The course of true therapy may not always run smooth. Conflicts and ill feelings can arise just the same as elsewhere – therapists can offend, get things wrong, be clumsy or annoying as well as others. Like others too, they can also be unprofessional, unethical and even, it's tough to think, criminal.

It may be that your therapist hasn't done anything 'wrong' as such, but you just feel as if you aren't getting anywhere or you have a vague and repeated sense of unease in the consulting room. Therapy works best if you are able to be as open and honest about any difficulty you may be having – which may be challenging if you struggle with being assertive.

A trickier outcome is when you end up needing to make a formal complaint about things, when professional boundaries are not respected.

A good outcome of addressing any niggle or outrage would be a fruitful conversation that not only resolves things between you both, but also enriches your therapy. A grievance against your therapist may well rhyme with another outside the consulting room – feeling your therapist is say, 'judging you as silly' (a real complaint made to me) may point to similar feelings you may have about a parent (as it turned out in my case).

A trickier outcome however is when you end up needing to make a formal complaint about things, when professional boundaries are not respected. We know what to expect from our GP or hairdresser or window cleaner. But many intending clients that I meet don't know what to expect in therapy, or indeed what is deemed 'normal' behaviour in a therapist. This helps to fuel a power differential – an intending client is vulnerable, by definition, and may be keen or even desperate to feel better. This means hope, time, money and maybe more will be invested into a therapist – the professional - who knows more than the client about the process a client is thinking about committing to. It's ok to ask about how your therapist views the process, and what the sessions might 'look like'. I tend to know what my plumber is doing to fix the problem so I know what I'm paying for and what to say to the next plumber if things go wrong. I also happen to be someone who likes to know how things work, especially if I'm paying for it – not uncommon.

A good therapist should be open to discussing their approach. Admittedly this can often be a difficult thing to nail down, as therapy doesn't follow a pre-ordained trajectory or follow any set rules. But it should be possible to describe general ideas, theoretical influences and techniques used. Exploring the process at the outset may encourage an essential spirit of collaboration, which also involves being as open and honest as you can be – not only about the issues you want to address in the work, but also how you experience your therapist and the work. If something happens or is said that makes you feel uncomfortable in any way, you have a right to address this – just as you may speak up if your dentist feels your leg rather than your molar or your hairdresser starts texting while cutting your fringe.

Any reputable therapist will be open to feedback.

But even if the therapy has been explained as well as possible, it may still be unclear as to what is or isn't appropriate for your therapist to say or do. There are obvious no-nos: your therapist is drunk (sad, but has been true), falls asleep (yup, I've heard that one more than once), tries it on with you, fails to turn up, talks about him/herself incessantly or spends session time moaning about his/her mortgage payments. But of course some things are less clear cut. What if you feel derided or not taken seriously enough or simply uncomfortable, but you can't be sure about these feelings as you may often feel similarly amongst friends or family. Even in doubt, I'd encourage you to talk about this.

Any reputable therapist will be open to feedback. I like to think I'm one of these and indeed, I've been clumsy, I've got something wrong, I've even cocked up timings and double booked clients. I've been told that my weekly sessions are of no apparent help. Most often though, I've had a useful conversation about what went wrong, why it may have gone wrong and what can be learnt from it. Conversations like these offer a really valuable opportunity to resolve a potential rupture or conflict, and may also offer 'safe' practice for someone who tends to swerve conflict or confrontation of any sort. 'Safe' because a therapist shouldn't retaliate, punish or disappear in the face of a tricky conversation, but calmly hear.

It's uncomfortable for me to think about fellow professionals who behave badly, but if you can't resolve a conflict in the room, there are other ways to get heard and seek redress. It may be worth deciding what you want – an apology, an explanation or even for your therapist to be struck off a professional register. In private practice this means contacting a therapist's professional body – the UKCP or BACP for example, who have machinery in place to resolve conflict and discipline their members after a process of inquiry. Both have published ethical codes that may help guide you on the standard you should expect. If you are seeing a therapist in a service (a GP practice, a charity or statutory one), there should be an internal procedure to go through first. Either way, if you are unhappy about what has happened, you deserve to be heard.

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