Therapists: You Have a Clinical Will. But Would It Actually Work?

The new BACP Ethical Framework makes having a Clinical Will an explicit requirement. But for independent, remote and internationally practising therapists, the more important question may be whether it can actually be put into action. 

Most therapists understand the importance of planning for unexpected illness, incapacity or death. We recognise our responsibilities to clients, the need to protect confidential information, and the importance of preparing for circumstances in which we might suddenly become unable to practise.

Yet there is often a considerable distance between recognising those responsibilities and establishing arrangements that someone else could realistically implement. We might have discussed a Clinical Will in supervision, identified a trusted colleague, or completed a template and filed it safely away. But there is a question I think deserves considerably more attention:

If something happened to you tomorrow, would your Clinical Will actually work?

Not whether it exists. Not whether it has been signed or stored somewhere safe. But whether another person could put your arrangements into action when you were no longer available to explain them. There is an important difference between documenting our intentions and establishing a system that allows those intentions to be carried out.

What changes for BACP members in November 2026?
The new BACP Ethical Framework for the Counselling Professions 2026 becomes mandatory for members at midday on Tuesday 3 November 2026. It introduces an explicit requirement concerning Clinical Wills under section 4.5, which addresses managing breaks and endings in ways that minimise their impact on clients and service users. Two provisions are particularly relevant.

Section 4.5(d) requires practitioners to manage unplanned breaks or endings in ways that minimise the risk of harm and disruption to clients.

Section 4.5(e) requires practitioners to have a Clinical Will and appoint an executor who is bound by confidentiality and can communicate with clients if the practitioner becomes unable to contact them or dies.

This is an important development. The previous framework already addressed the responsibilities involved in unexpected illness and death, including appointing somebody to communicate with clients. The 2026 framework makes the requirement for a Clinical Will explicit. For BACP members who have yet to prepare one, the November deadline provides a clear reason to act. 

But I would encourage practitioners to think beyond the existence of the document itself. BACP does not prescribe a particular template or detailed continuity planning system. The framework establishes professional responsibilities while leaving practitioners to determine how they will meet them in their own circumstances. That creates a practical question.

How confident are you that your arrangements could actually be implemented?

When the unexpected becomes reality
My interest in clinical continuity is both professional and personal. As a therapist, I have long understood the ethical importance of preparing for unexpected endings. My work and writing have explored grief, client death and the impact of loss within therapeutic practice. However, my understanding of continuity planning changed considerably when serious illness unexpectedly interrupted my own work.

I experienced first-hand what it means to be unable to manage the ordinary responsibilities of a clinical practice, and to need arrangements that do not depend on the practitioner being available to provide instructions. Experiences like this bring questions about clinical continuity into sharper focus.

• Who knows that something has happened?
• Who understands what needs to be done?
• How will clients be contacted?
• Where is essential information held?
• Who has permission to access it, and how can they do so securely?

These are not questions we can necessarily resolve from a hospital bed, during a serious personal crisis, or after an unexpected death. They need to be considered beforehand.

A Clinical Will is not the same as a continuity system
A Clinical Will is an important document. It can identify a nominated Clinical Executor, record a practitioner's wishes and provide authority and instructions for appropriate action. But the document is only one part of effective continuity planning.
Imagine that a therapist has prepared a Clinical Will naming a trusted colleague.

The colleague knows they have been nominated and has agreed to act if necessary.

Then the therapist suddenly becomes unavailable.

The colleague needs to establish which clients have appointments scheduled, how to contact them, where relevant records are held, what immediate safeguarding considerations may exist, and which communications are appropriate.

But perhaps the appointment system is protected by two-factor authentication linked to the therapist's personal telephone. Client contact details are stored in another system. Nobody knows where the relevant access instructions are kept, and the colleague is uncertain what authority they have to use the information.

The Clinical Will exists. The nominated person is willing.

Yet the arrangements may still be extremely difficult to implement.

A Clinical Will records what should happen. A functioning continuity system makes it possible for the right person to take appropriate action.

That distinction matters because continuity planning is not simply about producing a document. It is about anticipating the practical circumstances in which that document might be needed.

The particular challenges of working independently
For therapists working within organisations, some continuity arrangements may already exist. A practice manager might recognise an unexplained absence. Administrative staff may have access to appointment information. Established procedures may determine how clients are contacted following an unexpected interruption. For independent practitioners, those structures may be absent. Many of us are responsible for almost every aspect of our own practice. We manage appointments, records, client communication, financial administration, technology and professional correspondence.
We may be the only person who knows how these systems fit together.

This becomes particularly relevant for therapists working remotely or from home. There may be no colleague physically present to recognise that we have become unwell or that appointments are being missed. For lone practitioners, even identifying that continuity arrangements need to be activated can present a challenge. And for therapists working internationally, additional considerations may arise. Our clients, professional bodies, supervisors, nominated colleagues and information systems may be located across different countries.

A Clinical Executor might be based in the UK while the therapist practises from France. Clients may be located elsewhere, and records may be held using services operated across multiple jurisdictions. These arrangements are not necessarily problematic, but they require deliberate planning.

The 2026 BACP Ethical Framework explicitly recognises that professional and legal responsibilities may vary between jurisdictions. Its requirements concerning confidentiality, safeguarding and cross-border working reinforce the importance of understanding the contexts in which we practise. We cannot simply assume that a traditional, locally focused Clinical Will template will address every practical consideration.

The information security problem
Before training as a therapist, I spent more than a decade working at IBM as an IT consultant. I have a degree in IT and extensive professional experience and training in information and data security. That background has strongly influenced how I think about clinical continuity. One of the central challenges is balancing two responsibilities that can initially appear to conflict.

We must protect client information against unauthorised access.

But we must also establish a secure and appropriate means for an authorised person to obtain essential information if we become unexpectedly unavailable.

Good information security does not mean making information inaccessible under every circumstance. It means establishing appropriate controls so that access is available to the right people, for legitimate purposes, under defined conditions. In therapeutic practice, this is particularly important because we hold deeply sensitive personal information. We cannot resolve the issue simply by sharing all our passwords with another person. Nor is it sufficient to store everything securely if nobody else can access the information when it is genuinely needed. A workable arrangement requires consideration of authority, access, security and proportionality.

The nominated person should be able to obtain the information necessary to undertake their agreed responsibilities without automatically receiving unrestricted access to everything in the therapist's professional or personal life. This is where clinical continuity planning becomes an exercise in information management as much as professional ethics.

Five questions worth asking about your existing arrangements
If you already have a Clinical Will, it may be worth considering the following questions.

1. Who would know that something had happened? Before anyone can implement continuity arrangements, somebody must recognise that they need to be activated. If you work alone, who would notice an unexplained absence? How would they know which person to contact? An effective arrangement should not depend entirely on clients reporting missed appointments.

2. Does your nominated person know what they have agreed to do? Naming someone in a document does not necessarily mean they understand the responsibilities involved. Have they explicitly agreed to the role? Do they know what might be expected of them? Have you discussed the practical and professional boundaries of their involvement? A clear, realistic agreement is more useful than a nomination made without detailed discussion.

3. Could they access the information they actually need? Consider your appointment system, client contact information, relevant clinical records and communication platforms. Where is this information held? What security measures protect it? Can the nominated person obtain appropriate access without relying on you to supply passwords or authorisation during an emergency? Access arrangements must be both practically workable and consistent with applicable confidentiality and data protection requirements.

4. Would they know what to do with the information? Access alone does not provide an operational plan. Would your nominated person know how to identify clients requiring urgent attention, communicate appropriately about your unexpected absence, and arrange suitable signposting or onward support? What instructions would help them make proportionate decisions without requiring unnecessary access to sensitive clinical material?

5. Have you reviewed your arrangements recently? Even a carefully prepared Clinical Will can become ineffective if the information supporting it is outdated. We change practice management systems, telephone numbers, email providers, supervisors and professional contacts. Our caseloads and working arrangements evolve. Continuity planning therefore needs to be maintained, rather than treated as a document completed once and filed away indefinitely.

Try looking at your practice through somebody else's eyes
One useful exercise is to imagine that you are the colleague who has been asked to activate your own continuity arrangements.

• You have no opportunity to ask the therapist any questions.
• You have only the documents, instructions and access arrangements that have already been prepared.
• Could you establish what needs to happen first?
• Would you know where to find the relevant information?
• Could you identify your responsibilities and their limits?
• Could you communicate appropriately with clients while preserving confidentiality?
• And could you do all of this without creating additional, avoidable difficulties for the people affected?

This exercise can expose gaps that are difficult to recognise when we are the person who knows how everything works. A process that feels obvious to us may be considerably less obvious to somebody encountering it for the first time, particularly in stressful circumstances.

Beyond compliance: continuity planning as professional care
It is understandable that therapists postpone this work. Considering our own incapacity or death can be uncomfortable. The administrative questions can seem complicated, and there is rarely a convenient time to work through them. For independent practitioners already balancing clinical responsibilities with the demands of running a business, continuity planning can easily become another task that remains on the list. The approaching BACP deadline may understandably encourage therapists to address the immediate requirement. But I believe it is helpful to view this work more broadly.

Clinical continuity is not simply an administrative exercise or a requirement imposed by a professional body. It is part of how we care for clients, including when we are no longer personally able to provide that care. We cannot guarantee that every unexpected event will be managed perfectly. Nor can we eliminate the distress or disruption that sudden endings may create.

What we can do is make reasonable preparations to reduce foreseeable difficulties, protect confidential information and help another person respond appropriately.

The aim is not to create an impossibly comprehensive system.

It is to ensure that the arrangements we have made are sufficiently clear, accessible and practical to be useful when they are needed.

From having a Clinical Will to having a workable plan
I developed the Clinical Continuity Toolkit in response to the gap between documenting professional intentions and creating practical arrangements that another person can implement. Drawing on my experience as a therapist, my personal experience of unexpected practice interruption, and my background in IT and information security, the toolkit provides a structured approach to continuity planning. It contains thirteen documents organised into nine sections, including a step-by-step Workbook, Clinical Continuity Will, worked examples, secure information arrangements, an operational Handover, communication templates and role-specific instructions. It is designed to be adaptable to different practice settings, including independent, remote, lone-working and international practice.

The objective is not simply to help therapists produce another document, but to help them establish arrangements that make sense for their own circumstances and can be understood by the people who may eventually need to use them.

The toolkit is available at an introductory price of £69 / 79€ until 12:00 noon French time on 3rd November 2026, after which the standard price will be £89 / 99€.
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Explore the Clinical Continuity Toolkit

Professional reference
British Association for Counselling and Psychotherapy (2026). Ethical Framework for the Counselling Professions 2026, particularly sections 3.1, 3.2 and 4.5.
Read the official BACP Ethical Framework 2026 (PDF)

Laura Harley is a BACP-accredited therapist and author of Confidential Grief: A Therapist's Guide to Client Suicide, Death, and the Impact on Practice. She previously worked for more than a decade as an IT consultant at IBM and has extensive experience in information security and data management. She practises internationally from France.
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This article offers general professional reflection and does not constitute legal or regulatory advice. Practitioners should ensure their continuity arrangements are appropriate to their own professional obligations and applicable legal requirements.