Dr Angela Kent

Profession: Practitioner psychologist

Registration Number: PYL17351

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 25/10/2021 End: 17:00 26/10/2021

Location: This hearing will take place virtually

Panel: Conduct and Competence Committee
Outcome: Caution

Please note that the decision can take up to 5 working days to be uploaded onto the HCPTS website. Please contact one of our Hearings Team Managers via tsteam@hcpts-uk.org or +44 (0)808 164 3084 if you require any further information.

 

Allegation

As a registered Psychologist (PYL17351) your fitness to practise is impaired by reason of misconduct. In that:

1. Between approximately April 2016 and December 2018, you did not maintain appropriate professional boundaries with Service User A, when :

a. You bought and/or gave Service User A presents, namely:

i. Bottles of vodka;

ii. Bunches of flowers and/or plants;

iii. Packets of cigarettes;

iv. 2 photo frames;

v. Drill set;

vi. Perfume;

vii. £50 voucher for ASDA;

viii. Advent calendars and/or Easter Eggs for Service User A’s children.

b. You bought a painting from Service User A;

c. You took Service User A to your own home and/or introduced Service User A to a family member, namely your daughter;

d. You took another service user to Service User A’ s home;

e. You invited Service User A to accompany you on a trip to the supermarket, ASDA;

f. You cuddled and/or hugged Service User A at the end of treatment sessions.

2. Between approximately May 2017 and January 2019 you sent a number of SMS texts to Service User A without a work-related reason to do so.

3. Between approximately May 2017 and March 2019, you made a number of phone calls to Service User A ‘s mobile without a work-related reason to do so.

4. The matters set out in particulars 1 to 3 amount to misconduct.

5. By reason of your misconduct your fitness to practise is impaired

Finding

Preliminary Matters

Application to amend the Allegation

1.Ms Reid applied at the outset of the hearing to amend Particular 1a.i and original Particular 1a.v of the Allegation so that they better reflected the evidence it expected to call. Ms Reid indicated that it was the HCPC’s intention to withdraw Particular 1e on grounds that there was no evidence on which the Panel would find it proved. Mr Kitching raised no objections to two of the three proposed amendments and submitted that the third proposed amendment (to Particular 1a.i) could be dealt with at a later stage in the proceedings and that this would not result in any witness having to be recalled.

2. The Panel has read all the papers in the case and is satisfied (i) that in withdrawing original Particular 1e, the HCPC has correctly identified the insufficiency of evidence to prove it and (ii) that the Registrant has been on notice of the HCPC’s intention to offer no evidence in relation to this part of the Allegation since 21 January 2021 and will have prepared her case on that basis. In these circumstances, the Panel approved the proposed withdrawal of Particular 1e of the Allegation and accordingly, it will be deleted, and original Particular 1f will now be re-numbered as Particular 1e.

3. In relation to original Particular 1a.v, the Panel notes that the Registrant was only given notice of this proposed amendment today. However, the Panel also notes that the Registrant does not object to the proposed amendment which adds an alternative type of DIY tool which it is alleged the Registrant gave to Service User A as a present. The Panel is satisfied that the proposed amendment does not cause prejudice or unfairness to the Registrant. Accordingly, the Panel approves this amendment.

4. At the conclusion of the evidence called by the HCPC, Ms Reid renewed her application to amend Particular 1a.i. This was in slightly different terms to those she had originally proposed in that Ms Reid proposed adding a new sub-particular as Particular 1a.ii with consequential re-numbering of the remaining sub-particulars of Particular 1a if the proposed amendment is approved by the Panel. Mr Kitching indicated that there would be no objection to the proposed amendment.

5. In relation to this proposed amendment, the Panel notes that Registrant does not object to the proposed amendment. The Panel is satisfied that it clarifies the allegation regarding alleged gifts of alcohol from the Registrant to Service User A. The Panel is satisfied that the proposed amendment does not cause prejudice or unfairness to the Registrant. Accordingly, the Panel approves this amendment as well as the consequential amendments to the numbering of the remainder of the sub-particulars of Particular 1a.

6. While the Panel was deliberating on the facts and grounds it noticed that the Allegation referred to the Registrant as “a registered Psychologist” rather than as “a registered Practitioner Psychologist” which is what appears on the HCPC Register. The Panel therefore proposed to amend the Allegation to reflect the Registrant’s entry on the Register. Both parties were put on notice of the Panel’s proposed amendment and given an opportunity to address the Panel. Neither party objected to the proposed amendment. The Panel, being satisfied that the there is no prejudice or unfairness to the Registrant, made the amendment.

Background

7. The Registrant is registered with the HCPC as a Psychologist. At the relevant time, the Registrant was employed as a Band 8B Principal Psychologist (Clinical) working within the Older Adult Community Mental Health Team of the Derbyshire Healthcare NHS Trust (the Trust). In her role, the Registrant was responsible for providing assessments and psychological interventions for patients over the age of 65 years suffering with functional illnesses (such as anxiety and depression). The Registrant also provided clinical and managerial supervision to other qualified psychologists in the South Derbyshire and South Dales Community Mental Health Team (CMHT).

8. The Registrant was also involved in a Trust project providing psychological support to six individuals, including Service User A, who had suffered traumatic sexual abuse in a children’s home. In Service User A’s case, the psychological support was to help her deal with the abuse and trauma she suffered during her childhood. This project work began in 2016 and was initially intended to be for only a limited period. However, this was extended in relation to Service User A to the end of December 2017. After this the Registrant continued to provide support to Service User A until late 2018.

9. During the relationship, it is alleged that the Registrant failed to maintain appropriate professional boundaries with Service User A by giving Service User A presents, buying a painting from her, taking Service User A to her own home, introducing Service User A to her daughter, bringing another patient to Service User A’s home, cuddling/hugging Service User A at the end of treatment sessions, sending personal text messages to her mobile phone and calling her without a work-related reason to do so. It is alleged that this behaviour caused Service User A to have concerns that the Registrant was trying to develop a romantic relationship with her. Service User A reported these concerns to the Trust’s Patient Experience Team on 12 March 2019. A follow-up interview with Service User A took place at her home on 18 March 2019.

10. The Trust started an internal investigation on about 4 April 2019 into Service User A’s concerns. The internal investigation reported in September 2019 and a disciplinary hearing took place in December 2019 which resulted in the Registrant’s dismissal by the Trust.

11. On 17 April 2019, the Trust referred its concerns regarding the Registrant to the HCPC.

Decision on Facts

Witness Evidence

12. The Panel heard evidence from three witnesses called by the HCPC:

i) Service User A
ii) JW is employed as a Band 8b Area Service Manager by the Trust. He has operational management of approximately eighty-two Trust staff members, as well as four sub-contractors who work within the Talking Therapies Service. JW was appointed by the Trust to conduct an internal investigation into the concerns raised by Service User A regarding the Registrant’s conduct on about 4 April 2019. During his investigation, JW was supported by LM, Clinical Psychologist and KH, Employee Relations Manager for People Services. The Panel has not heard from either LM or KH. The Panel notes that the terms of reference for the internal investigation are differently worded to those of the Allegation which it is considering.
iii) PB, who until her retirement from the position in June 2020, was employed by the Trust as a Band 8d Lead Psychologist for Acute and Community Services. In this position, PB was involved managing and providing management supervision to psychologists working in the Adult or Older Adult teams of the Trust and within the in-patient wards. PB was the Registrant’s line manager.
iv) The Registrant gave evidence. At the beginning of the hearing, Mr Kitching provided on her behalf a “matrix” of those matters in the Allegation which she admitted, admitted in part, or denied.
v) MK, the Registrant’s daughter.

Documentary evidence

13. The Panel has had regard to the documentary evidence provided by the parties. The HCPC bundle included but was not limited to the following documents:

  • Disciplinary Investigation Report and various appendices which included:
  • Notes of original meeting between the Trust and Service User A together with Service User A’s statement dated 7 August 2019
  • The Registrant’s pre-interview statement provided to the Trust on 29 May 2019
  • Statements of PB and DB taken by the Trust in June 2019
  • Character references provided to the Trust.

14. The Registrant’s bundle included:

  • A witness statement/reflection from the Registrant dated 10 August 2021
  • Emails
  • Training certificates
  • Testimonials
  • A note of a Complex Inquiry Team meeting

The Panel’s approach

15. In reaching its decision on the facts, the Panel has borne in mind that the burden of proving the Allegation is on the HCPC. The Registrant does not have to prove anything. The Panel has applied the civil standard of proof, namely the balance of probabilities, i.e., whether it is more likely than not that the events occurred.

Particular 1 – the stem

16. The Panel has approached the allegation set out in Paragraph 1 by first considering if it is satisfied that it is more likely then not that each of the factual matters alleged in the sub-paragraphs 1a.i to 1a.ix, 1b, 1c, 1d and 1e occurred. The Panel has then considered whether, in relation to each of the facts which it has found proved, it is satisfied that it is more likely than not that the Registrant did not maintain appropriate professional boundaries with Service User A.

Particular 1a.i is found not proved

17. At the outset of the hearing, Mr Kitching on the Registrant’s behalf indicated that the Registrant denied giving Service User A bottles of vodka but did admit giving her a small bottle of Baileys Liquor. At that stage in the proceedings there was no allegation which covered the gift of alcohol other than vodka. Before the close of the HCPC’s case, on the application of Ms Reid, the Panel agreed to amend the Allegation by adding an allegation of giving a bottle of alcohol other than vodka. This new allegation is numbered Particular 1a.ii.

18. The Registrant’s case is that she never gave Service User A bottles of vodka. She said she was worried about Service User A’s consumption of vodka on walks that she did every Saturday. The Registrant suggested that if she had given Service User A bottles of vodka as alleged it would have gone against the therapeutic approach she was adopting to encourage Service User A to cut down her consumption of vodka.

19. The evidence of Service User A to the Panel was that the Registrant would get the bottles of vodka on holiday and that she had been given bottles of vodka on four to five occasions and later added that it may have been six or seven times. Service User A explained that once a week on a Saturday when her children were with their father, she would go on a 27-mile walk and take vodka with her to drink. She said that the Registrant would sometimes buy the vodka for her walks and was the first person to recognise that her Saturday walks were an important time. Service User A claimed that there had been a couple of times when the Registrant had left receipts in the bag with the bottle of vodka, and she had those receipts at her home. When Service User A was cross examined by Mr Kitching, she was reminded that she had told the Trust on 18 March 2019 that the Registrant had given her 20 bottles of vodka and on 7 August 2019 that the Registrant had given her bottles of vodka on 25 to 30 occasions. When asked to explain the inconsistency in her various accounts of the number of bottles of vodka she claimed the Registrant had given her, Service User A said that she was relying on her memory and that because of the way her brain works, she has difficulty in remembering numbers and cannot count things. She denied having a drink problem or misusing alcohol. Service User A said the Registrant had advised against her drinking vodka on her walks.

20. Service User A accepted that she did purchase vodka herself and referred to a time when she had received some £6,500 from the police. This had enabled her to buy a few bottles of alcohol to put in her cabinet. She was referred to part of a text message from the Registrant on 26 December 2017 January 2018 which read “I hope you didn’t drink all of the vodka”. Service User A denied that she had purchased that vodka bottle but conceded that it was her routine for her Saturday walks to buy an inexpensive brand of vodka at a particular shop. She claimed that the Registrant had bought her bottles of more expensive vodka. When she was re-examined by Ms Reid Service User A said she herself bought vodka every week.

21. The Panel has concluded that the inconsistencies regarding the number of occasions or bottles of vodka given to her by the Registrant in Service User A’s account are significant. The Panel is satisfied that these undermine Service User A’s credibility and reliability on this matter. The Panel prefers the Registrant’s evidence and has given weight to her good character and to the fact that she has made numerous admissions to the other matters alleged against her. The Panel notes that there is no independent third-party evidence to support Service User A’s account. In these circumstances, the Panel has concluded that it does not have to consider the issue of not maintaining professional boundaries with Service User A and is satisfied that the HCPC has failed to discharge the burden of proving this matter.

22. Accordingly, the Panel finds Particular 1a.i not proved.

Particular 1a.ii is found proved

23. At the start of the proceedings this sub-particular of Particular 1 did not appear in the Allegation. However, as it has been indicated that the Registrant did admit giving Service User A a small bottle of Baileys liquor, the Panel agreed to amend the Allegation by adding an allegation of giving a bottle of alcohol other than vodka. Mr Kitching on behalf of the Registrant confirmed that the Registrant admitted this matter. The Registrant repeated her admission in evidence, explaining that in January 2018, she had given Service User A, a small bottle of Baileys which had been in the boot of her car. This had been for Service User A’s birthday which was a few days later. The Registrant explained that Service User A had made a resolution the previous year to mark her own birthday which she had never done before. The Registrant said that she had forgotten the date was approaching and had wanted to support Service User A in this resolution. The Registrant said she had had the choice between giving Service User A nothing or giving her an unwanted gift that she had in the boot of her car. She accepted that she had made the wrong decision.

24. Service User A was asked about receiving a bottle of Baileys from the Registrant by Ms Reid as this had not previously been mentioned by her in either interview with the Trust or in her witness statement for these proceedings. Service User A said she did now recall this but could not remember if it was for her birthday or not.

25. Based on the evidence and admission of the Registrant and the evidence of Service User A, the Panel is satisfied that the Registrant gave her a bottle of alcohol other than vodka.

26. The Panel has concluded that it was wholly inappropriate and unprofessional for the Registrant who knew that Service User A had a problem with alcohol in the past to give her alcohol, particularly where, as she claimed, she was supporting Service User A to cut down on her alcohol consumption. The Panel is also of the view that it was inappropriate and unprofessional for the Registrant to be giving a birthday present to Service User A. The Panel is satisfied that in making this gift, the Registrant did not maintain appropriate professional boundaries.

27. Accordingly, the Panel finds Particular 1a.ii proved.

Particular 1a.iii is found proved

28. At the outset of the hearing, Mr Kitching on the Registrant’s behalf indicated that she admitted giving bunches of flowers and a plant to Service User A. The Registrant confirmed her admission in her evidence and explained that she had given Service User A flowers from her own garden on about three occasions. She had also given her a plant which was one of several cuttings she had taken from a plant in her garden. The Panel also heard evidence from Service User A that the Registrant had first given her flowers from her garden at their first or second meeting. This had been the first gift she had received from the Registrant. Service User A gave evidence that she had received flowers from the Registrant’s Garden “a few times”.

29. Based on the evidence of both Service User A and the Registrant, the Panel is satisfied that the Registrant gave bunches of flowers and a plant to Service User A.

30. The Registrant denied that in doing this, she had not maintained appropriate professional boundaries with Service User A. The Panel is satisfied on the evidence of PB and of the Registrant herself, that SUA was a particularly vulnerable service user who had many insecurities. By giving Service User A gifts of flowers and a plant from her garden, the Registrant was potentially creating a situation where Service User A might come to rely on gifts from the Registrant and come to see this as a normalised component of their relationship. Service User A may have felt that the gifts were being foisted on her and query what the Registrant wanted or expected in return. The giving of gifts sets up different dynamics between the professional and the service user because of the power imbalance in their relationship. The Panel is satisfied that these gifts were inappropriate, and that the Registrant did not maintain appropriate professional boundaries when she made them.

31. Accordingly, the Panel finds Particular 1a.iii proved.

Particular 1a.iv is found proved

32. At the outset of the hearing, Mr Kitching on the Registrant’s behalf indicated that she admitted giving packets of cigarettes to Service User A. The Registrant confirmed her admission in her evidence and explained that she and Service User A had been in a shop so that Service User A could buy some milk. The Registrant had bought herself some cigarettes and had also bought one or two packets of cigarettes for Service User A. The Registrant also recalled a further occasion when she had been given some packets of cigarettes by a colleague and she had given a packet of these to Service User A.

33. The Panel notes that Service User A has given different accounts of how many packets of cigarettes she has been given by the Registrant. In her evidence to the Panel, Service User A said that the Registrant had given her cigarettes on five or six occasions. She referred to being given a packet from some cigarettes which had been bought back from a holiday and to cigarettes purchased from a shop. Service User A was seen twice as part of the Trust’s internal investigation. First on 18 March 2019, by PB and a colleague. The Panel has seen a typed version of the notes of that meeting, and it accepts the evidence of PB who took the notes, that while her typed version reflected what had been said by Service User A, she had put the various matters into some sort of order. PB told the Panel that Service User A had been distressed at times during the meeting, she had provided a lot of information which PB had found difficult to note so when she later typed up her notes of the meeting, she had organised the various gifts into a list which showed “packets of cigarettes (couple)”.

34. When Service User A was later interviewed as part of the investigation by JW on 7 August 2019, she stated that every time the Registrant went away, she would bring her cigarettes and estimated this to be roughly 25 to 30 times.

35. While the Panel notes the inconsistency in the accounts given by Service User A, it has concluded that Service User A’s initial account on 18 March 2019 and her evidence to the Panel are not significantly different from the Registrant’s account. In the circumstances, the Panel is satisfied that the Registrant gave at least three packets of cigarettes to Service User A.

36.The Registrant admitted from the outset that she did not maintain appropriate professional boundaries in giving packets of cigarettes to Service User A. The Panel has seen a text message in which the Registrant was counselling Service User A not to try to give up vodka, tablets, and smoking all at the same time. She suggested to Service User A that she should “let yourself smoke for now without beating yourself up”. The Panel considers that in making these gifts, the Registrant was encouraging a vulnerable service user, Service User A to continue with an unhealthy behaviour, and in doing so, she did not maintain appropriate professional boundaries. It is one thing to encourage and support a service user to give up smoking but quite another thing to support it by giving cigarettes as presents. The Panel considers that it was unprofessional of the Registrant and is satisfied that the Registrant did not maintain appropriate professional boundaries with Service User A by making these gifts.

37. Accordingly, the Panel finds Particular 1a.iv proved.

Particular 1a.v is found proved

38. At the outset of the hearing, Mr Kitching on the Registrant’s behalf indicated that she admitted giving Service User A 2 photo frames. The Registrant confirmed her admission in her evidence and explained that these had been two small photograph frames which she no longer needed and thought Service User A would like to use them for photographs of her children. In cross examination, the Registrant agreed that there were blue fish on the frames and that she had given them to Service User A for her birthday in January 2017.

39. Service User A’s evidence was that she had been given picture frames. In her Trust interviews on 18 March 2019, Service User A had described them as “2 little fish photo frames with Perspex glass” and on 7 August 2019 as “two blue fish photo frames”.

40. Based on the evidence from both Service User A and the Registrant, the Panel is satisfied that the Registrant gave Service User A 2 photo frames.

41. The Panel has concluded that this gift was made during the period when the Registrant was treating Service User A under the terms of a contract drawn up to cover the work on the project which at that time included five other service users. It appears from the evidence that the Registrant was treating Service User A differently to those other service users. The Panel takes the view that the gift of the photo frames was a very personal gift, especially when given to a such a vulnerable service user. It sent inappropriate signals to the service user. The Panel is satisfied that in making this gift, the Registrant did not maintain appropriate professional boundaries.

Particular 1a.vi is found proved in relation to the drill set only and not proved in relation to the small sander.

42. At the outset of the hearing, Mr Kitching on the Registrant’s behalf indicated that the Registrant admitted sending Service User A a small sander but denied sending a drill set. The Registrant confirmed her admission in her evidence and explained that she had ordered a small sander to be sent to Service User A. According to the Registrant, at the time, Service User A had been doing work on her kitchen and had taken all the cupboard doors off to sand down and then paint. The work had come to a standstill because of the number of layers of paint. The Registrant said that as the work was pre-occupying Service User A and she was worried about it coming to a stop, she had ordered a small sander for about £20 and arranged for it to be delivered to Service User A’s home. The Registrant said she had not seen the power tool herself and accepted the possibility that a drill set might have been sent in error.

43. According to Service User A, she received a drill set in the post from the Registrant. She said that she still had the drill set at her home. She told the Panel that “I’m a hammer and nails girl”. Service User A gave similar accounts both on 18 March 2019 and 7 August 2019 as part of the Trust’s investigation. The Panel has seen a text message from the Registrant to Service User A to watch out for something in the post and accepts that this text messages related to a power tool sent by the Registrant to Service User A. The Panel notes that Service User A is the only witness to have seen what arrived at her home. The Panel accepts Service User A’s evidence that it was a drill set she received and not a small sander. The Panel takes the view that the Registrant may well have intended to send a small sander as a gift but that this is not what was sent.

44. The Panel notes that this sub-particular is framed as “and/or”. The Panel is satisfied that only one power tool was sent to Service User A by the Registrant and that this was a drill set and not a small sander.

45. The Registrant admitted that in sending what she thought was a small sander to Service User A as a gift, she did not maintain appropriate professional boundaries. The Panel accepts this admission from the Registrant even though she was referring to a different power tool to the one the Panel has concluded was received by Service User A. The Panel feels able to accept her admission as the Registrant has agreed it is possible that the wrong power tool was delivered. The Registrant gave evidence that part of her role was to support Service User A to build her independence and resilience. The Panel considers that this gift was in effect “rescuing” Service User A and the professional boundary in this regard was to help Service User A to build independence and resilience. The Panel is satisfied that by sending her this gift, the Registrant did not maintain appropriate professional boundaries with Service User A.

46. Accordingly, the Panel finds Particular 1a.vi proved in relation to the drill set and not proved in relation to the small sander.

Particular 1a.vii is found proved

47. At the outset of the hearing, Mr Kitching on the Registrant’s behalf indicated that the Registrant denied giving Service User A perfume and had no recollection of having done so. In her evidence, the Registrant explained that she could only assume that Service User A was referring to an occasion where she had purchased a £20 Boots voucher from Service User A which she had received for Christmas 2017. The Registrant had purchased the Boots voucher as Service User A had said she did not shop at Boots and would not be able to use it. The Registrant said that she had later mentioned to Service User A that she had used the voucher to purchase some of her favourite perfume which had been drastically reduced in price. When she was cross-examined by Ms Reid, the Registrant said that she remembered showing Service User A her purchases which were in a bag from Boots but not giving her a bottle of perfume. The Registrant said it was possible that she might have done but she did not remember doing so.

48. Service User A gave evidence that she had once told the Registrant that she liked her perfume. She said that she had swapped a Boots voucher with the Registrant for cash. She said the Registrant had told her that she had used the voucher to buy some bottles of perfume and had given her one bottle from the bag. Service User A claimed that she did not in fact like the perfume and it was still at her house.

49. The Panel has concluded that it accepts Service User A’s evidence. It considers that there is a significant degree of agreement between Service User A and the Registrant about the circumstances surrounding the exchange of the Boots voucher for £20 cash and has decided that it is more likely than not that the Registrant has forgotten that she gave Service User A a small bottle of perfume. The Panel notes that the Registrant accepts that this is a possibility. In these circumstances, the Panel finds that the Registrant did give a small bottle of perfume to Service User A.

50. The Panel considers that it is inappropriate and unprofessional for the Registrant to be told that her perfume smells nice and then go on to give Service User A the same perfume. It is a very personal gift which gives too much information to Service User A about the Registrant’s private life. It does not protect the boundaries of either Service User A’s or the Registrant’s safe therapeutic space. The Panel is satisfied that in making this gift of perfume, the Registrant did not maintain appropriate professional boundaries.

51. Accordingly, the Panel finds Particular 1a.vii proved.

Particular 1a.viii is found proved

52. At the outset of the hearing, Mr Kitching on the Registrant’s behalf indicated that the Registrant admitted giving a £50 voucher for ASDA to Service User A but denied that in doing so, she had not maintained appropriate professional boundaries as she had given the voucher in error. The Registrant confirmed her admission in her evidence and explained that she had initially intended to give the voucher to Service User A but had changed her mind. Unbeknown to her, the voucher had been in a box of chocolates which she had given to Service User A and so had been given in error. The Registrant accepted that she had done nothing to remedy the situation and retrieve the voucher.

53. Service User A had told the Trust investigation on 18 March 2019 that when the Registrant had given her the £50 ASDA voucher at Christmas 2018, the Registrant had said it was for Service User A’s children as the Registrant knew that Service User A could not accept it for herself.

54. Based on this evidence, the Panel is satisfied that the Registrant did give a £50 ASDA voucher to Service User A. The Panel notes that if the Registrant did give the voucher in error, she did nothing to recover it.

55. The Panel considers that it is inappropriate and unprofessional for there to be any monetary exchanges between a psychologist and a service user. There are invariably procedures in place for the professional to report gifts made to them by service users. In this case, the Panel notes that the Registrant does not appear to have reported any of her gifts to the Registrant (as set out in the other particulars of Particular 1a) to the Trust. In making a gift of monetary gift of £50 by way of a voucher, the Registrant is reinforcing the power imbalance between herself and Service User A. It is indicating to Service User A that the Registrant is better off than she is to be able to afford to give her such an amount. The Panel acknowledges that if this was a genuine error, it might have been difficult but not impossible for the Registrant to rectify the error. The Panel is satisfied that in making this gift, the Registrant did not maintain appropriate professional boundaries with Service User A.

56. Accordingly, the Panel finds Particular 1a.viii proved.

Particular 1a.ix is found proved

57. At the outset of the hearing, Mr Kitching on the Registrant’s behalf indicated that the Registrant admitted giving Service User A an advent calendar and Easter Eggs for Service User A’s children. The Registrant confirmed her admission in her evidence and explained that the advent calendar had been in her car unlikely to be used and that in 2018, she had given two little Easter Eggs for Service User A’s children. The Registrant said that the gifts were intended to supplement gifts which Service User A had to give to her children.

58. Service User A did not specifically refer to these gifts in her evidence to the Panel, but she did refer to having been given an advent calendar when interviewed by JW on 7 August 2019 as part of the internal investigation.

59. The Panel is satisfied that the Registrant gave Service User A an advent calendar and two little Easter Eggs for her children.

60. The Registrant admitted that in making these gifts, she did not maintain appropriate professional boundaries. The Panel notes that the Registrant had been appointed to work with Service User A and that Service User A’s children were not part of that therapeutic relationship. The Panel considers that in making gifts to Service User A’s children, the Registrant was overstepping the professional boundary with her as Service User A may not have been able to afford to buy a similar level of gifts the following year. In her evidence, Service User A referred to the relationship she had with the Registrant as being “maternal”. The Panel considers that in making these gifts, the Registrant was reinforcing the “maternal” aspect of their relationship by getting closer to Service User A’s children, and views this as encroaching on Service User A’s family. The Registrant already knew that at some point her role with Service User A would come to an end by making these gifts to the children, she was creating a situation where she would have to end her involvement with those children. The Panel is in no doubt that the Registrant did not maintain appropriate boundaries with Service User A when she made these gifts.

61. Accordingly, the Panel finds Particular 1a.ix proved.

Particular 1 b is found proved

62. At the outset of the hearing, Mr Kitching on the Registrant’s behalf indicated that she admitted buying a painting from Service User A and that in doing so she had not maintained appropriate professional boundaries with Service User A. The Registrant repeated her admission in her evidence and explained that she had bought the painting in December 2017 at a time when Service User A had told her she was unable to buy her children Christmas presents, together with managing the expense of the Christmas period as her benefits had been stopped without warning. Service User A had told her that she was going to sell the painting. The Registrant suggested that it was agreed that she would buy the painting from Service User A to keep it safe and prevent her from losing it with a view to Service User A being able to buy the painting back once her benefits had been reinstated. The Registrant suggested that she never expected to keep the painting as she knew how much it meant to Service User A.

63. Service User A gave evidence that she had painted the painting herself and was quite proud of it. She said that she had told the Registrant that she was struggling financially but had not asked the Registrant for any money. Service User A said she had told the Registrant that she intended to sell the painting on the internet. She said the Registrant had said that she would buy the painting from her and offered her £200 for it which she accepted. The Registrant had given her a small memento of the painting. Service User A told the Panel that she had believed that the Registrant had wanted to buy the painting on its merits. She told the Panel that she had endorsed the back of the painting with the date and amount of the sale. Service User A told the Panel that she now believes that the Registrant had just wanted to give her money which she knew Service User A would not accept, and so had offered to buy the painting instead. Service User A confirmed that the Registrant had given the painting back to her after she had raised concerns about her with the Trust and that she has not repaid the £200.

64. The Panel has concluded that where there are differences in the accounts of Service User A and the Registrant, it prefers the evidence of Service User A. Service User A gave a detailed account of what she recalled had happened and the Panel accepts that Service User A believed that the Registrant had bought the painting on its merits and not as part of an arrangement to assist Service User A until her finances were sorted out.

65. The Panel notes the Registrant’s admission that in buying the painting she did not maintain professional boundaries with Service User A. The Panel takes the view that the Registrant would have remained within appropriate professional boundaries if she had restricted herself to supporting Service User A to sell the painting. In buying the painting the Registrant created a situation where she was taking something of emotional value to Service User A into her own home to hang. This action however well intentioned, made Service User A dependent on the Registrant. It did nothing to assist Service User A in developing independence and it created a personal proximity between the Registrant and Service User A and did nothing to maintain a safe therapeutic space. The Panel is satisfied that the Registrant did not maintain appropriate professional boundaries with Service User A when she bought the painting.

66. Accordingly, the Panel finds Particular 1b proved.

Particular 1 c is found proved

67. At the outset of the hearing, Mr Kitching on the Registrant’s behalf indicated that she admitted taking Service User A to her own home. Mr Kitching indicated that the Registrant also admitted she had introduced Service User A to her daughter. The Registrant repeated her admissions in her evidence. She explained that in 2018 she had made a short trip to her home with Service User A by car was to collect paperwork which Service User A had said she needed for a meeting the following week. The Registrant explained that Service User A’s solicitor had emailed her the paperwork so that she could then share it with Service User A who struggles to read or write due to dyslexia. The Registrant suggested that the reason she took Service User A with her was to collect the paperwork without losing the time which she had set aside to see Service User A. The Registrant told the Panel that she took Service User A into her home and that as Service User A was in the process of renovating her attic, she had taken Service User A to see her own renovated attic. The Registrant’s evidence was that she had not introduced Service User A to her daughter during this visit as her daughter was not at home.

68. The Registrant also gave evidence that there had been two occasions when her daughter, MK, had met Service User A. She said that on 18 September 2017 she had visited Service User A with her consent and knowledge to drop off a CD and wish her luck with an appointment which Service User A was due to attend that day. The Registrant’s daughter had been in the car with her, and Service User A had come out to the car to see her off and had been introduced to her daughter at that time. The Registrant said that Service User A had also met her daughter in September 2018 when the Registrant had responded to an urgent request from Service User A who had an important dental appointment but could not find anyone to look after her two children. The Registrant said she had agreed to take Service User A to her appointment and look after her children whilst she was with the dentist. She said that her daughter was with her as she was due to take her daughter to a sporting activity. The Registrant explained that she and her daughter had sat with the children whilst Service User A was in the dentist and she had then taken them all home via their corner shop, before taking her daughter on to her sporting activity.

69. The Panel also heard evidence from MK, the Registrant’s daughter who confirmed that she had never met Service User A at her home, but she had been introduced to her on two occasions. MK did not recall the dates but did recall meeting Service User A briefly outside Service User A’s home and again an occasion when she had been with her mother who was due to take her to a sporting activity. They had taken Service User A and her children to a dental appointment and she and her mother had looked after Service User A’s children while Service User A was with the dentist.

70. Service User A gave evidence that she had met the Registrant’s daughter on a number of occasions. She said that the Registrant had introduced her to her daughter when she had taken Service User A to her own home. She had been sitting in the Registrant’s kitchen and the Registrant’s daughter had come down and they had spoken. In cross examination, Service User A said that she had met the Registrant’s daughter who was just leaving the house. Service User A also said that the Registrant’s daughter had come to her home and played with her children three or four times.

71. Based on the evidence, including the Registrant’s admissions, the Panel is satisfied that the Registrant took Service User A to her own home. The Panel notes the difference in the accounts of the Registrant and MK and that of Service User A as to whether the Registrant introduced MK to Service User A at her own home. The Panel accepts the evidence of both the Registrant and MK that this did not happen and rejects Service User A’s evidence in this regard. In reaching this decision, the Panel has taken the Registrant’s good character into account as supporting her credibility. The Panel also notes that her account is corroborated by MK whose evidence that Panel found to be wholly credible. The Panel therefore finds that the HCPC has not discharged the burden of proving that the Registrant introduced her daughter to Service User A at her own home.

72. The Panel is also satisfied that the Registrant did introduce her daughter to Service User A on the two occasions which she had admitted in evidence, and which are corroborated by MK whose evidence that Panel has already indicated it found to be wholly credible. The Panel does not accept Service User A’s evidence that there were three or four occasions when the Registrant’s daughter played with her children at Service User A’s home.

73. The Panel notes that the Registrant accepts that in taking Service User A to her own home and in introducing Service User A to her daughter, she did not maintain appropriate boundaries. The Panel considers that it was wholly inappropriate to take Service User A to her own home. Psychologists should maintain a separation and distance from their clients. Clients should not know about their psychologists and their lives. The Panel considers that there were other options open to the Registrant to retrieve the paperwork needed by Service User A. The Panel is concerned to learn that the Registrant thought it appropriate to allow Service User A to see her renovated attic given Service User’s unresolved history of abuse in an attic at the Children’s Home. The Panel has no hesitation in finding that in taking Service User A to her own home, the Registrant did not maintain professional boundaries with Service User A.

74. The Panel is also satisfied that in introducing her daughter to Service User A on the two occasions referred to in her evidence, the Registrant did not maintain appropriate professional boundaries with Service User A. It is never appropriate to introduce family members to clients. Service User A may or may not have wanted to meet MK. It adds to the proximity of the relationship between the Registrant and Service User A now that their children have met. The Panel considers that Service User A should never have been put in that position.

75. Accordingly, the Panel finds Particular 1c proved.

Particular 1 d is found proved

76. At the outset of the hearing, Mr Kitching on the Registrant’s behalf indicated that she admitted taking another service user to Service User A’s home but denied that she did not maintain appropriate professional boundaries in doing so. The Registrant confirmed her admission in her evidence, explaining that she had arranged a one-off planned session with one other female service user (Service User B) at both service users’ request as she had considered that the meeting would be therapeutically helpful for both women as they had been in care together. She said that the meeting had been repeatedly requested by both women who had given their full consent. The Registrant said the meeting had been carefully planned and considered and that she had been mindful to discuss issues of confidentiality with them both, particularly since Service User A had stipulated that she would like the meeting to take place at her home and had rejected any alternatives. The Registrant said she was extremely careful to ensure that she had the full consent and understanding of both parties in advance to ensure that each party knew what was going to happen.

77. In Service User A’s witness statement, which she adopted as her evidence in chief, she had referred to there being two other patients of the Registrant who had been brought round to her house. The Panel has seen that in her meetings as part of the Trust’s investigation, Service User A also referred to there being two service users being taken to her house. However, the Panel has also seen a note of a meeting dated 8 June 2017 of the Complex Inquiry Team at which the Registrant was present. In the note of the meeting there is a reference to the proposed visit of one service user only to Service User A’s home address.

78. The Panel is satisfied that there was only one visit by one other service user to Service User A’s home and that Service User A is mistaken in her evidence when she refers to there being two service users. The Panel notes that the allegation refers to “another service user” in the singular.

79. In evidence before the Panel, Service User A said that she was aware that the Registrant was also dealing with other service users who had been in the same Children’s Home with her. She said she had felt pressured by the Registrant to act as an advocate to help other people to move forward and so she had agreed for the first service user to come round to her house. However, she said that no time had been set and she had been given about an hour’s notice from the Registrant by phone to say that they were on their way. When Service User B had arrived, she had hugged and greeted Service User A as if she had known her forever, but Service User A had not recognised Service User B. Service User B had thanked her for protecting her from certain members of staff in the Children’s Home who used to sexually abuse them. Service User B had suggested that the abuse happened in a certain room and when it was her turn to go into the room, Service User A had taken her place. Service User A said that she had no recollection of what Service User B was saying to her and no knowledge of protecting her from the abusers. When they had gone, Service User A said she was left feeling devastated by the visit and that all she could see was that she had taken someone else’s place to be abused and that was horrible.

80. The Panel is satisfied based on both Service User A’s evidence and that of the Registrant that the Registrant did take one other service user to Service User A’s home.

81. The Panel has heard and accepted evidence from PB that the Registrant did raise the possibility of arranging a meeting between Service User A and Service User B during one of their supervision sessions. PB said that whilst they had agreed that there could potentially be therapeutic value to this meeting it was not something that could be done easily without a lot of consideration around the risk issues and a thorough discussion with the safeguarding team to obtain their agreement. According to PB as there was no naturally occurring event for this meeting to take place, she had believed that the Registrant had not taken this any further. PB said she only learned of the meeting when told by Service User A in early 2019. The Panel has also seen hearsay evidence given as part of the Trust investigation from DA who was the Registrant’s clinical supervisor at the relevant time. The Panel has exercised caution in considering this evidence as DA is not a witness in this case. However, the Panel has concluded that it is appropriate to accept DA’s evidence that the Registrant had raised the possibility of a meeting between Service User A and another service user with her in supervision sessions. They had discussed this and decided that it would not be a good idea and as far as DA knew, no such meeting had taken place.

82. The Panel has concluded that it was not appropriate for such a meeting to take place anywhere other than a neutral venue as this breached both service users’ confidentiality and privacy. Service User B should not know where Service User A lived. Although the Registrant said that both service users had consented to the meeting, when she was cross examined by Ms Reid, the Registrant had accepted that it was not Service User A’s job to say where the professional boundaries were or to know where they were. The Registrant also accepted that it had not been appropriate to take Service User B to Service User A’s home. The Panel is satisfied that it was wholly inappropriate and unprofessional to take another service user to Service User A’s home and in doing so the Registrant did not maintain appropriate professional boundaries.

83. Accordingly, the Panel finds Particular 1d proved.

Particular 1 e is found proved

84. At the outset of the hearing, Mr Kitching on the Registrant’s behalf indicated that she admitted hugging Service User A at the end of treatment sessions on the basis that these were unsolicited hugs initiated by Service User A and that she had not been comfortable with this. Mr Kitching also indicated that the Registrant admitted that in doing so, she did not maintain appropriate professional boundaries with Service User A. The Registrant repeated her admission in her evidence, explaining that Service User A has approached her sometimes at the end of a session when she was getting into her car for a brief hug. She had not initiated this and would not characterise what happened as a “cuddle”.

85. Service User A’s evidence was that the Registrant had started hugging her at the end of their therapy sessions around three weeks after these had started. Service User A said she had just thought that this was how the Registrant was with her patients. Later in her evidence, Service User A said that the hugging had started as a “mutual thing”. She said that over time the hugging became a “chest to chest” hug and the Registrant would do it at the end of every therapy session. She said the hugs made her feel uncomfortable as she was not really the sort of person that likes to be hugged. Service User A accepted that she had not asked the Registrant to stop as she did not want to appear rude. In cross examination, Service User A explained that to her a “cuddle” and a “hug” was the same thing.

86. The Panel is satisfied based on the evidence of both Service User A and the Registrant that the Registrant hugged Service User A at the end of treatment sessions. The Panel does not see the need to consider whether or not there were also “cuddles” as Service User A has made it clear that to her this means the same things.

87. The Panel notes that the Registrant admits that she did not maintain appropriate professional boundaries by behaving in this way. In her evidence, the Registrant said she was acutely aware that boundaries are a crucial element in a client-therapist interaction; they set the limits for the therapist’s expression of power and a structure for the relationship, providing a consistent, reliable, predictable frame for the therapy. She said that at the time, she considered Service User A’s willingness to engage in physical interaction (a brief goodbye hug) as a positive sign and so she had allowed these hugs as a way of facilitating a positive and safe physical interaction. On reflection, however, the Registrant recognised that it would have been beneficial to have discussed this interaction with Service User A to carefully explore with her how they could keep their therapeutic relationship as clear and free from misinterpretation as possible.

88. The Panel considers that there should not have been any physical contact between the Registrant and Service User A that made Service User A feel uncomfortable. The Registrant should not have allowed the hugging to become normalised. Even if Service User A had considered hugging to be appropriate that does not make it so. The Panel accepts the Registrant’s admission and her analysis of why she did not maintain appropriate professional boundaries in this regard.

89. Accordingly, the Panel finds Particular 1e proved.

Particular 2 is found proved

90. At the outset of the hearing, Mr Kitching on the Registrant’s behalf indicated that she admitted sending a number of SMS text messages to Service User A without a work-related reason to do so, and that in doing so, she did not maintain appropriate professional boundaries with Service User A. The Registrant repeated her admission in her evidence, explaining that text messages were Service User A’s preferred method of communication. The Registrant said that the text messages were predominantly related to her sessions with Service User A or her ongoing support of Service User A after the project had ended. The Registrant stated that this form of contact left her actions open to misinterpretation and that over time the text messages had become too familiar in tone. The Registrant said that from 2018, particularly, the frequency of this form of communication had increased as the frequency of her direct contact with Service User A had decreased. The Registrant said that the text messages after December 2017 had been focused on supporting Service User A in relation to her medical needs, her outstanding claim cases, appointments and so on and these were related to the work that she was doing with Service User A at that time.

91. The Panel has seen a download of text messages between the Registrant and Service User A taken from Service User A’s mobile phone. The Panel has been able to review the nature, frequency, and content of these messages. The Panel can see that there were some clearly work-related text messages in which the Registrant was, for example, checking on appointments. However, there were too many texts which were signed off by the Registrant with an “x” or double “xx” or more. There were text messages sent by the Registrant on Christmas Day and Mother’s Day which were clearly not work-related. The Registrant discusses her own daughter in one text message and in other messages she talks about Service User A’s children who are not part of the work which the Registrant is doing on either a formal or more informal basis with Service User A. An example of a series of text messages which were not work-related, between the Registrant and Service User A sent on 13 April 2018 include the Registrant telling Service User A that she is “knackered” and explaining where she has been that day before moving on in the text to deal with what might be a work-related matter concerning Service User A’s eligibility for PIP payments. Service User A responds by suggesting that the Registrant comes round to her house, and they could get drunk and chat the night away and also suggests that the Registrant brings her daughter too and that it would be a “right laff”. Service User A then sends a second text to the Registrant saying “I think a girly night is just the therapy u need and I’m qualified to lol x.” The Registrant responded to these texts by saying “You are right” and then disclosed personal details about her daughter’s activities.

92. The Panel is satisfied that there are multiple examples in the text messages that they have seen which show by their content and the manner in which the Registrant signs them off with “kisses” that there was no work-related reason for sending these texts.

93. Accordingly, the Panel finds Particular 2 proved.

Particular 3 is found not proved

94. At the outset of the hearing, Mr Kitching on the Registrant’s behalf indicated that she denied making a number of phone calls to Service User A’s mobile phone without a work-related reason to do so. He also indicated that the Registrant denied that she did not maintain appropriate professional boundaries with Service User A when making phone calls to Service User A.

95. The Panel has seen heavily redacted phone records for the Registrant’s work mobile phone obtained by JW as part of the Trust’s internal investigation. Although the phone records have been redacted, those that were made to Service User A have been retained. The Panel has also seen a screen shot of Service User A’s mobile phone for the period 30 October 2018 to 3 January 2019. From these documents, it is clear that the Registrant did make a number of phone calls to Service User A and that these calls were of varying length.

96. Service User A’s evidence was that the Registrant would call her up to 20 times a week and during the calls they would discuss her partner and their relationship, her children, the police investigation, and the Registrant would encourage her to act as an advocate for survivors of abuse. The Panel notes that the phone records do not appear to substantiate the frequency of phone calls suggested by Service User A. The Registrant’s evidence was that all the phone calls were work-related. Her role with the Registrant after the end of 2017 had been focussed on more practical matters such as the police investigation and Service User A also needed help with the written side of this matter. She was also under medical care and needed assistance with appointments.

97. The Panel has considered whether it would be proper in this case to draw an inference from its finding of fact that there were text messages from the Registrant to Service User A for which there was no work-related reason, that this supports the HCPC’s case that some of the phone calls were similarly made without there being a work-related reason to do so. The Panel has concluded that it would not be proper to draw such a conclusion in this case. There is no independent evidence as to the content of the phone calls and so the Panel finds it cannot be satisfied that it is more likely than not that the HCPC has discharged the burden of proving Particular 3.

98. Accordingly, the Panel finds Particular 3 not proved.

Decision on Grounds

99. In reaching its decision on the statutory ground of misconduct, the Panel has taken note of the submissions of both parties. It has received and accepted legal advice.

100. The HCPC submissions were set out in the Case Summary and in further written submissions from Ms Reid. In summary, the submissions were that the number of failings of the Registrant over a long period of time, represent a sustained failure to maintain appropriate professional boundaries with a particularly vulnerable service user. Ms Reid submitted that the Registrant’s conduct, fell far below the standards expected of a registered Practitioner Psychologist. Ms Reid referred the Panel to certain standards in the HCPC Standards of Conduct, Performance and Ethics (2016) which she submitted were engaged in this case and had been breached.

101. Mr Kitching accepted on the Registrant’s behalf that by her admissions, repeated in her evidence and in her reflective statement, the Registrant had accepted that some of her conduct had fallen short of what was expected of a registered Practitioner Psychologist and amounted to misconduct.

102. When the Registrant gave evidence, she was asked by the Panel to explain why, as an experienced practitioner, she had found herself in the position where she had not maintained appropriate professional boundaries in a number of respects over a sustained period and why she had acted differently with Service User A to her other clients. The Registrant explained that the context of her work with Service User A had been completely different. Service User A had unique issues and completely different and overwhelming needs. There had also been a lack of resources. The Registrant said she had fallen into a “grey area” and had then allowed matters to drift. She had been working in isolation with Service User A who was reluctant to use anyone else. The Registrant said that it had been very easy under the circumstances to feel drawn in and the setting of the sessions (Service User A’s home) had made this more likely. She said that the therapeutic work had been diluted and once the project work with the five other service users had ended, she had felt quite responsible for Service User A because of the lack of other back up support for her. She had also felt impotent.

103. The Panel is satisfied that Registrant’s conduct which it has found proved, fell far below the high standards to be expected of a Practitioner Psychologist and that it amounts to serious misconduct. The Panel notes the Registrant’s acceptance that many of the matters alleged against her amount to misconduct. The Panel has concluded that these were not single or isolated departures from the standards expected of a Practitioner Psychologist. These were not single or isolated errors of judgement by the Registrant. Her failings were multi-dimensional: inappropriate gifts, inappropriate introductions, inappropriate physical contact, non-work-related text messages.

104. The Panel is satisfied that the cumulative effect of the Registrant’s misconduct impacted adversely on Service User A who told the Panel that she had been left devastated and in bits by it, she felt wrecked and was at best confused by the Registrant’s conduct. Service User A said she felt she had been misled and deceived by the Registrant as to the nature of their relationship.

105. Particular 1a.ii to ix – the Panel’s findings of fact in this Particular taken as a whole show that over a period of some two years, the Registrant gave a number of different gifts to Service User A including alcohol, in clear breach of appropriate professional boundaries. These were not single or isolated gifts. Professional boundaries are there to create a safe therapeutic space for both the client and the professional. In this case, Service User A was an extremely vulnerable client. The Registrant was aware of this. She also knew that Service User A was someone who had a history of making complaints against professionals when they did not meet her expectations or let her down. It was therefore particularly important that the Registrant made Service User A aware of where the professional boundaries of their relationship were and ensured that these were always appropriately maintained. The Panel is satisfied that she did not do this. In the circumstances, the Panel has no doubt that the Registrant’s conduct amounts to misconduct

106. The Panel considers that the Registrant’s misconduct impacted adversely on Service User A. Service User A gave evidence that when the Registrant had first started to give her presents, she had just thought the Registrant was being kind. She said she had not asked for presents, was not used to receiving such presents, and over time she had felt more awkward and uncomfortable as she could not give the Registrant anything in return.

107. In relation to Particular 1b, the Panel considers that the Registrant’s conduct in purchasing the painting from Service User A borders on an abuse of her position as a professional. It demonstrates that the Registrant had access to £200 and highlights the power imbalance between them. It is always important and the responsibility of the professional to ensure and maintain the correct power dynamic with clients. The Panel considers that this was particularly important with Service User A who might be described as a “professional complainer”. The Panel views the breach of professional boundaries in this matter as particularly serious and amounts to misconduct.

108. The Panel is satisfied that the Registrant’s misconduct impacted adversely on Service User A who had genuinely believed that the Registrant had admired the painting on its own merits and now she knew otherwise.

109. In relation to Particulars 1c, the Panel is satisfied that the Registrant’s conduct in taking Service User A to her own home and also introducing Service User A to her daughter in breach of professional boundaries, amounts to misconduct. Although Service User A only went to the Registrant’s home once and met her daughter on two occasions, the Panel take the view that the crossing of professional boundaries in this way is unacceptable behaviour in an experienced professional such as the Registrant who should have known that what she was doing was wholly unacceptable. The Registrant should not have revealed confidential information about her own address to the Registrant and she should not have revealed confidential information about Service User A to her own daughter. The Panel considers that the Registrant could have avoided both situations but chose not to do so.

110. In relation to Particular 1d, the Panel has no doubt that in taking another service user to Service User A’s home, the Registrant’s conduct fell far below the high standards expected of a Practitioner Psychologist. The Panel considers that the Registrant breached professional boundaries by revealing confidential information about both service users to each other and considers this to have been unprofessional and unacceptable. The Panel has no hesitation in concluding the Registrant’s conduct in this instance amounts to misconduct.

111. The Panel is satisfied that the Registrant’s misconduct impacted adversely on Service User A who felt that the meeting had been arranged at very short notice, had left her feeling completely drained and in utter shock and disbelief by what she had been told.

112. In relation to Particular 1e, the Panel has no difficulty in concluding that in hugging Service User A at the end of treatment sessions, the Registrant’s conduct fell below the standards expected of a Practitioner Psychologist. The Panel considers that the Registrant should have established appropriate professional boundaries with Service User A over physical contact, and it does not appear that she ever raised the matter with Service User A. The Panel is satisfied that the Registrant’s conduct amounts to misconduct.

113. In relation to Particular 2, the Panel notes that there were a significant number of non-work-related text messages from the Registrant to Service User A over a period of time. The Panel acknowledges that it was not alleged that in sending text messages without a work-related reason to do so, this too was a breach of professional boundaries. However, the Panel considers that it is very similar to it. For a practitioner to engage in personal communications with a client over a period of time, falls below the standards expected of them. The Panel has no hesitation, having regard to the content and manner of the text messages in this case, to find that this amounts to misconduct.

114. In reaching its decision on misconduct, the Panel has had in mind the HCPC Standards of Conduct, Performance and Ethics (2016) and has concluded that the following standards are engaged and have been breached:

Standard 1 Promote and protect the interests of service users and carers

Treat service users and carers with respect

1.1 You must treat service users and carers as individuals, respecting their privacy and dignity.

Maintain appropriate boundaries

1.7 You must keep your relationships with service users and carers professional

115. The Panel has concluded that the Registrant did not respect Service User A’s privacy when she introduced her to another service user and to her own daughter. The Panel also considers that the Registrant did not respect Service User A’s dignity when she bought the painting from her for £200 and then gave it back to her.

116. The Panel’s findings of fact in relation to Particular 1a-e demonstrate that over a period of two years the Registrant did not maintain appropriate professional boundaries with Service User A. The Panel’s findings of fact in relation to Particular 2 also demonstrate that the Registrant did not keep her relationship with Service User A professional.

Standard 5 Respect and confidentiality

Disclosing information

5.2 You must only disclose confidential information if:

  • you have permission;
  • the law allows it;
  • it is in the service user’s best interests; or
  • it is in the public interest, such as if it is necessary to protect public safety or prevent harm to other people.

117. The Panel has decided that the Registrant disclosed confidential information about both Service User A and Service User B when she introduced them to each other at Service User A’s home. The Panel does not consider that it was appropriate for either service user to know personal details about the other.

Standard 9 Be honest and trustworthy

Personal and professional behaviour

9.1 You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.

118. The Panel takes the view that the Registrant failed to make sure that her conduct justified the public’s trust and confidence in her and the Practitioner Psychologist profession when, for a period of over two years, she did not maintain appropriate professional boundaries with Service User A.

119. Accordingly, the Panel finds the statutory ground of misconduct proved in this case.

Decision on Impairment

120. The Panel heard evidence from the Registrant and a witness called on her behalf, Dr CB when this hearing reconvened on 25 October 2021. Prior to the hearing, the Panel had received a further witness statement from the Registrant dated 20 October 2021 in which she set out her further reflections on the issues that had led to these proceedings as well as her specific reflections on the Panel’s determination on the facts and statutory ground of misconduct.

121. In reaching its decision on impairment, the Panel has had regard to the Registrant’s evidence, the evidence of Dr CB, and to relevant documentary evidence in the form of testimonials and other documents in the Registrant’s bundle. The Panel has taken note of the submissions of both parties and the HCPTS Practice Note “Finding that Fitness to Practise is Impaired”. It has received and accepted legal advice. The Panel has borne in mind that the purpose of this hearing is not to punish the Registrant for past misdoings but to protect the public against the acts and omissions of those who are not fit to practise.

Submissions

122. Ms Reid submitted that the Registrant’s fitness to practise is impaired on both the personal and public components. In relation to the personal component, Ms Reid reminded the Panel that the misconduct was not an isolated incident but was, as the Panel has found, multi-dimensional, had continued over a period of around two years and had impacted adversely on a service user who, as the Registrant had known, was highly vulnerable. Ms Reid submitted that the misconduct was not easily remedied and that as it was not clear that the Registrant had fully remedied her misconduct, it could not be said that it was highly unlikely that this would not be repeated in the future. Ms Reid also submitted that the Registrant had only partial insight into her shortcomings.

123. In relation to the public component, Ms Reid submitted that a finding of impairment was necessary in this case to maintain standards and public confidence in the Practitioner Psychologist profession and in the regulatory process.

124. Mr Kitching submitted that this was a case in which the Panel could conclude that the Registrant’s fitness to practice is no longer impaired on either the personal or the public components. Mr Kitching explained that he used the words “no longer impaired” because he accepted that the Registrant’s fitness to practise had been impaired, and he specifically referred to late 2018 and early 2019. In relation to the personal component, Mr Kitching submitted that there has been no repetition of the misconduct. He referred to the gaining of insight as being a process of development and submitted that the Registrant has developed insight. This insight was evidenced by the Registrant’s admissions to the majority of the factual allegations and, significantly, her acceptance that her actions amounted to misconduct. Mr Kitching submitted that while the Registrant has accepted that the Panel’s description of her misconduct set out in its determination was well warranted, this was not recent insight. He submitted that the Registrant’s insight has developed as part of a process that started much earlier. Mr Kitching submitted that the misconduct was remediable, and he referred to the work the Registrant has undertaken to remedy her deficiencies through her reading and training and her supervision with Dr CB. He also referred to the Registrant’s genuine expressions of remorse and regret.

125. In relation to the public component, Mr Kitching submitted that the nature of the misconduct in this case was not such that a finding of impairment was required on public component grounds. He submitted that the Panel’s findings of fact and of misconduct in this case, as set out in its determination, were sufficient to mark the public interest in upholding standards and the public’s confidence in the profession. Mr Kitching submitted that neither a fellow member of the profession and a member of the public knowing the full facts of this case, including:

i) the context of the work the Registrant was asked and agreed to undertake;
ii) the serious nature of the failings;
iii) the Registrant’s acknowledgment of fault;
iv) the Registrant’s developing insight;
v) the steps taken by the Registrant to mitigate the risk of repetition;
vi) the fact that the Registrant had lost her job and had faced an internal inquiry and a disciplinary hearing by her former employer;
vii) the Registrant’s unblemished, lengthy and distinguished career;
viii) all the Panel’s comments in the determination
would consider that the Panel should find that the Registrant’s fitness to practise is impaired on public component grounds.

Decision

Personal component

126. The Panel first considered the personal component. The Panel has concluded that the misconduct in this case can be remedied. The Panel considers that the maintenance of appropriate professional boundaries is one of the fundamental and essential elements of the role of a Practitioner Psychologist. The Panel acknowledges that communicating with a service user by text is a fairly recent development in the profession which previously generally communicated with service users by letter. However, whatever the method of communication there should always be a work-related reason.

127. The Panel is satisfied that the Registrant has taken steps to remedy her misconduct. The Registrant told the Panel that she has spent the time since the complaint made against her in this case, reflecting on what had happened, how and why it had happened and she has examined her actions, her motives, and her errors of judgement. The Registrant said she had kept up to date with her Continuing Professional Development (CPD) requirements and had actively sought out and completed a number of paid courses related to the importance of setting and maintaining therapeutic boundaries. These included:

a) Professional Boundary training course (2 hours) with the National Training Academy;
b) Professional Boundaries in Health and Social care Level 2 – Learnpac;
c) Safeguarding Guarding Adults and Children – Learn with Unite.

128. The Registrant also said that she had devoted time to studying specific articles relevant to professional boundaries and explored what factors can cause a breakdown of boundaries and what to do if that happens. The Registrant referred to two particular articles which she had found “particularly thought-inspiring”: “Me and my Boundaries – a therapist’s tale” (September 2018), and “The dark side of professional ethics-APA-2014 A continuing education article Ethics Acculturation Model (EAM; Handlesman, Gottlieb, & Knapp, 2005)”.

129. The Registrant also told the Panel that she felt she would benefit from continuing the process of reflecting on what had happened with Service User A as she has been “profoundly shaken by the impact of this upon me as a person and as a Psychologist”. The Registrant said that she had started to work with Dr CB who was an experienced therapist and supervisor. She had also put in place measures for peer supervision and was attending a reflective practice group.

130. The Registrant said she had spent almost three years reflecting on this case, focussing on her actions and what she can do to make sure that it would never happen again. She said that if she found herself in a similar situation now, she would ensure that

1) She would not take on a significant piece of work of the same sort involving a significant number of re-traumatised clients, without clear information about the remit for the work, a direct line of communication with the referrers and an appropriate support system in place for the clients.

2) She would not take on a piece of clinical work without adequate clinical supervision in place from the outset of the work as this is a crucial point for addressing expectations, setting goals and therapeutic boundaries as well as understanding and managing powerful transference and countertransference.

131. The Registrant’s evidence of the steps she has taken to remedy her misconduct was amply supported by the evidence of her clinical supervisor, Dr CB. Dr CB is registered as a Practitioner Psychologist with the HCPC. She qualified as a Clinical Psychologist in 1981 and completed a Top-up Doctorate in Clinical Psychology in 2001. She has over 40 years’ experience working in the NHS, private sector and in higher education as a Clinical Psychologist. Dr CB has known the Registrant for about 10 years, having worked with her in the private sector for a number of years, during which time she supervised the Registrant’s work. Dr CB said she found the Registrant’s work to be of a very high standard and described her as an experienced Clinical Psychologist who communicated very well in her written work, who had a high standard of professional integrity, excellent timekeeping and had developed helpful working relationships with clients without any professional boundary issues. The Panel notes that other testimonial evidence confirms that the Registrant’s work apart from this matter has been to a high standard.

132. Dr CB told the Panel that in the summer of 2020 the Registrant had asked her to become her clinical supervisor for her work and also to supervise her in relation to these proceedings. Dr CB told the Panel that the Registrant wanted to understand the factors that had let to her misconduct so as to prevent a recurrence. They had met approximately once a month since then, including three meetings since August 2021 when the Panel had handed down its determination in respect of the facts and statutory ground.

133. Dr CB said that the Registrant had developed a very “in depth understanding” of what had gone wrong in her work with Service User A. Dr CB said that the while there were issues regarding the lack of clarity of the work and a lack of proper supervision of that work at the outset, the Registrant was willing to identify her own shortcomings and had not sought to blame others for what had gone wrong. Dr CB also referred to the Registrant having a “sophisticated understanding” of the factors in the contract itself and in Service User A which while they had led her to act “altruistically”, had in fact been detrimental to Service User A.

134. With regard to the risk of repetition, Dr CB told the Panel that the Registrant knew the aspects of Service User A’s difficulties that had drawn her in to “help” and resulted in her acting outside her normal role in breach of professional boundaries. The Registrant had considered carefully what to do in a similar situation and alternative ways to ensure a strong therapeutic relationship was maintained without breaching boundaries.

135. Dr CB said that she had seen the Panel’s determination and described the supervision sessions in relation to it as having been “very productive”. Dr CB said they had gone through the determination in detail to work out the “magnitude” of the breaches and what was so detrimental for Service User A. Dr CB said this had been “very valuable” to the Registrant’s understanding of the nature of what had happened and how to reduce the risk of repetition. Dr CB told the Panel that she considered the risk of repetition to be “highly unlikely”. She said the case had had a very significant impact on the Registrant and she had seen in the Registrant’s recent work examples of the Registrant being very careful to consider professional boundaries. Dr CB said that the Registrant is now able to apply the recent learning that she had undertaken to her work.

136. The Panel is satisfied that the Registrant has clearly understood what went wrong both during the time when she was treating Service User A along with the five other service users, and in the months during the period when her involvement with Service User A continued on an informal “as and when” basis. The Panel takes the view that the Registrant has developed good insight into her misconduct and the impact it has had not only on Service User A but also on her profession. The Registrant has recognised that by her actions she has damaged public confidence in her profession and brought it into disrepute.

137. The Panel is satisfied having read both statements submitted by the Registrant and having heard her evidence, that she has a good understanding of the wide-ranging impact of her misconduct on Service User A. It is an indication of her insight that the Registrant made significant admissions at the outset of this hearing which she confirmed in her evidence to the Panel. The Registrant has recognised that her conduct fell far below the high standards expected of a Practitioner Psychologist and indeed below her own standards, and it is a measure of her insight that in accepting full responsibility for what happened, the Registrant has not sought to lay the blame elsewhere.

138. The Panel is also satisfied that the Registrant has shown genuine remorse for her misconduct, as she demonstrated in her admissions, her evidence and in her reflective statement. Dr CB told the Panel that the Registrant has expressed a great deal of remorse. She described the Registrant as being “mortified” to have come to this situation. The Panel notes that the Registrant has thoroughly engaged with these proceedings and considers that the this has been a salutary experience for her.

139. The Panel has concluded that the Registrant has taken appropriate steps to remedy her misconduct and that the likelihood of her repeating it is low. The Registrant has good insight. She has taken active steps to put in place measures to ensure that in the future, should she find herself in a similar situation, she would recognise the “red flags” or potential dangers and know how to deal appropriately with them.

140. In these circumstances, the Panel has concluded that the Registrant’s fitness to practise is not impaired on the personal component.

Public component

141. The Panel first considered whether there was a need to make a finding of impairment in order to protect the public. The Panel has already found that the Registrant’s actions did cause Service User A unwarranted harm. However, the Panel has concluded, for all the reasons set out in relation the personal component above, that the risk of repetition in this case is low. The Panel has therefore concluded that a finding of impairment to protect the public under the public component is not required.

142. The Panel then considered whether, given the misconduct in this case, public confidence in the Practitioner Psychologist profession and its regulatory body would be undermined if there was no finding of impairment. The Panel has also considered whether it would be failing in its duty to declare and uphold proper standards of conduct and behaviour in that profession if it did not find impairment in this case.

143. The Panel considers that fellow professionals would be very concerned to hear of the Registrant’s misconduct and that a reasonable member of the public fully aware of all the facts would also be very concerned if there was no finding of impairment in this case. The Panel is satisfied that the Registrant breached a fundamental tenet of the Practitioner Psychologist profession when she did not adequately maintain appropriate professional boundaries with Service User A. The Panel is also satisfied that the Registrant’s misconduct has brought her profession into disrepute. However, while the Panel considers it is unlikely that in the future the Registrant will either breach a fundamental tenet of her profession or bring it into disrepute, it does not take the view that its findings of fact and of misconduct will be sufficient to maintain standards and the public’s confidence in the profession in this case.

144. The Registrant’s misconduct was, as the Panel has already noted, multi-dimensional and it continued over a period of almost two years. This was not an isolated incident and the impact of the misconduct on Service User A was significant. The Panel recognises that there have been no previous concerns regarding professional boundaries in relation to the Registrant’s work either before this matter or since. However, the Panel considers the failings in this case to be so serious and to fall far below the standards expected of a Practitioner Psychologist, that a finding of impairment is necessary not only to maintain public confidence in the profession and in its regulatory body but also to send out a message to the profession that such conduct will not be condoned.

145. The Panel therefore finds, on the public component, that the Registrant’s fitness to practise is impaired.

146. Accordingly, the Panel finds, on the public component alone, that the Registrant’s fitness to practise is impaired.

Decision on Sanction

147. In considering the appropriate and proportionate sanction in this case the Panel has taken note of the submissions of both parties. The Panel was referred to and has taken account of the HCPC’s Sanctions Policy. It has received and accepted legal advice. The Panel is aware that the purpose of any sanction it imposes is not to punish the Registrant, although it may have that effect, but it is to protect the public, to maintain confidence in the Practitioner Psychologist profession and to uphold its standards of conduct and behaviour. The Panel has also had in mind that any sanction it imposes must be appropriate and proportionate bearing in mind the findings it has made.

Submissions

148. Ms Reid reminded the Panel of the approach that it should adopt when considering sanctions and referred to various parts of the Sanctions Policy but did not advance submissions in respect of any particular sanction.

149. Mr Kitching submitted that the appropriate and proportionate sanction in this case was a Caution Order for a period of 12 months. He submitted that the findings in this case were such that while the Panel had found the Registrant’s failings to be serious, they did not fall within any of the categories set out in the Sanctions Policy under the heading “Serious Cases” (paragraphs 56 to 93). Mr Kitching referred to the Registrant’s motivation for her actions as being a misguided desire to help Service User A. He reminded the Panel that the Registrant has acknowledged the seriousness of the case, has developed good insight, shown genuine remorse and remedied her misconduct. He indicated that the Registrant accepts and understands the Panel’s decision on impairment and submitted that this is significant in and of itself, and a factor which should be relevant when considering the level of sanction required to satisfy the public interest aspect of the finding of impairment on the public component. In considering the factors set out in the Sanctions Policy which would usually be present when imposing a Caution Order, Mr Kitching submitted that the Registrant met the three of the factors set out in paragraph 101: there was a low risk of repetition, the Registrant had shown good insight and she had undertaken appropriate remediation. Referring to the fourth factor, Mr Kitching submitted that the Registrant’s conduct was isolated to a single service user but accepted that the conduct had persisted for a period of two years. He also submitted that the conduct was limited to a single service user but accepted that it was multi-dimensional. Mr Kitching also accepted that the conduct could not be described as “relatively minor”.

150. Mr Kitching submitted that as the Panel had not found impairment on the personal component a Conditions of Practice sanction was clearly inappropriate. There were no conditions necessary to satisfy the public interest identified by the Panel.

Decision

151. The Panel has considered mitigating and aggravating factors. The Panel first looked at the mitigating factors. The Panel notes the following:

  • there are no previous professional findings against the Registrant
  • the Registrant made early admissions to significant parts of the Allegation which extended beyond the facts to the statutory ground of misconduct
  • the Registrant has developed good insight
  • the Registrant has taken steps to remedy her misconduct
  • the Registrant has expressed genuine remorse, apologised, and has reflected properly on her misconduct.

152. The Panel considers the following to be an aggravating factor:
⦁ the harm caused to Service User A.

153. The Panel has considered the available sanctions in ascending order of seriousness. It has also decided that to take no action in this case would not be appropriate or proportionate given the serious nature of misconduct concerned. The Panel is satisfied that to ensure public confidence in the profession is not undermined, the misconduct must be marked by the imposition of a sanction.

154. The Panel then considered whether a Caution Order was the appropriate sanction. It has had in mind the HCPC’s Sanctions Policy paragraph 101 which states:

"A caution order is likely to be an appropriate sanction in cases in which:
⦁ the issue is isolated, limited, or relatively minor in nature;
⦁ there is a low risk of repetition;
⦁ the registrant has shown good insight; and
⦁ the registrant has undertaken appropriate remediation."

155. The Panel is satisfied that the Registrant has shown good insight into her misconduct which she had remedied by undertaking appropriately targeted training, put in place various forms of supervision appropriate for her experience, and has properly reflected on her failings. The Panel is also satisfied that the risk of repetition is low. The Panel has considered its findings in light of the Registrant’s otherwise lengthy and unblemished career. The Panel considers that the misconduct in this case involved one service user and so could be considered to have been (i) isolated in the sense that the Registrant must have seen hundreds if not thousands of service users during her career, and (ii) limited in the sense that it was time limited to a period of around two years. The Panel has already indicated that it is satisfied that the conduct could not be described as “relatively minor” but notes that the relevant bullet point in paragraph 101 of the Sanctions Policy is drafted in such a way that there is no requirement to find present all three of the factors set out therein.

156. The Panel has had very much in mind paragraph 102 of the Sanctions Policy which states:

“A caution order should be considered in cases where the nature of the allegations mean that meaningful practice restrictions cannot be imposed, but a suspension of practice order would be disproportionate.”

157. The Panel has concluded that since this is not a case which has involved clinical concerns for which conditions of practice might be appropriate, it would be artificial to devise workable or appropriate conditions of practice now since the Registrant has already done all that might have been asked of her by imposing conditions on her practice.

158. The Panel has also decided that while it is clear that the Registrant’s misconduct is serious, it does not consider it to be so serious that a Suspension Order is required to address the public interest concerns that arise. The Panel is satisfied that a Suspension Order in this case would be disproportionate.

159. The Panel has therefore concluded that the appropriate and proportionate sanction in this case is a Caution Order for a period of three years. The Panel first considered whether a period of one year would be sufficient in this case but has concluded that, given the serious nature of the issues involved, it would not be. The Panel takes the view that a Caution Order for a period of three years will enable the Registrant to continue to benefit from and reinforce the training and other measures she has already put in place to ensure that there is no repetition of her misconduct. The Panel is satisfied that a period of three years is required to mark the seriousness of the matter and to declare and uphold proper standards of conduct and behaviour in the Practitioner Psychologist profession. The Panel considers that the period of three years is required to send out a meaningful signal to the wider profession that such conduct is unacceptable. The Panel also considers that a period of three years is sufficient to maintain the public’s confidence in the profession and in its regulatory body.

Order

ORDER: The Registrar is directed to annotate the Register with a Caution Order against the name of Dr Angela Kent for a period of three years from the date on which the Order comes into effect.

Notes

No notes available

Hearing History

History of Hearings for Dr Angela Kent

Date Panel Hearing type Outcomes / Status
25/10/2021 Conduct and Competence Committee Final Hearing Caution
23/08/2021 Conduct and Competence Committee Final Hearing Adjourned part heard
;