What would you do if … ?

The nature of the therapist role can often produce challenging practical circumstances that can be difficult or awkward to deal with. It can be circumstances such as these that can result in claims or complaints against the practitioner, even when the choices made are done so with the best of intentions.

How does the practitioner ensure that they continue to behave professionally and in a supportive way with their clients, whilst dealing with the everyday practicalities of being a therapist?

The examples given are intended to act as a guide in how the therapist might begin to deal with the issue. For several of them, there is no one right answer.

What should you do if...

1. You are with a client and someone is ringing the doorbell. You ignore it but they won’t give up.

Given the sort of issues that can lead people to make complaints it’s always a good idea, particularly if you work from home, to spell out with your client in an initial written agreement, the sort of interruptions that they might reasonably expect. Let them know in advance that your consulting room is in a private home and that there may be unavoidable interruptions. Agree together that, if the doorbell rings repeatedly, you will ask them what they’d like you to do about it.

2. Five minutes before a client arrives your elderly neighbour phones you to say that they have slipped in the bath and they need your help. 

Of course you must act on your duty of care to help your neighbour. If you can’t reach your client to say that an emergency situation has arisen, then leave a note on the door, explaining what has happened and let the client know that you will phone them later on to re-schedule.

3. A client with whom you’ve been working for some time gives you a gift

The art here is not to offend or shame a client by not accepting their generosity, but simultaneously not putting yourself in the possible position of being accused of exploiting the client’s wealth or vulnerability. There is no ‘right’ answer here. Rather, taking into account your client’s history of giving and receiving, as well as the history of that in your relationship, the gift needs to be understood for its meaning and a decision needs to be made together with your client as to whether or not it is right for you to keep it.

4. A client asks you if they can borrow something of yours to keep for support over a long break.

Some practitioners make an offer of something for the client to hold over a long break. If you are going to do this make sure that it is something that is not important to you but has meaning for your client. Confusion can occur if the client does not offer to return the object and feels crushed when the therapist asks for it back. Some therapists keep a bowl of colourful stones and/or buttons in their consulting room for just such an occasion.

5. A client doesn’t turn up for their appointment. You get a call and find out that they are at home, locked in a room which you are highly concerned about. You don’t live far away. 

A therapist responded to a similar call and went to the client’s home. The therapist managed to get the client out of the locked room unharmed. Later the client claimed the therapist did not maintain appropriate professional boundaries; this claim was subsequently upheld. A pragmatic and safe solution is to call a friend or family member of the client and the emergency services, and then wait in the car outside the client’s home, letting someone in the house know what you’ve done and asking them to let the client know that you are there.

6. Your partner usually cooks supper while you see your early evening clients. 

This might seem perfectly normal to you but for some clients the knowledge that someone ‘important’ to you is cooking you a meal might arouse envy. If your home is a place of work it is important in these instances to avoid cooking just before or during client time. A civil action against an experienced therapist included an allegation that the smell of cooking in the house meant that the therapist wasn’t focussed on their work together.

7. Over the summer break you redecorate your consulting room.

This may seem insignificant but a complaint made against a therapist included a reference to the fact that the therapist had painted the consulting room the same colour of the room where the client had endured a bad experience. It might be wise to let your clients know when you plan to redecorate and to let them have some warning about any major changes of colour or furnishing.

8. A client who is struggling with a difficult situation is in great distress. You happen to have just read a novel that you thought dealt sensitively and usefully with the particular issue.

A therapist loaned their client a book in a similar situation and this formed part of a complaint against them that ended up in a civil action being settled out of court. It is important to remember that you can’t predict or have the space to process the impact a book will have on a client. Therapeutic interventions, however well meant, are best kept to the consulting room.

9. You realise after working with a client for a few months that you have been seeing their partner for counselling for a few years. 

In a case like this your duty of care is to the client you’ve been seeing the longest. You need to refer ‘Client 2’ to another therapist as quickly as possible. How you do this can be challenging. Above all you need to maintain confidentiality about your relationship with ‘Client 1’, who may not necessarily have told their partner that they are seeing you. In that instance you need to give ‘Client 2’ notice of onward referral, saying that you have realised that you can no longer be an effective therapist for them. You need to do this without mentioning anything to ‘Client 1’, who may not know that their partner has also gone to see you. This may indeed be a coincidence but you need to behave as though it is not.

10. It is very warm and uncomfortable in your consulting room. A client wants to move outside to the garden, where it’s cooler.

Tempting though this may be it is your responsibility to control the physical boundaries of the therapeutic frame. You cannot do this in your garden where neighbours could eavesdrop or where children might be playing. A therapist who did do this had a complaint made against them when they asked the neighbour’s children to stop kicking a ball over the fence. The client felt this was done in a harsh way and was thrown into a negative transference from which the relationship never recovered. A complaint was made, which was not upheld. Still, both client and therapist suffered from what was an error of judgement.

11. A client turns up with wet laundry in a basket and asks if they can use your dryer as theirs is broken and it’s either use yours or miss a session and go to a laundrette. 

It would seem as though this client is pushing the boundaries of your professional relationship, or is at least expressing some ambivalence. Invite the client and their laundry into your consulting room and help them to decide between the session and drying their laundry. This is a ‘therapy issue’. However practical it may appear to just let the client dry their clothes in your dryer - don’t. A similar offer ended up as a complaint as the therapist took the client into their private space and the client saw laundry belonging to the client’s partner and children.

12. A new client asks for your email address and mobile phone number.

These days, it is becoming the norm to communicate with one another by e-mail and text. If you do this with your clients you may want to think about putting some agreements about emails and texts between sessions in an initial written agreement, as some clients take advantage of having this information and use it as a way to intrude on the therapist in what should be down-time. One client complained that the therapist did not answer their emails. This was because they frequently sent long emails, which the therapist chose to discuss in the following session.