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Image showing words about words representing ethics and morals

Cognizance Therapeutic Principle

As a therapist, I must maintain good ethical practices in my clients’ best interests to promote their well-being.
Ethically the therapist-client relationship needs to be restricted by boundaries, and these important boundaries keep therapy focused on a working relationship and help protect both therapist and client.

No therapist should ever enter into any relationship outside of the normal therapeutic relationship. Any friendship, sexual relationships, financial partnerships, and any social and social media interaction is unethical.

No contact should be initiated outside of the regular therapy sessions unless necessary for rearranging or communicating changes to times and dates or to inform the client of cancellations or other essential information.

Online therapy ethics & ethos


As a professional full-time online therapist, I have for many years worked with clients in a way that I believe is founded on empathy, equality, and respect, and I now call this the cognizance therapeutic principle.

When working as a therapist, I do my best to create a harmonious and equal relationship between therapist and client. Although there is always a natural inequality between therapist and client, I found a working way that partly redresses the balance in a few essential areas.
Cognizance as a principle is the foundation that this online therapy service is based upon. It is the structure that binds together the ethical values and ethos to work with clients.

No testimonials requested from clients


I will not ask you to help me advertise my business by asking you to provide me with a testimonial; I work for you I do not expect you to work for me, nor do I expect you to interact with prospective clients who want to check if your testimonial is real or fake, that would not be ethical and very unprofessional and breaches the clients’ confidentiality.

Not charging for the first session


All therapists need to provide a free session to do risk assessments with their new clients and check to see if they are suitable before taking them on (especially working online). As successful therapy is often dependent on the therapeutic relationship’s strength, the client needs the time to see if they feel happy to continue. Not every therapist is suitable for every client. Why does the client have to pay for the privilege of finding out for themselves?

Promoting independence


In all interactions, I believe that the therapist should always try to build and promote the client’s autonomy by helping them to take responsibility for their own thoughts and actions. I do not ask for payment until after the session has ended, this gives the client time to reflect on the therapy session, and they have the freedom to pay only if they are happy to continue with therapy. This helps promote personal choice and responsibility.

No broken promises


There can never be any promise of success given to the client to persuade them to pay for therapy, which builds up false hope and can even damage a client’s self-esteem when therapy cannot deliver what has been promised. The truth is that all any therapist can do, is try their best to help you discover what is possible for you, I will do my very best to help and support you, to make the changes you want in your life, but I cannot promise you success only the possibility of progress.

This service tells the truth about your confidentiality.

It is important to inform my clients about the truth to help them make an informed choice based on facts and not misleading information, especially about confidentiality.

Some therapists promise total confidentiality but forget to inform the client that there is no total confidentiality as it is impossible to provide it. The truth is no security can be totally secure. All anyone can do is reduce the risks involved as much as it is practical and possible to do so.

Reducing information storage

One way to do that is to reduce risk is by reducing the amount of information stored or kept on file. One of the reasons why I do not keep detailed information about a client’s firsthand experiences or record sessions is to remove the possibility of a breach of confidentiality as much as is possible to do so.

Allowing the client to remain anonymous if they wish is one way to lessen the client’s risk, but it complicates working with people in crisis.

There is a risk that software can be insecure because of bad coding. People can steal sensitive documents, all offices can be broken into, and people can breach trust inadvertently or accidentally.

Not guaranteed

Whether you are promised HIPPA compliance or secure encrypted communications, which still does not guarantee total confidentiality, any statement promising any such guarantee is bad information at best and untruthful at worst; manipulating the client to get the clients custom.

There is nothing wrong in saying total confidentiality as most people know what the limits are. However, it still needs to be clarified for ethical disclosure, helping people to make an informed choice on the facts provided, not opinions

Application of cognizance

The principle covers five areas of focus.

Appreciation. 

To acknowledge the importance of the client’s morals, opinions, personal qualities, values, and personal experiences and hold them in high regard.

Awareness. 

To be conscious of the client’s life choices, internal and external emotional influences, and situational life pressures.

Knowledge.

To gain a working knowledge of the client’s world and help the client gain self-knowledge and behavioural and emotional insights. Perception. To see, hear and become aware of the importance of the client’s thoughts, emotions, life experiences and life choices. 

Recognition.

To accept that a client is a person of equal value who has the right to be treated as a human being with compassion and understanding.

The Cognizance Therapeutic principle is about helping the therapist be mindful of the client’s importance and value. It expects that the therapist will treat the client as a person of equal value and equal importance, to recognise the importance of respecting, upholding, and protecting the client’s autonomy and self-determination.

Working mindfully

As a therapist, I believe in working mindfully to enhance the client’s importance within the therapeutic alliance that I think is founded on equality and respect that I call the cognizance therapeutic principle.

The principle is founded on the belief that all humans are equal and treated on equal standing, whatever their race, religion, sex or sexual orientation. This way of working attempts to prioritise the relationship between therapist and client to prioritise the client’s experience and helps build trust and rapport while confirming the client’s importance, self-determination, and independence.

Actualising cognizance.

The therapeutic alliance between therapist and client is inherently unequal, as the client is always being seen as needing support, the therapist is seen as inheriting the supporting role.

As there will always be an imbalance of influence between therapist and client in the therapeutic relationship, the therapist can still be mindful of showing that both therapist and client are equally important by introducing the principle at the start of therapy. I achieve that by informing the client of four working practices, that is based on the principle.

Working practices

There is no charge for the first session.

The first contact is a time for evaluation for both therapist and client. Not charging equalises the relationship.
A free consultation gives both the client and therapist time to discover if continuing to the next paid session is in their best interests. The client needs to determine if they think the therapist can continue working with or if it is in their best interests to discontinue before becoming financially obligated. The therapist needs time to check if the client is suitable for the service they provide or any reasons why the offer of therapy needs to be discontinued, perhaps for ethical or safety concerns.

No charges for missed appointments

Automatically charging for a missed session in some cases both disrespects and punishes the client, the therapist, because of the natural imbalance between therapist and client. The therapist can impose the rules with impunity. Doing so not only risks disempowering the client but suggesting that the therapist is superior.

No payments are required until after the therapy session. The invoice is sent after the therapy session has ended to allow the client time to evaluate the session and their commitment to therapy without any pressure to continue from the therapist. This gives the client the responsibility to choose on their terms and, in so doing, enhance their independence.

No advanced payments required.

No payments are requested in advance or booking deposits. A therapist demanding payment in advance of the therapy session disrespects the client and brings the client’s trust into question, not a good start to a therapeutic relationship supposedly built on mutual trust and respect.

Equal Responsibility

The client and therapist each have an equal responsibility to attend any therapy sessions, and if the client has missed some sessions, the therapist may renegotiate the relationship.

This could include a condition that the client will pay for any further missed appointments without 48 hours prior notice or even insisting on payment in advance. This is allowing the therapist to protect themselves from being taken advantage of. therapy 

The exceptions

As therapy is complex, there must be limitations to protecting the therapist and client from unusual conditions. If the client has requested or insists on making payment for missing an appointment, the therapist can send the invoice and request payment. Insisting on not charging could disrespect the client’s wishes and personal ethics, so graciously excepting the reimbursement would be beneficial by recognising the importance of the client’s wishes. This may also confirm the client’s ability to make personal choices and further establish their independence.

Regularly missing sessions can be seen as the client creating an advantage over the therapist and being disrespectful. There could be mitigating circumstances that a therapist can judge as reasonable, such as the client is terminally ill and suffering from unpredictable consequences of the illness.
Under such conditions, the therapist may modify their arrangements.

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