“I worked with a client who…”

I’ve been involved in a fair amount of training, often as a trainee, but increasingly as a trainer.
…and it is useful and interesting to hear from other practitioners about their experience working with clients – it’s something which has informed my practice. It has benefited both myself, and my clients.
It’s heartening how many trainers are willing to share not only their good practice, but also their dilemmas, mistakes and difficulties. It’s often the difficulties that are most illuminating – What would I do in that situation? What did the trainer learn? What do I learn from their story? What is my practice?

It seems to be generally accepted practice to share information about work with clients, when training practitioners. There seem to be two strategies to attempt to hold the clients’ confidence safely – one is to avoid sharing information which would identify the client, and another is to agree a contract with trainees that they will hold information in confidence.
This is clearly inconsistent with how we manage client confidentiality with regard to supervision – specifically we tell our clients about supervision, and invite questions or concerns about that process.

Inadvertent disclosures do happen in training situations – the world of counselling and therapy is relatively small and well connected. A client story that stays in our trainer’s mind is also likely to have stayed in ours, if we have come across some part of it elsewhere. “I think I know this story” may be a familiar thought as a trainee.

I’ve thought quite a lot about confidentiality over the years. I’ve learnt to ‘wake up’ the process – to remind myself, and my clients, that I don’t offer or maintain confidentiality because it is a rule I need to follow, but instead because my clients usually feel safer to share because they know that I will keep their confidence.
I am clear with my clients when I will share information – I tell them about supervision, and about acting to prevent serious harm.
But what I haven’t done, until recently, is ask my clients about sharing information from sessions when I am training practitioners.

I’ve spent a lot of time as a client, so have a large store of client experiences of therapy and counselling to draw on, to illustrate and illuminate theory and practice for trainees. I know I have client permission, because I was the client.
I have generally either avoided sharing experience of work with my clients, whilst training, or done so in a highly circumspect way, whilst feeling quite uncomfortable about doing so. I would be mentally scanning for ways in which trainees might be able to put what I’m saying together with other information they hold, to cause an inadvertent breach of trust. I would be thinking about the trainees’ geographical, social and professional networks, to attempt to avoid any crossover with my client.

The balance has shifted over time – My energy and attention is now much more with my clients than with me as client. My own client stories have become stale – echoes of echoes, and I want to use more current experience to inform training discussions.
I do want to be more able to say to trainees: “I worked with a client who…”
This is a work in progress, and where I have got to is:

-I’ve started asking clients how they would feel about me sharing information in training situations.  It’s different to talking about supervision, because currently I’m making it clear that giving me permission to share in training is optional. The practical difficulty is that I then have to remember in the training moment whether that client has given me permission to share. I’m not sure if this is a sustainable approach in the long run, or whether I might move to making this kind of sharing a default part of the psychotherapy contract, with exceptions where indicated. (There are some circumstances where any information sharing could be psychologically or practically damaging).

-I will check if there are useful ways to illustrate the learning without using client material, for example; calling on my experience as a client, referring to the trainees’ own experience.

-I will run a quick guess/check about the likelihood of trainees coming across clients – I’m more cautious, for example, when training in the same county as my practice.

-I will actively disguise my client’s identity in training situations.

-I will, however, use more experience of interactions with clients in my training work – because it is really useful to do so.

Clients may not be as concerned about or affected by confidentiality as we are, and confidentiality is best held as a tool, rather than a rule.
Sharing our practice with trainees is a useful activity, which hopefully improves the quality of lives of both our trainees’ clients and our clients. We do, however, need to be congruent about how we do so.
I welcome any thoughts, comments and discussion about this…

© Stephen Tame 2015 stephentame@gmail.com

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