At this unprecedented time of the Covid-19 outbreak, the Manchester Institute for Psychotherapy is committed to help our trainees to continue to service their clients and to support them through these challenging times.

In order to help our trainees be the most competent they can be at this particular time of new challenges and uncertainties, we have put together MIP policies with regards to trainees at MIP throughout the Covid-19 challenges.

The UKCP, of which we are an accredited training organisation, have asked us to ensure that trainees have reviewed guidance in relation to remote working.

They have not said that trainees may not work remotely, or stipulated any training guidelines other than to emphasise that the Code of Ethics & Professional Practice must be adhered to, irrespective of whether clients are seen in person, online or otherwise. 

The parts of the Code which apply most here are those which relate to changes in the contract and competence of trainees.

*         Confirm each client’s consent with the specifics of the service you will offer through a clear contracting process at the outset of therapy.

*         Ensure that your professional work is adequately covered by appropriate indemnity insurance or by your employer’s indemnity arrangements.

*         Respect, protect and preserve client confidentiality.

*         Understand the limits of your competence and stay within them in all your professional activity.

Training Requirements

The Manchester Institute for Psychotherapy has required all trainees who are working online or remotely to have some training with regards to working online therapeutically.

In order that we can see that people have had training in online work, we have implemented MIP training in this particular sector.  We have emailed all trainees who work in this area to attend our ADL training in this above area.  This is not a recommendation, it is mandatory.  We also recognise that there have appeared online in direct response to the Covid-19 crisis free webinars that have been delivered by the BACP and other regulating bodies.  We have emailed trainees with this information.

Manchester Institute’s approach is as follows:

*         As said above, MIP trainees working with clients, whether through placements or privately, will be required to attend the one day’s ADL training that we have implemented on working therapeutically online.

*         Throughout the training at MIP, we will be asking our trainers to include information and teaching on ethics and safeguarding, as well as practice, with regards to online therapeutic work.

*         It is imperative that trainees working online take this to their supervisor and arrange at least one extra hour on online supervision if it has not already been included in supervision and MIP training.

*         MIP will be sending a form for supervisors to fill in which confirms the competency for their trainees in online work.  This will mean that the supervisors will have a part to play in assessing trainees’ competency for remote therapy.

*         The UKCP has recommended that you do not take on new clients online.  After discussions with other training centres, we have decided to take “a softer approach” with this because we trust you, with support from your supervisors and MIP, to work within your competency. To this end, MIP will be in regular touch with your supervisors to evidence and support this approach.

FRAMEWORK FOR REMOTE AND ONLINE THERAPEUTIC WORK RE. COVID-19

This framework/information below is intended to support you if you need to work online/remotely for the period of the Covid-19 emergency where there is the possibility that therapists or clients need to self-isolate because of Covid-19 measures.  The information has been put forward assuming that you may need to work with existing clients for an online duration where face to face contact is not possible, and that you are not experienced, or have little experience, in online therapeutic work. The Manchester Institute for Psychotherapy is putting on extensive ADL training in working online – see email re Susie Hewitt’s training day. Also, you should be having some training from your supervisor with regards to remote and online context. 

With regards to placements, and I understand that a number of you will be having your placements at MIP, that the mandatory training by Susie Hewitt and the recommendations from your supervisor will help and support you in the transition from face to face work to online work.

Before agreeing to online or telephone work:

*         Discuss your plans with your supervisor

*         Check what options you are realistically able to offer

*         Check what options are practically possible for the client

*         Assure the client that they can choose to discontinue until face to face can be resumed.  They do not need to agree to work online or by telephone.

*         Clients should not be charged for missing sessions if they decline alternative arrangements that you offer.

*         Make sure that you and your client’s internet are up to scratch, and that your client has downloaded the medium that you are going to work therapeutically on.

*         Check that your insurance will cover you for remote working.

*         Talk through any anxieties that your client may have in moving from face to face to remote/online working.

*         Clients need to be assured and reassured that confidentiality will be maintained and is the highest priority throughout the work with this new medium.

*         It is important that the medium you both use is safe and encrypted.

Refocussing/Recontracting

In the transition from face to face work to online work, you may need to refocus on what you have already done therapeutically in the face to face sessions and whether this is going to continue whilst you are on the new medium or perhaps establish a new contract for the present period of online working.

In the first session in the first medium, whether on the telephone or online, the contract and frame will be renegotiated. As said above, not just therapeutically but certainly practically.

*         Will you have a trial period to try different mediums, ie telephone versus video/zoom?

*         What happens if the technology fails?

*         Does your practical contract that you will have established on the face to face relationship still “hold water” for the new way of working?

*         Do arrangements for payments for absences need to be renegotiated.

*         Who will set up the meetings.

*         As said above, you will need to have an initial discussion around client/therapist anxieties using this new medium.

Confidentiality and Boundaries

This needs to be talked about at the onset of the telephone or online therapy as there may be some differences with regards to specifically boundaries.  For example, you will need to talk through with your clients that they have a safe place to work from, and that they are not going to be disturbed within the “therapeutic hour”. This is vitally important as the client may have other distractions such as children and other considerations to be taken into account.

With reference to confidentiality, the space needs to be an acquired private space that they can use where they can’t be heard or interrupted.

Telephone Technique

If you are going to have telephone counselling/therapy you will need to use reflection and verbal encouragements more than in a face to face session to maintain a sense of connection, and to convey that they client is being heard given there will be no visual clues like nodding your head etc.  If this medium is new to you, please talk about technique and communication style with your supervisor or indeed take some time in training for this to be discussed.

Risk

It is always a good idea when working with this new medium to review your risk assessment and consider if there are any risk factors that would be increased and to take this to supervision.  Please remember the usual protocols still apply in this context, ie your safeguarding policies.

If you do plan to be working remotely, be clear about the limits on what you can provide. Review the information required for you to ensure appropriate support if a crisis occurs.  Make sure you have their current GP details/postal address and telephone number. As said above, the usual protocols on safeguarding are the same whether it’s face to face or working remotely.  You will still need to have, for example, access to information about sources of emergency support in their area etc. 

Similar to working face to face, if you have any doubts about your client’s safety, for example they may disclose they feel suicidal, then it is important to contact your supervisor immediately and to discuss the safeguarding management of your client.

Acknowledgements

This information/guidance draws on documents drawn up by Adrienne Lee of the Berne Institute, Tree Staunton of BCPC, and Lizzie Wright of the Minster Centre.  If you wish to have more information with regards to remote and online working please go to the UKCP and/or BACP websites.

This policy will be reviewed and updated regularly as necessary

Bob Cooke

Manchester Institute for Psychotherapy

9.4.2020

Dual relationships are those in which the Psychotherapist is acting in at least one other role besides their professional one with a client or student.  For example, being both tutor and therapist to a student, or a therapist having a relationship with a client or student. Such relationships raise serious questions of conflswict of interest, power imbalance, harassment and issues concerning trust and confidence.  For this reason, MIP requires that with regards to all aspects of psychotherapy practice, including training contexts, dual relationships are prohibited.

In certain circumstances, e.g. visiting trainers running a group where their client is attending; or, dual relationships between committee members and clients, these will require a level of mutual consent in terms of how this is managed.

The Humanistic and Integrative Section of the United Kingdom Council for Psychotherapy, articulate the following reasons for separating out the psychotherapeutic relationship from other relationships, these reasons are supported by MIP:

• To prevent an undermining of the power and self-authority of the client through a disproportionate balance of power in the relationship due to the therapist also being the client’s trainer/supervisor/examiner which could, in extreme circumstances lead to a potential abuse of power on the part of the therapist.

• To provides a clear boundary around the client/therapist relationship with the purpose of protecting the possibility for in-depth relationship work, and to help provide safe conditions for working with transferential and subtle energetic material within the field of the relationship.

• To protect the therapeutic relationship from unnecessary pressure, demand and influence caused by the tension inherent in holding two or more roles which involve different tasks.

• To protect the integrity of the discreet relationships involved.

• To encourage authenticity and appropriate challenge in each domain of training, supervision, examination and the psychotherapeutic relationship.

• To provide clarity when working with relationships and tasks which are intrinsically interrelated and potentially capable of becoming confused and /or enmeshed (for example, there are supervision processes implicitly present within trainer/trainee relationship).

• To encourage commitment and integrity in trainers, supervisors, examiners and therapists by their taking responsibility for their own relationship and the power of their position.

Such relationships carry the risk of deleterious consequences for both parties, including the impairment of professional judgement for the therapist, tutor or supervisor.

Where a therapist, tutor or supervisor at MIP is found to be conducting a dual relationship with a client or student the case will be dealt with using the complaints procedure for professional misconduct.

Where a complaint is upheld, the therapist’s/tutor’s/supervisor’s membership from MIP may be suspended or withdrawn, and UKCP informed.

This policy will be reviewed every 18 months                                                                                 

Last revised November 2020