Helena, an experienced psychodynamic psychotherapist and counsellor in private practice, is also a qualified lawyer whose depth of knowledge she generously shared within this workshop. Her aim was to help us understand what would be needed to protect our clients in the unexpected event of our death or incapacitation in a way that would be supportive, empathic and respectful of confidentially and the clinical issues they had raised in counselling. Helena’s comprehensive ‘26 page pack’ will be of significant assistance to therapists as it guides us, virtually step-by-step, through this complex process and includes almost all we might need to understand about the process of creating a ‘Therapeutic Will’. Details of how to purchase a copy directly from Helena can be found at the end of this review.
I can only touch briefly here on a small number of the steps Helena explored underpinned by her appreciation that a Clinical or Therapeutic Will has three fundamental concepts:
- Support, containment and ethical management of clients.
- Terminating ethically and responsibly confidential aspects of a therapists’ practice.
- Strict preservation of confidentiality integral to the therapeutic alliance.
A therapist will choose two Executors whom they trust and respect to carry out such tasks well. The Executors must be experienced, practicing (not retired) counsellors or psychotherapists (occasionally a supervisor) as this work is informed by the understanding of holding boundaries, confidentially and how to support people grieving, angry, upset and feeling lost at the sudden loss of their counsellor due to death or serious illness/accident. It is important to remember the therapeutic alliance between counsellor and client is unique and special. The Executor may need to support the client for a short while before they finally meet with their own chosen new counsellor and so may need to help manage the client’s difficult emotions. Clients confidentiality is paramount. The British Psychoanalytic Council suggests Executors need to be members of professional bodies, i.e. the BPC, BACP, UKCP and BPS and to be guided by their Code of Ethics whilst having access to the support of their professional body and supervisors. Any potential Executors must be offered, beforehand, time to consider what might be required of them, and whether they have the space or energy to provide such a commitment. Executors may never need to Act, but the responsibility is one they will ‘hold’ until discharged by the process or when the therapist ceases counselling having ended safely with their clients and their practice.
Therapists must ensure their notes, papers, client’s data, documents, tax and accounts, outgoings paid, invoices for clients are paid and up to date and can be easily located by the Executors. A ‘client list’ will be created and kept current providing the clients’ contact details, name, address, times of future appointments. Actions by Executors about outstanding client fees will be to be agreed. Executors and therapist may meet on the premises to see where everything, including keys, may be found. The creation of Lasting Powers of Attorney’ will be discussed with legal input and eventual ‘shredding’ of all documents will be reviewed. The ‘Responsibilities of the Executors to the therapist’s clients’ includes exploring what support they are able to offer them and for how long, bearing in mind the ethos of this role is that it contains, it protects confidentiality and is short term. The Executors do not intend to become counsellors of the clients. Therapist and executors will discuss what is to be said to clients about what has happened to their therapist. Much care needs to be given to this aspect if the counsellor has died or is seriously ill in hospital – clients may want to visit, attend funerals or pay condolences. This is understandable but can create difficult situations as it may reveal much about the therapist’s personal life which they would not normally have shared, such as, who they live with, do they have a Faith or not, do they have children, do they belong to different organisations. Discretion is key here to prevent a situation where the client finds out something that might unduly upset them or undermines the counselling that has already taken place. Occasionally there are clients ‘who just cannot let go’ and these may need sensitive, extra support to move forward.
One important aspect is payment for the Executors for their time and costs in carrying out their duties and it needs to be pre-agreed in both amount or hour/mile, and how this will be paid. The Executors will agree between themselves who will do what with regard to the clients and to the administrative tasks. They may need to be able to discuss different elements of the work with the therapist’s bank and solicitor (possibly in respect of the personal will) in order to aid smooth operation of tasks involved and permissions need to be in place for this aspect. Acting as Executors will involve personal aspects too, as they may well be impacted by what has happened to the therapist, who may also be a friend or close colleague, and so may be grieving or struggling. Supervision is so important here as is their professional body, personal therapist and each other. There is so much more to this process, and I hope this small snapshot may encourage us all to read more from Helena Cook on this topic.
This was such a worthwhile workshop and raised so many questions and concerns from us. I think we all came away knowing the validity of have a Clinical or Therapeutic Will in place. Many thanks to Sinead who hosted the Zoom function for us so well so that this could take place.
A huge thank you too to Helena for all the hard work you put into this presentation together with its ‘pack’ which is very much appreciated.
A review by Jacqueline Holloway, HACP workshop co-organiser with Helen Gordon.
Helena recommended we might also like to become familiar with the following documents:
British Psychoanalytic Council: Guidance regarding instructions to Professional Trustees. Jan 2022
British Assoc. for Counselling & Psychotherapy: Good Practice in Action 104 (Fact sheet).