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?