As part of our work to protect the public and promote high standards of practice we launched the what complaints tell us about… resources in 2022. These resources are about different themes within therapy where complaints have been upheld. We are now continuing that work by preparing quarterly reviews from published complaints and looking at common themes to support members in identifying any common mistakes and helping clients understand what is and isn’t best practice.

The main allegations upheld against BACP members for the period of April to June 2023 can be summarised as follows:

Confidentiality

  • inappropriate sharing of information with a third party, without the client’s consent
  • proposal to write a report to third parties without client agreement
  • sharing information with a client that is related to their other clients

Boundaries

  • providing legal advice to a client (dual role) 
  • inviting a third party to a client session
  • providing individual therapy to different members of the same family without clear boundaries
  • use of text messages other than for arranging appointments 
  • accepting a client’s invitation to meet socially 
  • having a sexual relationship with a client

Contracting

  • not having a written contract, resulting in misunderstandings and confusion later
  • not being clear about arrangements with a third party

Therapeutic interventions or behaviour

  • not making the client the focus of attention 
  • lack of empathy 
  • using inappropriate and harmful language
  • inappropriate personal disclosures

Competence or fitness to practise

  • being psychologically unfit to practise
  • inappropriate tone in written messages
  • threatening tone of voice

Professional practice

  • arriving late for client sessions
  • allowing sessions to overrun 
  • changing rooms during a session
  • failing to review the client’s progress

Endings

  • ending abruptly and without warning
  • no proper ending
  • failing to provide details of alternative support

Candour

  • not taking steps to address the client’s concerns
  • not attempting to remediate harm or to apologise

Some of the complaints were around frequently recurring issues, such as unclear contracting with clients. Whilst written contracts may not be legally required, having only a verbal contract can lead to misunderstandings later. This may be because information is forgotten over time or because it is difficult to establish what was originally said and then becomes a situation of one word against the other.

As you can see from the summary of complaints, several published during the last three months concerned third parties. In some cases, the problem was with the therapist making disclosures to someone else without discussion with the client and without their consent. In other cases, the therapist invited a third party into the therapy session, without considering the impact on the original client and with no preparation or rationale. This led to a breakdown in trust between the client and counsellor.

Therapists need to be very clear about who their contract is actually with, and this is particularly important in family and couples therapy where multiple parties are involved. Which one is the client? In couples work, great care needs to be taken if you are offering some individual sessions with each partner as well as couples sessions. This is delicate work, requiring careful negotiation and agreement. In working with families, material disclosed in individual sessions should only be shared with other family members with the explicit agreement of the individuals concerned. Clear contracting means agreeing with each member where the boundaries of confidentiality lie, and maintaining those boundaries in order to retain the trust of each client. Such work can be complex, and should only be practised following rigorous training and with close supervision.

In the words of the Ethical Framework, ‘We must be competent to deliver the services being offered to at least fundamental professional standards or better.’ (Good Practice point 13).

Other complaints have been about endings, with the client and counsellor having differing perceptions about when the therapy had actually ended. The complaint might have been avoided had there been preparation for the ending and a distinct final session, maybe involving the reinforcement of boundaries and clarification around further contact - whether this was a pause or a conclusion, and whether the door would be left open for the client to return at a later date. Note; Good Practice point 39: ‘We will endeavour to inform clients well in advance of approaching endings and be sensitive to our client’s expectations and concerns when we are approaching the end of our work together.’

Overall, recent complaints have highlighted the need for clear and explicit contracting; safeguarding the therapeutic relationship; ensuring that both therapist and client agree about any communications with others and the possible involvement of others; and being clear about when the therapeutic contract has come to an end.

We have a number of resources that explore these topic areas in more detail in our 'What complaints tell us about.... ' series.

Read more...