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Supporting mission personnel and humanitarian workers worldwide

How we work - information for clients


Introduction. This page describes how we work with individuals in assessments, reviews, debriefing, and therapy. We do not ask you to sign a written contract, but we assume that you have agreed to the contents of this page when we work with you. Please click on each heading to read the details.

Confidentiality

General confidentiality. All client information shared with us, and not in the public domain, is kept confidential within ARREST, with the following exceptions:

Exceptions

  • Where a client gives permission for release of information (for example, to their company, or to another agency or health professional);
  • Where we consider there is a risk of harm, either to the client or to others;
  • Where a client discloses something that, by law, we have to share with the proper authorities (for example, knowledge of abuse of a child or vulnerable adult, or information about terrorism or other serious crime);
  • Any other exceptions described in our privacy policy.

  • Breaking confidentiality. If we need to break your confidentiality, we will do our best to inform you, and explain why.


    Third party information

    If you tell us information about a client without their knowledge, we usually have to tell the client unless there is a valid reason not to (such as a risk of serious harm). Even then, clients have a right to access their information. In the future we may need tell them what told us, if there is no longer a valid reason to withhold it from them.

    Confidentiality with children and families

    Children's confidentiality. Different members of a family, including children, have the right to confidentiality too. We will not automatically share information with other family members. When it is in a child's best interests to share information the child has given us with their parents or guardians, we will aim to gain the child's agreement before sharing it. We will, however, share information, without their agreement if necessary, to keep children safe.

    Older children. Please note that as children grow older, it is less likely to be in their best interests to share information with parents without their agreement. With adult children over 18, we will share necessary information with relevant health professionals rather than with parents.

    Supervision and training

    Supervision. To meet professional standards and ensure that we continue to offer a high quality service, we discuss our clinical work with supervisors. Our supervisors have their own confidentiality requirements, and in addition, we usually anonymise any casework that we take to supervision in order to protect our clients' confidentiality.

    Training. If we use case examples in teaching, we take special care to protect client confidentiality, for example by omitting or changing proper names or other details that might identify clients.

    Further privacy information

    This is a summary of our approach to confidentiality in our professional practice. For more detailed information about how we protect your privacy in compliance with data protection law, see our privacy policy.

    How we work with individuals

    Overview. The main services we offer to individuals are asssessments, reviews and debriefing, and therapy. These are offered face to face, or remotely by Skype, telephone or other channels.

    Assessments

    What is an assessment? In an assessment we will talk with you to work out what your mental health needs are. An assessment is usually a single appointment lasting 90 minutes to 3 hours, though occasionally it can extend across more than one appointment, or may involve gathering information (with your consent) from others.

    Couples & families. We can assess couples or families together or separately, as requested.

    Timing. Assessments can be carried out before deployment but can be offered mid-assignment.

    Outcomes. After our assessment we will give a conclusion and recommendations, which may include some of the following: no action needed; action for you or your company to take to help you on assignment; or further action required before you start or continue your assignment.

    After assignment. Particularly if you have a specific psychological need in mind, we also offer psychological assessments after assignment as distinct from a review or debriefing.

    Feedback. If requested, with your consent, we will provide feedback to your organisation about the outcome of assessment.

    Reviews and debriefing

    Personal debriefing. A review (also known as personal debriefing) is a specialist kind of assessment offered post-assignment or during home assignment. We aim to review with you the positive and negative aspects of your assignment and to identify what will help you thrive on your return to your host or passport country. Reviews usually last a minimum of 2-3 hours, and are available to individuals, couples, and families. We will usually conclude with recommendations, and will report to organisations only if requested.

    Critical incident debriefing. If you have experienced a critical incident (usually a life-threatening experience), we also offer critical incident stress debriefing to individuals, families, couples, and groups who have been affected by the same event. This involves talking through your experience and helping you to begin to move on from it.

    Is there a problem with debriefing?

    You may have heard of problems with debriefing. We have written extensively on the topic. See our publications or contact us for more details.

    Therapy

    Psychotherapy. We offer psychotherapy, a "talking treatment", in which the therapist works with you to achieve goals over a number of sessions. Though occasionally we use other approaches, our therapy is usually based on cognitive-behavioural therapy (CBT). This type of therapy focuses on how your thoughts, feelings, and behaviour affect each other, and look at practical ways to help you achieve your goals.

    Course. After an initial assessment we will discuss whether you need a further appointment. We may agree to meet for a set number of sessions and then review treatment, or to discuss at each appointment whether another is needed.

    Collaborative approach. We work collaboratively with you to help you gain more control over your life, and may ask you to complete tasks between sessions.

    Working with children and families

    Parent involvement. How we work with children changes depending on their emotional maturity. We usually involve parents, but less so as children grow older, depending on children's preferences and consent.

    Parents & assessments. In an assessment, there is a choice between the whole family coming together, or our assessing children and adults' needs separately. Sometimes it is important to consider each family member's needs in the context of the whole family, and to help the family work together on functioning better. At other times it is more helpful to focus on individual needs within the family.

    How we assess. To assess a child's needs, we usually begin with the whole family together, and may see children alone for part of the time, but will normally need to speak with at least one parent for most of the appointment. If you are coming as a family and want us to assess fully the needs of both children and parents, you may need to make a separate appointment for parents.

    Separately or together. Where children in a family have been living in a host country together, or have been affected by the same critical event, it is good to offer them the opportunity of debriefing together with their siblings and parents, but parents and children can sometimes be debriefed separately.

    Therapeutic approach. Our therapeutic approach tends to emphasise the child's behaviour more than their thoughts and feelings, again depending on their emotional maturity. Especially with younger children, we tend to work closely with parents and aim to help them find the best ways to help their children.

    How we communicate with you

    Overview. We offer remote services by email, Skype, telephone, and other platforms such as VSee. We may use any of these, and postal services and other methods, to contact you or others in connection with your care. There are limitations to the security of all forms of communication. Many of our clients work in contexts where they are unable to access the most secure communication methods. Where the choice is between insecure therapy and no therapy at all, we prefer to offer therapy, provided clients are aware of the risks.

    Email

    Emailing you. Regular email is not a secure way of communicating. We may use it to arrange appointments, but do not use it to send unencryped sensitive personal data. To communicate sensitive personal information, we may send you encrypted information via an email attachment or link that you will need a password to open. We will agree with you a way to send the password through a separate channel (e.g. SMS).

    Emailing us. You are welcome to email us or contact us between sessions. We may not always be able to respond immediately, and may defer our response until the next session. When you email or contact us, please be aware of the risks and consider sending sensitive information in a more secure way. If we have begun work with you, or worked with you before, we may ask you to use a secure method to email sensitive personal information. We have a variety of methods available for sensitive communication, and you may have your own. Ask us if you are unsure how to communicate securely.

    Skype

    Security. We use Skype for voice and audio calls, as it is encrypted, but we do not use Skype chats for sensitive personal information. We recognise concerns about the security of Skype, and also that many informed users in insecure environments view Skype communication as secure enough and better than no communication. We may use other secure platforms such as VSee, or Skype for Business, or Zoom as alternatives. Please see our article on Skype for a full discussion of our views on Skype.

    Logistics. When using Skype, we will arrange an agreed time and aim to call you. We will usually use video unless the connection may be poor. If the connection drops, we will try to call you back. We may disconnect the call if a connection drops to help make a new connection. If it is not possible to continue with a connection, we may continue on Skype chat. If a connection drops when you have disclosed information which leads us to believe you or someone else is at risk of harm, we may need to take action before speaking to you again.

    Other communication

    Please let us know if you are running late for an appointment, using our phone number if we have given it.

    Privacy

    Protecting your personal information

    Notes. The notes we write about you are mainly for the benefit of our working with you. They help remind us of details we need to remember so that we do not have to keep asking you too many of the same questions. We try to record only the information about you that helps us provide you with a good service. You can expect us to provide you with a copy of your notes on request. In rare circumstances (such as if it would put you at serious risk) we may withhold information from you.

    Security. We take client confidentiality and security very seriously, and store paper notes and electronic records securely in a variety of forms, including encrypted cloud and external media.

    Further information. See our privacy policy for further details of the information we collect about you, what we do with it, why, and what you can do about it.

    Boundaries

    What if we meet you elsewhere. Some of our work is in the public domain, or includes offering training and retreats attended by others. We also acknowledge that the mission sector we work in is a small world with many close connections. We may meet individual clients in other roles or contexts. If we do, we will not discuss the existence or content of therapeutic relationships in public.

    When it might be better not to work with you. Professional ethics advise extreme caution concerning relationships between therapists and clients outside therapy, and we need to hold those ethics in tension with the realities of working in a close-knit community. If you already know us from other contexts, you and we will need to consider whether it would be better for you to see someone else to meet you individual psychological needs.

    Social media. We do not accept contact requests from clients on social media. You are welcome to use our public Facebook page, or Debbie Hawker's or David Hawker's LinkedIn pages, to make general comments about our services or to like or endorse them. But please do not post confidential information there about you or anyone else.

    Googling you. We do not routinely conduct internet searches for individuals or families we work with. If you have a significant web presence that you would like us to be aware of, please direct us to it. You are welcome to search for us on the internet.

    Acknowledgements

    Portions of this page were adapted from information leaflets designed by InterHealth Worldwide and Dr Aaron Balick.



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