As Clinical Lead of our Employee Assistance Programme, Kevin writes about “supporting vulnerable clients” below.
As a young boy, I had an uncle whose company imported American comics. My favourite was Action Comics, featuring Superman. He was invulnerable, able to survive anything (except kryptonite), and he seemed a good role model for the weedy kid I was. Of course, we can all now deconstruct the whole Superman construct and see it for what it was; but invulnerability? No-one else possessed that particular attribute. No matter how much we aspired to it, we were all, by default, vulnerable.
Fast forward to today and vulnerability has taken on – if not a new meaning – at least a new focus. We talk about ‘vulnerable people’, we have legislation in place to protect them, we have conferences to discuss them and we have people who work with them. There are many who really care and these advocates can help if you let them.
Many therapists will have a DBS certificate; formerly a Criminal Records Bureau check, the Disclosure and Barring Service was established specifically to ensure that anyone working with ‘vulnerable people’ was required to show that they had never been caught being up to no good. When the DBS was first established, I contacted them and explained my work, as a therapist, a supervisor and a clinical manager. I asked them if the Government considered my clients to be ‘vulnerable adults’. They couldn’t tell me. They thought that, on the whole, most of my clients wouldn’t fall within their remit, but that once in a while I might come across a client who did. Better safe than sorry, I obtained my certificate, as many other therapists have. Many organisations insist that employed counsellors and psychotherapists have DBS clearance, but I would argue it is still a moot point. Sometimes when I am in the room with a client, I wonder which of us is the more vulnerable.
Having been a manager of counselling services for over 20 years, I am conscious that therapists see vulnerability in different, uncodified ways. I have had countless conversations with therapists who talk about a particular client as being vulnerable, but what they mean by this varies enormously. Some combination of projection, introjection, transference, countertransference and a number of other psychological processes seems to coalesce to make a therapist see certain clients as vulnerable, while not applying the same definition to their other clients.
When I first started working in primary care, I would sometimes get a referral for someone who suffered from ‘Chronic Acopia’. Thankfully, such referrals are a thing of the past, but defining someone as having a chronic inability to cope may well be a reason for that client to be labelled ‘vulnerable’ by some therapists. In reality, we all fail to cope sometimes; we all feel out of our depth; out of control; lacking resources to deal with life’s little surprises; so we could all be called ‘vulnerable’ at such times. But does that help? How then can we use the term in a helpful way? And what can we do when we really do see a client as ‘vulnerable’?
Probably most people would classify someone being trafficked for sex as vulnerable. Part of my reason for saying this is that we expect society (the law, the Government or our public bodies) to do something about it, to offer some protection. We are angry when they fail. In reality, those people are unlikely to access therapy prior to being discovered by other agencies. Therapists, though, do encounter clients who are either under pressure to behave sexually in a way that they don’t want to, or are making risky choices about sexual behaviour that seem to be likely to cause harm. What is our responsibility in such cases? Do we see the client as vulnerable? We empathise; we aspire to empower; we want to honour the client’s right to self-determination. But we also want to recognise our responsibility to see that the client comes to no harm because of our work.
We should also consider the suicidal client or the apparently suicidal client. We talk about suicidal ideation and suicidal intent as if they are two different things, but the line between the two can be very thin. BACP[i] doesn’t tell us what to do with such clients, but says instead that we should each formulate our own approach and be clear and consistent with clients. Some therapists are ‘disclosers’ while others are ‘non-disclosers’. Having stood in the witness box at an inquest and faced a bereaved family across the room, with the coroner asking me; ‘Exactly when would you have told the partner that this person was planning to die?’ I changed my personal stance. Since then, if I believed a client was in extremis, I would probably try and contact someone.
When discussing vulnerable clients, the only thing I can be sure of is that the first conversation needs to be with your supervisor. If you think a client is vulnerable, talk it through, and argue it through, with your supervisor. Challenge your assumptions and allow your supervisor to challenge you. If, after all of that, you still feel the client is vulnerable, then discuss it with the client and come to a joint decision about what your role should be. Avoid the pressure to be omnipotent. Be willing to refer to other agencies, to research on behalf of a client if that is helpful. If the client has been referred to you by an EAP, find out about the resources available through that service or through their employer.
[i] Reeves, A and Seber, S: Working with the suicidal client. BACP P7 information sheet. 2010