Much of the guidance about avoiding complaints is around the therapeutic 'frame' - or how we contain the work to keep it safe, boundaried and professional. Here we explore what goes on within the therapy itself, and what can be learned from things therapists have said or done during sessions.

Many problems would have been avoided if therapists had considered the possible effect of their interventions on clients more carefully before making them. Ask yourself 鈥淗ow is this likely to be received?鈥� and 鈥淔or whose benefit am I about to say this?鈥�. The personal moral qualities of care, empathy, humility, integrity, respect and sincerity are particularly relevant here.

Members commit to 鈥榩ut clients first by 'Making clients our primary concern while we are working with them' and 'Providing an appropriate standard of service to our clients'. (Ethical Framework 鈥極ur commitment to clients鈥�).听This commitment is reflected in Good Practice points 7 and 12.

Complaints about therapeutic interventions

Clients have complained about their therapists for:

Failing to empathise:

  • not reflecting on how information might be received
  • using body language or expressions which imply disgust
  • being judgmental or accusatory
  • interpreting clients鈥� normal and understandable reactions as acting out

Losing objectivity:

  • giving a personal opinion
  • making self-disclosures out of personal need rather than to advance the therapy
  • appearing to be invested in a particular outcome for the client
  • showing bias in couples or family therapy

Behaving inappropriately:

  • using language or tone of voice which show a lack of self-control
  • being rude or offensive
  • being bullying or manipulative
  • making innuendos or sexual advances

Not communicating effectively:

  • using therapeutic jargon without explanation
  • using metaphors which are unfamiliar or offensive to the client
  • using phrases which cause the client distress

Key considerations for practice

Responsibility

Therapists should take responsibility for the service they provide and not blame the client if there is resistance or the work becomes challenging or stuck. (Ethical Framework, Good Practice, point 50)

Therapists handle this in different ways according to their particular modality but it鈥檚 essential to remain ethical.

  • Be clear from the beginning about the way you work and what you are offering
  • Establish the client鈥檚 needs and assess your ability to meet them
  • Be honest about the possible challenges the therapy may present
  • Check your client鈥檚 understanding and get their explicit agreement to proceed

Boundaries

A strong bond can develop between therapist and client, especially with long-term clients. You're likely to get to know a client at depth, being entrusted with personal information that maybe no one else knows. It is important to:

  • remember that the relationship is a professional one
  • monitor whether it is straying into something more personal

Boundaries are important to provide containment and safety for the therapy to take place, and to protect both therapist and client.

See Boundaries - what complaints tell us

Disclosure and objectivity

Giving your personal opinions is rarely appropriate in counselling and psychotherapy, especially with vulnerable clients who might be unduly influenced and disempowered. You also need to ensure that any personal disclosures you might make are for the benefit of the client and not to satisfy a personal need.

  • Retain your objectivity
  • Keep the work client-focused
  • Guard against displaying a bias, especially in couples or family therapy. Give equal attention and respect to each member.

Self-awareness and reflection

Self-awareness is vital and you should constantly consider it in your own reflections and in supervision (Ethical Framework, Good Practice, point 53)

  • Be reflective
  • Consider the likely impact of your words or actions
  • Take issues to supervision at an early stage
  • Develop your own internal supervisor to monitor and evaluate possible interventions in session

Client feedback

Mistaken assumptions about how the work is going could be avoided simply by checking with clients how they are finding the therapy. (Ethical Framework, Good Practice, points 32 and 54)

  • Review the progress of the therapy with the client
  • Pay close attention to how the therapeutic relationship is developing
  • Be aware of how clients are experiencing the work

Self-care and fitness to practise

Take care not to use your clients to meet your own needs. (Ethical Framework, Our commitment to clients 2a, Good Practice, points 18 and 91d)

  • Monitor your fitness to practise
  • Attend to your own self-care
  • Recognise when you need to take a break
  • Recognise when you should have personal therapy

Competence and fitness to practise

Make sure that you are competent to do the work you're undertaking. Recognise if you:

  • are straying beyond your remit or working outside your role
  • are not qualified to make a judgement
  • need to refer the client on to another service or a specialist
  • need further training or CPD

See Competence - what complaints tell us

Accountability and candour

Try to recognise when things are going wrong and take appropriate action quickly. This might include:

  • taking the matter to supervision as a matter of urgency
  • offering an apology to the client
  • considering whether any practical remedies are required
  • reflecting on what has happened and deciding what would now cause the least harm to the client

Work with the client to repair the therapeutic rupture and rebuild the relationship. Make sure you learn from the experience, so as to avoid repeating any mistakes.听