Complaints and Grievances
in Psychotherapy
Fiona Palmer Barnes
review by Denis Postle
Counselling News
November 1998
This is a book about quality
assurance, how to manage
complaints and grievances.
Why did I feel so sceptical of
the procedures that it
outlines? Mainly because the
model of quality assurance
put forward is
retrospective - make a bad
mistake, be found out, get
struck off. In other words,
identify rejects and throw
them in the waste bin for
rework or scrap. For a book
which makes much of 'up to
date understanding of good
practice', I find it curious
that Fiona Palmer Barnes
propagates with such
certainty a quality assurance
stance that has elsewhere
been discredited.
In manufacturing industry,
up to date, best practice,
quality assurance uses
methods that monitor
production. Before the work
is about to go out of
specification, some
intervention is made to
return it to the specified
quality, so that the
probability of making rejects
is reduced to close to zero.
The psycho-practice
accountability of the
Independent Practitioners
Network [IPN], based on
linked small groups of
practitioners who get to
'know and stand by each
others work', is an example
of this second approach to
quality assurance. The text
does not refer to it.
Because of these and other
considerations, I didn't warm
to the book much.
It classifies, categorises and
catalogues, and a medicalised
approach to psycho-practice
is regarded as intrinsically
virtuous. Early on the author
announces that she will use
'the term 'patient' because it
is the most usual way for
analysts and psychotherapists
to speak of those who are
our clients and customers'.
Not for me or any of the
community of practitioners I
know. Elsewhere there is
'clinical responsibility'
'treatment' and 'case
material'.
This is not to be pedantic
about language and style.
There is an 'official' feel to
this book, it could easily be a
Department of Health, or
more to the point, a British
Medical Association
document. I expect this is
intended. I see it as part of
the mould into which UKCP,
BCP and BAC are pouring
the concrete of a statutory
psychotherapy profession.
Spell out a series of
procedural structures, label
them as 'good current
practice' and you define a
form of accountability that
intends to invalidate, and
attempts to extinguish, other
competing forms of practice.
Perhaps the psychotherapists
and counsellors devising
these legalistic structures are
well-intentioned but isn't it
curious that their chosen
approach is that of instilling
fear of sanctions? Indeed the
whole edifice of complaints
and grievances procedures as
delineated in this book, and
the discussion thereof, seems
to me to be rooted in fear.
For example, the author's
unquestioned assumptions
about the necessity for
practice insurance.
P36...adequate
insurance cover...
the likely increase in
litigation makes this all
the more essential.
P 39 clear and binding
contracts...may in the
near future become
helpful in defence
against legal action.
(My italics)
p67 It is essential that
all practitioners should
have professional
insurance. Without it
they are acting
recklessly.
The author appears to
inhabit a vision of human
nature that is filled with
'emotions that are powerful
and often quite primitive'
that must be 'contained' if
they are not to break out and
wreak havoc in the world.
The book seems to be
saying.... 'be terrified
of this possibility, construct
a narrowed, conformist,
restrictive, insured practice
that will keep us all safe
from the demons inside us
(and our clients).
And here is how to do it'.
It works....I felt terrified.
Though the topics, concerns
and problematic situations
will be familiar, I find it hard
to believe that many
practitioners will feel much
ownership of the procedures
this book details. Even less
will oppressed or dissatisfied
customers find them
accessible or helpful.
Certainly clients buying the
book so as to help them
pursue a complaint will be
well-advised to have at least a
first degree, if not a masters.
Most will find it way over
their heads.
