Client Notes and Confidentiality

Counselling notes can be accessed by:

• the client themselves (under the GDPR or the General Data Protection Regulations 2018)
• the coroner (if the client has died)
• the police (if the client gives you their written permission, or otherwise by court order)

It may be unclear exactly whether the term ‘notes’ refers simply to the clinical notes (where the factual themes are recorded briefly in writing) or also to the counsellor’s process notes (which by nature may include conjecture).

Counsellors working in the NHS should be aware that if a client dies, the executor of their will or a relative can request the health records to be released.

Podcast 11 looked in detail at note-taking. Particular issues to bear in mind in terms of client confidentiality – and so to cover in contracting – are:

• what the limits of confidentiality are
• who can access which notes
• for how long notes are retained
• agency policies on disclosure, and on sharing notes with other bodies where there is inter-agency working

The Actualising Tendency

The concept of the actualising tendency is commonly associated with Abraham Maslow and Carl Rogers, but in fact it was first introduced by Kurt Goldstein, a German neurologist and psychiatrist, in 1934 in a book entitled The Organism. However, the idea did not gain traction until 1943, when Maslow’s paper ‘A Theory of Human Motivation’ was published in Psychological Review. This formed the basis of the model that would later become known as ‘Maslow’s hierarchy of needs’.

Many people assume that all humanistic psychologists think the same, but in fact there were differences between Goldstein’s, Maslow’s and Rogers’ views of the actualising tendency. Goldstein first put forward the concept as a theory of motivation, whereas Maslow related it to the human desire to be the best that you can be. Maslow also asserted that certain conditions needed to be fulfilled – that is, meeting physiological, safety, relationship and esteem needs ­– in order to self-actualise. Maslow believed that only 1% of people reach self-actualisation.

In 1959, Rogers outlined his own ideas on the actualising tendency in a book chapter, ‘A Theory of Therapy, Personality and Interpersonal Relationships’. While he shared Maslow’s values relating to the intrinsic goodness of human nature, and the innate capacity of individuals for personal growth, he disagreed that the actualising tendency was self-driven and automatic. Instead, Rogers argued that people need the right emotional environment in order to grow emotionally; in particular, we must receive empathy, genuineness and acceptance.

Rogers wrote about this too in his final book, A Way of Being, in 1980, seven years before his death. He illustrates this with the story of potato plants kept in unfavourable conditions, which nonetheless demonstrated a tendency to try their best to grow. Rory provides a quotation relating to this, available in the handout that you can get below. Just like potato plants, we humans have an innate drive to be the very best we can be, given the circumstances in which we find ourselves.

Offering a Free First Meeting

Following a potential client’s initial enquiry, counsellors in private practice may wish to offer an initial session free of charge. Ken discusses the benefits to both parties of doing this, and the issues that you need to bear in mind in order to act ethically and respectfully in this situation. Ken has found that over 90% of people who come for a free first meeting do continue to paid counselling.

Research in Practice

Rory likens research to a wedge of cheese, with the thick end being the substantial research that takes place in the higher-education environment, and the thin end representing the continuing professional development that we must all commit to doing. The Ethical Framework for the Counselling Professions (British Association for Counselling and Psychotherapy, 2016, p. 13) states: ‘We value research and systematic inquiry by practitioners as enhancing our professional knowledge and providing an evidence-base for practice in ways that benefit our clients.’ In the UK, all qualified counsellors have completed a research project as part of their training. It is vital that we research any unfamiliar issues relating to our clients, e.g. through reading and the internet.

Links and Resources

The Organism by Kurt Goldstein (first published in German in 1934, and now published as an English translation by MIT Press, 2000)

A Way of Being by Carl Rogers (Houghton Mifflin, 1980, with a new edition published in 1996)

Counselling Tutor Facebook group