Clinical considerations and responsibilities
Fitness to practise
Those whose work is to help others should be fit to perforin their professional task. Whether the practitioner is a volunteer, in training or fully qualified with many years of experience they must be able to perform their role, so that those they support can have reasonable confidence in the ‘treatment’ they will receive. If a client has been offered help then they are entitled to assume that they will receive this; allowance is not made for personal difficulties in relation to the amount of care and skill that they can expect.
This creates challenges professions that place emphasis on the relational aspect of the work. Jung (1954) described psychotherapy as a ‘dialectical procedure’, the therapist as a ‘fellow participant’ in the process of individual development, with the implication that the whole being of the therapist is involved, over and above their skills and intellectual knowledge. While this is emphasised and theorised differently across the range of talking treatments, all therapeutic approaches require a degree of relationality between therapist and client, making the practitioner’s emotional and physical health relevant to fitness to practise issues. The personal and professional arc intertwined; as Bond (2010: 10) states, ‘From the client’s point of view, the personal ethics of the counsellor arc inseparable from the standards and ethics of counselling because one is the foundation of the other’.
All of the major professional organisations recognise the fitness to practise requirement in some way and demonstrate it through their codes or frameworks of ethics, which are discussed below. There arc difficult questions to answer: how does one recognise when one has become unfit? What are the suitable actions to take? Who is responsible for recognition and action? This chapter will consider first the major ethical codes relating to the subject of fitness to practise. It will then discuss the responsibilities of those involved, particularly the practitioner and their supervisor and workplace, if not in independent practice. Finally, it will consider what form appropriate action could take, and how decisions about it may be made.
Fitness to practise - ethical frameworks
All professional bodies have their own ethical codes or frameworks. Where there is no statutory requirement for regulation, the professional bodies will run their own complaints procedures to hear concerns about professional practice. Where there is a statutory requirement, the complaints procedure is run by a government body. Psychiatrists are required to be approved by the General Medical Council (GMC). Practitioner psychologists and social workers are subject to statutory regulation through the Health and Care Professions Council (HCPC), which has its own generic standards of conduct, performance and ethics (HCPC, 2012, 2016) as well as professionspecific standards of proficiency for training and ongoing development. Both the GMC and the HCPC are regulated by the government’s Professional Standards Authority (PSA). Counsellors and psychotherapists arc not regulated by statute (apart from arts therapists); however, many counselling and psychotherapy organisations have had their voluntary registers accredited by the PSA which publishes standards for the regulators and the organisations that hold voluntary registers (PSA, 2016a, 2016b).
If someone is removed from a statutory register they can no longer practise under that title; a psychiatrist could not continue to call themselves a psychiatrist. If they are struck off a voluntary register, they can no longer practise under the name of that professional body, but could still call themselves a counsellor/psychotherapist.
British Psychological Society (BPS)
The HCPC refers to fitness to practise for all practitioner psychologists in terms of conduct, health, up to date skills and knowledge, character and positive management of* ... the physical, psychological and emotional impact’ of practice (HCPC, 2015: 8). While emphasising the importance of practitioners consulting with workplaces, colleagues, professional bodies, unions and training establishments in the process of resolving any dilemmas about meeting proper standards, they do this in the overall context of being expected to take responsibility for their own practice.
The BPS continues to be the major professional organisation for psychologists. It publishes its own advisory Code of Ethics and Conduct (BPS, 2018), which may be used as evidence of standards to which a psychologist would be expected to adhere. Taking personal responsibility for professional and ethical judgement is emphasised while the challenges of self-monitoring arc recognised. This points towards the importance of consultation and discussion that is a necessary corollary to the independence of practice inherent in therapeutic work.