The end of ‘therapy’ as we know it?

Practitioner psychologists might want to take a look at new 'standards of conduct, performance and ethics' issued by the Health and Care Professions Council, taking effect from September 2023. The new formulations are expressed with more clearly stated expectations, e.g. 'must' rather than 'is able to' or 'demonstrate' rather than 'understand'. I assume this will make it somewhat easier to sanction non-compliant registrants. For clinical psychologists, I counted a total of 95 very generally worded 'standards', open to different interpretations, that must be adhered to.

With regard to record-keeping, registrants must 'keep full, clear and accurate records in accordance with applicable legislation, protocols and guidelines'. However, I doubt that many practitioners are up-to-date with these or would even know where to find them (I don't). Clients sometimes seek private therapy because they don't want to have an NHS or GP record of their reasons for seeking help (or a record made of seeking help at all).

On occasion, a client will say 'Don't write this down'. I have been asked by solicitors acting for clients to send them my session notes and so this is a relevant concern. It is, of course, understood that certain categories of information have to be notified to the authorities but information about, say, past abuse, infidelities, or sexual identity issues, could have a devastating effect on current family and social relationships if revealed.

So, what do 'full' and 'accurate' mean here? Independent practitioners rightly have to register with the Information Commissioner's Office (ICO) because they store personal data to which a person has a right of access, including session notes and data kept on phones. (None of my clients have ever requested this). However, if lawyers (and presumably the HCPC in case of a complaint) can demand access to personal data, will clients continue to trust the confidentiality of a therapeutic relationship? This could spell the end of 'therapy' as we know it.

An article by Peter Jenkins ('Record keeping and the law', in Private Practice, 2017, BACP) states: 'professional practice in counselling has shifted broadly to only record factual data about clients, and not keep process notes at all. Another practical option would be to keep only short-term process notes, as "post-it notes", to be shredded after use in supervision.'

An interesting example of the care needed in writing session notes arose not long ago in a 'case to answer' investigated by the HCPC. A clinical psychologist had included a tentative diagnosis in a sessional memo and when his client successfully demanded that the notes be provided to the GP, he was alleged by HCPC to have acted maliciously and fraudulently by expressing that tentative opinion. At the tribunal, expert witnesses for both parties had said that they could not comment on the psychologist's tentative diagnosis without further assessment of the client. Nevertheless, the lay panel upheld HCPC's allegations that the clinical opinion was wrong and amounted to malicious fraud. He was struck off.

Given that the BPS has now taken on the role of registering members of the 'wider psychological workforce', a register that is accredited by the Professional Standards Authority, they will have to deal with complaints coming from the public (or their lawyers) and so it is important that these issues are more widely known about and discussed.

Richard Hallam
London

Response: On accuracy, it is the Standards of Proficiency that have changed and are which are being introduced in September this year. And they do include a standard on record-keeping. But also, the Standards of Conduct, Performance and Ethics include a standard on record-keeping. These standards are currently under consultation and members could make a submission to HCPC if they wish.