Robin Shohet

(Article published in Self and Society Vol 45 No. 1 April 2017)

People have reported not feeling supported by their professional bodies around complaints.  As one of the aims of ISN is to create a supportive and challenging community, I wanted to post this article which might throw light on some of the issues that arise. It would be good to hear from people.

Many professionals have a fear of a complaint being made against them. In this article my aim has been to throw some light on some of the dynamics that might be operating around complaints in order to move towards a more compassionate, systemic view that goes beyond blame. Some of what I have written could be applied to relationships of any kind.

In July this year (2017), I am helping to organise a conference to look at the dynamics of complaints in the so-called helping professions. I start with the premise that whatever position we take around complaints is a form of countertransference.  In other words, whether we sit on an ethics committee, whether we start an insurance company for therapists, or even whether we organise a conference on the dynamics of complaints, we are trying to heal something in ourselves by the positions we take.,

I started with myself and found more authority issues, a tendency to split which I saw mirrored in how client and practitioner can be split when a complaint is made, and an omnipotent wish to protect “my” profession from going down the route of other professions  where fear has dominated to the detriment of all concerned.

Discovering this has helped me be clearer, but I recognise my understanding will always be incomplete.  What I want to do now is to share some of my understanding about what could be going on around complaints.  You may disagree with some or all of it.  You may feel supported in it. But it is the conversation that we might have after you have read it that will be important.

1. Our society is becoming increasingly litigious. This is bound to increase fear.  From a place of fear, we are more likely to be in survival mode, which lessens the opportunity to combine, to see a bigger picture.
2. It also means we become increasingly defensive. If I defend myself against you, I am implying you are dangerous. I therefore am attacking you, which justifies your attacking me.  We are caught into a vicious cycle.
3. Whatever the content of the complaint, there is a process question of Why now? This may (or may not) be connected to a stage in therapy, like ending or where, just before a breakthrough, a major rupture from earlier in the client’s life is often re-enacted.
4. A complaints procedure could be used as an avoidance technique. This does not mean we don’t look at the behaviour of the therapist, but we recognise that relationships are also co-created.
5. When we teach supervision we encourage supervisors not to believe what the supervisee says about their client uncritically. “I have a very difficult client” would be translated into “I am finding this client difficult.”  I would not believe a client’s version of their parents or of their partner uncritically – I would see it as their truth but not the In other words I am mindful of a bigger picture.  I would want a complaints procedure to hold a bigger picture, however obvious wrongdoing might appear.
6. People often mention so called bad therapists. So called bad practice exists in all professions and we may have an omnipotent fantasy it can be stopped.
7. We are the bad therapists too. If there is someone who says he has never done bad therapy (whatever that is), then this is someone who is likely to be doing bad therapy (whatever that is).
8. The people professions are different in that there is not an object involved eg a tooth or a car to be fixed or some product that can be exchanged or refunded. We are paying for a relationship not a product or something to be fixed.  The criteria for success or failure are hard to judge.
9. The therapy profession has not been going on as long as medicine, social work, teaching. It may have a wish to prove it has its own house in order. The desire to be accepted by mainstream has a cost, and this cost may be coming out in the approach to complaints where we over identify with the complainant.
10. If we look at some of the processes involved in OCD, then the patient is unable to cope with their anxiety. They invent rituals to help them feel safe. The rituals do not deal with the underlying anxiety so become more pronounced.
11. Are we caught in the same dynamic? A complaints ritual that does not deal with the underlying fears and anxieties, leading to an ever more vigorous complaints procedure.
12. Many years ago there was a channel 4 programme called Doctors Mistakes. What this particular hospital found was that instead of going into denial and defence, when the doctors admitted mistakes and apologised publicly, suing rates went down, learning went up, and so accident rates went further down. Is there something that therapeutic bodies can learn from that?
13. Do complaints offer a sense of offering to regain potency that is perhaps misguided? We know a lawyer who has successfully sued therapists and said it did not bring closure for the clients and he will no longer do it. There was suffering for the therapist and not the outcome the client really wanted.
14. We have a complaints procedure about therapy, which does not seem therapeutic. Why? What is the need of the complainant? This is not about pathologising the client, but given as mentioned earlier about doctor’s mistakes, then a system that enables this kind of inquiry and subsequent acknowledgment would seem most fruitful.
15. So by extension the first step in a complaint is to ask the complainant what they want. If it were a product it could be a replacement, or a fixing or a refund. For a relationship – what is wanted? If we again go back to doctor’s mistakes, is it acknowledgment rather than an identification with the complaint that might be needed? How can the question “What do you need?” be held? In other words the best support for the client might not be to pursue their client’s grievance at face value.
16. Or it might be. This is not throwing the baby out with the bathwater..
17. I think our relationship to what therapy is all about reflects our attitude to complaints. If we think it is about understanding ourselves, rather than being fixed, then whatever happens is an opportunity to reflect. A complaints process in the helping professions could go the route of reflection rather than pursuing the right/wrong process.
18. And of course if we can’t prove the therapy works we don’t get funding so we really are caught in a double bind. There is a much bigger picture here about justification and money and fixing.
19. In divorce courts, there used to be an adversarial framework, which created much distress. It is now recognised that it is more useful that the couple be held using methods like mediation. A complaints procedure which holds the practitioner and client would mirror the holding that is part of our work.
20. Supervision holds the therapeutic relationship. A complaints procedure could mirror that.
21. Society seems to be attracted to the Victim, Persecutor, Rescuer triangle We can fall into replicating that with initially therapist as persecutor, client as victim and complaints procedure as rescuer. This then turns into complaints procedure and client as persecutors and therapists  as victims.
22. Our work is about relationship and awareness and yet we can lose both foci in looking at complaints because it activates scripts like fairness, justice, power, betrayal and so on
23. An understanding of parallel process is vital in our work. Can we apply this to complaints? Is there a replication of a client’s or therapist’s or complaints body’s traumata being reenacted? An understanding of some of the dynamics of shame in the victim, persecutor, rescuer triangle could help with that.
24. Do both therapist and client have an image of a safe haven which gets betrayed by reality? Do therapists set themselves up to do more than we can, and thereby collude with a system that demands and blames?
25. I am back to looking at our personal countertransference and that of our profession. I believe that doing this can lead to less polarised positions and perhaps help us to embrace an understanding, inquiry process model rather than a right/wrong content model. This may help us work towards all parties being able to voice the feelings, unmet needs, values and expectations which might lie behind a complaint.