A Clinical Will is a set of instructions made by a therapist, counsellor or coach for what will happen to their practice in the event that they are no longer able to work due to sudden illness or death. As a minimum, it lays out how clients can be contacted and supported if a practitioner is unable to do so themselves. Additionally, a Clinical Will might also include details of other people or organisations related to a practitioner’s business that might need to be notified.
Importantly, the requirement is not only to make sure clients are notified if their therapist or counsellor is taken ill or dies, but that any contact is made by an appropriate person and takes place within the limits of clinical confidentiality. This person, usually known as a Clinical Trustee, might also help clients think about finding a new therapist, or simply support them in coming to terms with an unplanned end to their therapy. Therefore, the person we appoint to contact our clients on our behalf is usually a trusted colleague.
Imagine a client coming to a session to find that their therapist isn’t there. No one answers the door. They have a phone number or email address they can use to contact their therapist, but there is no reply. A few days later, they still haven’t heard from their therapist. The client is in the dark and unsure about whether to come for their next session, or even whether the therapy will continue.
What the client doesn’t know is that their therapist was taken ill suddenly and won’t be able to contact their clients until they recover. This really happens, or worse; therapists, like all people, sometimes die unexpectedly. In cases like these, clients are left unsupported and likely worried or distressed about what might have happened to their therapist. Often, the only person who knows where to find a comprehensive list of client contact details is the practitioner themselves.
Ethical practice is the foundation of our work as therapists, counsellors and coaches, and is based on our commitment to always act in the best interests of our clients. As part of our duty of care towards our clients, we have to consider what will happen in the event that we are suddenly unable to carry on working with them. For many clients, an unexpected or unexplained ending in the therapeutic process might be disturbing or damaging. For these reasons, Clinical Wills are explicitly mandated in the ethical frameworks of all major professional membership organisations such as the BACP, UKCP and BPC, as well as many training organisations.
A separate function of a Clinical Will is to reduce the administrative and emotional burden on family or friends if we fall ill or die, especially as they may be anxious or grieving, or preoccupied with other duties relating to our illness or death. In the same way that we take our ethical responsibilities seriously as practitioners, we should also consider how to minimise the impact of our illness or death on those closest to us - a Clinical Will helps do this.
In the event of death or illness of sufficient
severity to prevent the practitioner communicating directly with clients, we
will have appointed someone to communicate with clients and support them in
making alternative arrangements where this is desired. The person undertaking
this work will be bound by the confidentiality agreed between the practitioner
and client, and will usually be a trusted colleague, a specially appointed
trustee or a supervisor.
BACP Code of Ethics and Professional Practice
As a practitioner you must... have arrangements
in place for informing clients and, where appropriate, providing them with support
in the event of your illness or death.
UKCP Code of Ethics and Professional Practice
You must have a process in place to ensure that appropriate action will be taken if you were to
unexpectedly become unavailable, for example, due to serious illness, death, suspension or dismissal.
This is usually referred to as having a ‘clinical will’. Arrangements include identifying who will be
responsible for informing and arranging support for your clients if you are suddenly unavailable, and
ensure that any other relevant person or organisation such as a referring agency is also informed.
Employers may have a policy to make sure that this happens, independent practitioners must arrange their
own. Therapists must declare that they have arrangements in place that cover their practice.
BABCP Clinical Wills Policy
Registrants must nominate two colleagues to
hold a list of their patients and supervisees in confidence, in the event of
death or an inability to work.
BPC Code of Ethics
More recently, the BPC has drawn up additional, detailed guidance on Clinical Wills and how to give instructions to Clinical Trustees, available here.
Any Clinical Will needs to meet the following requirements to be fit for purpose:
The information contained in a Clinical Will needs to be easily accessible by a Clinical Trustee, so that they can contact and support clients if a practitioner is unable to do so themselves.
Practitioners need to store all client records, including those contained in a Clinical Will in line with data protection regulations such as the UK GDPR and DPA 2018. This means giving a Clinical Trustee access to records that include process notes or other information not related to the function of a Clinical Will would breach these regulations, as would making client information available to anyone not acting as your Clinical Trustee.
A Clinical Will also needs to be up-to-date. This means making necessary changes to client details as soon as possible. Forgetting to do this might mean that your Clinical Trustee does not contact a client you have taken on recently or mistakenly contacts a client you have already finished working with.
ClinicalWill.app is designed with these requirements in mind.
If you work as a practitioner in an organisational setting, there may be a formal procedure in place in case you fall ill or die. However, if you work in private practice you will need to take responsibility for your own Clinical Will. This may also apply if you work for a smaller organisation. If you are unsure, it is your responsibility to check, as it is unlikely anyone else will do so on your behalf.
The following practical points will help you set up a Clinical Will that is fit-for-purpose. As a starting point, decide what information to include. As a minimum, a Clinical Will should contain:
You may also want to include:
Beyond this information, you might also want to include non-clinical details related to your practice, such as:
As well as the information your Clinical Will contains, you also need to consider who will make sure your instructions are carried out, and how. Planning this will be your responsibility, therefore you should make sure you:
Once you have set up your Clinical Will, chosen your Clinical Trustees and Next of Kin or Clinical Will Initiator, it is important that you make sure the arrangements you have put in place remain fit-for-purpose as long as you are working. In particular, this means you should:
Lastly, it is important to remember that creating your Clinical Will will involve considering circumstances in which you might fall ill or die, or in which you might have to act as a Clinical Trustee for a colleague yourself. You might find doing this isn’t easy, either in relation to yourself, or in considering the likely impact on family, friends, clients and colleagues. As well as the practical planning involved, you might want help in working through the wider implications of what it means to face the possibility of your own death or illness, or that of a colleague. If you feel you need more support, you could speak to your supervisor or therapist about this.