Learning from complaints: accountability and duty of candour

What is accountability and duty of candour?

Accountability and duty of candour are about:

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

This means letting clients know about any issues or difficulties the therapeutic work may involve, and what is required from them when engaging in therapy.

Discussing what may be involved at the outset

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

Some people research different types of therapy in depth. Some have an initial conversation or assessment with potential therapists before deciding to continue. Others may not be aware that there are different types of therapists and modalities.

Clients will know different amounts about psychotherapy and how it is delivered. Whatever their starting point, you have an ethical duty to discuss important issues with them before therapy begins. You should also make sure your client understands any commitments required of them.

Acting in your client’s best interests

To help you meet these responsibilities, start with UKCP’s Code of Ethics and Professional Practice.

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.’

A written contract provides a transparent basis for informed consent and gives you a level of certainty. Find out more about psychotherapy 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, feeling worse before feeling better)
  • what is or isn’t being offered (for example, if you are unable to provide a clinical diagnosis).

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

Referring on

Sometimes therapy may not progress, or may take longer than expected. It may also become clear that the client’s issues will not be ‘resolved’. When this happens, you have a duty to be open with your client about it. 

You may also need to refer your client to another professional. This might be because they need medical help, or because therapy cannot meet their expectations. This duty is set out in point 24 of the code:

‘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.’

Find out more about ending therapy.

Maintaining a safe and contained space

The therapeutic space should be safe and contained.

At times, something in a client’s life may affect the therapeutic work. The duty of candour requires you to be alert to outside factors, particularly when working with children and adults at risk. Point 35 of 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 a mistake or experience a lapse of judgement in the therapeutic relationship, tell your supervisor and UKCP. Where appropriate, discuss it with your client too, to minimise any distress. This is set out in point 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 remind us that the duty of candour is about values and principles. It means creating a culture of openness, rooted in our interactions with clients and colleagues. It is about acting in the client’s best interests and doing the right thing. And when things go wrong, it is about taking responsibility and learning from it.