Knowledge beyond words: confusion and ethics

BACP has just published new ethical guidelines.* Before publication, Ivan Tyrrell questioned the main author of the guidelines, Tim Bond, about what they actually mean.

TYRRELL: The British Association for Counselling and Psychotherapy (BACP) is one of the main trade associations for therapists, and it is very active in trying to set standards that it would like to see adopted nationally. You played a big part, I believe, in preparing its new Ethical Framework for Good Practice in Counselling and Psychotherapy?

BOND: Yes, I was the author of most of it, except a few specialist professional conduct procedures.

TYRRELL: The word ‘ethics’ comes from the Greek ethikos, which means ‘dealing with human nature’. So, my first question is where does BACP’s knowledge of how to deal with human nature come from that qualifies it to set out this framework?

BOND: There are two dimensions to your question: one is the general question about where we gain the knowledge of what is ethical. The other dimension is, what is BACP’s claim to have a voice, with regard to ethics and the profession?
If I take the general point first, ideas about where one can get ethical knowledge from are changing quite rapidly. When I first started studying, moral philosophy was almost invariably linked to ideas about reason and analysis, and deducing practice from principles. Whereas now, because of cultural changes, and changes in academic understanding, there is a greater reluctance to rely exclusively on any one system of thought, particularly when you look at a professional practice. There are real risks working solely from principles, for example, because they tend to create a sense of disengagement from the people you are working with. That is both their value and their limitation. Their great value is in showing the need to step outside a complex situation to look at it afresh. Their limitation is that principles do not necessarily encourage an ethical way of being with the person you are working with.

TYRRELL: Can you define what you mean by an ethical way of being?

BOND: It is very much rooted in the quality of the relationship and the way in which, in the modern world, we interact with potentially different value positions. Respect for diversity and the quality of the relationship become more important than operating out of a single ethical perspective or belief.

TYRRELL: By that you would mean, for example, perhaps a religious framework …?

BOND: It could be a religious framework; it could be a cultural set of values; and of course cultural values are often deceptive because they go unquestioned.

TYRRELL: Well, they are usually conditioned-in.

BOND: Yes, they are within our ‘warp and weave’ and it is only when we are exposed to other cultures that we can become aware of them.
Nowadays, when people think about what it means to be ethical, the personal moral qualities have come more to the fore. Within the literature on talking therapies, these are often presented as ‘the personal qualities of the therapist’. We know from empirical studies of clients’ experiences that, very often, it is their sense of the personal qualities of their counsellor or psychotherapist which help them, which give them a sense of being valued and a feeling of safety. Very often, frameworks are secondary to that.

TYRRELL: Your stated aim in producing this document was to produce a framework that “provides the best possible protection of the public” — could you explain what that means and how you define protection?

BOND: There are several dimensions to protection. The first and most obvious one is that any profession should be able to assure the public that its members will not exploit, abuse or neglect them. Every profession needs safeguards in place to deal with those issues as they arise. Fortunately, they are relatively few in relation to the large volume of work that takes place within talking therapies. Once the safety net is in place, probably the more critical issue which would apply to the vast majority of encounters between clients and practitioners would be about enhancing the ethical quality of the relationship. That, in this context, means both addressing the way in which the relationship is established and managed, and also the quality of services provided.

TYRRELL: That is a key thing — the quality of service — but, before we talk about that, I would like to raise the stated second aim: that BACP wants this framework to encourage practitioners to consider the ethical basis of their routine work with clients, and “to embrace ethics as an essential integral part of their work”. How does one embrace ethics exactly? We can embrace a person, a child, or even a tree, if so inclined, but surely we cannot embrace ethics?
A big problem with a document such as this is that so many of the words used in it are what linguistic psychologists call ‘nominalisations’ [the term for an abstract noun which is produced by converting a verb into noun]. This makes this topic very, very difficult because one has to pin these words down. Just because one behaves ethically in a situation, for example, doesn’t mean one ‘has’ ethics. Ethics is not something that one can pick up, embrace and carry around. Similarly, one cannot ‘have’ counselling. Someone can be counselled, of course, but they don’t have it.
Nominalisations are confusing slippery words of influence, dangerous almost, because they mean different things to different people. No one can give someone ‘joy’, ‘love’ or ‘enlightenment’ because these words mean different things to different people, even though we manipulate one another all the time by pretending they are concrete things that can be given. One can be enlightened about something but not given enlightenment. One can be made angry by something happening but not have anger inside, as if it was blood. In the same way, one cannot have values. I think your document represents a heroic endeavour, but, because there are a lot of nominalisations in it, it is probably going to cause some confusion in many people.

BOND: Yes …

TYRRELL: I must ask you about this as it is absolutely central to good counselling, yet so many counsellors are not aware of this. How does one embrace ethics exactly? This is your phrase, not my phrase.

BOND: No, it’s certainly my phrase. What it is driving at is that, for some practitioners, ethics have been, as it were, an afterthought — something that was bolted on. The notion of embracing, in this context, is actually drawing ethics closer into everyday practice. So it is actually trying to promote a sense of ethical mindfulness within practitioners which is not solely related to those difficult and tricky dilemmas that we all face – should I break confidentiality in these particular circumstances to prevent some other wrong to somebody else? Ethical mindfulness should run throughout all routine work, as well as the exceptionally demanding work.

TYRRELL: So, basically, you want people to think about the consequences of their actions in some kind of ethical way, as part of whatever they are doing?

BOND: Yes. It is particularly significant in the context of the change that this document represents because it is a deliberate move away from a ‘rule-based’ system of ethics to one which is drawing people’s attention more to the issues and the possible ways of responding to issues, and encouraging them to take greater responsibility for their practice, and develop a corresponding degree of accountability for the decisions that they make.

TYRRELL: What you have just said, using the word ‘issues’, illustrates a fundamental problem. When we use a nominalisation like ‘issue’, which sounds as if it refers to something specific, it actually hides the fact that circumstances always alter cases. In any point in question, which is what an issue is, you have got to look at the particular event in the round and consider everybody’s roles in that event and recognise that no two events are the same. Approaching an event in that way would be an ‘ethical activity’, as it were. When we use nominalisations like ‘human rights’, ‘values’, ‘principles’, ‘sense of self’ and so on, it is incredibly difficult to form a relationship in one’s own mind with what these words might mean to someone else.

BOND: Yes, I accept that that is a fair comment, and it is in the nature of these documents that they are written in fairly abstract and general terms. Therefore, it represents a sort of value commitment, rather than an absolutely prescriptive, tightly bolted down behaviour.

TYRRELL: The thing is, when you say we should respect human rights and dignity — on the face of it, no one is going to disagree with that. But what exactly does it mean? Nobody comes into the world with ‘rights’. Rights can be defined by law, but there has to be an agreed shared perception in a community to abide by such laws. So, what are these shared perceptions? Is a counsellor operating from an ideology infringing the rights of their clients or treading on their dignity without anyone realising it? Does a psychopath who obeys every impulse and does whatever he wants, have rights? If he wants something now, should he have it, whatever it is?

BOND: Whilst I agree that there is a range of views with reference to human rights, most of them would not countenance the psychopath’s.

TYRRELL: No, I was just using that as an example to illustrate the point. Someone said to me the other day, “I have a right to high self esteem!” — two nominalisations there — and this is an absurdity.

BOND: Yes, I would agree with you.

TYRRELL: So, when people talk about human rights, there aren’t shared perceptions about what is meant.

BOND: Well, in the context of BACP’s new ethics document, human rights lead to a point of reference which would actually be the legal definition. And clearly human rights would mean an awful lot to practitioners working with, say, refugees in various oppressive situations. In our current society, we have the luxury of looking beyond those basic human rights to more relational rights and quality of life type issues which often get merged in with human rights.
But certainly in the wider international context it is extremely important that practitioners using a talking therapy are committed to human rights and also avoid being used by authorities in ways which abuse people’s human rights. Of course, in the history of mental health there have been times when practitioners were either coerced or voluntarily got themselves involved in some very degrading practices in relation to their clients.

TYRRELL: Could you give an example?

BOND: Well, for example, where psychiatric patients were compelled to receive medications, which later on proved to be extremely toxic, without any opportunity to give or withhold consent. There have also been some very brutal behavioural regimes used at various times in mental hospitals.

TYRRELL: Another area which will be of particular interest to our readers is where you talk about “enhancing the quality of professional knowledge and its application”. This is listed as one of the ‘values’ of counselling and psychotherapy — a commitment to doing this — along with “alleviating personal distress and suffering”. Now these are vague statements and BACP seems to have no way of dealing with the practicalities of overseeing how people uphold this sensible requirement.
The problem seems to me to be that, even assuming that all counsellors and psychotherapists are in the business to alleviate personal distress and suffering, many of the ways they are trained to use to do this do not work terribly well, and some can actually maintain people in their suffering. There is a lot of research, for example, showing that psychodynamic approaches to treating depression make depression worse, as does any form of counselling that encourages introspection, because emotionally arousing introspection is what causes depression in the first place! And yet these practitioners would sincerely believe themselves to be committed to relieving distress, even though, because of their training, they are not relieving it.

BOND: Yes, I realise that this is one of your concerns.

TYRRELL: At a workshop yesterday, I met a counsellor, accredited by BACP, who thought it was not necessary to set clear goals with clients. She was telling us about a client she had been seeing every week for three years who came to her because he was depressed and needed help. He was still depressed. She confidently believed that the ‘therapy’ she was doing must be helping him because in their sessions together she was unravelling and exploring ever deeper reasons for his state of mind. In the light of what is known about depression this is clearly unethical. She had been trained at the Tavistock in a type of psychodynamic therapy.

BOND: This takes us back to why excessive reliance on any one principle or value, or human quality, is now being questioned. You can only, as it were, achieve the alleviation of personal distress and suffering, at a level that is more than rhetorical, if you are also asking yourself — very systematically — how effectively you are doing it, how safely you are doing it, and how you know that you are doing it effectively and safely. That is why throughout our document there is a great emphasis on developing professional knowledge, and on research.

TYRRELL: Yes, that theme runs right through it.

BOND: It is one of the big shifts in the talking therapies — that research is being increasingly recognised as important.

TYRRELL: However, it is not just research into the effectiveness of different types of therapies which is needed but awareness of research findings about the brain and about human nature. Therapy approaches need to be open and flexible enough to incorporate and act on this kind of information, on an ongoing basis.
Moving on, though, to my next question. How is professional competence to be measured? In the framework you say, “All clients are entitled to good standards of practice and care from their practitioners in counselling or psychotherapy”. This is said a number of times. But how is professional competence to be measured?
It seems to me that no amount of ethics, agreement to commitments, particular therapeutic approaches or values have a meaning unless any given therapist can be shown to have a fairly reliable effect on getting people better. Are BACP-accredited counsellors, for example, getting people out of their depressions? Are they dealing well with anxiety disorders? Are they getting people over their addictions? Are they improving people’s relationships? Are they able to detraumatise people? In other words, does this ethical framework count for anything if that competence is not measured?

BOND: The broad drift of the document is in complete agreement with that point. It is laying stronger emphasis on the profession, and us individually, to look at what is the evidence for our claims, and is also therefore trying to create an infrastructure that will, over time, enable us to answer such questions much more effectively.
You talk about what is measured. As you know, the evidence based movement, which has clearly had an influence on the document, can be defined very narrowly as being restricted to particular paradigms of knowledge and particular methods derived from the natural sciences or it can be viewed more broadly as encompassing a whole range of approaches. These are the sort of debates that we need to have continually within the profession in order to develop our own strategies and approaches which are appropriate to our practice.
It is quite reasonable that there should be a range of views on those sorts of issues. But what is really important is that, as a profession, we are committed to actually looking at the impact of our work and how we know.

TYRRELL: I couldn’t agree more! You say in the document that “fostering a sense of self that is meaningful to the person, or persons, concerned” is one of the values in counselling and psychotherapy. Could you just explain what you mean by a sense of self that is meaningful?

READ ON >>

Return to top

* This interview was first published in 2002 in Volume 9, No, 1 of the Human Givens journal.

TIM BOND is reader in counselling and professional ethics at the University of Bristol. He is author of Standards and Ethics for Counselling in Action (Sage, 2000). He is on the professional conduct committee of BACP, which has been concerned with producing the ethical framework, ethical awareness-raising and training. He is a past chairman of BACP.

IVAN TYRRELL is an experienced psychotherapist. He teaches effective counselling skills at MindFields College, was a founding member of the European Therapy Studies Institute (ETSI) and co-developer of the human givens approach. He is a Fellow of the Human Givens Institute.

For more information on ethics also see:

> The article: 'The limits of tolerance: ethics and human nature'

> HGI Ethics Policy