How to Recognize Abuse in Therapy and What to Do About It

Silhouette of upset woman in open doorwayThe therapeutic relationship can be a very powerful relationship. In fact, power in this relationship is vital, and something ethical therapists should think carefully about. Ideally, the therapist uses the position of authority inherent to the role to empower people in therapy and encourage them toward wellness and autonomy. Unfortunately, this does not always happen. In some cases, therapists have been known to abuse the imbalance of power in the therapeutic relationship. This can of course be harmful to the people they are entrusted to help, who may not know exactly what is happening or what to do about it.

As a person in therapy, trusting your own experience and communicating about it are both essential to the outcome of therapy. If you have fears or doubts about something that happened or how you are being treated, in most cases you should speak with your therapist about these concerns. In turn, any such concerns should be taken seriously and addressed immediately by the therapist.

Some ways therapists may go astray in the therapeutic relationship include behaviors related to boundaries, to fostering dependence, to their duty of care to you, and to acting in hostile ways. A number of specific things would be red flags. While I will discuss some of them, please know this list is by no means exhaustive, nor can it possibly be. It is important to trust your instincts about how you are being treated.

Boundaries are extremely important in the therapeutic relationship, and many are outlined in the ethical codes mental health practitioners are bound by. It is incumbent upon your therapist to maintain appropriate and professional boundaries; this is one of the ways the therapist fosters trust in the relationship and in the therapeutic process. Maintaining boundaries means your therapist should neither cross boundaries nor allow you to cross them as part of the relationship. The therapeutic relationship should empower you and enrich your life.

Examples of boundaries being crossed include:

  • Violating confidentiality: Sharing your information with others, or others’ information with you.
  • Attending sessions while compromised: This includes being inebriated, or conducting sessions if the person in therapy is too inebriated to meaningfully engage the therapeutic process.
  • Conducting sessions while distracted: This means doing other things, such as running errands, having meals, or answering phone calls.
  • Not adhering to expected lengths of sessions: Sessions sometimes run a bit late, but consistently going long or cutting short, or if you don’t know how long sessions are supposed to be, is not respecting boundaries.
  • Expecting, asking for, or accepting favors or gifts: Small gestures such as thank-you cards are okay if offered, but should never be expected, and the person in therapy should never feel pressured to give anything.
  • Extending invitations or accepting invitations to social events: Your relationship is professional and should be conducted within the confines of professional contexts; while we, as therapists, do sometimes receive invitations to important social events involving people in therapy and generally are very touched and honored by this, we should decline them gracefully to preserve the integrity and safety of the professional relationship, which is our first priority.
  • Requesting support for their business: Therapists should not ask for donations, contributions of time or money, or any other support of their business outside of what you owe them directly for your therapy. This includes soliciting reviews for use in their marketing or websites.
  • Maintaining multiple relationships: Therapists generally should not be in a therapist role for people with whom they have other significant relationships, or for people with close ties to others the therapist is working with. In small communities with very limited numbers of therapists, this can be difficult, but therapists should work hard to find the best ethical balance they can while preserving the safety of the therapeutic space.
  • Any sexual innuendo, requests, pressure, or behavior: Licensed therapists are prohibited from sexual contact with the people they work with in therapy. If your therapist makes sexual overtures to you or encourages them from you, this is a serious violation of trust.

Fostering Dependence

Therapists are ethically obligated to support people in therapy in living full, independent lives to the extent this is possible for them. In some (hopefully few!) cases, therapists have intentionally fostered dependence. As a therapist, my goal is always, as I say, to “work myself out of a job,” because this means the person in therapy has achieved the goals established at the outset and moved into a better space.

Some clues that your therapist may be fostering dependence in the relationship include:

  • Pressuring you to cut off ties with important people in your life who support you.
  • Encouraging frequent out-of-session contacts with no reasonable clinical justification.
  • Responding negatively or dismissively to positive changes you make.
  • Having excessive influence over your personal choices—leisure activities, relationships, clothing choices, career choices, etc.
  • Pressuring you not to disclose your therapy work to others, or seeking to isolate you from other important people in your life.
  • Offering or encouraging you to use illegal or potentially addictive substances outside the boundaries of appropriate prescriptions by a qualified physician or psychiatrist.

For what it’s worth, some of the signs above are hallmarks of emotional abuse. You don’t deserve such abuse from anyone, let alone your therapist.

Deviations from Duty of Care

Therapists have a specific duty of care to you. This includes a legal and ethical duty to work actively toward your welfare and to be responsive to your needs.

Therapists have a specific duty of care to you. This includes a legal and ethical duty to work actively toward your welfare and to be responsive to your needs.

Some specific deviations from a therapist’s duty of care to you might include:

  • Failing to respond to suicidal or homicidal ideas you express during sessions, or encouraging such thinking or planning.
  • Not listening to your concerns about your well-being or your priorities in this regard, or failing to respond when you voice such concerns.
  • Being dishonest or deceptive in regards to the goals, process, or prognosis of your therapy.
  • Abandoning you—suddenly terminating therapy without explanation or referrals to other qualified providers, or failing to respond to reasonable needs or requests for support.

Hostile or Abusive Behaviors

Therapists may sometimes need to confront problematic behaviors or hold reasonable expectations regarding behavior of the person in therapy. However, this boundary should never take the shape of openly hostile or abusive behaviors.

Some indications your therapist is engaging in hostile behavior include:

  • Expressing excessive anger at you or your behaviors.
  • Using language with you or about you that is insulting, demeaning, or inappropriate—using profanity in the therapy room is not particularly uncommon, but this language should never be directed at you in an insulting way or used in ways that are frightening or offensive to you. My rule of thumb is to follow the lead of the person in therapy; if the person chooses to use profanity to express strong feelings, that is fine with me, but I do not use such language outside the context of the person’s own use of it. Strong language, whether profane or not, should not be directed at you in insulting or abusive ways.
  • Yelling at you—again, raised voices sometimes accompany the discharge of strong emotions, and this can be fine and even healing at times. However, your therapist should not be yelling at you in demeaning or belittling ways, or ways that feel frightening or upsetting.
  • Violating your boundaries—if you set a clear boundary about something you don’t want to discuss, your physical space or touching, or language you find upsetting, this should be respected. It may reasonably happen that your therapist might express an opinion about the clinical benefit of talking about something that feels uncomfortable to you; however, this should be a calm expression that helps you understand and feel supported rather than an angry or confrontational demand.
  • Threats—you should not feel threatened by your therapist. Threatening to disclose sensitive information to others, to use it against you inside or outside of therapy, or to terminate therapy if you don’t “toe the line” are red flags. A therapist may need to terminate therapy with you if they believe it is not benefitting you or for other reasons, but this should be handled in a sensitive way that helps you to understand the reasons for it and offers other options.

The scenarios above provide a broad overview of some behaviors that may be indicators of a problematic or abusive therapeutic relationship. In some of these cases, it is conceivable that there might be reasonable clinical justification for certain behaviors. However, if you feel uncomfortable about your therapeutic relationship, you should address that discomfort—it is real, valid, and deserves attention.

If You Have Concerns Regarding Therapy or Your Therapist

If you have concerns about the safety or appropriateness of your therapy relationship, in most cases the best first step is to bring these to the attention of your therapist. In many cases, there may have been a miscommunication of some sort and your therapist will be grateful to you for bringing this to their attention so it can be addressed. (Good therapists want to help you feel better!)

If this does not seem possible or reasonable in your circumstances, you are always free to seek a second opinion from another therapist. Although it’s rarely advisable to have multiple concurrent therapists, one session to consult with a different therapist about how your therapy is going and explore the possibility of changing to a therapist who may be a better fit for you is always a reasonable step.

If you have serious concerns about how you have been treated in therapy, you can contact the licensing board for the type of professional you are working with in your state and ask what your options are. A simple web search should help you find this body. For example, searching for “counselor board state of Indiana” should help you navigate to the relevant authority that can help you with your specific questions or concerns.

© Copyright 2016 GoodTherapy.org. All rights reserved. Permission to publish granted by Sunda Friedman TeBockhorst, PhD, GoodTherapy.org Topic Expert Contributor

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Ellie

    May 25th, 2016 at 8:43 AM

    Many therapy patients I believe would question whether this was happening to them because we have been so ingrained to believe that these would be authority figures and these are people whose authority and knowledge you wouldn’t question. That can be tricky because you become dependent on this person and to them question them or to begin to believe that they are abusing you could be difficult for many people to accept or even report.

  • Stephanie

    May 25th, 2016 at 10:32 AM

    There could be a problem when your therapist seems to need more help with stuff than what you do, and expects that you will do it!

  • trey

    May 27th, 2016 at 9:39 AM

    This is a huge reason why I am scared to share so much private information with people, because I am afraid that someone one day will break my confidence and will start to tell other people my business. That is not something that I would look forward to at all, and I think that is why I am such a private person now. I have had that trust violated too many times in the past,m and it really does suck when that happens to you.

  • Shari

    May 27th, 2016 at 1:42 PM

    Goodness this is something that would need to be reported! Abusers are abusers no matter who they are and should never be allowed to treat others in this way.
    People are going to counseling and therapy for help, many time to get away from abusive situations in their lives. Never would it be of any help to add more to their plate than what they can already have to handle. This is criminal behavior in my mind.

  • marshall P

    May 28th, 2016 at 10:03 AM

    Don’t you ever think that there are those who won’t believe you because of their own stereotypes about therapy and treatment?

  • TINA

    May 28th, 2016 at 5:59 PM

    I had a therapist once who always seemed to have so many other things on her mind other than what I was trying to talk to her about. After a while I kind of got tired of feeling like I was the one leading the conversation so I just stopped going to my appointments

  • Matt

    May 29th, 2016 at 9:56 AM

    You report the behavior and don’t stop reporting until finally someone is willing to listen to you.

  • martin p

    May 30th, 2016 at 6:55 AM

    For many people it might be kind of difficult for them to see for a very long time that they are being used and abused by this person. They have gone to them for help and who would ever think that you are trying to get help from an abusive situation and that automatically you end up in another one? I think that for people who find themselves in a situation such as this, it might take them a little longer to grasp that this is what is happening because this is what they have always been accustomed to anyway.

  • Brenda

    June 1st, 2016 at 2:17 PM

    I swear, I think that there are those people, not many but there are some who get into certain fields of work knowing that they can very much take advantage of another person if they do this. I don’t understand this line of thought but it happens more than I am sure we can even imagine.
    They have to at some point feel terrible for kicking another person when they are down and really taking advantage of those insecurities, but then again, I don’t know that they even care.
    they probably even relish the though of doing that.

  • Kimberley S

    April 21st, 2017 at 11:14 AM

    I had a therapist who violated every code of ethics known. He had sex with me, romanced me, wanted texting of sexual fantasies about him and I. Called and texted me all the time
    Drugged and hypnotized me. Kept me confused about what he was doing with me.
    So much more. A sexual pervert with a license to sexually exploit, abuse, get his sexual pleasure from me. And, he got paid for all this, doing all the harm he could to me.

  • samantha

    March 8th, 2020 at 1:25 PM

    I have only just reported my therapist from 15 years ago for doing this to me. I encourage everyone that has had any ethical boundaries broken to REPORT. I waited and now he has done the same to someone else.

  • yes mam

    July 16th, 2017 at 5:13 AM

    I teturned to therapy that made me very uncomfortable.I felt like I was supposed to bring a gift to my therapist.Did the therapist have Aspergers? He clearly did not know what to day. Anyone can be passed through grad school. It’s a shame. Brochures need to be made available so people can know what to look for and what to avoid in therapy.know one thing for sure, if you are very vulnerable you can get scammed on psyched out and much worse in therapy!!! It happens too often! Those who are tough going into therapy have less risk, but things still go wrong when you trust a professional who has more problems/nuts than a fruitcake.

  • Clint

    December 1st, 2017 at 4:27 AM

    I had a therapist who used to fall asleep in sessions and received backhanders from my family……i only found out about the backhanders 15 years later by complete accident.

  • anonymous s.c.c./h

    April 11th, 2021 at 4:03 PM

    me too. how do i report this ..do you know . i live in vt. id like to start a class action suit if possible, but my motives are not about monetary compensation but rather to now after 10years and the continuation of his same practices on other young women , as young as 15years old ..i feel i need to report this to do the right thing and im ready now? any help or advice would be greatly appreciated. im so sorry this has happened to you as well :(

  • Steve

    April 11th, 2021 at 9:51 PM

    I am dealing with a practitioner also, in Australia -he was in Florida ten years ago…. also trying to gear up a class action. . This guy recently abused ( emotionally) a 15 y.o girl here recently… Any chance your guy worked for a missionary organisation in Ft Meyers FL ?

  • Raquelle

    September 26th, 2021 at 8:50 AM

    I’ve been going to my psychologist for two years! The other day I had a appointment with her she raised her voice at me and I feel so traumatized I can’t stop thinking about it. She was always so sweet natured I didn’t recognize that side of her she told me to find someone else and then she scheduled another appointment with me. I need to cancel I just can’t go back I feel like I was a waste of time to her and I don’t want to waste anymore of her time and I just don’t want to talk with her anymore she raised her voice and asked me HOW DO YOU WANT ME TO HELP YOU ? I’m so sorry

  • Stephen

    September 27th, 2021 at 3:36 PM

    Hi Raquelle , so sorry to hear that. Don’t go back .. find another.. check them out first.. look at reviews etc. Are you in Australia ? If so I can give you some tips..

  • Anonymous

    November 21st, 2021 at 3:58 PM

    They can ruin your life and you can do nothing. He disempowered me. Made me doubt my intuition. He performed therapies on me before establishing safety. What he did was so consistently wrong that it can’t help but seem intentional. I can’t help but think that this 65 year old hack didn’t like having a young 30 something with an attractive girl in his office. It rubbed him the wrong way so he rubbed that young man out.

  • Stephen

    November 23rd, 2021 at 12:54 AM

    Unfortunately the profession, it turns out – attracts Narcissists. It’s amazing how far they can get into your head. Trusting you get to heal.

  • James

    May 15th, 2022 at 4:31 PM

    I had an organization assigned to me by the mental health dept in a program to help those who have a history of cronic mental health issues. The program is supposed to provide a client with a “whatever it takes approach” and you have a case worker, therapist, and in this situation which was the most important, a housing specialist to help me get back to the area where i lived most my life, until a different group had “helped” me get housing 90 miles from there where i cant find work, have no friends, and medical care and everything that i know is over a 90 min drive. The first group had only recently taken on adults and so 7 months their case worker claimed to be handling it and couldnt, her covering up that she didnt know and wasted my time caused me to be advised to go to this new group. The new groups therapist triggered trauma in the first call to me, i kept asking to please talk to his supervisor and check, until im screaming PLEASE STOP IT. This should have been a giant sign to run, but was told to try because the housing specialist is here and there was not many groups who had this. So when they straightend out the misunderstanding and wanted to have me meet my team, i was already bothered and explained how badly ive been misled and then damaged by peoples mistakes, and was assured he understood that hes dealing with a person who has had years of sexual and phsyical abuse growing up, and since i lost all my money and was homeless living in my car, the amount of abuse received because i didnt look mentally ill and then would be driven to a break down til they realized i was not lying. Then how ive now been isolated and desperatly trying to get out of the horrible area that im in. He assured me that he would set up 2 weekly sessions and make sure they get the skills so that im not going to need to use the crisis line. I was very open and honest with everything. I also spent a good half hour explaining how he triggered me and the things to never do if i become distressed or am coming to them in that state. Things were ok for 5 session and then when some big stresses hit me that i needed help, and i started freaking out, then things were bad. He once again did all the same actions as I expressed not to. He kept taking over me and saying my name preventing me from commuiicating the trauma, i sent emails to try and communicate and was told (dispite when i first met, was told i could send emails of things because discussing past truama often caused attacks which cut my speech and are also very horrible to experience.) I now was told email is not therapy and was not going to read anything i sent. I had expressed that the morning appointment on mondays when he first offered it was not good, explained then that afternoon and not the first day of the week is best to handle therapy. He asked me to just try it out. Now hes saying that i had committed to that time and i agreed that i would meet then and was not going to discuss it further. He said if i couldnt make them he would try to call for a session later that week. Which i mentioned was what he already did and i wanted a second appointment, which he said was not what was agreed, he also asserted the case worker was not someone who is able to support me in several things i was led to believe she was. When i spoke to her and was freaking out on how im being treated i kept being acused by both that i was talking to them disrespectfully and they would not tolerate that behavior. The case worker then hung up on me that week, and then the next week accused me of recording her because the call sounded funny. and i expressed that i was already anxious because of the weeks previous treatment and expressed my voice is loud and im upset can we text if you cant handle the tone. I asked if i needed to get a form from the ada to accomidate that request and she said that if i was threatening a lawsuit the call must end and again hung up. It got so bad that i had to insist that either they provide another therapist or i need outside therapy. The dept of mental health even heard him with me and agreed but she said she thinks he just isnt a good match. They took two months to find someone else. I then have their housing guy week after week share that hes finding nothing except a handful of listings that were often all not in the area or the right size for the benefit help i get., and i had started with 6 months and then 5 and then 4 months until i needed to have found a place or would lose the housing assist and be homeless again. and then 3 months. i was told to send him listings i find that he will check on for me. A waitlsted place i was on for 3 years comes up and i sent him the info. He tells me that unfortunatly that i didnt qualify for that place since it was actually for currently homeless. Then im down to 2 months and ive been fed all kinds of rules that i couldnt email or text anything aside from the housing, they said reasons from HIPPA regulation to even telling the dept of mental health i caused their email server to crash from the 8 emails i sent one day. I expresed to the DMH i worked in tech thats a bold face lie. Then with 2 months. I get a call from the waitlisted place that they needed an answer. I expressed that my housing specialist said i didnt qualify and they said that nothing he said was true and she never spoke to anyone but me when she alerted me two months before. The only problem is that i now had to get the housing assistant stuff done and everything in 5 days and it takes about 3 weeks and she couldnt hold it any longer. He continued to say he was looking and then would send more that were seniors only or when i would tell him i want one of the listings he would say he would look into it and then 4 days later would hear it was rented. i had tried to call the listings and they wouldnt talk to me he had to arrange it. They finally got me a new therapist who i went over all my stuff to really express not to treat me that way. I was so pleased how she seemed to get me, then she asked to help with the housing due to the short time. 6 weeks. i was presenting all the listings where i was needing help everything and how i was being lied to by the hosuing person and how i dont think hes doing much and that i need someone whos working at it as i am which was hours a day. then the day i was originally expected to be moved and the place i was living had scheduled a walk through. i had a month to spare on the help but i was told this would not be an issue. the stress was horrible. I got the property to extend my move out a month. i was in terrible shape and was hardly fuctioning well. i was in panic so much and i would end up having an attack when i would get them on the phone and get hung up on again. Then I expressed if i became homeless again because of them, i was going to kill myself and i had ONE MONTH. They met at my place and encouraged me to go to the hospital. since the hospital also agreed that a 3 day hold was not helpful to a 30 day deadline. They sent me home. The next day i was to meet with the therapist and i was cornered in a room i couldnt leave and accused of being on drugs since the hospital showed i had ampetamine and benzos and pot, pot is legal and i have taken add meds for years and while im listing hunting it was needed. I expressed the benzos were because ive been at level 10 for months. i went into a panic attack as they seemed to be innterrogating me, paramedics came. i was not really in a great place and they had me sign a bunch of things. Then said that i would now meet on mondays for both which i expressed was not good and they said i already agreed with that. I was really confused. Then a couple days later when i insisted to have proof that the housing guys doing work, i called the crisis line and talked with one of the region supervisors and then monday comes, i had to cancel a medical appointment to make it and got there and told that i was texted that the appointment was a phone appointment. Which im in thier lobby in a seizure like state that i get when its bad and im barely able to get out words. i find they contacted the housing authority and told them to explain how im not entitled to things which i hadnt asked for they were the housing guys bad advise. I waited 3 hours to talk to the supervisor who i was told would be explained everything going on and she sat as i am unable to get much out and im writing things down to try and communicate and about to collapse. and shes just looking as though i was scum. I asked what she knew about this situation and she said just i wanted to talk. yet as i try to get out a few words of how im being abused she snapped no changes i get what i get i can leave if i dont like it. The next day my therapy session is the therapist trying to over and over get me to agree that i should ask another group and i had less than a month, and expressed a new group would not be able to even start until about 6 weeks. I realised they needed me to say i wanted to leave or else they were oblgated to care. (which turned out to be true) they suddenly claimed they didnt feel safe and called the supervisor in and security. I was so freaked out and scared, and told no im through and demanded i leave. I was barely able to walk and had to sit down half way to the door. i was told i could get the paperwork i requested the next week. Then they found out that was not ok and then i was told they were sill my providers and advised to not miss sessions to not appear like i was not cooperating. That next session was her asking what i thought i could have done better and was increasingly asking to express how i failed them. and what i did wrong. i collapsed in my home and was not getting any words out and i blacked out waking hours later. the next week she asked what that was about and i expressed i collapsed. she said flippantly “oh should i call 911 if that happens again today” and i hung up. NOT ALL ABUSE IS SEXUAL AND IT WOULD HELP TO HAVE A PLACE TO HELP PEOPLE WITH THIS ABUSE. Because even though its a year from this and im so damaged from it. The new team has really struggled to understand why im constantly panicking. i have had so many checks on welfare and been hospitalized twice. i am still in the bad location but almost that was lost, my mental state was so bad that thankfully the case worker at the housing authority realized that and made that call. I got the records from them after a year of trying and them not sending to me or new care team. They have notes making me out to be the horrible monster and they said im malingering all of this to get disability housing and i should not be getting the programs care and thats why they ended things. I am so damaged and have so little of money and the place i lived was robbed and my car became so damaged from driving i need to junk it since i cant afford an engine or a new car. The new group has me on a waitlist for a housing assist and i they are getting me a new therapist because the prior had to relocate. and i have become a complete agraphopic basketcase and its unfair and i cant seem to stop the pain.

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