Wednesday, 23 February 2022

Practitioner ethics and Again Rachel

I do enjoy a good fiction book from time to time. 

It was 25 years ago that I read "Rachel's Holiday" by Marian Keyes (1998). This book took me on a journey through the then unknown territory of addiction. Centring around Rachel Walsh, a twenty-something relatively-single party-girl living in New York, who ODs then is signed into an Irish treatment centre called the Cloisters to treat her drug addiction. Over a period of weeks, she is brought, unwilling millimetre by millimetre, face to face with herself, her actions, and her shame. While it sounds quite depressing, I found it a joyful book.

Ms Keyes has just published a sequel about Rachel Walsh, called "Again Rachel" (2022). To set the scene, Rachel is now fully qualified as an addiction counsellor, and is head of the Cloister's treatment team. She has her own house, her sister's daughter Kate is living with her, she has a dog (though canine needs barely feature), is unmarried, but is seeing a nice man. The book begins with her old flame from the first book, Luke Costello, turning up in Ireland for his mother's funeral.

Over a couple of days, I devoured the book. But as I was reading, I became more uncomfortable. I found things which seemed so glaringly unethical that they began to spoil Rachel's return for me. After what felt to me like the authenticity of the Rachel's Holiday material, Again Rachel feels inexpert about counselling practice.

Firstly, as a counsellor, Rachel must be cognisant of recovery boundaries between herself and her clients. "Counselors who have successfully dealt with addictive disorders in their own lives can often relate to their clients with profound understanding, empathy and clarity" (Herring, 2002). Former addicts often become counsellors, but they will be made very aware of relapse, boundaries, and the professional line in their training. Counsellors use frequent self-reflection, have regular professional supervision, and will have to often explicitly evaluate and disclose any personal and ethical issues which may affect their ability to practice. Boundaries will be regularly tested. This is the normality of good practice. 

However, the book is silent on these practice issues and puts Rachel in a position where she appears unaware of her own actions and motivations over a period of six years. The result is that Rachel appears to be an unethical and oblivious practitioner.

Secondly, how safe are her clients while she is off in la-la land? If her self-knowledge is so poor, how must that affect her client relationships, objectivity and practice ability? Several sessions are mentioned where Rachel appears to turn up, just having come from a personally very traumatic situation: a less than ideal way to enter practice. 

Thirdly, Rachel often seems to 'wing-it' when seeing clients and leading group therapy. It seemed to me that client session preparation did not draw on processes or models. Sure, Rachel does her client research, but the theoretical considerations of practice appear absent. While too much of this would slow the narrative, a light seasoning of it would add authenticity.

Fourthly, as head of the counselling team, Rachel is leading others and so must meet a higher test for ethics. She would be well-aware of what her behaviour and state of mind needed to be, and that she needed to recuse herself from practice when the issues from her past began to arise. She should be well-aware in leading her staff what safe practice protocols are, and that she needs to lead by example. The signs in the book that Rachel evaluated her own safe practice, the safety of her clients, or the staff around her are absent.

These are not all the practice issues I noticed in the book, but they are the four big ones for me. 

I appreciate that this is fiction, and that Ms Keyes is a writer, not a counsellor.  But as a recovering addict herself, I figured that she would know what good practice consists of, and have access to good practitioners. She could consult to be sure that what she is writing is believable. 

Having read the reviews online, it appears that no one else has noticed the poor ethical practice. What did you think?


Sam

References

  • Keyes, M. (2022). Again, Rachel. Penguin Random House UK
  • Keyes, M. (1998). Rachel's Holiday. Penguin Random House UK
  • Herring, B. (2002). A Basic Set of Core Ethical Guidelines For Addiction Treatment Professionals. https://www.billherring.com/basic-set-core-ethical-guidelines-addiction-treatment-professionals

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