Safeguarding vulnerable adults in therapy

When a client presents for therapy we assess them in a number of different ways. Is this an issue we can help with? Are they suitable candidates for hypnosis? Are there medical issues or medications we need to be aware of? Do they think creatively, visually, or some other way? But what steps do you take to decide if they fall under the category of ‘vulnerable adult’? Do you think about it with every client or just the ones you think might come under the definitions?

What is a ‘vulnerable adult’?

Some organisations are moving away from the term ‘vulnerable’ and using terminology such as ‘adults in need of support’ or ‘adults at risk of harm’ but I’m going to stick to the more established terminology in this article.

According to the NHS a vulnerable adult is someone over the age of 16 who ‘is or may be for any reason unable to take care of him or herself, or unable to protect him or herself against significant harm or exploitation’ [1] and this makes the definition broader than you might think because it makes no mention of another important concept, that of ‘capacity’.

Capacity is defined by the Mental Capacity Act of 2005 [2] and essentially refers to whether or not someone is able to make rational, informed decisions. A lack of capacity can be indicated by the inability to understand, remember, or apply information that is essential to making a decision, or the inability to communicate a decision to someone else once it has been made.

Lack of capacity can be a temporary or permanent condition, and might be caused by mental or physical health conditions or brain injuries, or could be due to the use of alcohol or drugs. Simply making bad decisions doesn’t indicate a lack of capacity!

Which therapy clients need safeguarding?

Safeguarding a vulnerable adult is just what it sounds like. Taking whatever steps they need you to take (over and above what you do for every client) to keep them safe and free from harm or exploitation.

Clients who lack capacity are by definition vulnerable, but their lack of capacity means they cannot give consent for you to work with them. Their lack of capacity might also mean they are unsuited to hypnosis altogether, but if you do intend to work with someone in this situation, you would need written consent from whoever is responsible for their care. But – and this is important - having capacity and being able to take care of yourself are not the same thing.

Someone may have the mental capacity to make decisions for themselves and therefore to give consent for hypnotherapy, but still be considered ‘vulnerable’ because they are unable to take care of or protect themselves in other ways, for example, because of a physical disability. So, we need to be aware of any situations in which this arises and what to do about it.

Identifying vulnerable therapy clients

The first part of safeguarding someone who is vulnerable is, of course, recognizing that they fall into this category. This isn’t always easy, since harm and exploitation can occur in many ways: physical, psychological, emotional, organisational/institutional, or financial abuse, self-harm, discrimination, slavery, and so on. And we must also be aware that acts of omission and self-neglect can also result in harm.

Indicators that a client is susceptible to any of these might include:

• The presence of physical, psychological or emotional disabilities or conditions.
  
  
• Having special educational needs.
  
  
• Things the client tells you about their family, work, relationships etc.
  
  
• Things the client actively avoids talking about in sessions.
  
  
• Physical injuries or emotional/behavioural indicators that give you concerns about the client’s safety.
  
  

If you want to know more, there’s a very comprehensive list of indicators for all types of abuse and neglect on https://www.nidirect.gov.uk/articles/recognising-adult-abuse-exploitation-and-neglect 

 

How to safeguard a vulnerable therapy client

This is a tricky one, because how to safeguard a client is going to be an individual thing, depending on why they are considered vulnerable and what support and help they already have. However, you could think about:

• How might the nature of their vulnerability affect their suitability for hypnotherapy?
  
  
• How might the nature of their vulnerability influence the techniques we choose to help them?
  
  
• Do they need help in accessing our services? If so, what help can we offer?
  
  
• Do they need special considerations, such as a having a chaperone present during sessions?
  
  
• Do any ‘duty of care’ issues arise around their vulnerability?
  
  
• Can we ethically and respectfully balance these considerations with the client's entitlement to confidentiality?
  
  
• Do you need to take positive steps to avoid accusations that you are exploiting the client? (A tricky one, but those who think of hypnosis as mind control, or who seek to control the client's actions or spending, might express worries in that direction. Perhaps consider having a chaperone or recording the sessions when working with someone vulnerable.)

The Care Act also sets out several general principles that you can use to guide you in deciding what action to take. [3]

• Empowerment – encourage the client to make their own decisions where possible.
  
  
• Prevention – take action before a problem develops or gets worse if you can.
  
  
• Proportionality – make sure your response is proportional to the level of risk.
  
  
• Protection – ensure it is there where it is needed.
  
  
• Partnership –with the community and local services .
  
  
• Accountability – you are responsible for safeguarding your clients, accountability is also a part of supervision, so it’s worth discussing any clients you feel may need support due to vulnerability with your supervisor.
  
  

Remember if you suspect a client is being abused, neglected, or exploited, it isn’t your job to confront those involved or try to resolve the situation yourself. You should simply pass on your concerns to the proper authorities - probably after a discussion with your supervisor - and they will take the necessary action*.

 

*As we don’t have any automatic ‘duty to rescue’ enshrined in British law, you should always reserve the right to break confidentiality if you feel your client or others are at risk of harm in your client contract. Otherwise, you could act to save a vulnerable client from harm and find yourself being sued for breach of contract. There is more about this in the ‘bonus article’ that comes with my book ‘The Hypnotherapist’s Companion’.

 

 

 

 

 

[1] Uhs.nhs.uk. (2013). What does 'vulnerable adult' mean? [online] Available at: https://www.uhs.nhs.uk/HealthProfessionals/Clinical-law-updates/Whatismeantbyavulnerableadult.aspx. [accessed 8.12.20]

[2] Rethink Mental Illness. (n.d.). Mental capacity and mental illness. [online] Available at: https://www.rethink.org/advice-and-information/rights-restrictions/mental-health-laws/mental-capacity-and-mental-illness/?gclid=Cj0KCQiA5bz-BRD-ARIsABjT4nilR6ZTxt8-FFqM7bNn9gcL7bCCYOTUKFIDVVGDdXfzrzE9HveiF_gaAgcfEALw_wcB [Accessed 8 Dec. 2020].

[3] Ann Craft Trust. (n.d.). Six Principles of Adult Safeguarding - ACT. [online] Available at: https://www.anncrafttrust.org/resources/six-principles-adult-safeguarding/?gclid=Cj0KCQiA5bz-BRD-ARIsABjT4njv73Djz0NFgDdakPHHkKJhKimmbuTGuoRNHWabQFqWQHzJXMHS5UMaAldKEALw_wcB [Accessed 8 Dec. 2020].

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Author: Debbie Waller is an experienced hypnotherapist and hypnotherapy trainer. She is the author of Their Worlds, Your Words and has co-written the Hypnotherapy Handbook, both of which are available from Amazon.
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