Learning from complaints: accountability and duty of candour

What is accountability and duty of candour?

Accountability and duty of candour is about:

• being transparent about what is, or could be, involved in therapy with clients
• taking responsibility for acting in the client’s best interests.

It is about taking responsibility for working with clients - letting them know of any issues or difficulties that the therapeutic work may involve and what is required from the client when engaging in therapy.

Discussing what may be involved at the outset

Starting therapy can be a daunting experience, especially if it is someone’s first time.

Some people may do a lot of research into different types of therapies, some may have an initial conversation or an assessment with potential therapists before deciding to continue, while others may not be aware that there are different types of therapists and modalities.

Irrespective of how much or how little a client knows about psychotherapy and how a psychotherapist delivers therapy, it is the therapist’s ethical duty to take responsibility for working with clients and to discuss important issues before they embark on the therapeutic journey.

You should also ensure that your client is made aware of any commitment required from them.

Acting in your client’s best interest

To help you meet these responsibilities, a good place to start is the UKCP code of ethics.

Point 14 of the code says:

‘Explain to a client, or prospective client, your terms, fees and conditions and, have information readily available to clarify other related questions such as likely length of therapy, methods of practice to be used, the extent of your own involvement, complaints process and how to make a complaint, as well as arrangements for referral and termination of therapy.’

It is a good idea to have a written contract. It provides a transparent basis for informed consent and gives you a level of certainty. For more on contracts, see our Learning from Complaints webpage on contracts.

So that there is no ambiguity, we advise that you:

• ask the client to confirm and consent to the way in which therapy will be offered
• help the client to understand the nature of any proposed therapy including:
  • what they can expect
  • what risks are involved (for example, will they feel worse before they feel better)
  • what is or isn’t being offered (for example, if you are unable to provide a clinical diagnosis).

It is worth asking your client to discuss with you anything they are unhappy or unsure about whether that be an aspect of the therapy or you as a therapist. They may be wondering what standards or behaviour they should expect from you. We advise that you provide them with a copy of the UKCP Code of Ethics and Professional Practice and let them know about the availability of a complaints procedure.

Referring on

If things are not progressing in therapy or taking longer than expected or it becomes clear that the client’s issues will not be ‘resolved’, it is your duty to be open about this with them. Sometimes, if a client needs medical help or intervention, or it becomes clear that the therapy will not be able to meet their expectations, you have a duty to refer them to another professional when appropriate. This is set out at code 24:

‘Understand the limits of your competence and stay within them in all your professional activity, referring clients to another professional when appropriate. This includes recognising that particular client groups, such as children and families, have needs which not all practitioners are equipped to address.’

See also our Learning from Complaints webpage on ending therapy.

Maintaining a safe and contained space

The therapeutic space should be a safe and contained place.

There may be times when a client experiences something in their lives which is affecting the therapeutic work. The duty of candour requires therapists to be alert to any extraneous factors, particularly when it comes to children and vulnerable adults. Point 35 in the code says:

‘Safeguard children and vulnerable adults, recognising your legal responsibilities concerning their rights and taking appropriate action should you consider any such person is at risk of harm.’

If you make mistake or experience a lapse of judgment in the therapeutic relationship, you should notify your supervisor, UKCP and, if appropriate, discuss it with the client too, to minimise any distress that may be caused, as set out in 37 of the code:

‘Challenge questionable practice in yourself or others, reporting to UKCP potential breaches of this Code, and activating formal complaints procedures especially where there may be ongoing harm to clients or you have significant grounds for believing clients to be at risk of harm.’

Conclusion

These obligations serve to remind us that the duty of candour is about values and principles.  It is about creating a culture of openness and is rooted in interactions with clients and colleagues in the psychotherapeutic world. It is, about acting in the client’s best interests, doing the right thing and taking responsibility if things go wrong, and learning if things do go wrong.