Endings in therapeutic relationships

When my psychologist decided she didn't want to work with me any more, she ended it by email.

We had been working together for two months, I had spent £700 on her services, and she had issued me a detailed email setting out how we would work together. I considered us to have a contract. I expected to have a final session together.

I wrote to my psychologist, expressing how damaging it had been for me to be dropped so abruptly: to my mind, for not masking my autistic traits. She responded that any contact from me was 'harassment'. 

That word tipped this into something more serious than the end of a therapeutic relationship that wasn't a good fit. I felt that I was not 'supposed' to speak up if I had been treated badly. I experienced it as a power play to shut down an uncomfortable conversation.

I approached the British Psychological Society. They said that they could not do anything without a completed 'Fitness to Practice' investigation by the Health and Care Professions Council (HCPC). I did not want to do this. In my opinion, the psychologist had behaved unprofessionally, unsafely and unkindly – but 'fitness to practice' is a very big statement to make about another person. I asked several times if there were any possibilities for a mediated resolution. They said that HCPC was the only route to have my complaint considered.

The HCPC took about 9 months to investigate my complaint. They asked the psychologist's clinical supervisor whether ending like this was within the parameters of acceptable practice for a psychologist. The clinical supervisor's opinion was that there is no obligation for closing courtesies in the 'getting to know you' stage. I wasn't given the right to debate what the threshold is of 'getting to know you' – or indeed to ask for an independent opinion. What does 'duty of care' look like over time, in an evolving psychologist/client relationship?

I reverted to the BPS and asked them to reconsider my complaint against their own rules, e.g.

1. Section 5.1 of the British Psychological Society Practice Guidelines states that '[when a psychologist decides to terminate an agreement] psychologists will, as far as possible, work to ease the transition of service provision and give as much notice as is practical in the particular situation.'

2. Section 8.2 states that regulation 20 of the Health and Social Care Act 2008 requires psychologists to enable complaints and concerns to be raised freely.

There was almost an additional extra year of being directed back to other areas of HCPC to review my case, with the conclusion that the HCPC was satisfied that its process had been applied correctly against its rules. Pressing the BPS directly again, I was told that BPS will not comment or act on any breaches of its rules where the threshold for 'unfit to practice' has not been met.

Looking back over HCPC judgements, the upheld 'unfit to practice' cases are generally 'practitioner veered into inappropriate personal relationship with the client'; 'practitioner in denial about decline in their own health'; 'practitioner making false or inadequate records'. What complaints procedure can clients of private psychologists access for matters which are harmful/unethical/prejudice the reputation of the profession, but below 'unfit to practice'?

Two sides

I share my story with you fully aware that all stories have two sides. Personality clashes, mistakes, misunderstandings will always happen; but respectful and open complaints handling rebuilds trust and encourages reflective practice. 

My motivation for sharing is a wish for things to be better for others in the future. I think endings are extremely important in therapy. It is where the client crystallises their internal narrative of what happened. It is the point in the relationship when the power imbalance is typically most tilted against the client. 

That imbalance looms large for a client. The client makes a much larger investment in terms of their emotions, time and money. They have much more to lose when a therapy relationship breaks down. It is much harder for them to rebuild trust and move forwards into another therapy relationship.

Complaining is daunting and vulnerable for a client. It exposes your private information for scrutiny by strangers. It requires you to be confident in your perceptions of what happened and what should have happened, despite the fact that for most people therapy is something that they do rarely and witness never. It requires you to relive something that was upsetting. It is a process based on trust in the individual and trust in the system.

So I share because I would like these systemic issues to be raised and discussed publicly. Over 18 months of telling my story I have yet to have somebody say that I deserved better than an abrupt emailed termination; I have yet to have somebody acknowledge how important endings are in therapeutic relationships; I have yet to have somebody share my concerns around complaints procedures, scrutiny and accountability.

If this is to be the end of the story for me and Psychology, I wonder whether you readers might help in at least adding a 'P.S.'