What to do if a client is dissatisfied

In this chapter, I will describe which ways are open to deal with the client's dissatisfaction. Respect for clients requires an openness to non-defensively hear criticism and concerns - whether from a client or a colleague - about one's professional conduct, giving them the proper opportunity to voice their dissatisfaction, or to file a complaint. 

Example 9.1

Chris could not live with how his sister was treated by her ex-husband, Henry, and started a crusade against him in order to get his sister rehabilitated. This crusade resulted in a criminal court case against Chris. In the course of the procedure the public prosecutor asked Philippa, in her capacity as judicial forensic psychologist and legal expert, to examine Chris and formulated detailed questions to that end. Philippa examined Chris and wrote a draft report, which Chris did not accept and consequently was not submitted by Philippa. Subsequently, during the hearing, a new report was demanded. Philippa examined Chris again, wrote a new draft report, and got Chris's informed consent to submit it to the court. 

Two years after, Chris raised a complaint against Philippa. In his opinion, the auto-anamnesis was incomplete and incorrect and Philippa had failed to take a reliable hetero-anamnesis. She also failed to request medical data elsewhere. In addition, the grounds for the Asperger's syndrome diagnosis were missing. According to Chris, the facts from the report did not correspond to reality. With his complaint, Chris wants to get more information about how Philippa came to the incorrect facts. To this end, the criminal files from which Philippa had obtained her information must be made avail- able to the disciplinary board. Moreover, the diagnosis of personality disorder and Asperger's has since been disproved. 

First of all, the disciplinary board points out that in the disciplinary review of professional action, it is not about whether that action could have been done better, but about giving an answer to the question whether the professional acted within the limits of reasonably competent professional practice. This criterion took into account the state of the art at the time of the actions that were deemed worthy of complaint and took into consideration the professional norm or standard at that time. 

The board finds that Philippa in her report has set out in detail the documents on which her report is based. She described the design of the examination and the data from the documents. Furthermore, she recorded the conversation with Chris about the charges as well as his life history. She then reported the psychological examination and the forensic psychological assessment and subsequently answered the questions asked by the applicant for the examination. 

Chris disputes, incidentally without proper substantiation, the conclusions drawn by Philippa, but the extensive data can certainly support those conclusions. The board notes that the report shows that there was no real possibility for a hetero-anamnesis examination and it is of the opinion that the report meets the board's criteria for a suitable examination, namely: 

1. Does the report explain in an insightful and consistent manner the details on which the conclusion of the report is based? 

2. Are the grounds set out in the report demonstrably and sufficiently supported by the facts, circumstances, and findings of the report? 

3. Can the grounds mentioned justify the conclusion drawn from them? 

4. Did the report respect the limits of the expertise of the reporter? 

5. Did the examination method to answer the question posed achieve the intended goal, or did the reporter exceed the boundaries of reasonableness and fairness? 

Thereby, it is the board's opinion that the complaint should be rejected as manifestly unfounded. 

Professional ethics of psychologists are good for their clients, they are also good for the psychologists themselves, and they are good for the profession of psychology. To promote these values and to further their integration in psychologists' conduct, that is the aim of this book. In the previous chapters counsel was given to understand, to apply, and to incorporate the ethical principles of respect, competence, responsibility, and integrity in professional psychologists' practice. Subsequently Chapter 8 on ethical problem solving gave guidance on how to deal with ethical complications and dilemmas. 

However, neither properly looking ahead nor problem-solving guidance is a guarantee for preventing difficulties. Things may go wrong. Sometimes expectations about psychologists' interventions are too high, sometimes an assessment's outcome is disappointing, or sometimes a psychologist's report leads to unfavourable consequences, as perceived by the client. The last mentioned may easily happen in conditions where the client's engagement with the psychologist is not fully volitional, as it was the case in Example 9.1. After all, formal consent to such an engagement does not necessarily imply full emotional voluntariness. 

Seeking help for one's phobic anxieties is not the same as accepting a psychological assessment as an unavoidable part of a job application procedure, and definitely not the same as being subjected to a forensic psychological assessment. Sometimes some doubt has been cast upon the correctness of the psychologist's conduct, sometimes the psychologist's action is experienced as bluntly crossing boundaries of decent professional acting, but sometimes just something needs to be found to blame and to discredit the psychologist. If one of these conditions occurs, some clients may want to talk about their dissatisfied feelings with the criticised psychologist or with one of the psychologist's colleagues, others slam the door in leaving the psychologist's office, only wanting to raise a complaint. 

Respect for clients requires openness to hear criticism and concern - whether it is a client or a colleague - about one's professional acting and practice in a non-defensive way, giving them proper opportunities to talk about their dissatisfaction or eventually to raise a complaint. After all, even if it could be it beneficial for the client and the psychologist to settle dissatisfaction in a private talk or some kind of mediation, it is always up to the client to submit a formal complaint in order to have the psychologist's professional conduct evaluated. 

It is the opinion of the European Federation of Psychologists' Associations (EFPA) that national psychologists' associations cannot stay passive when faced with allegations of infringement of their ethical standards. In other words, these standards should not be purely aspirational in nature. In the Preamble of its Meta-Code of Ethics, the EFPA demands national associations have procedures to investigate and decide upon complaints against their members. Taking into account the nature and seriousness of the complaint, this may lead to corrective actions or a disciplinary sanction. Since this book aims to facilitate individual psychologists in reflecting upon the ethical dimensions of professional conduct, this chapter too is meant to give guidance to individual psychologists, more specifically how to act when clients show their dissatisfaction in one way or another. 

Only limited attention will be paid to the more legalistic framework regarding the profession as a collective, that is, see the EFPA (2022) document Complaints About Alleged Unethical Conduct of Psychologists: Recommendations on Evaluative Procedures and Corrective Actions. Just a single example of disciplinary board cases is given as an impression of what to expect in case of a formal complaint. 
 

The disciplinary scrutinisation and evaluation of psychologists' conduct may have been "outsourced" to legal disciplinary boards in countries where psychologist titles - or the titles of some psychology subfields - are legally protected. In some countries this might be a substantial proportion of practitioner psychologists, if not all of them. Where adjudication and action elements are being undertaken by external organisations with more power linked to providing credentials, some national associations changed the focus from an investigatory and, as required, a consequent disciplinary purpose, to an educational centre of attention. 

However, this does not imply that the national psychologists' associations are freed from responsibilities regarding actions in cases of (alleged) infringement of ethical standards. 

Providing professional standards as reference for disciplinary boards for rulings that attach consequences for membership still remain the responsibility of the national psychologists' associations. For instance, can an association stand idly by if a member is deprived of the right to continue their professional practice by a statutory disciplinary tribunal because of severe infringement of ethical standards? Will the association allow its deontological code then to be merely aspirational? 

Apart from this, complaints against a number of psychologists still have to be handled by the psychologists' association. In such a situation, some intervention such as mediation is necessary to settle the disturbed relationship between the indignant client and the psychologist or to provide a formal assessment to evaluate whether there was an infringement of the psychologists' ethical standards and whether a disciplinary measure is appropriate. 

Nevertheless, it is not only the responsibility of the psychologists' associations to take action in the case of complaints. At an earlier stage, individual colleagues may become involved having heard about the possible non-compliance, whether or not from the offended person themselves. As set out in Chapter 7, there is an obligation to give a reasonable critique of the professional actions of colleagues, and to take action to inform colleagues and, if appropriate, the relevant professional associations and authorities, if there is a question of unethical action. This means that psychologists in their respective roles - for instance, as just being colleagues or as officers of the psychologists' association - have the ethical duty to take such signs seriously and not to look away from them. This means being open to lend an ear to a dissatisfied client, to make a fraternal appeal to a colleague who might have over- stepped the ethical standard - as with Patsy in Example 9.2 (aka Example 7.19) - or, in the ultimate case, to make colleagues or the psychologists' as- sociation aware of it, which Patsy could not. 
 

Example 9.2 (Example 7.19 contd.) 

On two separate occasions Patsy, a clinical psychologist, heard from two clients that they had both had an intimate romance with their previous, one and the same, psychologist-psychotherapist. Neither of them seemed to regret the escapade and neither of them wanted to be involved in anything that could lead to complaint procedures of any kind against their former lover-psychologist. Both explicitly claimed confidentiality with respect to their "confession" and did not want their identities revealed. 

Patsy decided to contact the colleague in question for a collegial appeal regarding professional ethics, thereby strictly avoiding any reference to both of her clients. The colleague did not even try to conceal or mitigate the fact that there had been romantic relationships with some clients and claimed that these were fully consensual. He was fully convinced that no harm was done or would be done, bluntly stating that similar situations might occur in the future too. Moreover, the colleague asked, somewhat provocatively, whether Patsy's clients really agreed with this action of hers. Patsy felt shocked but realised that no evidence could be provided in any formal evaluative procedure, because of the decisiveness of her clients not to cooperate. 

First of all, psychologists need to be open to critique of their own professional actions and to loyally cooperate with the evaluation of these actions, if these are questioned. Although not explicitly stated in the Meta-Code, this moral obligation of openness to receive critique can be seen as the logical counterpart of the obligation to give a reasonable critique of the professional actions of colleagues, as laid down in Article 3.4.5, Actions of Colleagues. Deduced from such a moral requirement, one may understand the more legalistic demand as shown in the Appendix of the EFPA's Recommendations on Evaluative Procedures and Corrective Actions, which states that "psychologists should be obliged by the National Association's statutes to co-operate in procedures concerning complaints about professional con- duct during their membership" and that "members' refusal to co-operate in evaluation procedures should be seen as an offence." 

Nevertheless, especially in a formal complaint procedure, in which one might be faced with lawyers who had become involved and eventually end up before a tribunal, it demands professional and personal maturity and courage to take a critical look inside oneself and ask whether the person could be right. It requires professional and personal maturity not to slide into defensive behaviour by frantically searching for justifications and excuses or blaming the other person. The profit of such a critical self-reflection might not only be improving the ethical quality of one's work, but also leading towards the best condition to face honestly the other person and to show understanding for their objections. 
 

Openness to critique and loyal cooperation in having one's professional conduct evaluated can be seen as vital conditions for upholding of ethical standards in the profession. Nevertheless, one may wonder if such an evaluation will give enough satisfaction to plaintiffs (persons or entities bringing the case, from now called complainants), who most of the time are clients. An important issue in this chapter is: Whose interests have been infringed in cases of unethical behaviour, and whose interests have been damaged most seriously? Those of the client, who is primarily the wronged party, or those of the psychologists' community, whose professional ethics rules are violated and whose reputation might be at stake? Whose interest is mostly served by a disciplinary evaluation and an eventual sanction? 

Evaluative and disciplinary procedures are to a certain extent comparable to criminal law procedures. In spite of the fact that the complainant usually is the accusatorial party in front of the disciplinary tribunal - unlike criminal law cases, where the public prosecutor and not the victim is the antagonist of the accused - as a rule the outcome of the evaluative and discplinary procedures exclusively concerns the relationship between the censured psychologist and the professional collective. Be it a warning, a reproach, a suspension, or an expulsion from membership, acquiring satisfaction from these sanctions is all that the complainant gets out of it. When there is no legal power behind the decision, a psychologists' association has more limited powers, the most severe being expulsion from membership. 

There may be violations of norms, which justify a community to take ac- tion to protect others from being victimised. There also may be violations of norms that justify a community feeling deeply harmed and determined to impose punishment, even if this is not, or not anymore, in the victim's interest, or in the interest of others in their direct environment. Upholding norms by the collective is meant to prevent individuals feeling powerless in the process, especially individuals in a relatively weak and vulnerable position. The disciplinary procedures of the psychologists' associations may find their raisons d'être, especially in this last condition as there will be the possibility of meaningful sanctions. 

However, insofar as client vulnerability provides justification for a special complaint procedure within the rules of a psychologists' association, one may wonder whether the individual client is served in the best possible way by disciplinary procedures. If a sanction is imposed after a disciplinary procedure - which is often long and drawn out - in which discrepancies will be accentuated rather than diminished, will the resulting sanction bring the satisfaction that the complainant is waiting for? Sometimes it does, some- times certainly not - far from it. Some complainants are after blood, but not all of them. Some of the latter could feel more and better understood in their complaint if a well-meant apology were given. However, after a formal evaluative and disciplinary process, an explanation and apology - if appropriate as such - will often be further away than ever. And how often could this count as a "good" result for the psychologist as well? 

Mediation 

As mentioned above, the EFPA demands national associations to have investigative, corrective, and disciplinary procedures to decide upon com- plaints against members and to determine necessary action. In these for- mal investigation and evaluation procedures, parties usually become more and more sharply opposed to each other, which may cause a heavy load, both on the psychologist and on the complainant. Instead, though not recommended by the EFPA anymore, mediation could bring the opposing par- ties to more mutual understanding. Although mediation seems to occupy a very modest place - if any - in the complaints handling procedures of associations (prevalence figures are not available, also due to its informal nature), it can certainly be seen as a valuable option to try to solve a problem between a psychologist and a client. 

In mediation, the complaint can be seen as an expression of a problem or conflict between the complainant and the accused psychologist. Seen from that point of view, the interests of the psychologists' association are not directly at stake. In an informal, semi-structured process, an impartial mediator assists the disputing parties to work through and resolve problems or conflicts together. It is a non-judgemental, voluntary process that focuses on helping parties to find mutually satisfying resolutions to their problems, consistent with the interests of each party. Whether or not by one's own initiative, participation in mediation is always on a voluntary basis. Each person, complainant and psychologist, is autonomous and able to determine their own actions. This requires that each party is free to close the mediation process at any moment if they no longer consider the mediation as being helpful. 

As conflicting parties are facilitated to come to a solution themselves and have the freedom to terminate this process at any time, mediation conditions are essentially different from binding oneself beforehand to a final decision of any authority, as in arbitration. The involvement of a third party may be seen as a complicating factor. Therefore, possible juridical or complaint procedures, which may already have been started, must be deferred in order to be able to start with mediation. 
 

Solutions found in mediation may well be better for the complainant and the accused than a judicial judgement. After all, both parties carry the outcome, which is certainly not the case if the disciplinary tribunal rules against one party. Therefore, it might be preferable to choose mediation instead of a formal complaint procedure for the client to be understood in their complaint about the actions by the psychologist involved, and not by the disciplinary court on behalf of the profession; and even if there is no violation of any professional ethics principle, mediation will probably give the psychologist a better opportunity to come to an understanding of the client's objections and to be able to show these, rather than standing in front of a tribunal. 

If mediation is not initiated by the client or the psychologist themselves, but in the framework of an ethics complaint procedure, it begins with the willingness of the psychologists' association to recommend the opportunity for mediation to the complainant and to the accused psychologist, and to refrain from further investigation and evaluative procedures during the period of mediation. This implies that the association will not interfere in the process, nor to be asked for agreement on the mediation outcome. As a party of indirect interest, the association puts itself, so to say, on the "reserve bench." 

In considering whether the opportunity for mediation should be offered or not, the fundamental question arises: How should the client's individual interest of atonement be weighed against the interests of the psychologists' association in upholding norms by evaluating the accused psychologist's professional behaviour, and eventually sanctioning trespassers? A consideration in the decision whether to offer mediation or not should have regard for the seriousness of the alleged infringement. Thereby, the nature of the complaint should be taken into account, as well as the possible further risk to the public and to the reputation of the profession. This means that in cer- tain cases the profession - embodied in the psychologists' association - may decide that its collective responsibility does not allow it to stay passive. This is the case when the possible infringement of the profession's ethical standards is such a serious offence that other clients' welfare or the profession's standing are seriously at stake. In that case the association will not abstain from formal evaluation of the alleged misconduct. 

Not to take away the vital importance of what has just been stated, nor questioning its eventual impact, it is challenging to reflect upon another per- spective. Seen from a moral point of view one may wonder if, in its ultimate consequence, the complainant and the accused should not always be offered the opportunity to come to an agreement by themselves. In its ultimate con- sequence, it could be taken for granted that, for instance, even serious breaches could be compensated financially, and psychologists thus have a lucky escape from being sanctioned heavily. 
 

After all, it is not unthinkable that some complainants will choose such options. One may wonder, which principle informs objections that may arise against such a solution? Does a direct atonement for distress or compensation for harm not outweigh formal sanctions? Is not directly paying off the debt superior to punishment for breaching norms? And why should the possibility of a more satisfactory settlement be given to someone who raises a minor complaint, and not to someone raising a serious one? One might argue that cases of serious harm in particular deserve the best possible atonement. 

Until now, these reflections were mainly focused on the significance mediation could have for the complainant. However, for the psychologist involved, the significance of mediation is probably as large as it is for the complainant. To explain one's point of view and to show understanding for the complainant's angle is more easily done if one is not being put in a defensive position. Thus, mediation gives opportunities, which are less likely in a formal exchange of documents or a hearing in front of a tribunal. This is especially so if the real motives to complain are hidden behind formal objections; the implosion of high expectations, the disappointment about the outcome of an examination, the confrontation with painful developments in life. Sometimes the client holds the psychologist, the messenger, responsible for these and seeks pretexts for a complaint. 

The fact that in cases of mediation the profession steps back and does not have any influence on the outcome does not mean that the outcome of the mediation is not in the interest of the profession. After all, mediation could well contribute to restoring the complainant's confidence in the profession and, moreover, it is conceivable that more understanding for the complainant's point of view could bring the psychologist to an improved re- flection on the ethical dimensions of their professional actions, maybe more than disciplinary sanctions would do. 

Up to this point, mediation seems to be the morally ideal way to bring conflicting parties together in order to find a solution, agreed by both of them. By its nature, mediation could contribute to raise the psychologist's ethical awareness and the client's appreciation of the psychologist's profession's ethics. However, this is a wishful view. Realistically, expectations regarding this opportunity should unfortunately not be too high. Options for mediation, if offered in current complaint procedures, seem to be chosen by only a minority of the complainants. It seems that the majority prefer a formal complaint procedure. Moreover, certainly not all mediations lead to an end that is acceptable to both parties. As mentioned before, parties are free to close the mediation process at any moment if they no longer con- sider the mediation as being helpful. Therefore, there might be instances where a mediation procedure is closed in an untimely manner and consequently a formal complaint procedure is opened or reopened. 

Disciplinary Procedures 

Whether or not after the complainant's or the psychologist's refusal of mediation, an untimely closing of a mediation, or the association's decision not to offer mediation, a complaint may lead to formal disciplinary procedures. Then, an investigation will take place through the formal complaint procedure, be it a separate stage in the process or not. The investigation will in- volve gathering evidence from the complainant, from the psychologist who is the subject of the complaint, and from any other source that will provide assistance. 

From the very beginning of a complaint procedure, the psychologist needs to be aware of the prevailing ethical principles and code regulations that still pertain in such a challenging situation. 

Example 9.3

Pascal, a clinical psychologist, was not amused when he received a letter from  the disciplinary  board  that Mrs. Chapman  had  raised a  complaint against him because of breaching confidentiality in his contact with her general practitioner. Pascal was invited to give a first reply, in the context of the investigation. Pascal wrote an angry letter, stating that such a complaint by "someone with clear histrionic personality characteristics has to be seen as a revengeful acting out of despair (see Mrs. Chapman's enclosed record). Thereby Mrs. Chapman's  complaint  should immediately  be  dismissed." 

Justified by the fair trial principle of "equality of arms," psychologists may decide to breach confidentiality to properly defend themselves against allegations. However, psychologists are not completely free in this. Ethical principles should still guide actions and psychologists are still subject to their code of conduct. Therefore, the disclosure of data from the client's file must be done respectfully and limited to those data that are relevant and necessary for the defence. However, the use of psychopathological labels in this con- text can only be seen as complainant bashing by inappropriately attempting to disqualify complainants and bluntly neglect to show appropriate respect. 

However, it does not only happen that psychologists try to disqualify complainants in such a blatant way. At least as serious are attempts to exclude more categorically certain people from raising complaints in the first place. 
 

Example 9.4

Paola, a forensic psychologist and manager of a large bureau of forensic experts, contacted her psychologists' association, claiming immunity for the members of her team, since forensic expertise too easily leads to disciplinary complaints. Paola argued that it happens all the time that unsatisfied parties, supported by their lawyers, try to seek ways to disqualify unfavourable forensic reports by misusing disciplinary procedures. These procedures bring along an excessive extra workload and a substantial strain for the psychologists involved. In her opinion, this should be an argument for the psychologists' association no longer to burden the staff members of this respectable expert bureau with disciplinary procedures. 

The association's reply was not particularly welcomed. It said that the as- sociation's members are obliged to cooperate loyally if there is any reason to evaluate their professional conduct. This obligation is fully incompatible with any claim on immunity. As the association did acknowledge the higher complaint rates in forensic psychology, it recommended Paola set up special ethics courses for her staff members, in order to sensitise her colleagues to the special pitfalls in the practice of forensic psychology. In this way the ethical quality of their work could be improved and the prevention of complaints could be maximised. A second recommendation was to initiate a programme of training to prepare her colleagues to appropriately defend their cases in front of the disciplinary tribunal. 

The second recommendation, given to Paola, brings us to the point that many psychologists are ill-prepared when faced with a complaint. Even in countries where disciplinary cases are regularly publicised, the idea of having to show up for a hearing is rather disturbing for many colleagues. Arguments that support could be provided when facing disciplinary procedures through one's personal insurance - where this is available - may be valid in theory, but in practice having one's conduct being scrutinised easily brings highly uncomfortable feelings, even in cases of a good conscience. Standing in front of a tribunal is standing in front of a tribunal. This is a situation where one cannot count on friendly fraternal understanding, since such a tribunal should be impartial, in every respect. 

However, psychologists should realise that they, as much as the complainants, are protected by fair procedures - by hearing both parties, by the tribunal's impartiality, and by legal maxims as the burden of proof weighs upon the plaintiff (complainant) and the burden of proof lies upon the one who asserts and not upon the one who denies, although the latter principle is not always fully applicable. After all, psychologists do have an obligation to implement proper record keeping, which may shift some of the onus of proof to the psychologist. 
 

 This does not take away that, as long as the tribunal is not convinced by the complainant's arguments and evidence, the complaint will be regarded as unproven. The standard of proof in a tribunal's operation may vary. Unlike in criminal court cases where the rule is beyond reasonable doubt, the standard in a psychologists' disciplinary court might be the balance of probabilities, which means that the seriousness of the possible consequences for the psychologist will be taken into account. So, if a verdict will lead in all probability to the psychologist being struck off the register, the bar is set higher. What does it actually mean, hearing about a colleague against whom a complaint was lodged? Do we tend to avoid them, stop referring clients, or are we still open to give fraternal support? Though not mentioned in the Meta-Code, being supportive to colleagues could be seen as a consequence of the overall responsibility for the profession; not to unduly protect col- leagues, but to contribute to the support system of the profession. From this perspective, it is not suitable to ostracise colleagues because of complaints being raised against them. Even since unproven complaints may not be un- true, we must rely on the tribunal's verdict. But even then, evidence does not necessarily mean that it was more than just an error, and errors are dis- tinct from malpractice. There is no justification to see minor infringements as capital sins. 

It is significant that the EFPA's Recommendations do not only refer to disciplinary actions, which involve sanctions as a reprimand or suspension from a register. As, or even more important, are corrective actions, designed to improve future performance, for instance requiring specific additional training or retraining and supervised practice. Even where disciplinary actions are determined, the need for corrective actions in addition, such as further education or supervision, should be considered, as stated in the Recommendations. 

The importance of respectful ways to handle clients' complaints about psychologists' professional acting and the significance of fair assessment thereof, also with the aim of upholding the standard of professional ethics, is beyond any doubt. Whether or not incidence numbers can be seen as significant, the real significance is in the mere facts. 

However, a prevalence indication might be given by the number of complaints against Dutch health psychologists, all by definition psychologist practitioners and thereby constituting a well-defined reference population in this case. The Dutch legal disciplinary boards ruled in 2021 a total number of 80 formal complaints, concerning 0.47% of the population of health psychologists. The 15 justified complaints were 0.09%, regardless of the se- verity. Four of the involved psychologists were suspended and one was expelled. 
 

It is clear that the prevalence in the health psychologists' client population is only a fraction of it. Furthermore, we need to be aware that non-registered psychologists and psychologists from non-health sectors are not included in this overview. No data are available about complaint-related mediation, if this kind of intervention is used as such. 

Things can go wrong. Errors are made. Infringements will occur. Whether or not their incidence - comparable with the number of criminal cases ruled in 2021 by Dutch judges - can be seen as significant depends on our moral standards. 

Recommendations

What to do if someone has a complaint about you? It can just happen to any of us. 

A misconceived remark, a poorly timed confrontation in therapy, an appointment not noted …. But also, an unfulfilled expectation, a shattered il- lusion, a pathological reaction …. 

A client can be disappointed, angry, indignant, and complain. Justified or not. Wherever that complaint ends up in our practice, with a colleague, with the management, or with the complaints committee, one has to do something with it. With this in mind, here are some suggestions for how to handle a complaint, whether it is a face-to-face confrontation during a therapy session, a separate "complaint meeting," or formal complaint handling. 

• Try to understand the client making a complaint. Whatever the motives, try to imagine what the situation might mean to the client. Imagine if something like this happened to someone close to you, what would you think? 

• Try to be open and not to get defensive right away. Perhaps your client is right, or at least has a point. A clarification of what you meant may take a lot of chill out of the air. 

• If your client is right or has a point, do not try to cover it up. Acknowledge and apologise if possible. From a professional and everyday moral point of view, withholding a deserved apology is always questionable. Arguments such as being obliged by the insurance company never to admit guilt are outdated. Do not lie. Denying a fact that happened may help win the case if your word goes against the complainant, but you will lose your integrity and your credibility with at least one person. 

• Check your file and dig into your memory to see exactly what happened to what you were accused of. In case of an intervention, find out why you did or did not do something. Read the code of professional ethics again. This may help to clarify whether or not you are rightly accused of something. 

• Try to be dispassionate, even if you feel angry or scared. Emotional arguments and words do not make it any better. Derogatory language is inappropriate, and psychopathological labelling of your client in the context of a dialogue about a complaint or during the formal complaint handling is certainly not done. Even if you were actually right. 

• In the context of the complaint handling, it may be appropriate for a reasonable defence to provide confidential information about the client to the complaints committee or the disciplinary committee. But be restrained. Information provided too eagerly can easily be experienced as a manipulative action to emphasise the pathological characteristics of the client and thereby may not only harm your client but also your case. 

• Be courageous. Standing before a tribunal is far from pleasant. Try to see it as a matter of honour to which we are obliged by our profession. If, in the opinion of the committee or board, you have fallen short, try to learn from it, rather than cowering in shame or playing the betrayed innocent. 

Conclusions

Things can go wrong. Errors are made. Infringements will occur. The profession needs to take responsibility to maintain its high standards of professional ethics by having solid procedures to investigate and to decide upon complaints. In criticising the psychologist's professional conduct in retrospect, the imposition of sanctions may be unavoidable. However, corrective actions to ameliorate the ethical quality of future professional conduct, like requiring additional training, might be more constructive in promoting good ethical behaviour. 

Beyond any doubt is the importance of respectfully handling clients' complaints about psychologists' professional acting and the significance of fair assessment thereof, also with the aim of upholding the standard of professional ethics. Let us focus on prevention and as individual psychologists be open to look critically into our own behaviour and thus comply with the professional ethics requirement to be loyal in listening to our dissatisfied or angry clients, to be open to fraternal appeals from concerned colleagues, or, in the ultimate case, having our professional conduct reviewed if a complaint is made. Or, maybe better, come to a settlement as a result of a mediation process. 

Casper Koene is from the Netherlands but lives in Brussels. He worked as a clinical psychologist in sheltered workshops, in care for adults with intellectual disabilities, and in outpatient psychiatry. He then worked as a psychological adviser and senior policy officer at the Dutch Ministry of Social Affairs. Since
1972, he has worked as a psychotherapist in his own practice. Casper was chair and board member of the Ethical Advisory Board of the national Dutch association of psychologists (NIP). He was chair of EFPA's Task Force on Ethics and then chair and member of the Task Force's successor, the Standing Committee on Ethics (now the Board of Ethics). Casper is currently an acting member of the Belgian statutory disciplinary board for psychologists. 

Ethics for European Psychologists, 2nd edition, by Geoff Lindsay, Haldor Øvreeide, Casper Koene, ISBN 9780889376373

© 2025 Hogrefe Publishing   

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