More on the McCarron case

Last month I was alarmed to hear that the Health and Care Professions Council had failed to strike off a practitioner psychologist after finding allegations of serious sexual misconduct proved. The full committee findings are now online. I think it raises a few questions about how the panel came to its decision.

John McCarron, a psychologist from Lancashire. was suspended for a year after beginning a sexual relationship with a vulnerable client shortly after the therapy ended. I’ve chatted about the case on Twitter with various psychologists, all of whom have been shaking their heads at what looks like a worryingly lenient decision. I received a few thoughts from Leigh Emery about the sanction.

Been reading about this. Seems there are 2 important issues in this case:

1) the panel considered that sexual relationship was consensual and started after therapy had ended as a mitigating factor.

2) The HCPC sanctions policy allow for either striking off in most extreme circumstances (e.g. abuse) or, for lesser offences such as this, a maximum of 12 months suspension.

In this case the psychologist’s behaviour wasn’t considered extreme enough to warrant striking off as the relationship was consensual and started after therapy had ended, so he was given the next most severe sanction (12 months suspension).

I’m not saying I agree with the decision, just that this appears to be the reason for it. If you ask me, the HCPC sanctions policy needs reviewing.

Leigh also sent me a link to the HCPC Indicative Sanctions Policy. It doesn’t say a huge amount about the level of sanction for serious sexual misconduct. By comparison, the Indicative Sanctions Guidance for my own regulator, the Nursing and Midwifery Council, is quite clear.

In all cases of serious sexual misconduct, it will be highly likely that the only proportionate sanction will be a striking-off order. If panels decide to impose a sanction other than a striking-off order, then they will need to be particularly careful
in explaining clearly and fully the reasons why they made such a determination, so that it can be understood by those who have not heard all of the evidence in the case.

Also worth reading is the Professional Standards Authority’s Clear Sexual Boundaries Between Healthcare Professionals and Patients: Guidance for Fitness For Practise Panels. As with the HCPC sanctions policy, it doesn’t go so far as to say, “For x misconduct, issue y sanction”. However, it does point to some aggravating factors (e.g. vulnerability of the client, behaviour that could be construed as grooming) and mitigating ones in cases such as these.

Going back to Leigh’s interpretation of the findings, the relevant section seems to be this one.

86. In deciding which sanction to impose, the Panel is aware that Striking Off is a sanction of last resort for serious, deliberate and reckless acts involving abuse of trust, such as sexual abuse, dishonesty and persistent failure. The Registrant’s actions, as found, were sexually motivated and involved a serious breach of trust. However, the Panel takes the view that this was not a deliberate plan on the part of the Registrant. This was a mutually consensual and intimate relationship where the Registrant and Client A had made a conscious decision to embark on a romantic affair following the ending of their therapeutic relationship, albeit that was only a matter of days before. There can be no doubt that Client A was vulnerable and had psychological issues and this was a serious breach of professional boundaries. However, the Panel reminds itself that Striking Off is a sanction of last resort and believes that there remains scope for the Registrant to address and remedy his failings. The Panel is also aware that the Registrant had his own vulnerabilities which he failed to address.

It’s true that the sexual relationship only took place after the therapy ended (though, as the Panel concedes, we’re talking days afterwards). But it’s quite clear from the findings that the therapy was taking a sexual turn long beforehand.

17. At the second therapy session, on 20 November 2012, the Registrant asked Client A questions about her husband. A discussion ensued about the relationship between Client A and her husband which, according to Client A, made her feel ‘a little awkward.’…

20. In further therapy sessions the Registrant started to refer to Client A’s “awakened sexuality”. According to Client A, the Registrant would occasionally ask her whether she still thought about him, which Client A found embarrassing. During January 2013, Client A states that the Registrant set her homework tasks which included reflecting upon her ‘sexuality/intimacy.’ Client A felt that these tasks were unrelated to her own issues and subsequently went to a staff counsellor at her workplace to seek advice. In an email dated 25 January 2013, the Registrant asked Client A about her early experiences with her parents and how these might have impacted on her view of herself and her “sexuality and sexual interests”….

21. On 16 February 2013 Client A states that she received an email from the Registrant enquiring what her sexual fantasies were towards him.  Client A showed that email to a friend who advised her to stop receiving therapy from the Registrant.  Client A says that she ignored her friend’s advice as she was flattered by the attention that was being given to her by the Registrant.  Thereafter, Client A states that emails were exchanged between her and the Registrant where the issue of Client A’s sexual fantasies was revisited.

It also seems clear that the client had developed a romantic transference onto McCarron. This is something that can happen during therapy. When it does, it’s something that the therapist needs to be taking to supervision right away. Very likely it may have to result in passing the client to another therapist. At the very least it requires a clear statement about what the boundaries are. McCarron doesn’t seem to have done anything at all to maintain his boundaries. Quite the opposite in fact.

On a side note, in the various therapy abuse cases I’ve written about on this blog, I’ve seen several perpetrators try to pin the blame on transference and counter-transference as a way to excuse their actions. It hasn’t impressed me then and it doesn’t impress me now.

In the findings, there’s some discussion about certain homework tasks that McCarron set the client on the topic of sexuality. The hearing’s expert witness concluded that these tasks were not appropriate, but the Panel seems to have disagreed with some of his findings. I know that there’s a sex therapist who reads this blog regularly, so I’d be interested to hear his thoughts on this.

There’s a couple of other aspects of the hearing that leave me unimpressed with McCarron. I’m not impressed that he didn’t turn up to the hearing (though he did send a representative). I’m also not impressed that he tried some semantic mouthwash to argue that he wasn’t providing psychology, but life coaching. Neither of these tactics seem to have impressed the Panel either.

Believe it or not, this isn’t even the first time McCarron has faced a misconduct hearing. In 2007 he was disciplined by the British Psychological Society for using insulting language to his clients, calling one of them a “waste of space” and an “idiot”.

The findings end with some words about what ought to happen at the end of the suspension.

88. A future review Panel may be assisted by the personal attendance of the Registrant, and in addition that Panel may wish to hear from or on behalf of the Registrant as to how these circumstances amount to a breach of professional boundaries and how the Registrant came to breach the trust of his client, a patient to whom he owed a continuing duty of care, despite the fact that their professional therapeutic relationship had concluded before their intimate physical relationship commenced. That future Panel may also wish to hear how the Registrant will seek to avoid such a situation in the future if he were to resume his career, and what other measures have been taken by him to assist him in that respect.

 

Perhaps you might bother to turn up to that one, John?

 

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8 Comments to “More on the McCarron case”

  1. I wonder if there is a lack of understanding on the part of the HCPC about the significance of a sexual ‘relationship’ between client and therapist that starts after the therapy has ended. Talking therapy is different from other activities that the HCPC regulate. If I see a podiatrist (for example) as a client who I fancy and then we strike up a sexual relationship after I am no longer his/her patient then I can see that the HCPC might consider that not to be as serious an example of misconduct than if we started the relationship while I was still the patient. However, in psychological therapy the emotional and symbolic power difference between therapist and client can be present long after therapy ends and his would be one reason why a sexual relationship after therapy ends is still extremely concerning and, possibly, very damaging to the client. To me, this case highlights that the HCPC does not sufficiently understand the specific ethical intricacies of talking therapies in order to effectively regulate these practitioners.

    • I’m not sure that the problem is a lack of understanding of psychological therapies. After all, it’s not as if the psychotherapy bodies have been doing a better job in similar cases. Rob Waygood, suspended for 6 months by the UKCP; Stuart Macfarlane, suspended for 2 years by the Guild of Analytical Psychologists; Geoffrey Pick, suspended for 1 year by the Arbours Association and UKCP (then readmitted, then resigned when the media took an interest). All for the same kind of misconduct, or in some cases far worse.

      I think the HCPC Panel have simply made a bad decision. Even if one doesn’t take into account the therapeutic relationship, it’s still a vulnerable client, with what could easily be construed as grooming behaviour, and a registrant who hasn’t shown remorse and hasn’t turned up to the hearing to account for himself.

      I have absolutely no doubt that if this was a mental health nurse before the NMC, it would have been a striking-off.

  2. From a psychosexual therapy standpoint, my first thought on reading the HCPC online findings are that those who are supposed to regulate UK therapy, along with many of therapists and counsellors they notionally police, have a lot to learn about sex therapy and continue to be inadequately trained in raising sexual issues with clients and assisting clients to address them appropriately.

    The point about whether the homework set by John McCarron for his clients amounted to masturbation exercises is a good illustration of this. Neither the panel and its expert witnesses appear comfortable with the “M” word, preferring “self-pleasure” or the rather coy “solitary activity relating to her sexuality”. The point about sex therapy is that it deals with bodies and pleasures honestly. The obfuscation around the sexual homework means that it is impossible to know whether McCarron was asking his client to masturbate or to meditate on sex and sexuality. Both might be equally appropriate clinically in sex therapy work, but the reticence in use of language means it is impossible to say what was going on, even with the involvement of expert witnesses! This says all we need to know about how therapy and sex come together in the UK.

    Raising sexual issues with clients in a neutral way that is not seductive towards the clients is a skill that many therapists find hard to master. Rather than learn how to do it, they understandably often choose not to raise such issues at all for fear of acting inappropriately. Meanwhile, rogue therapists for whom seducing clients may be part of the attraction of the work, can continue to hide behind the transference smoke screen. Frankly I am fairly shocked at the HCPC’s readiness to accept transference as mitigation in this case, as it demonstrates a poor understanding of the theoretical concept and its application in therapy. I would argue that transference is nothing more than a spurious technical term that the early psychoanalysts used to explain the fact that they often wanted to sleep with their clients and vice versa. This was dressed up by Freud into a therapeutic technique, but I can only imagine it working when the therapist is a blank page psychoanalyst onto whom the client can project their fantasies. In the case of McCarron, who readily emailed his client about her sexual fantasies, whatever neutral therapeutic environment may have existed at the beginning of the work was long gone. For me, being attracted sexually to clients is natural and to be expected. It is what you do with it next that counts. What I advise trainees is that you should use any sexual attraction appropriately within the work to benefit first the client and second yourself. This may mean accepting openly that you and the client are attracted, that you cannot do anything about it and that you both try to learn from the experience. In the case of McCarron he got this completely wrong: first he appears to have dismissed the clients raising of her attraction to him by querying why she was telling him this and what she expected him to do. He had the chance to take the lead here and engage in real therapy. Instead, he appears to have decided, without setting any apparent boundaries, that the work should become more intimate. You can only imagine the client’s confusion, rejection and then her excitement at the renewed attention.

    The fact that McCarron and his client had sex only a few days after the therapy ended is highly suspicious and enabled him to slip through the ethical lacuna regarding sleeping with your clients (BAD) and sleeping with your ex clients (NOT BAD as long as appropriate time has elapsed). BACP for example, while prohibiting sexual relations with clients, only recommends that practitioners “think carefully about, and exercise considerable caution before, entering into personal relationships with former clients” and should expect to be “professionally accountable” if this is bad for the client. One of the rules of sex therapy is that you should not have any sexual relationship with your clients. Given the potential power any therapist has this seems to me to be necessary for us all, but particularly if we engage in sex therapy with clients. Call me old fashioned, but the fact that McCarron slept with a client who was married and therefore probably colluded in some sort of deception of her husband, indicates that he is a very poor understanding of individual ethics, let alone therapeutic ones.

    Even if we give McCarron the benefit of doubt in terms of deliberate sexual misconduct, it is clear that he was operating well beyond his competence and training by extending the original brief, helping a client with anxiety, to exploring her sexuality and encouraging its “awakening”. Setting masturbation exercises to enable a client to explore their own pleasure and encouraging them to explore sexual fantasies are standard sex therapy tools. But these tools should only be used as part of a well-thought out treatment plan that the client to which the client has consented and in a therapeutic relationship where the boundaries are crystal clear. This was far from the case. McCarron has been fortunate not to have been more severely censured.

    • Thanks for this. Given that I don’t have any knowledge or experience of sex therapy I was particularly looking forward to your take on the topic, and you’ve certainly given me a lot to think about.

      Overall what you say makes a lot of sense, and I find myself broadly agreeing with nearly everything you say above. Perhaps one exception may be about whether it’s okay to sleep with an ex-client . Though that might be because I work in a child and adolescent mental health service so have additional reasons to have reservations about that.

  3. I couldn’t agree with this blog and comments more. As for sleeping with a client, I understand that at least two years must have elapsed, and even then it’s dodgy territory. How can this decision be a deterrent to this sort of thing continuing to happen, or to protect the public? For a victim to go through this trauma, have the guts to report it, endure the stress of the hearing with aggressive and ridiculous questionning about life coaching, all for a mere suspension! How can the Registrant be diagnosed with counter-transference without a proper assessment, let alone questionning as he never bothered to turn up! It appears that the system (or this particular Panel) were more concerned about protecting their own profession, than the public.The determination that has been released contradicts itself and does not make sense. We can only hope that the PSA will review this decision and reverse this travesty of justice.

    • I personally have strong reservations about his sleeping with a client being assumed to be part of counter-transference. People develop sexual attractions to each other all the time in all kinds of different contexts, and there’s no need to invoke an abstract psychodynamic concept to explain it.

      I don’t think there’s anything unusual in a therapist feeling a sense of sexual attraction towards a client, simply because human beings are evolved to have those feelings. It’s just that most professionals don’t act on those sensations. Whether or not counter-transference is a factor, it really isn’t difficult to not sleep with clients.

  4. I think that what is being glossed over here by the HCPC is that the so called ending of the therapy does not sound by any means like a natural ending of a therapeutic process which has reached some sort of completion. Neither her original problems nor her transference had been worked through. It seems that he terminated the therapy precisely so that he can have sex with her, with no regard for her own well-being and the issues which made her seek help in the first place. Transference is a powerful thing, and therapists’ training (depending on the orientation) equips them at the very least to resist identifying with it, and ideally to see their patient through it and also use it to gain insight into their patient’s inner world. There is a power differential in the therapeutic relationship which always tips on the side of the therapist, even if the patient does not realise this. He abused his power. He failed her in every way.

  5. On the sleeping with clients point, my description of this practice as “not bad” if its an ex-client is a description of the current ethical orthodoxy for BACP, etc., rather than my own position. My own ethical position and that of College of Sexual and Relationship Therapists (COSRT), my accrediting organisation, is clear: “Sexual contact and/or sexualised behaviour by the Member are unacceptable with anyone to whom the Member is providing, or has provided therapy. It is not acceptable for a therapist to have a sexual relationship with anyone who is or has been his or her own client.” See: http://www.cosrt.org.uk/wp-content/uploads/2012/10/3_code_ethics_members.pdf

    How we manage our sexual feelings towards our clients and their feelings towards us is one of the most important skills a therapist can learn. However, none of the training I underwent dared cover this, which is unfortunate because in my experience trainee therapists often get themselves in these tangles and should be encouraged to learn from them. Unfortunately the message from on high is that this is a taboo not just in terms of action, but also serious professional discussion. I well recall the nervousness of trainees and the disapproving attitude of supervisor whenever this came up. While protecting clients is non-negotiable, we also need to recognise that therapists do make mistakes and train (and where necessary re-train) them to use the so-called transference therapeutically. Unfortunately, most therapists pretend this doesn’t exist, or doesn’t happen to them. As a result the profession doesn’t learn how easily it can happen and how damaging it can be. In this case, the result is that it can be seen as somehow acceptable that a therapist and client mark the end of therapy by getting in the sack.

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