2.11 The failure of CAM therapeutic relationships: complaints
The issue of complaints is uncomfortable for any health practitioner. CAM practitioners may be particularly reluctant to accept that their actions may give rise to complaints. Since many therapists do not perceive their therapy to be intrinsically harmful, they are unlikely to make provision for when it goes wrong. Moreover, the comparative absence of litigation against CAM practitioners may give a false sense of security, whereby therapists do not consider themselves above the law but see the law as of little concern to them. Similarly, the lack of power of many professional bodies in CAM means that practitioners may not believe they will be dealt with harshly, even if they are subjected to a formal complaint by a patient (Stone, 2002, p. 199).
Many therapists are reluctant to accept the idea that there can ever be failed therapeutic relationships. When a person consults a therapist only once and returns, the practitioner may assume this is a testament to their therapeutic skills. In the absence of a widespread audit of practice, few practitioners follow up why a patient has not returned. Although the comparative lack of complaints against CAM practitioners is encouraging, the following reasons may constrain dissatisfied individuals from expressing their concerns.
The person may not know where or to whom to complain.
The professional organisation of which the practitioner is a member may not have formal complaint procedures or the procedures may be very weak.
The practitioner may not be a member of a professional organisation. Remember, there are very few ‘protected titles’ in CAM, so anyone can call themselves a ‘masseur’ or ‘healer’, and they do not need training to use such titles.
The person may not be able to verbalise their complaint; for example, perhaps they felt threatened or uncomfortable. Therefore, it would be hard for them to present a firm case against the practitioner. Instead they may choose to ‘vote with their feet’ and not return for more treatment.
The person may be embarrassed, especially if their concern is of a sexual nature or involves humiliation or threats.
The amount of time and emotional energy a complaint takes may put people off following it through.
Lack of expertise or knowledge may mean the person does not realise they are being treated in an incompetent or unprofessional way. This issue is very important in the diverse world of CAM where, with over 200 modalities available, few people know precisely what to expect from treatment.
People may not want to initiate a complaint against someone they get on well with. Even when the therapy fails to deliver results or causes harm, people may be less likely to complain when they believe the therapist is fundamentally a good person.
The statutory bodies regulating osteopathy and chiropractic spend a considerable amount of their energy facilitating complaints from the public and investigating alleged practitioner abuses. The websites of some CAM professional organisations explicitly advise people how to bring a complaint (see, for example, General Chiropractic Council, 2004; General Osteopathic Council, 2004). In these professions, most complaints are about lack of communication and poor interaction between the practitioner and the user. However, note that, even in well organised complaint systems such as these, many users are unlikely to complain when they are unhappy because of the reasons outlined above.