6. Code of Practice
This Code of Practice applies the values and ethical principles outlined above to more specific situations which may arise in the practice of Strategic psychotherapy.
Many sections of the Code of Practice are interrelated. Please keep this in mind when reading and applying this Code.
Resolving Conflicts Between Ethical Priorities
Members may find themselves caught between conflicting ethical principles which could involve issues of public interest. In these circumstances, they are urged to consider the specific situation in which they find themselves and discuss it with their supervisor and/or other experienced members.
Even after conscientious consideration of the salient issues, some ethical dilemmas cannot be resolved easily or wholly satisfactorily. In all such cases careful and complete notes should be kept – especially in relation to what consultation has taken place, and with whom.
6.1. Anti-Discriminatory Practices
Members need to avoid discriminatory practices through including the following in all their interactions with clients, families, and communities.
- Client Respect. Members working with clients do so in ways which affirm both the common humanity and uniqueness of each person. Members must be sensitive to the cultural context and worldview of the client, for instance whether the individual, family or the community is taken as central.
- Client Autonomy. Members are responsible for working in ways that respect and promote the client’s ability to make decisions in the light of his/her own beliefs, values, and context.
- Member Awareness. Members are responsible for ensuring that any problems with mutual comprehension due to language, cultural differences or for any other reason are addressed at an early stage. The use of an interpreter needs to be carefully considered at the outset of strategic psychotherapy.
Members have a responsibility to consider and address their own prejudices, stereotyping attitudes, and behaviour. They are to give particular consideration to ways in which these may affect the strategic psychotherapy relationship and influence their responses.
- No stereotyping. Members must not impose on their clients any stereotypes of behaviour, values, or roles related to age, gender, religion, race, ethnicity, disability, nationality, sexual preference, diagnosis, or any other factor which would interfere with the objective provision of providing therapeutic services to the clients.
6.2. Responsibility to client
Members are personally responsible for making sure they promote and protect the best interests of their clients. To achieve this, members must:
- provide the best possible standard of strategic psychotherapy or hypnotherapy care to your clients
- act with honesty and integrity in all interactions with clients, care givers, and associates
- not exploit or abuse the therapeutic relationship with clients
- not act to deceive or coerce clients in any way
- be sensitive to cultural differences and not allow one’s beliefs or values about a clients’ age, disability, gender identity, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, and sexual orientation to adversely affect the way therapeutic services or professional advice is provided
- be sensitive to factors such as a client’s lifestyle to provide a good standard of strategic psychotherapy
- avoid misunderstandings by making reasonable efforts to answer clients’ questions and avoid any apparent misunderstandings about the therapeutic services to be performed.
- when providing information members must use language that is reasonably understandable to the client, whenever possible
- establish with clients at the outset of strategic psychotherapy if they are involved in other therapeutic or helping relationships. It is important to consider whether strategic psychotherapy is still appropriate.
- gain the client’s permission before conferring in any way with other professional workers.
Client Self Determination
During strategic psychotherapy sessions, the balance of power is unequal, and members must take care not to abuse their power. Members do not normally act on behalf of their clients. If they do, it will only be with express written consent of their client, or else in exceptional circumstances. Ericksonian based therapy holds to the principle that clients are responsible and able to make their own decisions, thus members do not normally give direct and specific advice
Protection of vulnerable people
A member must safeguard and promote the welfare of children, young people, and adults with additional vulnerabilities to whom they provide services.
Members must cooperate with any local disclosure procedures via local statutory social services concerning any children, young people or any persons with additional needs who are considered to be at risk of suffering significant harm due to physical, sexual, psychological, or emotional abuse or neglect.
ISPA recommends all Members have current security checks in place. For example, DBS (Disclosure and Barring Service), Police Check, Working with Children Check etc. These, or similar checks are often mandatory in countries across the world. The member must know the security checks for the country where they practise or offer services.
The member must hold the additional relevant check when working with all children under 18 and any persons with additional needs. ISPA members recommend: ‘If the client is a child under the age of 16, another person should always be present. This may be someone with parental responsibility’
If a member has concerns about the welfare of a child, young person or vulnerable adult, their concerns need to be discussed with a supervisor. If after these discussions, it is considered the person is at risk, or may be in need, a mandatory report must be made to the relevant statutory services, e.g., children services, police. This includes cases when it is considered someone may be at risk of suffering significant harm.
In general, discuss concerns with the child, young person, or vulnerable adult – as far as their age and understanding allow and with their parents or guardians. The parent/guardian should be notified that a report has been made. You should try to get their agreement to make a referral to statutory social services, unless you consider that such a discussion would place the child or yourself at risk of significant harm or danger.
Referral
When the member needs to refer their client to a medical practitioner or medical health care provider, e.g., nurse, social worker, it is considered best practice is to refer them back to their GP who will on refer on to others.
Breaks and Termination of Therapy
Members work with clients to reach a recognised ending when clients:
- have received the help they sought or
- or members see strategic psychotherapy is apparently no longer helping or
- wish to terminate their treatment.
External circumstances may lead to termination for other reasons which are not therapeutic.
Members must make arrangements to care for the immediate needs of clients should a sudden and unforeseen ending by the member be required.
Members should take care to prepare their clients appropriately for any planned breaks from their sessions. They should also take steps to ensure the wellbeing of their clients during such breaks.
6.3. Personal and Professional conduct
Members must maintain high standards of personal conduct as well as professional conduct. They are expected to be law-abiding and of good character. ISPA members are expected to display honesty, integrity, and trustworthiness.
Termination of membership
ISPA membership will be terminated if a member is convicted of a criminal offence involving one of the following types of behaviour:
- Violence
- Abuse
- Sexual misconduct
- Drink-driving offences where someone was hurt or killed
- Serious offences involving dishonesty
- Any serious criminal offences for which you received a prison sentence.
- Drug or alcohol related offences, including dealing and supply.
If a member is convicted of a criminal offence or has accepted either a written or verbal Police caution, the ISPA National Secretary must be informed at the earliest opportunity. Each case will be considered individually as to fitness for continuing ISPA Membership. A membership decision will be made in the light of the circumstances of each case.
Personal Conduct
A member must inform ISPA National Secretary if they have any relevant information about their own conduct or competence that may impair their judgement or ability to practise. Members must let ISPA if they are:
- convicted of a criminal offence (other than a minor motoring offence)
- accepting a Police caution
- disciplined by any organisation responsible for regulating or licensing a healthcare practitioner or social care profession
- suspended or placed under a practice restriction order by an employer or similar organisation because of concerns about their conduct or competence
- asked, or has been asked, to leave a professional association or register
Members are required to co-operate with any ISPA investigation or formal inquiry into professional conduct, performance or health, or the conduct of any other healthcare provider where appropriate.
Modifying one’s practice when impaired by certain physical or mental conditions
A member must not practise while suffering from any physical or mental impairment, condition, or disorder (including an addiction to alcohol or a drug whether prescribed or not) which is likely to detrimentally affect their ability to practice strategic psychotherapy or which places clients at risk of harm.
If a member has concerns regarding another ISPA member i.e., they believe the member might be failing to meet this requirement, their concerns should be raised with the ISPA Standards Officer.
All members should understand how their own wellbeing and health may compromise the provision of a good standard of practice. Members need to be reflective of their practice and should consider seeking and acting on any advice from qualified medical practitioners and/or supervisors.
Actions in a professional practice which might undermine public confidence or bring the profession into disrepute would include:
- Involving clients in, or telling them about, arguments between members or other healthcare professionals
- Undermining, bullying, gaslighting or defaming other members without due cause or with vexatious intent. This behaviour is not accepted under any circumstances.
- Soliciting the clients of other healthcare professionals.
- Areas of a member’s life which might undermine public confidence or bring the
profession into disrepute include, for example, misuse of drugs or alcohol, convictions for fraud or dishonesty, convictions related to violence, sexual abuse, or the use of pornography.
6.4. Contract with Client / Informed consent
No services can be offered or practised without gaining informed consent from the client.
A member must obtain adequate informed consent prior to providing therapeutic services. In certain circumstances it might not be possible to obtain adequate informed consent, a member must then attempt to obtain informed assent prior to providing services.
Members must document the informed consent and/or assent. If no consent or assent can be confirmed, member must document the steps taken to obtain it and the basis for proceeding without either in the client record.
Elements of informed consent
Elements for informed consent may vary depending upon the particular circumstances. It is important to recognise consent is not a “one-off” exercise or discussion. It is a continuous process and needs effective and ongoing communication with the client.
The member must ensure the following general elements are satisfied when seeking informed consent:
- The discussion of consent is conducted in a language easily understood by all.
- The client has the capacity to consent.
- The client has been informed of all appropriate significant information concerning the therapeutic service(s); unless there is a clear exception which has been agreed upon ahead of time, or unless it is not reasonably possible to obtain consent.
- The client has freely and without undue influence expressed their consent.
- The client has been informed of:
- the procedures of the therapy,
- fees for the intended service(s)
- limits of confidentiality including how information is collected, recorded, used, stored, for how long, who has access and how.
- Consent has been obtained in writing where possible; and the consent of the client, or of other appropriate persons where the client is not legally capable of giving informed consent, has been appropriately documented in the member’s practice record for the client.
- The client may decide to participate, decline to participate, or wish to withdraw from services or procedures offered.
- There may be certain conditions where the member may withdraw or terminate the therapeutic services.
A person has capacity if they can understand, remember, use, and weigh up the information needed to make an informed decision, and can communicate their wishes.
It should always be assumed adults have the capacity to make a decision unless it is shown to be otherwise.
Lack of capacity to give informed consent
If a person is considered unable to give informed consent, another person with legal authority to do so, may give written consent on their behalf. E.g. primary care givers, parents, or those with parental responsibility of a child under 16 years old.
Children under 16 years of age
When working with young people, members need to determine the capacity of the young person to provide informed consent. This young person is deemed to have given informed consent when they can demonstrate a level of adequate or competent understanding and shows the ability to apply knowledge of what is being proposed.
For children younger than 16 years old, the person with parental responsibility should give written consent on behalf of that child. Members must always make reference to the regulatory situation in the jurisdiction of their practice, in particular any Family and Children Acts which define conditions of parental responsibility.
Persons deemed to be legally incapacitated
If an individual is deemed to be not legally capable of giving an informed consent to a member, the member must:
- obtain any necessary documentation to determine the identity of all parties with legal entitlement to provide or withhold consent for services. A copy needs to be kept on the client’s record.
- provide an appropriate and understandable explanation of the services to the individual.
- obtain informed written consent
- where possible obtain the individual’s assent to the procedure or intervention; and
- document the explanation and any consents and assents in the client’s record.
Observing and recording
When therapeutic sessions with a client are to be observed by a third party or recorded in any mechanical or electronic manner for audio or visual purposes, a member must obtain informed consent from the client or the client’s legal guardian in advance.
6.5. Responsibility to Colleagues and Others
Respecting others
A member must, in their work-related activities and professional relationships, respect the rights of others to hold values, attitudes, and opinions that differ from their own. This includes not engaging in bullying, gaslighting, undermining or defaming clients, work colleagues and others.
Professional cooperation
A member must seek to work co-operatively with other professionals in a professional and cooperative manner, for the good of, and best interests of, their clients.
A member must respect the skills and contributions others bring to the wellbeing of their client. A member must not attempt to dissuade clients from seeking or continuing treatment by their registered medical practitioner.
When working in a team, a member must remain accountable for their professional conduct, the care or professional advice they provide, any failure to act, and any reason for tasks they may delegate. There is a particular need to be clear about who is responsible for the safekeeping of client records.
6.6. Confidentiality
A member must always respect the confidentiality of their clients. This duty of confidentiality towards their client is fundamental to the trust placed in the therapist to ensure successful therapeutic outcomes.
A member must disclose the limits of any confidentiality to their clients at the earliest opportunity and before informed consent is obtained. A member must not knowingly release any personal or confidential information to anyone who is not entitled to it.
A member must check people who ask for client information are entitled to it and are adherent to all related laws protecting data and codes of confidentiality.
If a member works with others, such as other practitioners, healthcare workers and practice staff, it is important there are proper confidentiality and privacy procedures in place. All should be aware of their duty of confidentiality, whether they have professional or contractual obligations to protect confidentiality or not.
A member must protect the privacy of any client’s health records in their financial management system where a bookkeeper or accountant is employed.
Informing about limits of confidentiality
A member must inform clients at the commencement of the professional relationship of the limits of confidentiality to be maintained by the member, and by any other person engaged in the provision of therapeutic services to them who is under the member’s supervision.
Multiple clients
When therapeutic services are rendered to more than one client who have a relationship, whether in a joint session or otherwise, a member must at the beginning of the professional relationship:
- clarify for all clients the way confidentiality will be handled; and
- provide all clients with the opportunity to discuss and accept whatever limitations to confidentiality apply before proceeding.
The client is entitled to presume the member and their staff have the same approach to confidentiality. The member must ensure that anyone who has access to their client’s personal information, understands it is accessible to them in confidence and they must treat it accordingly.
Ongoing confidentiality
A member must continue to treat as confidential all information regarding a client after the professional relationship between the member and the client has ended. This ongoing period of confidentiality lasts for 7 years from the date of the last session between the member and client.
6.6.1. Disclosure of confidential information
Except as otherwise permitted by law, including this Code, a member may only disclose confidential information about a client to a third party if the client has provided written consent.
For purposes of determining whether a member is permitted or required to disclose confidential information under this Code without the client’s written consent requires a court-based subpoena.
Information shared must only relate to the specific reason for the request and in relation to the purpose of using that information.
Members need to seek legal professional advice in each case within their jurisdiction of practice.
A member may disclose confidential client information without the informed written consent of the client if:
- the member determines that disclosure is necessary to protect against a clear and substantial risk of imminent serious harm being inflicted by the client on themself, or on another individual
- the member determines that disclosure is necessary to protect an identifiable child, consistent with applicable law
- the member determines that disclosure is necessary to protect a vulnerable adult who by virtue of condition or circumstance is unable to seek support or assistance for abuse or neglect, consistent with applicable law
- it is in accordance with any other lawful requirement to do so.
Clients without legal capacity
At the beginning of a professional relationship with a client who is a minor or who is under a legal disability, a member must inform the client in an appropriate and understandable way of the legal exceptions to confidentiality regarding communications with the member
Client access to the clinical record
A member must provide access to and permit the reproduction and release of confidential information about a client when requested by that client, unless there is a significant likelihood that disclosure of the information would cause:
- a substantial adverse effect on the client’s physical, mental, or emotional health
- harm to a third party.
Seeking legal advice
Different and sometimes competing legal requirements may bear on a release of information request. It is a member’s responsibility to seek professional legal advice as needed to ensure that information requests are handled with due consideration of all legal requirements relevant to the particular circumstance at hand under the jurisdiction where the service is offered.
Sharing with professionals
When rendering therapeutic services as part of a professional team or when interacting with other professionals concerning the welfare of a client, a member may share confidential information about the client if:
- the member takes steps to ensure that all persons receiving the information are informed about the confidential nature of the information in accordance with this Code
- the member informs the client in advance that the client’s confidential information will be shared with other practitioners of the professional team
- The member only shares information relevant to the purpose of sharing that information for the welfare of the client.
6.6.2. Exceptional Circumstances
Exceptional circumstances may arise which give the member good grounds for believing serious harm may occur to the client or to other people. In such circumstance the client’s consent to change the agreement about confidentiality should be sought whenever possible, unless there are also good grounds for believing the client is no longer willing or able to take responsibility for his/her actions.
Normally, the decision to break confidentiality should be discussed with the client and should be made only after consultation with a supervisor or an experienced member.
Any disclosure of confidential information should be restricted to relevant information, conveyed only to appropriate people and for appropriate reasons likely to alleviate the exceptional circumstances.
The ethical considerations include achieving a balance between acting in the best interest of the client and dealing with the exceptional circumstances.
While members hold different views about breaking confidentiality, such as potential self-harm, suicide, and harm to others, they must also consider those put forward in interests of the client and the member’s responsibilities under the law and to the wider community.
These circumstances should be communicated to both clients and significant others e.g., supervisor, agency,
6.7. Privacy and Data protection
Data protection and /or privacy legislation details its requirements regarding transparency, information-giving requirements, as well as data subject rights.
The data subject rights include, for example, the right to be forgotten, the right to access personal data, and the right to have data corrected and erased.
Each member is responsible for keeping up to date with current legislation (ref GDPR, DPA, Privacy) and any legislation that occurs relating to the jurisdiction in which they practice.
Processing personal data includes, but is not limited to holding, obtaining, recording, using, and disclosing information.
Privacy policies should be in place and communicated effectively to clients, staff, and relevant service providers.
A member must only retain or use information about a client:
- To continue to provide care for that person
- To satisfy legal, financial or insurance requirements
- For purposes where that person has given express consent to use the information, for example to a third party
- If a member has good cause to believe that the client, the member, or others (or the public) may be harmed if the information is not disclosed.
6.8. Management of privacy, data, and admin systems
Length of record retention
A member must ensure all information in their professional records concerning a client is maintained for not less than seven years after the last date professional services were rendered to that client.
A member must keep records relating to minors for not less than seven years following the date the minor reached the age of majority
A member must use their judgment in those circumstances in which it may be appropriate to maintain their professional records for longer than seven years.
Content of records
A member must keep records for all their client sessions which are a true representation of their interaction with clients.
A member should maintain records which are complete and legible and include the following:
- the name and contact information of the client
- the presenting problem(s) or the purpose of the consultation
- the fee arrangement
- the date and substance of each professional service, including relevant information on interventions, progress, any issues of informed consent, and issues related to termination
- notations and any results of formal consultations with other service providers
- any releases or consents executed by the client; copies of any emails or other communications related to the file.
Location of records
Practice records must be maintained or stored at the member’s primary place of practice. They need always be under the sole control of the member, or of another appointed member, or in a professional storage facility obligated to provide confidential and secure storage.
Records stored in software on Personal computers or “in the cloud” need to be password protected and have the necessary privacy controls in place.
Security of records
A member must ensure that:
- the records of all their professional services, including those of their supervisees, are secured, including but not limited to by restricting access to files, locking file cabinets, and providing secure storage for files.
- the privacy of all client information and data is assured.
- if a professional storage facility is used it maintains appropriate security practices.
Electronic/optical storage security
When client information is prepared, kept, or maintained by electronic or optical techniques, a member must ensure that these techniques are designed and operated so that the information is reasonably secure from loss, tampering, interference, or unauthorized use or access. A member must also take all reasonable steps to ensure any electronic/optical storage is updated as necessary to ensure the information remains accessible if previous storage strategies become obsolete.
Information on the practice arrangement, including terms and conditions, fee structure, cancellation policy, data privacy policy, how you may be contacted, location of work, and any joint working arrangements if you work in collaboration with others should be easily available to clients.
A member should deal respectfully, promptly, and fairly with any complaint and tell any complainants that they have the right to resolve an unresolved complaint with ISPA or your country’s Association or register.
Data protection
Members must give clients access to their personal records upon request, in accordance with legislative rights. This must be done in writing, within a reasonable time, bearing in mind any concerns about the impact that information may have on the client or others.
6.9. Professional Documentation
A member must appropriately document their professional work in order to:
- facilitate provision of services in the future by themself or by other professional service providers
- ensure accountability; and
- meet other legal or institutional requirements.
All reports, letters, or other documents containing information, opinions, or assessments prepared by a member in the course of that member’s professional services must be signed by the member before they are provided to another party, in order to ensure authorship/responsibility is clear.
Electronic Documents
For the purposes of electronically created, transmitted, or filed documents, “signing” a document may include affixing an electronic signature or providing some other method of identification and authentication when the document is sent that ensures authorship/responsibility is clear.
