The advice below is provided by the BACP, the Britist Association for Counselling and Psychotherapy. The original document may be viewed here
Professionals such as doctors and dentists are expected to provide patients with a quality service and we generally have some idea of what to expect when we seek their help. People receiving therapy are entitled to just as good a standard of care. However, many intending clients do not know what to expect or what is or is not normal in therapy. They are unlikely to know whether any concerns they may have are valid or not.
In the first part, I will suggest ways of working with your therapist to make the most of the therapy, particularly when difficulties arise. In the second part I will deal with the situation when attempts to resolve the problem have failed. I will then explain the role of BACP in providing information and dealing with complaints against its members. When choosing a therapist, it is wise to select someone who belongs to a professional body with a complaints procedure.
On this web page, the word ‘client’ refers to anyone receiving counselling or psychotherapy, irrespective of the setting. The words ‘therapist’ and ‘therapy’ include ‘counsellor/psychotherapist’ and ‘counselling/psychotherapy’. A ‘client’ may be an individual, a couple, a family or group receiving therapy. This is regardless of whether there is any payment by the client for those services.
How to make the most of therapy
You can get the best results by:
- Being open
- Saying how you are really feeling
- Giving your therapist honest feedback on how you experience the therapy.
Good therapy should feel safe and enable you to take risks with the issues you are prepared to work on. This includes saying how you think that you and your therapist are working together.
Working with your therapist when things go wrong
You may start out hoping for a good outcome from therapy or you may be ambivalent. Whatever your expectations may have been, something may happen that leaves you feeling uncomfortable or unsure. You may feel confused, or feel that what took place wasn’t helpful. It can be really hard to say ‘You are not helping me’ or ‘I felt bothered about x or y after our last session’ and to explain why you feel this way. The therapist may come across as a powerful person and you may worry about their reaction to critical comments.
The therapy may have been useful until something happened which felt disturbing. You may be reluctant to talk about this for fear of spoiling what had been a good relationship. Uncomfortable feelings are normal and it can be hard to accept that therapy is not always a comfortable process. Therapists strive to deliver a good standard of care but sometimes, as in all human relationships, things can go wrong. The question is how to tell your therapist about your concerns.
It is important to:
- Accept your uncomfortable feelings
- Think about what has caused them
- Discuss them with your therapist.
Thinking about the problem
If you feel uncomfortable about any particular aspect of your therapy, it is important to spend time thinking about why. It might be something like:
- My therapist first agreed to see me for a reduced fee but now says she must increase her charges and I can’t afford it
- My therapist keeps changing the time of my appointment at short notice
- I found out that my therapist is a trainee and I think she should have told me at the beginning. I worry about whether she is good enough
- My therapist often doesn’t say anything and waits for me to speak. The long silences make me feel uncomfortable
- My therapist used to give me a hug but now doesn’t
- I would feel better if my therapist would give me a hug sometimes, but she won’t
- My therapist often talks about herself in sessions. I feel annoyed because sometimes the session is more about her than me
- My therapist said I could ring her whenever I needed her but now she’s told me to stop and I don’t understand why
- My counsellor wants to tape some of my sessions. I don’t know if this is normal
- I feel very uncomfortable because my counsellor takes notes during sessions
- I met my therapist in a social setting and felt disturbed by some of the things she said about herself. I can’t relate to her now in the same way that I did before
- My therapist suddenly told me that she can’t carry on working with me because she got a fulltime job and next week will be my last session. I feel she’s dumping me and I’m very upset
- My therapist won’t give me any advice although I keep asking her what I should do. I expected to be given more help in making decisions
- My therapist has suggested we meet at her home rather than my GP’s surgery where we started. Is that all right?
Talking to someone trustworthy or writing down what happened might help to clarify your thoughts and feelings. The aim is to be clear about what your concern is before talking to your therapist.
Telling the therapist what the issue is
Once you have thought about the issue, you should talk to the therapist. This is important if the therapy is to continue to be useful. You could choose to email, telephone or write a letter. It can sometimes be easier to say difficult things about problems in a relationship when there is some distance between the individuals. It is best to tell your therapist what is wrong as soon as you can. Most people who start therapy do so because they want to feel better. It can be puzzling if you find that you feel worse. This is not unusual because therapy can be stressful and is uncomfortable at times. However, sometimes therapists can get things wrong. It is important to check out why your therapist behaved in the way that they did. Even a small thing such as the way the therapist spoke, the particular words used, the tone of voice or facial expression can be unsettling. A competent therapist will listen in an open way and work with you to understand what took place, and thereby achieve a better outcome.
You should give regular feedback during sessions about what aspects of the therapy have been helpful and what have not. A good therapist will invite you to do this and will allow time for it. This should help issues to be dealt with when they arise.
When the therapeutic relationship is not working
You do not have to stay with a therapist with whom you cannot relate or feel safe, or whom you cannot trust. You may feel trapped and think you have to continue but this is not the case. You have the right to decide when to stop. You have the right to look for another therapist. If the service is being provided by an organisation with access to a number of therapists such as a GP practice or voluntary organisation, switching to a different therapist within the service may be possible. If you are working with a therapist in private practice then you can simply approach another therapist.
- Be open and give feedback about how you experience your therapy
- Say what is and is not helpful
- Raise concerns about practical matters such as increases in fees or changes to the time of sessions
- Give honest feedback. Therapists can often sense when clients have issues but they are not mind readers.
What can you do if you are dissatisfied?
If you have tried to talk to the therapist and the response has been unhelpful, or you have serious issues about your therapist’s competence, you need to decide what to do. The first step is to ask yourself what you want. It may be that you want an apology, an acknowledgement of what happened and an undertaking that it won’t happen again. You may simply want an explanation about why something happened. In that case, it can be best to put your concern in writing, explaining the outcome that you would like, and allow the therapist time to respond. You may receive an explanation or an apology, either of which may satisfy you and enable therapy to continue. If you are not satisfied by the response, you can contact the Professional Conduct department of BACP which deals with complaints against its members. If your therapy is provided by an organisation such as a GP practice or Employee Assistance Programme (EAP), you should first take your concerns to the person responsible for the service within the organisation. Such organisations are likely to have their own written complaints procedure, which may include an internal grievance or mediation route. Independent dispute resolution such as mediation or conciliation may be preferable to making a formal complaint to BACP. Taking a complaint to a formal hearing is often a very onerous and emotionally draining step for both parties, involving a substantial amount of time and energy. This should be weighed up when deciding how best to deal with unsatisfactory practice.
Exploitation – the power imbalance
Clients often feel very dependent on their counsellor. Most therapists are worthy of the trust placed in them but there are some therapists who may exploit that dependency, whether consciously or not. Clients who have been on the receiving end of malpractice or misconduct by therapists, or conduct that brings the profession into disrepute, are encouraged to use the Professional Conduct Procedure which can be found at the end of the BACP Ethical Framework for Good Practice in Counselling and Psychotherapy (2007:9). You are encouraged to seek to resolve such issues with your therapist before taking this step, except where it is not feasible or feels inappropriate for you.
Other sources of help from BACP
1. The Ethical Framework
If you are dissatisfied or worried about the quality of the service you have received from a BACP member, you can obtain a copy of the Ethical Framework. It gives guidance on the standard to be expected of a BACP member.
The Ethical Framework covers a wide range of issues including:
- The importance of trust
- What therapists and clients need to agree before counselling commences, such as payment, length of sessions, meeting times and areas to be covered in therapy (this agreement is often referred to as the contract)
- Record keeping
- The need for therapists to maintain competent standards of practice
- The importance of clear information about the services on offer
- The nature and limitations of client confidentiality
- The responsibility of therapists to respond promptly and appropriately to complaints.
A team is available that can help you explore the difficulties you might be experiencing or simply discuss what to expect from your therapist in terms of good practice. If you wish to make a complaint, you can expect to be supported in the process, as this will protect other clients in the future.
You can also confirm whether a therapist is a member of BACP and on The Register and they can provide you with details of other professional bodies where you can check your therapist’s membership.
About the author of this page
Tessa Roxburgh is a retired solicitor who also trained as a counsellor. She currently lectures at Warwick University on the Open Studies programme and formerly worked for Relate.
BACP (2013) Ethical Framework for Good Practice in Counselling and Psychotherapy. Lutterworth: BACP. www.bacp.co.uk/ethical_framework
BACP Professional Conduct Procedure, which can be accessed via: www.bacpregister.co.uk/public/ prof_conduct
Russell, J. (1993) Out of bounds: sexual exploitation in counselling and therapy. London: Sage Publications.
Syme, G. (2003) Dual relationships in counselling and psychotherapy: exploring the limits. London: Sage Publications.
Which? (2000) Guide to good counselling and psychotherapy. London: Which? Publications.
The Clinic for Boundary Studies (formerly POPAN) www.professionalboundaries.org.uk Helpline: 020 3468 4194
MIND www.mind.org.uk Tel: 0845 766 0163
Citzens Advice www.citizensadvice.org.uk local branches may be found in your phone book