking 30 hours of personal counselling with an officially certified counsellor. These are the standards required for ones accreditation by BAPC. Counsellor-client relationships context: relationships existing between the agency and its clients acts as a factor that determines the intensity of financial losses, punishments and unprofessional conduct charges concerning psychologists. These are grave matters as they can result to termination of an agency’s operating license. Our agency will carefully monitor any developing relationship between a counselor and the client. Focusing on personal relationships compromises a counselor’s professional decisions. This is because he starts using the client to satisfy his emotional, social or economic needs instead of focusing on client’s recovery; this is not part of his terms of reference. A love affair is an example of a dual relationship which restricts the counselor from having a focused approach thus losing the competence to ward off any of the client’s harmful acts (Forester-Miller & Rubenstein, 1992). This relationship context applies to a counseling agency as is the case with as an expert cedes his professional conduct to appear more like a personal manager rather than playing a supervisory role. These relationships might also end abruptly within a counseling program; these are always characterized by emotional outbursts that negatively affects these sessions. Rural and smaller societies are very cohesive and these dual and multi faceted relationships are almost unavoidable (Brownlee, 1996).When setting up an agency in such areas, therapists should take proper precautions like utilizing proper documentation and making informed choices to ensure no expoloitation takes place that can compromise on agency’s reputation. Termination and Referral If a counsellor at Tower Hamlets establishes that his or her services are not of assistance to their client, they will cease their offering services right away. However, they should not abandon or neglect their clients but instead they should offer assistance to the clients in making proper appointments for the extension of treatment with another proficient counsellor or psychiatrist (Combs et al, 2006). In observing the principles of respect and professionalism, the counsellor will obtain a client’s accord when accepting the referral. The clients understand that our agency is focused on serving their interests when making such moves. However, the counsellors are advised to fulfil their responsibilities all the time (Kitchener, 1984). Agency placement Clinical Placement provides undergraduates with an opportunity to apply what they have learnt in class to the industry. It gives the student an opportunity to engage in direct client contact and assists to build up counseling proficiency. These placements will be structured to present different situations to these students when building their experience. There will be a supervisor responsible for monitoring intern activities and ensures that they are not exposed to threats to their wellbeing and safety (Malkin, 2008). Periodic communication and visits also helps in protecting these students by for instance ensuring that they provide emergency contacts used to contact the school administration. Authentification and verification of student details is done to establish several facts about the students as well as evaluating their health. Health and safety standards Accidents of any kind involving the students must be accounted by the agency management of the school (Sy and Cote, 2005). The school’s first precedence is the welfare of its young students. The school management should in turn communicate with parent, carers or next of kin on the nature of the accident and alert them instantaneously if treatment is requisite. Fire exits and alarms have been established in case of a fire emergency. In addition all staff members are taught first aid skills Counsellors in Lifeline Tower Hamlets also rely on security methods when dealing with clients who pose a potential threat of physical abuse. One of the measures used to alleviate an altercation between a counsellor and his or her client is to make available a simple method of egress for clients if they become aggravated during the session. Staff members are always advised to work in twos or threes in field activities so as to avoid being attacked by client. Proper counselling rooms have also been designed to include and emergency button in case the counsellor is attacked by the client. The counsellors chair is put closest to the door so that they can easily escape if need be. Risk assessment is also done to ascertain the exact internal and external threats to the student while in their placement. This asseses health conditions, maturity levels and naivety for the agency to exactly establish the kind of a person they are dealing with (Southern et al, 2010). References BACP (2007) Ethical Framework for Good Practice in Counselling and Psychotherapy. Lutterworth: BACP. Brownlee, K. (1996). Ethics in community mental health care: The ethics of non-sexual dual relationships: A dilemma for the rural mental health profession. Community Mental Health Journal, 32(5), 497-503. Combs, J.G., Liu, Y., Hall, A.T. and Ketchen, D.J. (2006), “How much do high performance work practices matter? A meta-analysis of their effects on organizational performance”, Personnel Psychology, Vol. 59, pp. 501-28. DH (2003) Department of Health: Mental Health Act; Code of Practice 2nd edition. Retrieved from www.doh.gov.uk/pub/docs/doh/mhcop.pdf. On13th May 2013 DH (2006) Caldicott Guardian Manual, 2006, available from DH Publications Orderline, PO Box 777, London, SE1 6XH. Dovidio, J.F., Gaertner, S.L., Kawakami, K. and Hodson, G. (2002) Why can’t we just get along? Interpersonal biases and interracial distrust. Cultural Diversity and Ethnic Minority Psychology, 8. Pp.88-102. Forester-Miller, H. & Rubenstein, R.L. (1992). Group Counseling: Ethics and Professional Issues. In D. Capuzzi & D. R. Gross (Eds.) Introduction to Group Counseling (307- 323). Denver, CO: Love Publishing Co. Kitchener, K. S. (1984). Intuition, critical evaluation and ethical principles: The foundation for ethical decisions in counseling psychology. Counseling Psychologist, 12(3), 43-55. Laszloffy, T. and Hardy, K. (2000) Uncommon strategies for a common problem: Addressing racism in family therapy. Family Process, Spring, Vol.39. 1. pp.35. Leather, P., Beale, D., Santos, A., Watts, J., and Lee, L. (2003). Outcomes of environmental appraisal of different hospital waiting areas. Environment and Behavior, 35, pp. 842-869. Malkin, J. (2008). 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(2005), “The contagious leader: impact of leader’s affect on group member affect and group processes”, Journal of Applied Psychology, Vol. 90 No. 2, pp. 295-305. Ulrich, R., Zimring, C., Zhu, X., DuBose, J., Seo, H-B., and Choi, Y-S. (2008). A review of the research literature on evidence-based healthcare design. Health Environments Research and Design Journal, 1, pp. 61-125. Wilson, S. (2003) : Disability, counselling and psychotherapy: Challenges and opportunities. Basic texts in counselling and psychotherapy. Basingstoke, England: Palgrave. xiv, 144 pp. ISBN: 0-333-96496-9 (paperback) Read More